Epidemiology and Divergent Transmission Dynamics of Cholera and Diphtheria in Kaduna State, Nigeria, 2023–2024: A Retrospective Surveillance Study
Abstract:
Nigeria
continues to experience recurrent cholera and diphtheria outbreaks, driven by
distinct yet overlapping structural vulnerabilities. While cholera transmission
is environmentally mediated and amplified by flooding and inadequate water,
sanitation, and hygiene (WASH) systems, diphtheria resurgence reflects immunity
gaps in under-vaccinated populations. This retrospective analytical study
examined cholera and diphtheria cases reported in Kaduna State between January
2023 and December 2024 using Integrated Disease Surveillance and Response
(IDSR) data and standard Nigeria Centre for Disease Control case definitions.
Descriptive statistics, incidence rates per 100,000 population, cumulative
attack rates, and chi-square tests were used. A total of 1,161 suspected cases
were reported (323 diphtheria and 838 cholera). Diphtheria declined
significantly between 2023 and 2024 (χ² = 57.07; p < 0.001), with incidence
decreasing from 2.47 to 1.33 per 100,000 population. In contrast, cholera
incidence increased approximately 81-fold, from 0.12 to 9.74 per 100,000 (χ² =
1593.05; p < 0.001). The cumulative attack rates were 0.0038% for diphtheria
and 0.0099% for cholera. Both diseases peaked in October, corresponding to the
late rainy season. No deaths were recorded in the surveillance dataset;
however, incomplete documentation of outcomes cannot be excluded. These
findings demonstrate divergent transmission ecologies operating within a shared
structural context. Effective epidemic control requires integrated yet disease-specific
strategies that simultaneously strengthen immunization systems and invest in
climate-resilient WASH infrastructure.
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