Nigeria : Cholera Outbreak Emergency Plan of Action (EPoA) DREF Operation n° MDRNG033 - Nigeria - ReliefWeb

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A. Situation Analysis

Description of the disaster Nigeria is experiencing one of its worst cholera outbreaks in years. According to Nigeria Centre for Disease Control (NCDC) Cholera Situation Report No. 38, as of 21st September 2021, a total of 73,055 suspected cases including 2,407 deaths (CFR 3.3%) have been reported from 27 states out of 36 states and in Abuja, the Federal Capital Territory (FCT). According to the NCDC, children between 5 and 14 are the most affected age group and the overall case fatality rate is 3.3%. So far, the affected states are Benue, Delta, Zamfara, Gombe, Bayelsa, Kogi, Sokoto, Bauchi, Ekiti, Osun, Kano, Kaduna, Plateau, Kebbi, Cross River, Nasarawa, Ogun, Niger, Jigawa, Yobe, Kwara, Adamawa, Enugu, Katsina, Borno, Taraba, Abia, and the FCT.

With over 2,407 people dead from suspected cholera this year, there are concerns that there might be an undercount given that many affected communities are in hard-to-reach areas with high security challenges. Indeed, although the overall situation across the country seemed to be improving with significant reduction of cases as of week 32, it has also been highlighted those cases are being reported in additional states and cases increasing again as of week 38 in areas where it had dropped.

This year's outbreak, which is associated with a higher case fatality rate than the previous four years is also worsened by the COVID-19 pandemic. States with high levels of rainfall are worst hit due to seasonal flooding. Aside from being endemic and seasonal in Nigeria, cholera is also common in environments with high levels of poor sanitation, lack of clean food and water, and areas where open defecation is common practice.

The National Cholera Emergency Operations Centre (EOC) was activated on the 22 June 2021, following an increase in the number of cholera cases at the start of the rainy season. The Emergency Operations Center (EOC) which is hosted at NCDC, is being coordinated in collaboration with the Federal Ministries of Health, Environment and Water Resources, National Primary Health Care Development Agency (NPHCDA), World Health Organization (WHO), IFRC, the Nigerian Red Cross Society (NRCS) and other implementing partners. The national multi-sectoral EOC activated at level 2 continues to coordinate the national response. According to sitrep from the EOC, cholera activity in Nigeria in 2021 has grossly surpassed the total case counts identified in 2020 and 2019, when 1,800 cases and 3,500 cases were reported, respectively.

Cholera is a water-borne disease, and the risk of transmission is higher where there is poor sanitation and disruption of clean water supply. Cholera is transmitted directly through food or water contaminated with faecal material from an infected person due to poor sanitation and hygiene services practiced in the locations. Most infected people develop no symptoms or only mild diarrhoea. However, 1 in 10 infected people develop severe cholera, which causes symptoms including profuse watery diarrhea, vomiting, rapid heart rate, low blood pressure, muscle cramps, restlessness, or and/irritability. Symptoms typically appear 2-3 days after exposure but can develop up to 5 days after exposure. Individuals with severe cholera can develop acute renal failure, severe electrolyte imbalances, and coma. If left untreated, these can lead to shock and rapid death.

The long-term solution for cholera control lies in access to safely managed drinking water, maintenance of proper sanitation and hygiene. Treatment through fluid replacement is the recommended approach, typically through ORS or IV fluids. Zinc is recommended in small children, and it is highly recommended to continue breastfeeding, even when the mother is affected. NRCS has been conducting low scale awareness on prevention and early detection, of cases due to lack of resources. The Government of Nigeria has called on all local and international partners to support in intensifying the response to save lives and curb the spread of this epidemic.

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