Epidemiology, diagnostics and factors associated with mortality during a cholera epidemic in Nigeria, October 2020–October 2021: a retrospective analysis of national surveillance data

Elimian, Kelly; Yennan, Sebastian; Musah, Anwar; Cheshi, Iliya Danladi; King, Carina; Dunkwu, Lauryn; Mohammed, Ahmed Ladan; Ekeng, Eme; Akande, Oluwatosin Wuraola; Ayres, Stephanie; Gandi, Benjamin; Pembi, Emmanuel; Saleh, Fatima; Omar, Ahmed Nasir; Crawford, Emily; Olopha, Olubunmi Omowumi; Nnaji, Robinson; Muhammad, Basheer; Luka-Lawal, Rejoice; Ihueze, Adachioma; Olatunji, David Idowu; Ojukwu, Chidimma; Akinpelu, Afolabi Muftau; Adaga, Ene; Yusuf, Abubakar; Nwadiuto, Ifeoma; Ngishe, Samuel; Alowooye, Agnes Bosede; Nwogwugwu, Peace Chinma; Kamaldeen, Khadeejah; Abah, Henry Nweke; Chukwuebuka, Egbuna Hyacinth; Yusuff, Hakeem Abiola; Mamadu, Ibrahim; Mohammed, Abbas Aliyu; Peter, Sarah; Abbah, Okpachi Christopher; Oladotun, Popoola Michael; Oifoh, Santino; Olugbile, Micheal; Agogo, Emmanuel; Ndodo, Nnaemeka; Babatunde, Olajumoke; Mba, Nwando; Ilori, Elsie; Alfvén, Tobias; Myles, Puja; Ochu, Chinwe Lucia; Ihekweazu, Chikwe; Adetifa, Ifedayo

doi:10.1136/bmjopen-2022-063703

Cited by 18 publications

(13 citation statements)

References 22 publications

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“…Like the previous cholera outbreaks, the northern region of Nigeria, particularly the North-East region, disproportionately accounted for a higher burden from the outbreak. Consistent with existing literature [ 4 , 5 ], the substantial burden of the cholera outbreak in the North-East was partly attributed to the Boko Haram insurgency [ 3 ], which has exacerbated the already poor water, sanitation, and hygiene (WASH) services, living conditions and population congestion in the region [ 6 ]. Insurgency in the region is also believed to have weakened the Integrated Disease Surveillance and Response (IDSR) system for infectious diseases, especially regarding surveillance data collection and transmission at the community level, leading to an underestimation of disease burden [ 7 ].…”

Section: Introductionsupporting

confidence: 64%

“…It is therefore not surprising that HCWs in Bauchi State had higher knowledge scores and lower odds of inadequate knowledge of cholera vaccination than their Adamawa State counterparts. This is because Bauchi State has consistently accounted for higher absolute number of cholera cases than any other state in Nigeria in the latest cholera outbreaks in Nigeria [ 2 , 3 ]. Expectedly, Bauchi State has witnessed more characterised by frequent vaccination campaigns than Adamawa State [ 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…Nigeria has experienced several cholera outbreaks in recent decades, recording over 40,000 cholera cases and 1700 deaths in 2010 [ 1 ] and over 50,000 cases and 800 deaths in 2018 [ 2 ]. Between October 2020 and October 2021, amidst the COVID-19 pandemic, the country experienced an unprecedented cholera outbreak which spanned across 33 of its 37 states (including the Federal Capital Territory), recording over 93,000 cholera cases and 3000 deaths (case fatality rate: 4%) [ 3 ]. Like the previous cholera outbreaks, the northern region of Nigeria, particularly the North-East region, disproportionately accounted for a higher burden from the outbreak.…”

Section: Introductionmentioning

confidence: 99%

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Healthcare workers knowledge of cholera multi-stranded interventions and its determining factors in North-East Nigeria: planning and policy implications

et al. 2023

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Background Healthcare workers’ (HCWs) knowledge of multi-stranded cholera interventions (including case management, water, sanitation, and hygiene (WASH), surveillance/laboratory methods, coordination, and vaccination) is crucial to the implementation of these interventions in healthcare facilities, especially in conflict-affected settings where cholera burden is particularly high. We aimed to assess Nigerian HCWs’ knowledge of cholera interventions and identify the associated factors. Methods We conducted a cross-sectional study using a structured interviewer-administered questionnaire with HCWs from 120 healthcare facilities in Adamawa and Bauchi States, North-East Nigeria. A knowledge score was created by assigning a point for each correct response. HCWs’ knowledge of cholera interventions, calculated as a score, was recoded for ease of interpretation as follows: 0–50 (low); 51–70 (moderate); ≥ 71 (high). Additionally, we defined the inadequacy of HCWs’ knowledge of cholera interventions based on a policy-relevant threshold of equal or lesser than 75 scores for an intervention. Multivariable logistic regression was used to identify the factors associated with the adequacy of knowledge score. Results Overall, 490 HCWs participated in the study (254 in Adamawa and 236 in Bauchi), with a mean age of 35.5 years. HCWs’ knowledge score was high for surveillance/laboratory methods, moderate for case management, WASH, and vaccination, and low for coordination. HCWs’ knowledge of coordination improved with higher cadre, working in urban- or peri-urban-based healthcare facilities, and secondary education; cholera case management and vaccination knowledge improved with post-secondary education, working in Bauchi State and urban areas, previous training in cholera case management and response to a cholera outbreak—working in peri-urban areas had a negative effect. HCWs’ knowledge of surveillance/laboratory methods improved with a higher cadre, 1-year duration in current position, secondary or post-secondary education, previous training in cholera case management and response to a cholera outbreak. However, HCWs’ current position had both positive and negative impacts on their WASH knowledge. Conclusions HCWs in both study locations recorded a considerable knowledge of multi-stranded cholera interventions. While HCWs’ demographic characteristics appeared irrelevant in determining their knowledge of cholera interventions, geographic location and experiences from the current position, training and involvement in cholera outbreak response played a significant role.

