Background
Methods
Methodological framework
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Identifying the research question(s)
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Identifying relevant studies
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Selecting the relevant studies
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Charting the data
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Collating, summarizing and reporting the research findings
Stage 1: identifying the research question
Stage 2: identifying relevant studies
Stage 3: selection of relevant documents
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The document had to be a peer-reviewed journal article, conference paper, book chapter, review, case study or short paper
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The document had to focus on cholera, be it in an epidemic or endemic context, in Nigeria
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The document had to include Vibrio cholerae or its abbreviation
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The document had to be written in English and published between 1970 (when cholera outbreak was first reported in Nigeria) and the period of data search (November 2018)
Stage 4: data charting
Stage 5: collating, summarising and reporting the results
Results
Description of documents
Characteristic | Frequency (%) |
---|---|
General characteristics | |
Authors’ affiliation | |
Academic institution | 22 (48.89) |
Academic and government | 7 (15.56) |
Academic and hospital | 1 (2.22) |
Academic and International NGO | 1 (2.22) |
Governmental health institution | 12 (26.67) |
Governmental health institution and International NGO | 1 (2.22) |
International NGO | 1 (2.22) |
Document type | |
Conference proceeding | 5 (11.11) |
Peer-reviewed journal | 40 (88.89) |
Publication period | |
< 1990 | 4 (8.89) |
1990–2000 | 6 (13.33) |
2001–2010 | 6 (13.33) |
2011–2018 | 29 (64.44) |
State where study was undertaken | |
Akwa-Ibom and Cross-River | 1 (2.22) |
Bauchi | 1 (2.22) |
Bauchi and Gombe | 1 (2.22) |
Bauchi, Borno and Gombe | 2 (4.44) |
Bauchi, Borno and Osun | 1 (2.22) |
Benue | 1 (2.22) |
Borno | 2 (4.44) |
Cross-River | 4 (8.89) |
Jigawa | 2 (4.44) |
Kaduna | 4 (8.89) |
Kano | 2 (4.44) |
Katsina | 1 (2.22) |
Lagos | 2 (4.44) |
Nasarawa | 1 (2.22) |
Niger | 1 (2.22) |
Ogun | 1 (2.22) |
Osun | 2 (4.44) |
Oyo | 7 (15.56) |
Rivers | 1 (2.22) |
Multiple states (> 3 states) | 8 (17.78) |
Study context | |
Epidemic | 29 (64.44) |
Endemic | 9 (20.00) |
Endemic and epidemic | 6 (13.33) |
Unspecified | 1 (2.22) |
Study approach | |
Prospective | 18 (40.00) |
Retrospective | 23 (51.11) |
Prospective and retrospective | 3 (6.67) |
Unclear | 1 (2.22) |
Study design | |
Case-control | 10 (22.22) |
Cross-sectional | 28 (62.22) |
Review | 4 (8.89) |
Unspecified | 3 (6.67) |
Median sample size reported in documents (IQR)a | 329 (109–1220) |
Age group of study participants | |
All age groups | 17 (37.78) |
Adults | 2 (4.44) |
Children under-5 years | 1 (2.22) |
Children under-14 years | 1 (2.22) |
Unspecified | 24 (53.33) |
Funding for study | |
Unspecified | 41 (91.11) |
Yes | 4 (8.89) |
Ethical approval for the study | |
Unspecified | 34 (75.56) |
Yes | 11 (24.44) |
Clinical characteristics | |
Data collection approach | |
Record extraction | 4 (8.89) |
Microbiological examination | 7 (15.56) |
Questionnaire | 9 (20.00) |
Record extraction and microbiological examination | 1 (2.22) |
Questionnaire and microbiological examination | 9 (20.00) |
Record extraction and questionnaire | 2 (4.44) |
Record extraction, questionnaire and microbiological examination | 1 (2.22) |
Record extraction, questionnaire and observation | 2 (4.44) |
Unspecified | 10 (22.22) |
Report of case fatality rate (%) | |
No | 23 (51.11) |
Yes | 22 (48.89) |
Mean (SD) case fatality rateb | 6.53 (3.90) |
Report of attack rate | |
No | 40 (88.89) |
Yes | 5 (11.11) |
Location of sample collection | |
Community | 11 (24.44) |
IDP camp | 1 (2.22) |
Primary | 1 (2.22) |
Secondary | 1 (2.22) |
Tertiary | 4 (8.89) |
Primary and secondary | 1 (2.22) |
Secondary and tertiary | 3 (6.67) |
Tertiary and private | 1 (2.22) |
Unspecified health facility | 2 (4.44) |
Unspecified health facility and community | 4 (8.89) |
Unspecified health facility and IDP camp | 1 (2.22) |
Unspecified | 15 (33.33) |
Culture | |
No | 11 (24.44) |
Yes | 22 (48.89) |
Unspecified | 12 (26.67) |
Rapid diagnostic test performed | |
No | 40 (88.89) |
Yes | 5 (11.11) |
Identified biotype | |
Classical | 1 (2.22) |
El-Tor | 4 (8.89) |
Classical & El-Tor | 2 (4.44) |
Atypical El-Tor | 1 (2.22) |
Unspecified | 37 (82.22) |
Identified serogroup | |
O1 | 13 (28.89) |
Non-O1 | 2 (4.44) |
Unspecified | 30 (66.67) |
Identified serotype | |
Ogawa | 8 (17.78) |
Inaba | 1 (2.22) |
Ogawa and Inaba | 1 (2.22) |
Unspecified | 35 (77.78) |
Thematic analysis of documents
Driver | Citation frequency of the reviewed documents |
---|---|
Social (demographic, cultural and economic) | 35 |
Biological (host and genetics) | 3 |
Environmental and climatic | 11 |
Health systems-related | 8 |
Multiplea | 27 |
Cholera transmission driver | Level/category | Examples from the reviewed documents |
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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 |