Descriptive epidemiology of cholera outbreak in Nigeria, January\u2013November, 2018: implications for the global roadmap strategy

Kelly Osezele Elimian,Womi-Eteng Eteng,Ayodele Adeyemo,Somto Mezue,Wondimagegnehu Alemu,Michel Yao,Oyeronke Oyebanji,Michael Oladotun Popoola ,Geoffrey Namara,Linda Haj Omar,Eme Ekeng,Adesola Ogunleye,Ifeanyi Okudo,Clement Peter,Ibrahima Socé Fall ,Nanpring Williams,Caroline Martin ,Ibrahim Mamadu,Anwar Musah,Patrick Abok,Arisekola Jinadu,Sebastian Yennan,Thieno Balde,Chikwe Ihekweazu

doi:10.1186/s12889-019-7559-6

Abstract

BackgroundThe cholera outbreak in 2018 in Nigeria reaffirms its public health threat to the country. Evidence on the current epidemiology of cholera required for the design and implementation of appropriate interventions towards attaining the global roadmap strategic goals for cholera elimination however seems lacking. Thus, this study aimed at addressing this gap by describing the epidemiology of the 2018 cholera outbreak in Nigeria.MethodsThis was a retrospective analysis of surveillance data collected between January 1st and November 19th, 2018. A cholera case was defined as an individual aged 2 years or older presenting with acute watery diarrhoea and severe dehydration or dying from acute watery diarrhoea. Descriptive analyses were performed and presented with respect to person, time and place using appropriate statistics.ResultsThere were 43,996 cholera cases and 836 cholera deaths across 20 states in Nigeria during the outbreak period, with an attack rate (AR) of 127.43/100,000 population and a case fatality rate (CFR) of 1.90%. Individuals aged 15 years or older (47.76%) were the most affected age group, but the proportion of affected males and females was about the same (49.00 and 51.00% respectively). The outbreak was characterised by four distinct epidemic waves, with higher number of deaths recorded in the third and fourth waves. States from the north-west and north-east regions of the country recorded the highest ARs while those from the north-central recorded the highest CFRs.ConclusionThe severity and wide-geographical distribution of cholera cases and deaths during the 2018 outbreak are indicative of an elevated burden, which was more notable in the northern region of the country. Overall, the findings reaffirm the strategic role of a multi-sectoral approach in the design and implementation of public health interventions aimed at preventing and controlling cholera in Nigeria.

Highlights

The cholera outbreak in 2018 in Nigeria reaffirms its public health threat to the country
Nigeria has experienced several cholera outbreaks characterised by high Case Fatality Rate (CFR), notable ones being the epidemic of 1991 which resulted in 59,478 cases and 7654 deaths, and the CFR of 12.9% reported for that outbreak remains the highest for the country to date
This study describes the epidemiology of the 2018 cholera outbreak in Nigeria in terms of time, place and person

Summary

Introduction

The cholera outbreak in 2018 in Nigeria reaffirms its public health threat to the country. Nigeria has experienced several cholera outbreaks characterised by high CFRs, notable ones being the epidemic of 1991 which resulted in 59,478 cases and 7654 deaths, and the CFR of 12.9% reported for that outbreak remains the highest for the country to date. Another major cholera outbreak occurred in Kano state in March, 1999, with cases spreading to Adamawa and Edo states by May of that year; and the outbreak resulted in 26,358 cases and 2085 deaths. Despite the aforementioned efforts toward cholera prevention and control, the cholera outbreak of 2018 reaffirms the serious public health threat of cholera and, importantly, the need for the country to adopt holistic countermeasures

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