Public Health Implications of Cholera- a Water Sanitation and Hygiene (WASH) Related Infectious Disease in the Era of Climate Change: The Nigeria Experience

Nnenna Ihua

Department of Haematology, Blood Transfusion & Immunology, PAMO University of Medical Sciences, Port Harcourt, Nigeria.

Owhorchukwu Amadi-Wali

Department of Medical Microbiology & Parasitology, Rivers State University, Port Harcourt, Nigeria.

Evelyn Orevaoghene Onosakponome

Department of Medical Laboratory Science, PAMO University of Medical Sciences, Port Harcourt, Nigeria.

Chidi L.C. Ndukwu. *

Faculty of Medical Laboratory Science, Federal University, Otuoke, Bayelsa State, Nigeria.

Roseanne Adah Ikpeama

Department of Medical Laboratory Science, PAMO University of Medical Sciences, Port Harcourt, Nigeria.

Cyrilgentle Ugochukwu Okorocha

Department of Public Health, Claretian University of Nigeria, Maryland Nekede, Imo State, Nigeria.

*Author to whom correspondence should be addressed.


Water, sanitation and hygiene (WASH) play key roles in management of infectious diseases like cholera and other waterborne diseases; given that millions of people globally have no access to safe water. This cross-sectional study, conducted in 7 communities of Ogoni region (Khana, Gokana, Tai and Eleme LGAs), Orashi region (Abua/Odual, Ahoada West, Ahoada East and Ogba-Egbema-Ndoni LGAs) and Obolo region (Andoni LGA) all in Rivers State, Nigeria, enrolled 274 inhabitants comprising 164 females and 110 males. These included persons passing watery stools accompanied with vomiting, abdominal cramps and those with such prehistory. Questionnaires were used to obtain socio-demographic data. A total of 274 faecal samples were collected and transported in Cary-Blair stool culture transport medium to Rivers State University Teaching Hospital laboratory; and inoculated on Thiosulphate sulphate citrate bile salt-sucrose agar. Gram staining and biochemical tests were performed using standard procedures. Among the 274 subjects, 40 were infected giving a prevalence rate of 14.6%, including 26(15.9%) females and 14(12.7%) males though this was statistically insignificant, (U=8738.000, p=0.474). On educational levels, those who attended secondary schools had the highest prevalence rate (26.3%), compared with others and it was statistically significant, (p=0.00). WASH perceived predisposing factor showed the prevalence rate among those without access to safe water was 33(21.6%) against those with access to safe water 7(5.8%) and was statistically significant, (p=0.00). Subjects engaged in routine environmental sanitation and hygiene practices had lower prevalence 7(7.6%) than their counterparts, 33(18.1%), p=0.02. Respondents who think climate change had a positive impact on cholera transmission had prevalence of 34(23.3%) against those who disagreed, 6(4.7%), which was statistically significant. The study deduced that unavailability of safe drinking water, climate change, and unhygienic practices were major predisposing factors to cholera infection. Provision of safe water is advocated as greater percentage of the communities lacked access to safe drinking water. Routine environmental sanitation exercise should be revisited and enforced.

Keywords: Cholera, WASH-related infectious diseases, climate change, safe drinking water, unhygienic practices, environmental sanitation and hygiene, public health

How to Cite

Ihua , N., Amadi-Wali , O., Onosakponome, E. O., Ndukwu., C. L., Ikpeama , R. A., & Okorocha , C. U. (2024). Public Health Implications of Cholera- a Water Sanitation and Hygiene (WASH) Related Infectious Disease in the Era of Climate Change: The Nigeria Experience. International Journal of TROPICAL DISEASE & Health, 45(6), 32–49.


Download data is not yet available.


Ramamurthy T, Sharma NC. Cholera outbreaks in India. Curr Top Microbiol Immunol. 2014;379:49-85

Wolfe M, Kaur M, Yates T, Woodin M, Lantagne D. A systematic review and meta-analysis of the association between water, sanitation, and hygiene exposures and cholera in case–control studies. ASTMH. 2018;99:534–45.

World Health Organization (WHO) Cholera Annual Report 2020 Weekly Epidemiological Record 37. 2021;96:445-460. Accessed 18th march 2023

World Health Organization. Disease Outbreak News; Cholera – Global situation; 2023 Available:

World Health Organization. Cholera: Key Facts World Health Organization; 2018b Available:

Tulchinsky TH, Varavikova EA. Expanding the concept of public health. The New Public Health. 2024;43-90

Mai L, Bao LJ, Shi L, Wong CS, Zeng EY. A review of methods for measuring microplastics in aquatic environments. Environ Sci Pollut Res Int. 2018;25(12): 11319-332.

