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. 2022 Dec;28(12):2472-2481.
doi: 10.3201/eid2812.212398.

Association between Conflict and Cholera in Nigeria and the Democratic Republic of the Congo

Gina E C Charnley, Kévin Jean, Ilan Kelman, Katy A M Gaythorpe, Kris A Murray

Association between Conflict and Cholera in Nigeria and the Democratic Republic of the Congo

Gina E C Charnley et al. Emerg Infect Dis. 2022 Dec.

Abstract

Cholera outbreaks contribute substantially to illness and death in low- and middle-income countries. Cholera outbreaks are associated with several social and environmental risk factors, and extreme conditions can act as catalysts. A social extreme known to be associated with infectious disease outbreaks is conflict, causing disruption to services, loss of income, and displacement. To determine the extent of this association, we used the self-controlled case-series method and found that conflict increased the risk for cholera in Nigeria by 3.6 times and in the Democratic Republic of the Congo by 2.6 times. We also found that 19.7% of cholera outbreaks in Nigeria and 12.3% of outbreaks in the Democratic Republic of the Congo were attributable to conflict. Our results highlight the value of providing rapid and sufficient assistance during conflict-associated cholera outbreaks and working toward conflict resolution and addressing preexisting vulnerabilities, such as poverty and access to healthcare.

Keywords: Democratic Republic of the Congo; Nigeria; bacteria; cholera; conflicts; disease outbreaks; epidemiology; public health; vibrio cholerae.

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Figures

Figure 1
Figure 1
Changes in cholera and conflict for the full datasets used in study of the association between conflict and cholera in Nigeria and the Democratic Republic of the Congo (DRC). A, B) Monthly cholera cases and deaths for Nigeria (A) and DRC (B). C, D) Monthly frequency of conflict exposures and fatalities for Nigeria (C) and DRC (D).
Figure 2
Figure 2
Number of conflicts and cholera cases as a percentage of the total number of national cases by administrative level 1 for Nigeria (A) and the Democratic Republic of the Congo (B).
Figure 3
Figure 3
Percentage of events in each dataset used in study of the association between conflict and cholera for Nigeria (A) and the Democratic Republic of the Congo (B) by administrative level 1. FCT, Federal Capital Territory.
Figure 4
Figure 4
Swimmer plots showing the conflict exposure period in the self-controlled case series model (1 week after the onset) and the outbreaks (black triangles) for each state/province for Nigeria (A) and the Democratic Republic of the Congo (B). Data were compiled by epidemiologic week. FCT, Federal Capital Territory.
Figure 5
Figure 5
IRRs for the effect of exposure to conflict within 1 week of the event and cholera at a subnational level for Nigeria (A) and the Democratic Republic of the Congo (B). Only results that were significant at the threshold p<0.05 are plotted. IRR, incidence rate ratio.
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