Using self-controlled case series to understand the relationship between conflict and cholera in Nigeria and the Democratic Republic of Congo

Abstract Cholera outbreaks significantly contribute to disease mortality and morbidity in low- and middle-income countries. Cholera outbreaks have several social and environmental risk factors and extreme conditions can act as catalysts. A social extreme with known links to infectious disease outbreaks is conflict, causing disruption to services, loss of income and displacement. Here, we used the self-controlled case series method in a novel application and found that conflict increased the risk of cholera in Nigeria by 3.6 times and 19.7% of cholera outbreaks were attributable to conflict. In the Democratic Republic of Congo (DRC), conflict increased the risk of cholera by 2.6 times and 12.3% of cholera outbreaks were attributable to conflict. Our results highlight the importance of rapid and sufficient assistance during conflict-related cholera outbreaks, while also working towards conflict resolution and addressing pre-existing vulnerabilities such as poverty and access to healthcare. Article Summary Line Conflict significantly increased the risk of cholera outbreaks in Nigeria and the Democratic Republic of Congo and pre-existing vulnerabilities and conflict resolution should be a top priority to protect health.