Charnley G E, Yennan S, Ochu C, Kelman I, Gaythorpe KA, Murray KA. The impact of social and environmental extremes on cholera time varying reproduction number in Nigeria. PLOS glob. public health. 2022;2(12):e0000869.

Centers for Disease Control and Prevention. Disease Threats and Global WASH Killers:

Cholera, Typhoid, and Other Waterborne Infections; 2022 Available:

Owhonda G, Luke A, Ogbondah BO, Nwadiuto I, Abikor V, Owhondah E. Outbreak investigation of cholera in a rural community, Rivers State Nigeria: an interventional epidemiological study. IJCMPH. 2023;10: 860-8.

Adagbada AO, Adesida SA, Nwaokorie FO, Niemogha MT, Coker AO. Cholera epidemiology in Nigeria: an overview. Pan Afr Med J. 2012;12:59.

Ali M, Nelson AR, Lopez AL, Sack DA. Updated global burden of cholera in endemic countries. PLoS Negl Trop Dis PLoS neglected tropical diseases, 2015;9(6):e0003832.

Nichols G, Lake I, Heaviside C. Climate change and water-related infectious diseases. Atmosphere, 2018;9(10):385.

Elimian KO, Mezue S, Musah A, Oyebanji O, Fall IS, Yennan S. Ihekweazu C. What are the drivers of recurrent cholera transmission in Nigeria? Evidence from a scoping review. BMC Public Health, 2020;20:1-13.

Elimian KO, Musah A, Mezue S, Oyebanji O, Yennan S, Jinadu A. Ihekweazu C. Descriptive epidemiology of cholera outbreak in Nigeria, January–November, 2018: implications for the global roadmap strategy. BMC Public Health, 2019;19(1): 1-11.

Abdussalam AF. Modelling the climatic drivers of cholera dynamics in Northern Nigeria using generalised additive models. Int J Geogr Environ Manag. 2016;2(1):84-97.

Ranjbar R, Rahbar M, Naghoni A, Farshad S, Davari A, Shahcheraghi F. A cholera outbreak associated with drinking contaminated well water. Arch Iran Med. 2011;14(5):339-40.

Kanu NE, Osinubi MO, Okeke CC, Nwadiuto I. Cholera outbreak in andoni local government area, Rivers State, Nigeria; january 2015: The role of hand washing with soap. NJM. 2015;27(2):140-46.

Mora C, Spirandelli D, Franklin EC, Lynham, J, Kantar MB, Miles W. Hunter CL. Broad threat to humanity from cumulative climate hazards intensified by greenhouse gas emissions. Nat Clim Change. 2018;8(12):1062-71.

Asadgol Z, Mohammadi H, Kermani M, Badirzadeh A, Gholami M. The effect of climate change on cholera disease: The road ahead using artificial neural network. PloS One. 2019;14(11):e0224813.

Musa SS, Gyeltshen D, Manirambona E, Wada YH, Sani AF, Ullah I, Lucero-Prisno DE. Dual tension as Nigeria battles cholera during the COVID-19 pandemic; 2021

Wolfe M, Kaur M, Yates T, Woodin M, Lantagne D. A systematic review and meta-analysis of the association between water, sanitation, and hygiene exposures and cholera in case–control studies. ASTMH. 2018;99:534–45

Levy K, Smith SM, Carlton EJ. Climate change impacts on waterborne diseases: Moving toward designing interventions. Curr. Environ. Health Rep. 2018;5: 272-82.

Charnley GE, Kelman I, Green N, Hinsley W, Gaythorpe KA, Murray KA. Exploring relationships between drought and epidemic cholera in Africa using generalised linear models. BMC Infect Dis. 2021;21(1):1-12.

Talavera A, Perez EM. Is cholera disease associated with poverty? JIDC. 2009;3(06):408-11.

Elimian K, Yennan S, Musah A, Cheshi ID, King C, Dunkwu L, Adetifa I. Epidemiology, diagnostics and factors associated with mortality during a cholera epidemic in Nigeria, October 2020–October 2021: A retrospective analysis of national surveillance data. BMJ Open. 2022;12(9):e063703.

Brown I, Eyenghe T, Boyle SH. Power relations: A catalyst in the building of flood disaster resilience capacities in the Orashi Region of Rivers State. Int J Hydro. 2021;5(6):302-15.

Clinton HI, Khadijat AI. Correlation and partitioning of some heavy metals in aquatic media around a make shift crude oil refining area. Int. J. Environ. 2019;8(2):1-17.

Cheesbrough M. Microbiological tests. District Laboratory Practice in Tropical Countries. United Kingdom:Part 1. Ed.2. 2009;1-266

Hutton G, Chase C. Water supply, sanitation, and hygiene. In: Mock CN, Nugent R, Kobusingye O, Smith KR, editors. Injury Prevention and Environmental Health. 3rd ed. Washington (DC): The International Bank for Reconstruction and Development / The World Bank. 2017;Chapter 9.