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Section: Introductionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Healthcare workers knowledge of cholera multi-stranded interventions and its determining factors in North-East Nigeria: planning and policy implications

et al. 2023

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“…This study benefitted by the availability of detailed surveillance data, which provided a line list of cases by date and district of origin, age, sex, and subcounty. It also benefited by a relatively small number of cases when compared with other countries, like The Democratic Republic of the Congo and Nigeria 22,23 or Ethiopia, 24 which, in some years, reports many thousands of cases. In Uganda, cholera occurs during defined outbreaks, and there does not appear to be yearround cholera in any area of the country.…”

Section: Discussionmentioning

confidence: 99%

Development of a Scorecard to Monitor Progress toward National Cholera Elimination: Its Application in Uganda

Bwire

Sack

Lunkuse

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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In 2017, the Global Task Force for Cholera Control (GTFCC) set a goal to eliminate cholera from ≥ 20 countries and to reduce cholera deaths by 90% by 2030. Many countries have included oral cholera vaccine (OCV) in their cholera control plans. We felt that a simple, user-friendly monitoring tool would be useful to guide national progress toward cholera elimination. We reviewed cholera surveillance data of Uganda from 2015 to 2021 by date and district. We defined a district as having eliminated cholera if cholera was not reported in that district for at least 4 years. We prepared maps to show districts with cholera, districts that had eliminated it, and districts that had eliminated it but then “relapsed.” These maps were compared with districts where OCV was used and the hotspot map recommended by the GTFCC. Between 2018 and 2021, OCV was administered in 16 districts previously identified as hotspots. In 2018, cholera was reported during at least one of the four previous years from 36 of the 146 districts of Uganda. This number decreased to 18 districts by 2021. Cholera was deemed “eliminated” from four of these 18 districts but then “relapsed.” The cholera elimination scorecard effectively demonstrated national progress toward cholera elimination and identified districts where additional resources are needed to achieve elimination by 2030. Identification of the districts that have eliminated cholera and those that have relapsed will assist the national programs to focus on addressing the factors that result in elimination or relapse of cholera.

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“…Since its documented emergence in 1972, cholera has sporadically affected Nigeria, with outbreaks particularly prevalent in the Northern states. The country faced its biggest cholera epidemic in a decade in 2021 [1]. The Nigeria Centre for Disease Control (NCDC) recorded 3604 fatalities and a total of 109,189 suspected cases as of December 19, 2021 [2].…”

Section: Introductionmentioning

confidence: 99%

The interplay among conflict, water scarcity, and cholera in Northern Nigeria

Gulumbe,

Yusuf,

Faggo

et al. 2023

Public Health Challenges

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Cholera is a recurring issue in Nigeria, with outbreaks predominantly affecting the Northern states. In 2021, Nigeria experienced its most significant cholera epidemic in a decade, resulting in thousands of fatalities and cases. The spread of cholera and other waterborne diseases in Nigeria is linked to various factors such as flooding, conflict, and water scarcity. The country's poor drinking water quality and lack of equitable access to clean water exacerbate the problem, particularly in the conflict‐affected areas of the North. This paper discusses the interaction of conflict‐related displacement, water shortages, and cholera transmission in Northern Nigeria and provides insights into how these factors impact water resources and public health. This information can inform initiatives and policies to reduce the impact of conflict on water resources and enhance access to clean water in impacted areas. The article suggests that the primary challenges in eliminating cholera in the region include a lack of information due to severe security situations, bureaucratic requirements for delivering essential supplies, and a chronic shortage of water. A successful response to cholera in conflict and displacement situations also requires community engagement and the security and safety of humanitarian personnel. Long‐term solutions to the uprisings in the region are necessary to put an end to the issues related to banditry and insurgency.

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Epidemiology, diagnostics and factors associated with mortality during a cholera epidemic in Nigeria, October 2020–October 2021: a retrospective analysis of national surveillance data

Cited by 18 publications

References 22 publications

Healthcare workers knowledge of cholera multi-stranded interventions and its determining factors in North-East Nigeria: planning and policy implications

Healthcare workers knowledge of cholera multi-stranded interventions and its determining factors in North-East Nigeria: planning and policy implications

Development of a Scorecard to Monitor Progress toward National Cholera Elimination: Its Application in Uganda

The interplay among conflict, water scarcity, and cholera in Northern Nigeria

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