INVESTIGATING THE SOCIOECONOMIC DETERMINANTS OF CHOLERA OUTBREAKS IN NIGERIAN COMMUNITIES

CHAPTER ONE

INTRODUCTION

Background of the Study

Cholera is a common waterborne illness that causes severe diarrhea, leading to dehydration and death. Vibrio cholera is commonly present in brackish water that has a moderate level of salt. The microorganism can be found in various water sources such as wells, ponds, rivers, coastal waterways, and beaches (Codeço, 2018). The spread of cholera is greatly influenced by environmental factors such as temperature, water salinity, sea surface temperature, and rainfall (De Magny, Cazelles, & Guégan, 2018). Humans can acquire the illness through an environmental source, known as primary transmission, which is particularly common in coastal regions where the vibrio bacterium naturally exists in reservoirs (Colwell & Spira, 201).  According to Lipp et al. (2021), first infections commonly occur in brackish waterways that are used for occupational or recreational purposes. 

The main method by which cholera is transmitted to people is by the ingestion of water or food that has been contaminated with the faecal matter of an infected individual. Moreover, this form of transmission is known as secondary transmission (Mandal, Mandal, & Pal, 2019).  The microorganism is present in wells, ponds, rivers, coastal waterways, and estuaries (Codeço, 2018). However, the transmission of cholera is significantly affected by environmental elements such as temperature, water salinity, sea surface temperature, and rainfall (De Magny, Cazelles, & Guégan, 2019). The precise impact of alterations in these variables and their collective affects remains a topic of significant fascination for scientists, despite the fact that the intricate interconnections are not completely comprehended (Ruiz-Moreno et al., 2019). 

Previously, it was believed that only humans carried V. cholerae, however it has been discovered that the vibrio also exists in several marine creatures (Lipp 2022). Humans can contract the infection through an environmental source, referred to as primary transmission, which is especially prevalent in coastal areas where the vibrio bacterium is naturally present in reservoirs (Colwell & Spira, 2018).  The primary mode of transmission for humans is by the consumption of water or food that has been contaminated with the faecal matter of another individual infected with cholera. Furthermore, this type of transmission is referred to as secondary transmission (Colwell & Spira, 2023; Mandal, Mandal, & Pal, 2019). Vibrio cholerae has the ability to persist in habitats that are not water-based, such as in faeces and on vegetables that have been contaminated. It may survive for a maximum of seven days in these conditions. This makes cholera a possible danger in regions where there is inadequate sanitation infrastructure (Colwell & Spira, 2024). The rise in disease occurrence, however, cannot be attributed to a single causal source. Nevertheless, cholera prevalence, disease risk, and incidence rates are influenced by the interaction of environmental, climatic, and socioeconomic factors. While sanitation and nutrition are crucial determinants, and it is evident that effective sanitation and sanitary practices significantly mitigate the spread of disease. Therefore, a survey will be conducted in order to investigate the socioeconomic determinants of cholera outbreaks in Nigerian communities.

Statement of the Problem

Cholera is a disease transmitted by water that presents major public health difficulties in the country. Cholera outbreaks in Nigeria occur repeatedly and are frequently associated with inadequacies in water, sanitation, and hygiene (WASH) infrastructure.  According to WHO (2020), these issues are worsened by socioeconomic inequalities and environmental circumstances. An important factor that affects the occurrence of cholera epidemics is the limited availability of clean water and appropriate sanitation facilities in most areas in Nigeria. A considerable section of the Nigerian population lacks access to enhanced sanitation facilities, hence elevating the chances of transmitting cholera bacteria through the ingestion of faecal matter (Shittu et al., 2020). Inadequate sanitation practices and the practice of open defecation contribute to the contamination of water sources, therefore sustaining the cycle of cholera transmission in both densely populated urban areas and rural villages (NPC, 2020).

