Low case fatality during 2017 cholera outbreak in Borno State, North Eastern Nigeria

Abstract

Background: Cholera is endemic in sub-Saharan Africa, especially in areas affected by natural disaster and human conflict. Northeastern Nigeria is experiencing a health crisis due to the destruction of essential amenities such as health infrastructure, sanitation facilities, water supplies, and human resources by Boko Haram insurgents. In 2017, a cholera outbreak occurred in five local government areas (LGAs) hosting internally displaced persons. The Nigeria Center for Disease Control, World Health Organization, Mĕdecins Sans Frontiĕres International, and several other organizations supported disease containment. An emergency operating center (EOC) established by the State Ministry of Health (SMoH) then coordinated the outbreak response. Methods: We conducted a retrospective analysis of data extracted from the line list utilized by the SMoH to investigate outbreaks. We evaluated the outbreak by time, place, and person. Attack rate by LGA and age-specific case fatality rate (CFR) was calculated based on cases with complete records for age, sex, place of residence, date of symptom onset, and disease outcome. Results: A total of 5889 cholera cases were reported from five LGAs with an overall attack rate of 395.3/100,000 population. Among 4956 cases with documented outcome, the overall CFR was 0.87%, with CFR ranging from 0% to 6.98% by LGA. The age-specific CFR was highest among those aged ≥60 years (1.92%) and least among those aged 20–29 years at 0.3%. The epidemiological curve revealed two peaks that coincided with periods of heavy rain and flooding. Conclusion: This study reports on the largest ever documented cholera outbreak in five LGAs in Borno State. The outbreak was focused in LGA hit hardest by the destructive activities of insurgents and then spread to neighboring LGAs. The low CFR recorded in this cholera outbreak was achieved through timely detection, reporting, and response by the coordinated efforts of the EOC established by the SMoH that harmonized the outbreak response.

Knowledge of cholera and its prevention amongst urban residents of a district in Abuja: The pivotal role of health education

“…Health education has been reported in many studies to be a pivotal tool in curtailing the occurrence of cholera infection (8,13,16,24). Therefore, the response given by this study population concerning overcrowdedness further calls for urgent health education for Durumi community in order to further curtail subsequent cholera infection in the community.…”

“…In the last quarter of 2009, it was speculated that more than 260 people died of cholera in four northern states with over 96 people in Maidugari, Biu, Gwoza, Dikwa and Jere council areas of Bauchi state (8). In another study carried out in 2014 in the Federal Capital Territory (FCT) Abuja, Gomani, Kwali Local Government Area was reported to have a high morbidity and mortality of cholera (13). It was also reported in 2017 that Borno North-eastern part as well as Kwara, North-Central parts of the country had their episodes of cholera outbreaks and many lives were lost (13,12).…”

“…In another study carried out in 2014 in the Federal Capital Territory (FCT) Abuja, Gomani, Kwali Local Government Area was reported to have a high morbidity and mortality of cholera (13). It was also reported in 2017 that Borno North-eastern part as well as Kwara, North-Central parts of the country had their episodes of cholera outbreaks and many lives were lost (13,12). It was also reported that cholera cases are still ravaging eight States including Adamawa, Bauchi, Kano, Katsina, Zamfara, Kogi, Plateau and Kaduna, although, there appears to be a relative decline in the number of new cases (13,12).…”

“…The persistence of cholera in Nigeria has been attributed by many studies to disruption in public sanitation services, landslides and floods also contribute to outbreak by disrupting the normal balance of nature, open flow of sewage water within the surrounding, food and water supplies contaminated by parasites and bacteria when essential system like those for water and sewage are destroyed, lack of resources, infrastructure and disaster preparedness system among others (4,8,13,14). Generally, it is believed that cholera occurs in most countries in the dry season, but in Nigeria where it is endemic, it occurs in both rainy and dry seasons, although the burden of cholera tends to increase during beginning of rainy and dry seasons (15).…”

Evaluation of monitoring tools for WASH response in a cholera outbreak in northeast Nigeria

“…Currently, armed conflict and terrorism in northeast Nigeria have created enabling conditions for cholera transmission such as overcrowded living conditions due to population displacement; disruption of water and sanitation services; and destruction of basic amenities, including health infrastructure (Denue et al 2018;Elimian et al 2020). In February 2019, there were approximately 1.95 million internally displaced persons (IDPs) in Borno State, where more than half of United Nations International Children's Fund (UNICEF) documented IDP camps did not meet Sphere Standards for water quantity (57%) and sanitation access (58%) (SI and Alima 2019).…”