Using self-controlled case series to understand the relationship between conflict and cholera in Nigeria and the Democratic Republic of Congo

Cholera outbreaks significantly contribute to disease mortality and morbidity in low- and middle-income countries. Cholera outbreaks have several social and environmental risk factors and extreme conditions can act as catalysts. A social extreme with known links to infectious disease outbreaks is conflict, causing disruption to services, loss of income and displacement. Here, we used the self-controlled case series method in a novel application and found that conflict increased the risk of cholera in Nigeria by 3.6 times and 19.7% of cholera outbreaks were attributable to conflict. In the Democratic Republic of Congo (DRC), conflict increased the risk of cholera by 2.6 times and 12.3% of cholera outbreaks were attributable to conflict. Our results highlight the importance of rapid and sufficient assistance during conflict-related cholera outbreaks, while also working towards conflict resolution and addressing pre-existing vulnerabilities such as poverty and access to healthcare. Article Summary LineConflict significantly increased the risk of cholera outbreaks in Nigeria and the Democratic Republic of Congo and pre-existing vulnerabilities and conflict resolution should be a top priority to protect health.