Abstract

Abstract
Background: Cholera remains a major global public health problem globally and in Nigeria, with recurrent outbreaks particularly affecting resource-limited settings. Zamfara State has experienced recurrent cholera outbreaks, reflecting persistent environmental, infrastructural, and health system challenges. Nigeria reports cholera outbreaks almost annually, and Zamfara State has emerged as one of the persistently affected areas, with repeated outbreaks occurring across multiple local government areas (LGAs). These recurrent outbreaks highlight the limitations of predominantly reactive response strategies and underscore the need for sustainable, multisectoral approaches.
Methods: A narrative review guided by PRISMA principles was conducted using peer-reviewed literature, surveillance reports, and policy documents published between 2000 and 2024. Databases searched included PubMed, WHO IRIS, CDC repositories, the Global Task Force on Cholera Control (GTFCC) resource hub, and Nigeria Centre for Disease Control and Prevention (NCDC) archives. In total, 42 relevant studies and reports were synthesized.
Findings: Evidence indicates that cholera in Zamfara State follows predictable seasonal and geographical patterns, with outbreaks driven by unsafe water sources, poor sanitation, flooding, population displacement, and insecurity. Children under five years and young adults are disproportionately affected. Although recent interventions such as improved case management, reactive oral cholera vaccination (OCV), and partner-supported WASH (water, sanitation and hygiene) activities, have reduced case fatality rates, laboratory confirmation and preventive infrastructure remain limited. Structural determinants beyond the health sector continue to sustain transmission.
Conclusion: Lasting cholera control in Zamfara State requires a shift from emergency response to proactive, multisectoral prevention aligned with the GTFCC 2030 roadmap. Strengthening WASH infrastructure, surveillance and laboratory capacity, community engagement, and cross-sectoral coordination is essential for breaking the cycle of recurrent outbreaks.

Key words: Cholera, Multisectoral approach, WASH, Zamfara State, Nigeria.