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

Author:

Elimian KellyORCID,Yennan Sebastian,Musah AnwarORCID,Cheshi Iliya Danladi,King Carina,Dunkwu Lauryn,Mohammed Ahmed Ladan,Ekeng Eme,Akande Oluwatosin WuraolaORCID,Ayres Stephanie,Gandi Benjamin,Pembi Emmanuel,Saleh Fatima,Omar Ahmed Nasir,Crawford Emily,Olopha Olubunmi Omowumi,Nnaji Robinson,Muhammad Basheer,Luka-Lawal Rejoice,Ihueze Adachioma Chinonso,Olatunji David,Ojukwu Chidimma,Akinpelu Afolabi Muftau,Adaga Ene,Abubakar Yusuf,Nwadiuto Ifeoma,Ngishe Samuel,Alowooye Agnes Bosede,Nwogwugwu Peace Chinma,Kamaldeen Khadeejah,Abah Henry Nweke,Chukwuebuka Egbuna Hyacinth,Yusuff Hakeem Abiola,Mamadu Ibrahim,Mohammed Abbas Aliyu,Peter Sarah,Abbah Okpachi Christopher,Oladotun Popoola Michael,Oifoh Santino,Olugbile Micheal,Agogo Emmanuel,Ndodo Nnaemeka,Babatunde Olajumoke,Mba Nwando,Oladejo John,Ilori Elsie,Alfvén Tobias,Myles Puja,Ochu Chinwe LuciaORCID,Ihekweazu Chikwe,Adetifa Ifedayo

Abstract

ObjectivesNigeria 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.DesignA retrospective analysis of national surveillance data.Setting33 of 37 states (including the Federal Capital Territory) in Nigeria.ParticipantsPersons 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 measuresAttack 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.ResultsOverall, 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).ConclusionsCholera 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.

Publisher

BMJ

Subject

General Medicine

Reference40 articles.

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