Rising cholera cases: Harnessing the momentum of COVID-19 to strengthen Nigeria's health systems

Tackling Cholera Outbreak Amidst COVID-19 Pandemic in Nigeria: Challenges and Recommendations

Background: Since the first confirmed case of the Novel Coronavirus Disease 2019 (COVID-19) in Nigeria, the pandemic has become a major public health challenge, affecting different sectors of the country. While Nigeria is battling to control the spread of COVID-19, the eruption of new cholera cases has put additional pressure on the strained healthcare system.

Evidence: We showed how the overwhelming focus on COVID-19 has jeopardized key cholera containment measures such as disease surveillance, risk communication, and case management.

Policy Options and Recommendations: We recommend provision and universal access to safe water and sanitation as key cholera preventive and control measures. However, these are resources that developing countries including Nigeria find rather challenging to provide. We also proposed the implementation of well-coordinated multi-sectoral interventions that involve strengthening disease surveillance including access to safe drinking water, vaccines, and treatment, especially in vulnerable communities.

Conclusion: This policy brief provides evidence for policymakers, which if acted upon, will foster sustainable solutions to the lingering cholera outbreaks in Nigeria.

Cholera epidemic amidst the COVID-19 pandemic in Moroto district, Uganda: Hurdles and opportunities for control

INTRODUCTION

On 21st March 2020, the first COVID-19 case was detected in Uganda and a COVID-19 pandemic declared. On the same date, a nationwide lockdown was instituted in response to the pandemic. Subsequently, more cases were detected amongst the returning international travelers as the disease continued to spread across the country. On May 14th, 2020, a cholera epidemic was confirmed in Moroto district at a time when the district had registered several COVID-19 cases and was in lockdown. This study aimed to describe the cholera epidemic and response activities during the COVID-19 pandemic as well as the hurdles and opportunities for cholera control encountered during the response.

MATERIALS AND METHODS

In a cross-sectional study design, we reviewed Moroto district's weekly epidemiological records on cholera and COVID-19 from April to July 2020. We obtained additional information through a review of the outbreak investigation and control reports. Data were analyzed and presented in frequencies, proportions, attack rates, case fatality rates, graphs, and maps.

RESULTS

As of June 28th, 2020, 458 cases presenting with severe diarrhea and/or vomiting were line listed in Moroto district. The most affected age group was 15-30 years, 30.1% (138/458). The females, 59.0% [270/458], were the majority. The Case Fatality Rate (CFR) was 0.4% (2/458). Whereas home use of contaminated water following the vandalization of the only clean water source in Natapar Kocuc village, Moroto district, could have elicited the epidemic, implementing COVID-19 preventive and control measures presented some hurdles and opportunities for cholera control. The significant hurdles were observing the COVID-19 control measures such as social distancing, wearing of masks, and limited time in the community due to the need to observe curfew rules starting at 6.00 pm. The opportunities from COVID-19 measures complementary to cholera control measures included frequent hand washing, travel restrictions within the district & surrounding areas, and closure of markets.

CONCLUSION

COVID-19 preventive and control measures such as social distancing, wearing of masks, and curfew rules may be a hurdle to cholera control whereas frequent hand washing, travel restrictions within the district & surrounding areas, and closure of markets may present opportunities for cholera control. Other settings experiencing concurrent cholera and COVID-19 outbreaks can borrow lessons from this study.

Rising cholera cases: Harnessing the momentum of COVID-19 to strengthen Nigeria's health systems

Recently, there has been a surge in cholera cases in Nigeria. With the exhausting health resources and the overwhelming attention towards COVID‐19, Nigeria is in danger of worsening the epidemiological profile of cholera in the country. Thus, it is pertinent to address the surge to prevent further weakening of the country's health system. In this paper, we, therefore, explore the various interrelated factors accounting for the surge in Nigeria. It is therefore suggested that multifaceted public health strategies be employed that leverage the current level of disease preparedness and response capacities to the COVID‐19 pandemic to reduce the impacts of cholera. These measures will not only help in strengthening the country's health system but also enhance the achievement of the relevant strategies toward eradicating cholera.