Understanding the factors enabling and blocking sustained implementation of cholera interventions in a fragile region of Nigeria: a multi-phase group model building study protocol

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Despite the possible underestimation due to limited surveillance and reluctance to report cases for economic reasons, approximately 2.9 million cholera cases and 95,000 cholera-related deaths are recorded annually worldwide. While substantial progress has been made towards cholera control in the SDG era, a combination of climate change, natural and man-made disasters, and rapid unplanned urbanisation continue to support transmission. The attainment of these goals hinges upon six interventions: water, sanitation and hygiene (WASH); surveillance and reporting; use of oral cholera vaccine (OCV); healthcare system strengthening; leadership and coordination; and community engagement and empowerment. According to the joint WHO and UN Children’s Fund (UNICEF) updated estimates for WASH in households in 2017, 8 out of 10 people in rural areas in sub-Saharan Africa still lacked basic drinking water; 7 out of 10 lacked basic sanitation services; and 3 billion people lacked basic handwashing faci...