Despite the country’s long experience with cholera outbreaks, nothing is done by relevant health authorities to pre-empt future attacks
| By Chinwe Okafor | Dec. 9, 2013 @ 01:00 GMT
THE resurgence of cholera outbreak in Nigeria has brought to the fore the level of unsanitary conditions the country is exposed to. This issue came up when the World Toilet Day was celebrated on November 19. According to official reports, the country recorded 2, 771 cases of cholera between September and October 2013. Within the same period, 124 deaths were recorded with a fatality rate of 4.5 percent as at November 12. The consequences are shocking because more than 1.2 million people die every year from diseases attributable to poor sanitation, water and hygiene.
According to a United Nations, UN, study estimates, out of the seven billion people in the world, six billion have access to mobile phones. Ironically, only 4.5 billion have access to functional toilets. And of the 2.5 billion who do not have proper sanitation, 1.1 billion defecate in the open. Nigeria is among the top five countries where people defecate in the open. Michael Ojo, country representative of Water Aid Nigeria, said that barely two years to the Millennium Development Goals, MDGs, Nigeria, is yet to address the problem of poor sanitation and that a staggering 37 million people still practice open defecation, adding that this causes nearly 100,000 children under the age of five dying of diarrhea in Nigeria every year due to poor sanitation and inadequate portable water supply.
Onyebuchi Chukwu, minister of health, said the figures in cholera statistics were estimates and that trickles of incidences and mortalities may still be coming. “In Sokoto and Katsina states, the gastroenteritis outbreaks have not been proved to be cholera. While further investigations continue, only confirmed cases are included in the current statistics.”
He said that the affected states were being supported to respond to the outbreak by supplying them with emergency drugs, diagnostic kits and other commodities. He said that the ministry had realised that the affected states would require further assistance and that efforts were being made to upscale the technical and material assistance to those states immediately. According to Chukwu, he had directed the immediate release of adequate quantities of emergency drugs, ‘cholera kits’ to all the affected states for prompt and adequate treatment of cases. Moreover, he said the ministry had deployed additional response teams to all the affected states to assist in investigating and verifying the cases and tracing contacts.
Chukwu, has also ordered the mobilisation and sensitisation of clinicians and relevant healthcare workers in areas affected for patient management and care and immediate promotion/public awareness campaign to enhance, among others, aims, good personal, community and food hygiene. He has asked all federal health facilities in the country to provide free services to cholera patients, and urged Nigerians, including healthcare workers, to increase their propensity for hygiene-based health-seeking behaviour so as to ensure their safety.
The minister listed the hygienic practices to include hand washing with soap after visiting the toilet and also before eating, regular and intermittent washing of hands with soap and water, avoidance of open defecation, boiling of water before drinking, protection of food from houseflies, thorough washing of fruits and vegetables before eating, and environmental cleanliness. He said: “We have directed the Nigeria Centre for Disease Control, NCDC, to immediately co-ordinate all response activities and report to him daily on the patterns of occurrence, efforts at achieving total control of the outbreaks and status of the control.” He gave the assurance that the Federal Government would continue to enhance surveillance and intervention measures, and implement public health awareness campaigns aimed at stemming occurrences and also solicited for the support and understanding of all Nigerians in order to end the outbreak of the disease. He thanked the World Health Organisation, WHO, and all other collaborating partners for their assistance.
Findings have revealed that Nigeria suffered cholera epidemics during the rainy seasons of 2010 and 2011, with nearly 2,000 people killed over two years, while 2012 saw few reported infections. Realnews investigations have revealed that the 2013 cholera outbreak first broke out in a refugee camp in Namu village, Qua’pan local government area of Plateau State where at the last count 11 lives had been lost out of 130 that were hospitalised. After this, the federal ministry of health said it would investigate it and that the investigation would determine the kind of intervention to be deployed in the community. While investigations were going on, there were reports of cholera outbreak in other states, and more lives were lost. The affected states were Zamfara with 1,110 cases and 51 deaths, Nasarawa with 105 cases and five deaths. Ogun with 115 cases and five deaths while Oyo State had 29 cases and six deaths.
Lagos State, was not left. About 134 cases were reported and investigations revealed that the infection was caused by a contaminated African salad popularly known as ‘Abacha’. Jide Idris, Lagos State commissioner for health, said the cholera epidemic in the state was mostly contacted through the popular African salad known as ‘Abacha’, contaminated well-water sources, especially in areas like Ikare, Amuwo-Odofin local government area and Badia area of Apapa local government, other infected foods from food sellers, and unhygienic habits. He said other suspected areas were Ajeromi, Lagos Island, Oshodi-Isolo and Surulere local governments. He urged members of the public to be vigilant and report any suspected case to the nearest health facility and the directorate of disease control in the state’s ministry of health.
However, the most recent case in Lagos State occurred in Yaba, where a couple ate the locally made African salad. While the wife was infected with cholera, the husband remained hale and hearty. Reports from African Examiner revealed that the victim, whose name was given as Blessing, woke up around 2.00am with severe stooling and vomiting. Blessing was immediately rushed to a private hospital in the area and was later transferred to the military hospital, Yaba, after her case became critical.
At a time when she was getting better and was about to be discharged from the hospital, her condition suddenly changed. She stooled for about four times before she died after the doctor changed her medication. It was gathered that another cholera victim in the same hospital survived. Also, at Onike in Yaba, two pupils of a primary school were infected with cholera as the deadly epidemic was spreading fast in Lagos. Once infected, the bacteria is excreted from the stool. Thus, the infection can spread rapidly, particularly in areas where human waste is untreated.
The United Nations Children’s Fund, UNICEF, has blamed the worsening sanitary situation for the spread of diseases in Nigeria, saying that about 100 million people lack access to sanitary toilets. Kannan Nadar, chief sanitary, water and hygiene officer, UNICEF, said that the situation in Nigeria is very critical. “Nigeria has about one hundred million people without access to toilets, this is worrisome, as it is possible for everyone to own a toilet, which doesn’t cost much. Sanitation and toilets are fundamental human rights. Since it is possible for everyone to own toilet, it is not justified for people to die of diseases related to open defecation.” Meanwhile, medical experts are now monitoring outbreaks in 14 of Nigeria’s 36 states. Nigeria had the first series of cholera outbreak between 1970- 1990. Despite this long experience with cholera, an understanding of the epidemiology of the disease to help stop its reoccurrence is still lacking.