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Table 3 A description of the drivers of cholera transmission in Nigeria

From: What are the drivers of recurrent cholera transmission in Nigeria? Evidence from a scoping review

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