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 | Â |
 • 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 | Â | |
 • 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 | Â | |
 • Governance/political | • Water scarcity due to inadequate power supply (electricity) • Inadequate public water supply | |
Macro-level | Â | |
 • 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 | Â |
 • Natural disaster | • Flooding | |
Environmental | Â | |
 • 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 |