Northeast Nigeria: Flash Update #1 - Cholera outbreak and AWD cases in Borno, Adamawa and Yobe (BAY) states (As of 3 September 2021)

HIGHLIGHTS

• More than 2,000 cholera and acute watery diarrhea (AWD) cases, including 76 fatalities were reported in 25 local government areas (LGAs) across Borno, Adamawa and Yobe (BAY) states over the last two months. It is the first time in three years that BAY states are simultaneously hit by cholera outbreaks. The registered cases is likely a significant undercount.

• On 31 August, the Borno State Government declared an outbreak of cholera during a press conference, with Adamawa State Government declaring an outbreak earlier in August. As of 3 September, there are 666 cases in Borno State with 45 deaths; 124 cases in Adamawa State with 5 deaths; Yobe State reporting an estimated 1,300 AWD cases, the highest reported in all three states, including 26 deaths as reported by the Yobe State Ministry of Health.

• Government and partners in the three states have activated emergency response mechanisms, including the establishment of cholera treatment facilities and deployment of emergency teams and vital supplies to affected areas. It is noted that there is limitation in the state and federal capacities for sampling, assessment. Importation of critical inputs to the cholera response has also proved difficult. Both these factors may impede a timely response and efforts to prevent the spread of the disease.

• Some of the worst affected locations are hard-to-reach areas, impacting the prompt delivery of vital supplies and access for medical teams. Over 3.5 million litres of chlorinated water were supplied to affected and vulnerable households; more than 500,000 people were reached with hygiene promotion and risk awareness programmes, focused on prevention and control of diarrheal diseases.

• Some of the worst-affected locations have already run out of vital supplies. Import restrictions have resulted in shortages related to urgently needed Ringer Lactate solution critical for cholera treatment.
Situation Overview More than 2,000 of cases of cholera and acute watery diarrhea (AWD) have been reported in 25 local government areas (LGAs) across Borno, Adamawa and Yobe (BAY) states in north-east Nigeria as of 1 September 2021.

These reported cases include 75 associated deaths. The onset of the rainy season, marked by multiple flash flooding incidents that contaminated several water sources, have increased the risk of water-borne disease outbreaks especially AWD and cholera in the region. Limited health and water, hygiene and sanitation (WASH) facilities, further weakened by 12 years of conflict, poor hygiene practices, especially open defecation and congestion - across camps and communities hosting displaced and affected populations - are among the risk factors that have contributed to the rapid spread of these diseases across these three states.

Borno

The cholera outbreak in Borno is particularly concerning as 75 per cent of the total 666 reported cases and 68 per cent of total 45 fatalities (as of 1 September) are clustered in Gwoza and Damboa LGAs. These are currently hard-to-reach locations due to ongoing insecurity, where WASH facilities and health systems are particularly weak. Over 300,000 civilians in Damboa LGA are currently facing acute shortages of clean water, while complicated/critical health cases are being referred to neighbouring LGAs (between 60 to 90 kilometers away) due to the absence of secondary health care facilities or services in the LGA. Gwoza LGA, is facing a similar situation of acute water shortages and major health service gaps since July when the only aid agency providing secondary health care services suspended operations. Poor hygiene facilities combined with overcrowding, especially across camps and host communities, is still a major risk factor for rapid spread being reported in the two LGAs.

Adamawa

Adamawa State currently has some 124 cholera cases and 5 fatalities across six LGAs, including the capital city of Yola. A spike in cases, reaching 50 in mid-August, prompted the declaration of a cholera outbreak by the Government to activate a response. Although new cases marginally dropped towards the end of August, heavy rainfall and flooding incidents affecting some 15 LGAs in recent days could potentially trigger a surge in new cases. This has temporary displaced people and contaminated of water sources in affected communities.

Yobe

Yobe is yet to officially declare a cholera outbreak, although the State has the highest number of AWD cases. An estimated 1,300 people have been affected across 12 LGAs. Of the total 104 samples tested so far with cholera rapid diagnostic tests (RDTs) and cultured test in Yobe State, 77 (which accounts for 74 per cent of total samples tested) returned positive including for V. cholerae. Damaturu, the state capital, is the most affected accounting for more than 60 per cent of the number of reported cases.