{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T05:25:07Z","timestamp":1788067507885,"version":"build-2784847793"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T00:00:00Z","timestamp":1721952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Forte, Sweden","award":["2020-00027"],"award-info":[{"award-number":["2020-00027"]}]},{"name":"Forte, Sweden","award":["2020-00027"],"award-info":[{"award-number":["2020-00027"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Nigeria accounts for a substantial cholera burden globally, particularly in its northeast region, where insurgency is persistent and widespread. We used participatory group model building workshops to explore enablers and barriers to implementing known cholera interventions, including water, sanitation and hygiene, surveillance and laboratory, case management, community engagement, oral cholera vaccine, and leadership and coordination, as well as exploring leverage points for interventions and collaboration. The study engaged key cholera stakeholders in the northeastern States of Adamawa and Bauchi, as well as national stakeholders in Abuja. Adamawa and Bauchi States\u2019 group modes building participants comprised 49 community members and 43 healthcare providers, while the 23 national participants comprised government ministry, department and agency staff, and development partners. Data were analysed thematically and validated via consultation with selected participants. The study identified four overarching themes regarding the enablers and barriers to implementing cholera interventions: (1) political will, (2) health system resources and structures, (3) community trust and culture, and (4) spill-over effect of COVID-19. Specifically, inadequate political will exerts its effect directly (e.g. limited funding for prepositioning essential cholera supplies) or indirectly (e.g. overlapping policies) on implementing cholera interventions. The healthcare system structure (e.g. centralization of cholera management in a State capital) and limited surveillance tools weaken the capacity to implement cholera interventions. Community trust emerges as integral to strengthening the healthcare system\u2019s resilience in mitigating the impacts of cholera outbreaks. Lastly, the spill-over effects of COVID-19 helped promote interventions similar to cholera (e.g. water, sanitation and hygiene) and directly enhanced political will. In conclusion, the study offers insights into the complex barriers and enablers to implementing cholera interventions in Nigeria\u2019s cholera-endemic settings. Strong political commitment, strengthening the healthcare system, building community trust and an effective public health system can enhance the implementation of cholera interventions in Nigeria.<\/jats:p>","DOI":"10.1093\/heapol\/czae067","type":"journal-article","created":{"date-parts":[[2024,7,27]],"date-time":"2024-07-27T00:57:52Z","timestamp":1722041872000},"page":"970-984","source":"Crossref","is-referenced-by-count":15,"title":["Enablers and barriers to implementing cholera interventions in Nigeria: a community-based system dynamics approach"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2729-1613","authenticated-orcid":false,"given":"Kelly","family":"Elimian","sequence":"first","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet , Stockholm,","place":["Sweden"]},{"name":"Exhale Health Foundation , Abuja,","place":["Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5810-9725","authenticated-orcid":false,"given":"Karin","family":"Diaconu","sequence":"additional","affiliation":[{"name":"Institute for Global Health and Development, Queen Margaret University , Edinburgh,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Ansah","sequence":"additional","affiliation":[{"name":"Center for Community Health Integration, School of Medicine, Case Western Reserve University , Cleveland,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6885-6716","authenticated-orcid":false,"given":"Carina","family":"King","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozius","family":"Dewa","sequence":"additional","affiliation":[{"name":"School of Health Systems and Public Health, University of Pretoria , Pretoria,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Yennan","sequence":"additional","affiliation":[{"name":"Nigeria Centre for Disease Control and Prevention , Abuja,","place":["Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Gandi","sequence":"additional","affiliation":[{"name":"Bauchi State Ministry of Health , Bauchi State,","place":["Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6179-3970","authenticated-orcid":false,"given":"Birger Carl","family":"Forsberg","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet , 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