BMJ Open (Sep 2022)
Epidemiology, diagnostics and factors associated with mortality during a cholera epidemic in Nigeria, October 2020–October 2021: a retrospective analysis of national surveillance data
- Chikwe Ihekweazu,
- Carina King,
- Puja Myles,
- Fatima Saleh,
- Tobias Alfvén,
- Emmanuel Pembi,
- Emmanuel Agogo,
- Chinwe Lucia Ochu,
- Samuel Ngishe,
- Hakeem Abiola Yusuff,
- Ifeoma Nwadiuto,
- Abbas Aliyu Mohammed,
- Nwando Mba,
- Elsie Ilori,
- John Oladejo,
- Ibrahim Mamadu,
- Oluwatosin Wuraola Akande,
- Lauryn Dunkwu,
- Nnaemeka Ndodo,
- David Olatunji,
- Kelly Elimian,
- Sebastian Yennan,
- Anwar Musah,
- Iliya Danladi Cheshi,
- Ahmed Ladan Mohammed,
- Eme Ekeng,
- Stephanie Ayres,
- Benjamin Gandi,
- Ahmed Nasir Omar,
- Emily Crawford,
- Olubunmi Omowumi Olopha,
- Robinson Nnaji,
- Basheer Muhammad,
- Rejoice Luka-Lawal,
- Adachioma Chinonso Ihueze,
- Chidimma Ojukwu,
- Afolabi Muftau Akinpelu,
- Ene Adaga,
- Yusuf Abubakar,
- Agnes Bosede Alowooye,
- Peace Chinma Nwogwugwu,
- Khadeejah Kamaldeen,
- Henry Nweke Abah,
- Egbuna Hyacinth Chukwuebuka,
- Sarah Peter,
- Okpachi Christopher Abbah,
- Popoola Michael Oladotun,
- Santino Oifoh,
- Micheal Olugbile,
- Olajumoke Babatunde,
- Ifedayo Adetifa
Affiliations
- Chikwe Ihekweazu
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Carina King
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Puja Myles
- Clinical Practice Research Datalink, London, UK
- Fatima Saleh
- Nigeria Centre for Disease Control, FCT, Abuja, Nigeria
- Tobias Alfvén
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Emmanuel Pembi
- Adamawa State Ministry of Health, Yola, Nigeria
- Emmanuel Agogo
- Resolve to Saves Lives, Abuja, Nigeria
- Chinwe Lucia Ochu
- Nigeria Centre for Disease Control, FCT, Abuja, Nigeria
- Samuel Ngishe
- Public Health, Ministry of Health, Benue State, Makurdi, Nigeria
- Hakeem Abiola Yusuff
- Ogun State Ministry of Health, Abeokuta, Nigeria
- Ifeoma Nwadiuto
- Rivers State Ministry of Health, Port Harcourt, Nigeria
- Abbas Aliyu Mohammed
- Ministry of Health, Sokoto State, Sokoto, Nigeria
- Nwando Mba
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Elsie Ilori
- Nigeria Centre for Disease Control, FCT, Abuja, Nigeria
- John Oladejo
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Ibrahim Mamadu
- World Health Organization Country Office for Nigeria, Abuja, Nigeria
- Oluwatosin Wuraola Akande
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
- Lauryn Dunkwu
- Tony Blair Institute for Global Change, London, UK
- Nnaemeka Ndodo
- Nigeria Centre for Disease Control, Abuja, Nigeria
- David Olatunji
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Kelly Elimian
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Sebastian Yennan
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Anwar Musah
- Department of Risk and Disaster Reduction, University College London, London, UK
- Iliya Danladi Cheshi
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Ahmed Ladan Mohammed
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Eme Ekeng
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Stephanie Ayres
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Benjamin Gandi
- Bauchi State Ministry of Health, Bauchi, Nigeria
- Ahmed Nasir Omar
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Emily Crawford
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Olubunmi Omowumi Olopha
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Robinson Nnaji
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Basheer Muhammad
- Kano State Ministry of Health, Kano, Nigeria
- Rejoice Luka-Lawal
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Adachioma Chinonso Ihueze
- Georgetown University, Abuja, Nigeria
- Chidimma Ojukwu
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Afolabi Muftau Akinpelu
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Ene Adaga
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Yusuf Abubakar
- Zamfara State Ministry of Health, Zamfara State, Nigeria
- Agnes Bosede Alowooye
- Ekitit State Ministry of Health and Human Services, Ado-Ekiti, Nigeria
- Peace Chinma Nwogwugwu
- Abia State Ministry of Health, Umuanhia, Nigeria
- Khadeejah Kamaldeen
- Kwara State Ministry of Health, Ilorin, Nigeria
- Henry Nweke Abah
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Egbuna Hyacinth Chukwuebuka
- Imo State Ministry of Health, Owerri, Nigeria
- Sarah Peter
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Okpachi Christopher Abbah
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Popoola Michael Oladotun
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Santino Oifoh
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Micheal Olugbile
- World Bank Nigeria Office, Abuja, Nigeria
- Olajumoke Babatunde
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Ifedayo Adetifa
- Nigeria Centre for Disease Control, Abuja, Nigeria
- DOI
- https://doi.org/10.1136/bmjopen-2022-063703
- Journal volume & issue
-
Vol. 12,
no. 9
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.