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. 2022 Sep 19;12(9):e063703.
doi: 10.1136/bmjopen-2022-063703.

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

Kelly Elimian  1   2 , Sebastian Yennan  3 , Anwar Musah  4 , Iliya Danladi Cheshi  3 , Carina King  2 , Lauryn Dunkwu  5 , Ahmed Ladan Mohammed  3 , Eme Ekeng  3 , Oluwatosin Wuraola Akande  6 , Stephanie Ayres  2 , Benjamin Gandi  7 , Emmanuel Pembi  8 , Fatima Saleh  3 , Ahmed Nasir Omar  3 , Emily Crawford  3 , Olubunmi Omowumi Olopha  3 , Robinson Nnaji  3 , Basheer Muhammad  9 , Rejoice Luka-Lawal  3 , Adachioma Chinonso Ihueze  10 , David Olatunji  3 , Chidimma Ojukwu  3 , Afolabi Muftau Akinpelu  3 , Ene Adaga  3 , Yusuf Abubakar  11 , Ifeoma Nwadiuto  12 , Samuel Ngishe  13 , Agnes Bosede Alowooye  14 , Peace Chinma Nwogwugwu  15 , Khadeejah Kamaldeen  16 , Henry Nweke Abah  3 , Egbuna Hyacinth Chukwuebuka  17 , Hakeem Abiola Yusuff  18 , Ibrahim Mamadu  19 , Abbas Aliyu Mohammed  20 , Sarah Peter  3 , Okpachi Christopher Abbah  3 , Popoola Michael Oladotun  3 , Santino Oifoh  3 , Micheal Olugbile  21 , Emmanuel Agogo  22 , Nnaemeka Ndodo  3 , Olajumoke Babatunde  3 , Nwando Mba  3 , John Oladejo  3 , Elsie Ilori  3 , Tobias Alfvén  2 , Puja Myles  23 , Chinwe Lucia Ochu  3 , Chikwe Ihekweazu  3 , Ifedayo Adetifa  3
Affiliations

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

Kelly Elimian et al. BMJ Open. .

Abstract

Objectives: Nigeria reported an upsurge in cholera cases in October 2020, which then transitioned into a large, disseminated epidemic for most of 2021. This study aimed to describe the epidemiology, diagnostic performance of rapid diagnostic test (RDT) kits and the factors associated with mortality during the epidemic.

Design: A retrospective analysis of national surveillance data.

Setting: 33 of 37 states (including the Federal Capital Territory) in Nigeria.

Participants: Persons who met cholera case definition (a person of any age with acute watery diarrhoea, with or without vomiting) between October 2020 and October 2021 within the Nigeria Centre for Disease Control surveillance data.

Outcome measures: Attack rate (AR; per 100 000 persons), case fatality rate (CFR; %) and accuracy of RDT performance compared with culture using area under the receiver operating characteristic curve (AUROC). Additionally, individual factors associated with cholera deaths and hospitalisation were presented as adjusted OR with 95% CIs.

Results: Overall, 93 598 cholera cases and 3298 deaths (CFR: 3.5%) were reported across 33 of 37 states in Nigeria within the study period. The proportions of cholera cases were higher in men aged 5-14 years and women aged 25-44 years. The overall AR was 46.5 per 100 000 persons. The North-West region recorded the highest AR with 102 per 100 000. Older age, male gender, residency in the North-Central region and severe dehydration significantly increased the odds of cholera deaths. The cholera RDT had excellent diagnostic accuracy (AUROC=0.91; 95% CI 0.87 to 0.96).

Conclusions: Cholera remains a serious public health threat in Nigeria with a high mortality rate. Thus, we recommend making RDT kits more widely accessible for improved surveillance and prompt case management across the country.

Keywords: Diagnostic microbiology; EPIDEMIOLOGY; Public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow of data within the surveillance system in Nigeria. Source: NCDC Surveillance and Epidemiology Department. Partner refers to the World Health Organization Country Office. DSNO, Disease Surveillance and Notification Officer; LGA, Local Government Area; NCDC, Nigeria Centre for Disease Control.
Figure 2
Figure 2
Distribution of cholera cases and deaths by epidemiological week and type of surveillance system. (A) Distribution of cholera cases and deaths by epidemiological week. (B) Distribution of cholera cases by epidemiological week using conventional surveillance system (green) and digital (Tatafo) event notification system (grey)
Figure 3
Figure 3
Distribution of cholera cases by age group and gender.
Figure 4
Figure 4
Spatial distribution of cholera cases and deaths on the map of Nigeria.
See this image and copyright information in PMC

References

    1. Ali M, Lopez AL, You YA, et al. . The global burden of cholera. Bull World Health Organ 2012;90:209–18. 10.2471/BLT.11.093427 - DOI - PMC - PubMed
    1. World Health Organization . Cholera Wkly Epidemiol Rec; 2020: 445–54. https://apps.who.int/iris/bitstream/handle/10665/345271/WER9637-445-454-...
    1. World Health Organization . Weekly epidemiological record cholera Cholera; 2019. https://apps.who.int/iris/bitstream/handle/10665/334242/WER9537-441-448-...
    1. Cholera Platform . Cholera Outbreaks in Central and West Africa : 2020 Regional Update-Week 1-53, 2020. Available: www.plateformecholera.info
    1. World Health Organization Africa . Weekly Bulletin on Outbreaks and other Emergencies, Week 27: 29 June - 5 July 2020; 2020. https://apps.who.int/iris/bitstream/handle/10665/332993/OEW27-2905050720...

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