World Health Organization. Cholera Annual Report 2020 Weekly Epidemiological Record 37. 2021;96:445-60.

Orimbo EO, Oyugi E, Dulacha D, Obonyo M, Hussein A, Githuku J, Gura Z. Knowledge, attitude and practices on cholera in an arid county, Kenya, 2018: A mixed-methods approach. PLoS One. 2020;15(2):e0229437.

White S, Mutula AC, Buroko MM, Heath T, Mazimwe FK, Blanchet K, Dreibelbis R. How does handwashing behaviour change in response to a cholera outbreak? A qualitative case study in the Democratic Republic of the Congo. PLoS One. 2022;17(4):e0266849.

Endris AA, Addissie A, Ahmed M, Abagero A, Techane B, Tadesse M. Epidemiology of cholera outbreak and summary of the preparedness and response activities in Addis Ababa, Ethiopia, 2016; 2022

Matta G, Kumar P, Uniyal DP, Joshi DU. Communicating water, sanitation, and hygiene under sustainable development goals 3, 4, and 6 as the panacea for epidemics and pandemics referencing the succession of COVID-19 surges. ACS Es& T Water. 2022;2(5):667-89.

Matias WR, Teng JE, Hilaire IJ, Harris JB, Franke MF, Ivers LC. Household and individual risk factors for cholera among cholera vaccine recipients in rural Haiti. ASTMH. 2017;97(2):436.

World Health Organization. The world health report 2002: reducing risks, promoting healthy life. World Health Organization; 2002.

Sorensen C, Murray V, Lemery J, Balbus J. Climate change and women's health: Impacts and policy directions. PLoS Med. 2018;15(7):e1002603.

Gupta S, Tutu RA, Boateng J, Busingye JD, Elavarthi S. Self-reported functional, communicative, and critical health literacy on foodborne diseases in Accra, Ghana. Trop Med Health. 2018;46:1-10.

Tutu RA, Gupta S. Busingye JD. Examining health literacy on cholera in an endemic community in Accra, Ghana: A cross-sectional study. Trop Med Health. 2019;47:31.

Tutu RA, Gupta S, Elavarthi S, Busingye JD, Boateng JK. Exploring the development of a household cholera-focused health literacy scale in James Town, Accra. J Infect Public Health. 2019;12(1):62-69

Jubayer A, Islam MH, Nayan MM. Child-sensitive water, sanitation, and hygiene composite score and its association with child nutritional outcomes in St. Martin's Island, Bangladesh. SAGE Open Med; 2022.

Melaku A, Addis T. Handwashing practices and associated factors among school children in Kirkos and Akaki Kality Sub-Cities, Addis Ababa, Ethiopia. Environ Health Insights. 2023;23:17.

Shehu B, Nazim F. Clean water and sanitation for all: Study on SDGs 6.1 and 6.2 Targets with State Policies and Interventions in Nigeria. Environ Sci Proc. 2022;15(1):71.

Biswas AK. Urban water security for developing countries. River. 2022;1: 15-24.

Challa JM, Getachew T, Debella A, Merid M, Atnafe G, Eyeberu A, Regassa LD. Inadequate hand washing, lack of clean drinking water and latrines as major determinants of cholera outbreak in Somali Region, Ethiopia in 2019. Front Public Health. 2022;10:845057.

Tabor R, Almhawish N, Aladhan I, Tarnas M, Sullivan R, Karah N, Abbara A. Disruption to water supply and waterborne communicable diseases in northeast Syria: a spatiotemporal analysis. Confl Health. 2023;17(1):1-15.

Shackleton D, Memon FA, Nichols G, Phalkey R, Chen AS. Mechanisms of cholera transmission via environment in India and Bangladesh: state of the science review. Rev Environ Health; 2023.

Usmani M, Brumfield KD, Magers BM, Chaves-Gonzalez J, Ticehurst H, Barciela R, Jutla A. Combating cholera by building predictive capabilities for pathogenic Vibrio cholerae in Yemen. Sci Rep. 2023;13(1):2255.

Kruger SE, Lorah PA, Okamoto KW. Mapping climate change’s impact on cholera infection risk in Bangladesh. PLOS Glob Public Health. 2022;2(10): e0000711.

Dan-Nwafor CC, Ogbonna U, Onyiah P, Gidado S, Adebobola B, Nguku P, Nsubuga P. A cholera outbreak in a rural north central Nigerian community: an unmatched case-control study. BMC Public Health. 2019;19:1-7.

Fagbamila IO, Abdulkarim MA, Aworh MK, Uba B, Balogun MS, Nguku P, Waziri NE. Cholera outbreak in some communities in North-East Nigeria, 2019: an unmatched case–control study. BMC Public Health. 2023;23(1):1-11.