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Effect of Community-Based Cholera Prevention Programmes on Cholera Incidence in Flood-Prone Communities in Nigeria

Abstract

Cholera remains an important public health concern in Nigeria, particularly in communities affected by flooding, inadequate access to safe drinking water, poor sanitation, and limited hygiene infrastructure. Flooding can contaminate water sources, damage sanitation facilities, displace households, and increase exposure to conditions that facilitate the transmission of Vibrio cholerae. Community-based cholera prevention programmes provide an opportunity to reduce transmission through interventions such as health education, household water treatment, promotion of hand hygiene, sanitation improvement, safe water provision, environmental sanitation, early detection and reporting of suspected cases, and community mobilization. However, the effectiveness of such programmes may be affected by inadequate resources, poor infrastructure, limited community participation, delayed outbreak response, unsafe water sources, and recurrent flooding. Strengthening community-based cholera prevention activities may therefore contribute to reducing cholera transmission in flood-prone communities. Against this background, this study investigates the effect of community-based cholera prevention programmes on cholera incidence in flood-prone communities in Nigeria. The study will be anchored on the Social Ecological Model, Health Belief Model, and PRECEDE-PROCEED Model. The Social Ecological Model emphasizes the interaction between individual, household, community, environmental, healthcare-system, and policy factors in determining exposure to cholera and adoption of preventive practices. The Health Belief Model explains how community members' perceptions of cholera susceptibility and severity, perceived benefits of preventive measures, perceived barriers, and cues to action may influence their adoption of safe water, sanitation, and hygiene practices. The PRECEDE-PROCEED Model provides a framework for assessing the predisposing, enabling, and reinforcing factors that influence health behaviours and the implementation of community-based health interventions. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based cholera prevention programmes may influence cholera incidence in flood-prone communities in Nigeria. The study will adopt a quantitative quasi-experimental or community-based comparative research design. The study population will comprise households and adult community members residing in selected flood-prone communities in Nigeria, as well as community health workers and programme personnel involved in cholera prevention activities. A multistage sampling technique will be used to select states, local government areas, flood-prone communities, households, and eligible participants. Community-based cholera prevention programmes will be assessed using indicators such as community health education, household water treatment, access to safe drinking water, handwashing promotion, distribution of water-treatment materials, sanitation campaigns, environmental sanitation activities, safe food-handling education, community mobilization, hygiene promotion, early warning and reporting mechanisms, community health worker involvement, outbreak preparedness, and referral arrangements. Cholera incidence will be assessed using indicators such as the number of laboratory-confirmed cholera cases, suspected cases meeting the applicable surveillance definition, incidence rate within the study population, occurrence of cholera outbreaks, hospitalization for cholera, cholera-related deaths, and temporal patterns of cases during and after flood events. Where appropriate, surveillance records will be reviewed to distinguish suspected, probable, and laboratory-confirmed cases according to applicable public health surveillance definitions. Data will be collected using structured questionnaires, household surveys, community health records, cholera surveillance registers, laboratory records, healthcare facility records, environmental health reports, water and sanitation assessments, and programme monitoring documents. Descriptive statistics will be used to summarize household characteristics, prevention programme coverage, water and sanitation conditions, and cholera occurrence. Inferential statistical techniques, including chi-square tests, correlation analysis, Poisson or negative binomial regression where appropriate, and logistic or multiple regression analysis, will be used to determine the effect of community-based cholera prevention programmes on cholera incidence. Where a quasi-experimental design is adopted, cholera incidence before and after implementation of strengthened prevention programmes may be compared, or intervention communities may be compared with similar flood-prone communities receiving routine public health services. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community-based cholera prevention programmes have a significant negative effect on cholera incidence in flood-prone communities in Nigeria, indicating that effective prevention activities may reduce the occurrence of cholera. Communities with greater coverage of safe-water interventions, household water treatment, sanitation activities, hygiene education, and early detection and reporting mechanisms are expected to experience fewer cholera cases than communities with limited prevention coverage. Community health education may improve knowledge and adoption of preventive practices, while access to safe water and sanitation may reduce exposure to contaminated sources. Community-based surveillance and early reporting may also facilitate faster public health responses when suspected cases occur. However, recurrent flooding, damaged water and sanitation infrastructure, population displacement, inadequate access to safe water, poverty, limited programme funding, weak community participation, and delays in outbreak response may reduce the effectiveness of prevention programmes. The study therefore expects sustained, community-centred, adequately resourced, and flood-responsive cholera prevention programmes to contribute significantly to reducing cholera incidence in flood-prone communities in Nigeria. The study is expected to contribute to the literature on community-based cholera prevention, cholera incidence, water sanitation and hygiene, flood-related health risks, outbreak prevention, community health, infectious disease surveillance, environmental health, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention, National Primary Health Care Development Agency, Federal Ministry of Water Resources and Sanitation, state ministries of health, state emergency management agencies, local government health authorities, environmental health departments, community health workers, development partners, humanitarian organizations, and policymakers regarding strategies for preventing cholera outbreaks. The study will also provide evidence-based recommendations for strengthening community-based cholera prevention programmes, expanding access to safe drinking water, improving sanitation and hygiene infrastructure, strengthening household water-treatment practices, developing flood-responsive surveillance systems, increasing community participation, improving health education, strengthening early warning and outbreak response mechanisms, and integrating cholera prevention into broader flood preparedness and community health programmes across Nigeria.

Keywords: Community-based cholera prevention, cholera incidence, flood-prone communities, cholera prevention programmes, water sanitation and hygiene, WASH, outbreak prevention, community health, flood-related health risks, Nigeria, public health.