Denue Ballah Akawu, Akawu Cecilia Balla, Kwayabura Salihu Aliyu, Kida Ibrahim
Department of Medicine, College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria.
Department of Medical Geography, University of Maiduguri, Maiduguri, Borno State, Nigeria.
Ann Afr Med. 2018 Oct-Dec;17(4):203-209. doi: 10.4103/aam.aam_66_17.
Cholera is endemic in sub-Saharan Africa, especially in areas affected by natural disaster and human conflict. Northeastern Nigeria is experiencing a health crisis due to the destruction of essential amenities such as health infrastructure, sanitation facilities, water supplies, and human resources by Boko Haram insurgents. In 2017, a cholera outbreak occurred in five local government areas (LGAs) hosting internally displaced persons. The Nigeria Center for Disease Control, World Health Organization, Mĕdecins Sans Frontiĕres International, and several other organizations supported disease containment. An emergency operating center (EOC) established by the State Ministry of Health (SMoH) then coordinated the outbreak response.
We conducted a retrospective analysis of data extracted from the line list utilized by the SMoH to investigate outbreaks. We evaluated the outbreak by time, place, and person. Attack rate by LGA and age-specific case fatality rate (CFR) was calculated based on cases with complete records for age, sex, place of residence, date of symptom onset, and disease outcome.
A total of 5889 cholera cases were reported from five LGAs with an overall attack rate of 395.3/100,000 population. Among 4956 cases with documented outcome, the overall CFR was 0.87%, with CFR ranging from 0% to 6.98% by LGA. The age-specific CFR was highest among those aged ≥60 years (1.92%) and least among those aged 20-29 years at 0.3%. The epidemiological curve revealed two peaks that coincided with periods of heavy rain and flooding.
This study reports on the largest ever documented cholera outbreak in five LGAs in Borno State. The outbreak was focused in LGA hit hardest by the destructive activities of insurgents and then spread to neighboring LGAs. The low CFR recorded in this cholera outbreak was achieved through timely detection, reporting, and response by the coordinated efforts of the EOC established by the SMoH that harmonized the outbreak response.
霍乱在撒哈拉以南非洲地区呈地方性流行，尤其是在受自然灾害和人类冲突影响的地区。尼日利亚东北部正因博科圣地叛乱分子对卫生基础设施、卫生设施、供水和人力资源等基本生活设施的破坏而经历一场健康危机。2017年，在五个收容境内流离失所者的地方政府辖区发生了霍乱疫情。尼日利亚疾病控制中心、世界卫生组织、无国界医生组织国际部及其他几个组织为疾病控制提供了支持。随后，由该州卫生部设立的一个应急行动中心协调了疫情应对工作。
我们对从该州卫生部用于调查疫情的一览表中提取的数据进行了回顾性分析。我们按时间、地点和人群对疫情进行了评估。根据年龄、性别、居住地点、症状出现日期和疾病转归记录完整的病例，计算了各地方政府辖区的发病率和特定年龄组的病死率（CFR）。
五个地方政府辖区共报告了5889例霍乱病例，总体发病率为395.3/10万人口。在4956例有记录转归的病例中，总体病死率为0.87%，各地方政府辖区的病死率在0%至6.98%之间。特定年龄组的病死率在60岁及以上人群中最高（1.92%），在20 - 29岁人群中最低，为0.3%。流行病学曲线显示有两个高峰，与暴雨和洪水期相吻合。
本研究报告了博尔诺州五个地方政府辖区有史以来记录的最大规模霍乱疫情。疫情集中在受叛乱分子破坏活动影响最严重的地方政府辖区，并随后蔓延至邻近的地方政府辖区内霍乱疫情通过该州卫生部设立的应急行动中心的协调努力实现了及时发现、报告和应对，从而实现了较低的病死率。
