What are the drivers of recurrent cholera transmission in Nigeria? Evidence from a scoping review

Kelly Osezele Elimian,Kobina Ampah,Sebastian Yennan,Nanpring Williams,Lynda Haj Omar,Patrick Okumu Abok,Thieno Balde,Somto Mezue,Arisekola Jinadu,Anwar Musah,Oyeronke Oyebanji,Luka Ibrahim,Wondimagegnehu Alemu,Michel Yao,Ibrahima Soce Fall,Ifeanyi Okudo,Clement Peter,Chikwe Ihekweazu

doi:10.1186/s12889-020-08521-y

Abstract

BackgroundThe 2018 cholera outbreak in Nigeria affected over half of the states in the country, and was characterised by high attack and case fatality rates. The country continues to record cholera cases and related deaths to date. However, there is a dearth of evidence on context-specific drivers and their operational mechanisms in mediating recurrent cholera transmission in Nigeria. This study therefore aimed to fill this important research gap, with a view to informing the design and implementation of appropriate preventive and control measures.MethodsFour bibliographic literature sources (CINAHL (Plus with full text), Web of Science, Google Scholar and PubMed), and one journal (African Journals Online) were searched to retrieve documents relating to cholera transmission in Nigeria. Titles and abstracts of the identified documents were screened according to a predefined study protocol. Data extraction and bibliometric analysis of all eligible documents were conducted, which was followed by thematic and systematic analyses.ResultsForty-five documents met the inclusion criteria and were included in the final analysis. The majority of the documents were peer-reviewed journal articles (89%) and conducted predominantly in the context of cholera epidemics (64%). The narrative analysis indicates that social, biological, environmental and climatic, health systems, and a combination of two or more factors appear to drive cholera transmission in Nigeria. Regarding operational dynamics, a substantial number of the identified drivers appear to be functionally interdependent of each other.ConclusionThe drivers of recurring cholera transmission in Nigeria are diverse but functionally interdependent; thus, underlining the importance of adopting a multi-sectoral approach for cholera prevention and control.

Highlights

The 2018 cholera outbreak in Nigeria affected over half of the states in the country, and was characterised by high attack and case fatality rates
Stage 1: identifying the research question The overarching research questions that guided this scoping review were: (1) what are the drivers of recurrent cholera transmission in Nigeria, and (2) what is the operational dynamics of the identified drivers relating to cholera transmission in Nigeria?
The majority (64.44%) of the studies were undertaken in the context of cholera epidemics, and predominantly cross-sectional (62.22%) in terms of epidemiological design

Summary

Introduction

The 2018 cholera outbreak in Nigeria affected over half of the states in the country, and was characterised by high attack and case fatality rates. Modelling exercises indicate that cholera burden remains a global threat, with an estimate of about 2.86 million suspected cases and 95,000 deaths per year [4]. Evidence indicates that these figures could be higher if social, political and economic disincentives for reporting cholera cases are taken into account [5]. Inadequate access to portable water and poor sanitary conditions remain the principal determinant of cholera transmission in Nigeria, in line with global epidemiology [14]

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Conclusion