Table 3.
A description of the drivers of cholera transmission in Nigeria
| Cholera transmission driver | Level/category | Examples from the reviewed documents |
|---|---|---|
| Social | Micro-level | |
| • Household |
• Large household size and over-crowdedness • Poor sanitation and hygiene practices • Poor sewage disposal practices • Socioeconomic status (income and/or education) • Inter-family transmission/contact • Reliance on contaminated water sources (e.g. open wells) |
|
| Micro-level | ||
| • Individual |
• Open defecation • Consumption of seafood, sea and estuarine waters • Inadequate knowledge, and poor attitude and practices towards cholera • Religious beliefs (e.g. reluctance among female patients to seek care from male-dominated health providers) • Superstitious beliefs and/or myths |
|
| Macro-level | ||
| • Governance/political |
• Water scarcity due to inadequate power supply (electricity) • Inadequate public water supply |
|
| Macro-level | ||
| • Trade and migration |
• Increased fishing activities (e.g. trade traffic on the Calabar river estuary) • Increased migration and internal displacement of people (primarily due to armed conflicts) |
|
| Biological | Genetics |
• Acquisition of resistance genes • Changes in the major virulence determinant genes |
| Environmental and climatic | Environmental | |
| • Natural disaster | • Flooding | |
| Environmental | ||
| • Human-made |
• Contaminated water sources by poor sewage disposal, waste dumps, abattoir, among others. • Street-vended and sachet water |
|
| Climatic | • Unfavourable weather variables including rainfall and temperature | |
| Health systems-related | Health provision |
• Inadequate funding for surveillance system • Inadequate training of health workers and health facilities • Inadequate supply of essential materials including oral cholera vaccine and oral rehydration solutions • Limited capacity for prompt and accurate cholera diagnosis, and delays in the notification of cholera cases |
| Health seeking |
• Delay in seeking care at formal health facilities after cholera onset • Inadequate knowledge, attitude and practices towards cholera • |
|
| Interphase between health provision and seeking |
• Lack of trust by community members for formal health systems • Religious and/or superstitious beliefs |
|
| Multiple | A combination of two or more drivers |
• Over-crowdedness due to increasing population and natural disasters and human-made factors (e.g. conflicts) • Fragile surveillance system and limited political-will |