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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 driverLevel/categoryExamples from the reviewed documents
SocialMicro-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)
BiologicalGenetics• Acquisition of resistance genes
• Changes in the major virulence determinant genes
Environmental and climaticEnvironmental 
 • 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-relatedHealth 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
MultipleA 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