Factors Associated With The Propagation Of Cholera In Epidemics Across The Geopolitical Zones Of Nigeria: A Systematic Review

IntroductionCholera remains a significant public health challenge in Nigeria, with recurring outbreaks driven by environmental, socioeconomic, and healthcare-related factors. This systematic review examines the propagation of cholera across Nigerias six geopolitical zones, identifying key risk factors and regional disparities to inform targeted interventions. MethodsThe study adhered to the PRISMA guidelines, analyzing 40 peer-reviewed studies published between 2015 and 2024. Data were extracted from databases such as PubMed, Scopus, and Cochrane Library, alongside grey literature. Eligible studies included observational and interventional research focusing on cholera risk factors, WASH (Water, Sanitation, and Hygiene) infrastructure, healthcare preparedness, and population mobility. Quality assessment was performed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. ResultsThe review identified contaminated water sources, poor sanitation, and seasonal flooding as primary environmental drivers of cholera, particularly in the Northwest, Northeast, and South-South zones. Socioeconomic factors such as poverty, overcrowding, and inadequate healthcare access exacerbated outbreaks, especially in conflict-affected regions like the Northeast. Behavioral practices, including unsafe water storage and street food consumption, further contributed to transmission. WASH deficiencies showed a strong correlation with cholera incidence, with the Northeast having the highest case rates (180 per 100,000). Healthcare system preparedness varied, with the Southwest demonstrating faster response times (6 days) compared to the Northeast (14 days). Public health interventions reduced cholera cases by up to 50% in some regions, though challenges like vaccine hesitancy and logistical barriers persisted. ConclusionCholera propagation in Nigeria is multifaceted, requiring region-specific strategies that address environmental, socioeconomic, and healthcare vulnerabilities. Strengthening WASH infrastructure, expanding vaccination coverage, and improving emergency response systems are critical to mitigating future outbreaks. Policymakers must prioritize sustainable interventions tailored to the unique challenges of each geopolitical zone to achieve long-term cholera control.