Cholera in Nigeria: a five-decade review of outbreak dynamics and health system responses.

Abstract

Background: Cholera remains a significant public health concern in Nigeria, with recurrent outbreaks over the past five decades. Despite advancements in healthcare, the country continues to record high case fatality rates, largely due to inadequate water, sanitation, and hygiene (WASH) infrastructure, poor health systems, climate variability, and conflict-induced displacement.

Objective: This review aimed to examine the historical trends of cholera in Nigeria, identify key drivers of outbreaks, evaluate government and international responses, and recommend strategic measures for prevention and control.

Methods: A comprehensive analysis was conducted using historical outbreak data, peer-reviewed literature, and reports from national and international health agencies. The study focuses on outbreaks from 1970 to 2024, highlighting epidemiological trends, response strategies, and systemic challenges.

Results: Cholera has persisted as an endemic disease in Nigeria, with major outbreaks recorded in 1991, 2010, and 2021. Case fatality rates often exceeded the World Health Organization's (WHO) recommended threshold of < 1%, indicating systemic deficiencies in outbreak response and healthcare delivery. Contributing factors include poor sanitation, limited access to clean water, underfunded healthcare infrastructure, and weak surveillance systems. Climate change and population displacement due to conflict have further exacerbated the risk of transmission.

Conclusion: Nigeria's approach to cholera control remains reactive, with limited progress in sustainable prevention. Multi-sectoral strategies including improved WASH infrastructure, enhanced surveillance, local vaccine production, and community-based interventions are essential to achieving the WHO 2030 cholera elimination goals.