Cholera in Nigeria: A review of outbreaks, trends, contributing factors, and public health responses

Abstract

Cholera remains a significant public health challenge in Nigeria, with recurrent outbreaks exacerbated by inadequate water,
sanitation, and hygiene (WASH) infrastructure, as well as conflict and displacement. This review examines cholera outbreaks
in Nigeria from 2010 to 2024, analyzing epidemiological trends, contributing factors, and public health responses. Seasonal
peaks during periods of heavy rainfall and flooding have consistently facilitated Vibrio cholerae transmission, with Northern
regions disproportionately affected due to poor infrastructure and ongoing conflicts. Displacement into overcrowded camps
has heightened vulnerability, particularly in conflict-affected areas such as Borno and Adamawa. The outbreaks have exhibited
multiple epidemic waves within single periods, reflecting persistent transmission dynamics. Recent outbreaks have seen higher
incidence rates among children under the age of five and vulnerable populations, highlighting the need for targeted
interventions. Public health responses have focused on improving surveillance, case management, and WASH infrastructure,
with coordinated efforts from national and international agencies. Vaccination campaigns, particularly in high-risk areas, have
proven effective in controlling outbreaks. However, challenges remain, including inadequate healthcare capacity, vaccine
stockouts, and the emergence of antimicrobial-resistant Vibrio cholerae strains (serogroup O1) resistant to antibiotics such as
tetracycline, doxycycline, ampicillin, and trimethoprim-sulfamethoxazole, complicating treatment efforts. The COVID-19
pandemic further strained Nigeria’s healthcare system, underscoring the need for an integrated health system to be
strengthened to manage concurrent public health crises. This review emphasizes the importance of a multi-sectoral approach to
cholera prevention and control, addressing underlying social determinants and ensuring sustained investments in public health
infrastructure to mitigate future outbreaks.