Moreover, socioeconomic factors, such as poverty and overcrowded living situations, are pivotal in influencing the dynamics of cholera. Impoverished areas face restricted access to healthcare services and clean water infrastructure, rendering them more susceptible to cholera outbreaks (Olukoya et al., 2018). Overcrowding, which frequently occurs as a result of fast urbanization and the presence of informal settlements, enables the swift transmission of cholera bacteria due to near human proximity and insufficient waste management methods (UNDP, 2022). In a study by Johnson and Zubby (2023) Cholera outbreaks are also influenced by education levels and understanding of hygiene practices. Communities characterised by low literacy rates and insufficient health education face challenges in implementing efficacious preventive interventions, such as the adoption of handwashing with soap and safe water storage practices (UNICEF, 2020). Cultural beliefs and traditional practices around the handling and consumption of food can exacerbate the transmission patterns of cholera in particular populations (WHO, 2019). In order to tackle these socioeconomic variables, a holistic approach is needed that combines public health interventions with initiatives to enhance living circumstances and empower communities. Hence, it is in the light of these that the study seeks to investigate the socioeconomic determinants of cholera outbreaks in Nigerian communities.

 1.3  Objectives of the Study

The main purpose of this study is to investigate the socioeconomic determinants of cholera outbreaks in Nigerian communities. Specifically, the study will;

Investigate the if level of education contributes to cholera outbreaks in Nigerian communities.

Determine the extent poverty contributes to cholera outbreaks in Nigerian communities. 

Ascertain whether employment status contributes to cholera outbreaks in Nigerian communities. 

To propose proper hygiene practices for the prevention of cholera outbreaks.

1.4 Research Questions

The following questions have been prepared for the study:

Does level of education contribute to cholera outbreaks in Nigerian communities?

Does poverty contribute significantly to cholera outbreaks in Nigerian communities?

Does employment status affect access to resources that contribute to cholera prevention in Nigeria?

1.5 Research Hypotheses

H0: Socioeconomic factors do not significantly determine cholera outbreaks in Nigerian communities.

Ha: Socioeconomic factors significantly determines cholera outbreaks in Nigerian communities.

1.6 Significance of the Study

The study findings will assist public health authorities in Nigeria in enhancing strategies for the prevention of cholera. Furthermore, healthcare professionals will gain advantages from obtaining knowledge about the epidemiology and clinical handling of cholera outbreaks, thereby improving their capacity to deliver prompt and efficient treatment. Nevertheless, subsequent researchers will use it as a literature review. This means that other students who may decide to conduct studies in this area will have the opportunity to use this study as available literature that can be subjected to critical review. Invariably, the result of the study contributes immensely to the body of academic knowledge with regard to investigate the socioeconomic determinants of cholera outbreaks in Nigerian communities.

1.7 Scope of the study   

The scope of this study is boarded on the socioeconomic determinants of cholera outbreaks in Nigerian communities. Empirically, this study will determine whether there is adequate access to clean water and proper sanitation facilities in communities, the extent poverty contributes to cholera outbreaks, determine whether employment status affect access to resources that contribute to cholera prevention and propose proper hygiene practices for the prevention of cholera outbreaks.

Geographically, the study will be delimited to some rural communities in Enugu state.

1.8 Limitation of the study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. In addition, there was the element of researcher bias. Here, the researcher possessed some biases that may have been reflected in the way the data was collected, the type of people interviewed or sampled, and how the data gathered was interpreted thereafter. The potential for all this to influence the findings and conclusions could not be downplayed. More so, the findings of this study are limited to the sample population in the study area, hence they may not be suitable for use in comparison to other schools, local governments, states, and other countries in the world.

 1.9 Definition of Terms

Cholera: an acute diarrheal disease caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae.

Health: refers to the state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. It encompasses various factors that contribute to overall well-being.

Diarrhoea: is a condition characterized by loose or watery stools, usually occurring more frequently than usual.

Socioeconomic: refers to the combination of social and economic factors. It encompasses the way in which an individual's social status (including education, occupation, and income) and economic conditions influence their overall quality of life and opportunities.