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Nigeria 2017 Cholera Response and Prevention Plan (September 2017)

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A cholera outbreak was reported in Borno State, northeast Nigeria, by the State Ministry of Health. The first case was recorded on 16 August 2017 and the outbreak has, as of 12 September, claimed the lives of at least 44 individuals in the state. The number of suspected cases stands at over 1,730 with hotspots in various sites for displaced persons in Maiduguri, Dikwa, Monguno and Konduga. Most cases are concentrated in the “Muna Corridor” in Maiduguri, which includes 15 sites for displaced, including Muna Garage, Customs House and Farm Centre. Following a rapid risk assessment, the World Health Organization has graded the risk of spread in the Borno capital as “high,” given the congestion, poor infrastructure and water/sanitation conditions in the area.

More than half of the identified suspected cases in the confirmed locations are outpatients, therefore the currently available numbers may not reflect the true total caseload. Cases are also suspected in Mafa and various other local government areas (LGAs) have been identified as being at ‘high risk’ (Bama, Biu, Kala Balge, Kukawa, Mobbar, Ngala, Hawul, Damboa, Gwoza).

Women and girls are considered to be particularly vulnerable as gender roles influence the exposure to cholera. For example, it is usually women and girls who care for sick family members, clean latrines, fetch and handle untreated water and prepare food.

Health and Water, Sanitation and Hygiene (WASH) humanitarian partners are coordinating the response and supporting the Borno State Ministry of Health to contain the outbreak. This involves a significant scale-up in treatment, prevention and preparedness activities.

In terms of response and treatment, to date, partners have been able to open several cholera treatment centres (CTCs) using their readily available resources to handle the most severe cases: two in Maiduguri, one in Monguno and one in Dikwa, for a cumulative number of over 280 beds. Several oral rehydration points (ORPs) have also been set up in IDP sites to handle the less complicated cases. Surveillance teams are conducting door-to-door case investigations and referring patients for treatment when necessary.

For improved prevention and preparedness, handwashing points are being set up in all hotspots, water chlorination and water analysis are ongoing, and latrine desludging is also being performed regularly. Last but not least, hygiene promotion through radio, community groups, posters, and other methods is being done in camps and schools, a critical aspect of containing the outbreak.

Despite the Government’s and humanitarian partners’ efforts, without a significant, timely and holistic scale-up in all “very high” and “high” risk areas, the number of cases could very soon outpace the partners’ capacity to respond, resulting in avoidable suffering and loss of life. Additional funding and subsequent action are urgently required.

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