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Tackling Cholera Epidemic

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Despite combined efforts by relevant stakeholders, cholera disease has remained endemic in Nigeria, with northern states being the worst hit. Situation Report by the Nigerian Centre for Disease Control (NCDC), on cholera outbreak in Nigeria, has shown that in week 30 (23-29, July 2018), 154 new suspected cases were reported from five states- Adamawa(5), Borno (20), Katsina (1), Yobe (9) and Zamfara (119) including two new deaths in two States, Borno (1) and Katsina (1). According to the report, as at 29th July 2018, a total of 18,205 suspected cases including (CFR: 1.30 per cent) have been reported from 17 States (Adamawa, Anambra, Bauchi, Borno, Eboniyi, FCT, Gombe, Jigawa, Kaduna, Kano, Katsina, Kogi, Nasarawa, Niger, Plateau, Yobe and Zamfara) since the beginning of 2018. The report revealed that 51.9 per cent of the cases are aged 1 -14 years, 1-4 years (27.1 per cent) and 5-14years (24.9per cent) adding that 49.9 per cent are male and 50.1per cent female affected. In 2017, the NCDC Weekly Tackling Cholera Epidemic Epidemiological Report showed that 77 suspected cases of Cholera and one death were reported from four LGAs (two State) in week 22 compared with zero case at the same period in 2016. The report said that between weeks 1 and 22 (2017), 162 suspected Cholera cases and five deaths (CFR, 3.09 per cent) from 18 LGAs (13 States) were reported compared with 218 suspected cases and one death (CFR, 0.46per cent) from 26 LGAs (nine States) during the same period in 2016. According to the report, between weeks 1 and 52 (2016), 768 suspected Cholera cases with 14 laboratory confirmed cases and 32 deaths (CFR, 4.17per cent) from 57 LGAs (14 States) were reported compared with 5,301 cases with 29 laboratory confirmed cases and 186 deaths (CFR, 3.51 per cent) from 101 LGAs (18 States and FCT) during the same period in 2015. Also, between weeks 1 and 53 (2015), NCDC said 5301 suspected cholera cases with 29 lab-confirmed and 186 deaths (CFR, 3.51 per cent) from 101 LGAs (18 States and FCT) were reported compared with 35,996 cases with 306 lab confirmed and 755 deaths (CFR, 2.10per cent) from 182 LGAs (19 States and FCT) at the same period in 2014. Researchers have said that cholera disease is caused by eating food or drinking water contaminated with a bacteria called ‘Vibrio cholera’ . It is estimated that every year, there are roughly 1.3 to 4.0 million cases, and 21, 000 to 143, 000 deaths worldwide due to cholera. A family health physician in Abuja, Dr. Daniel Okafor, identified some factors promoting infectious diseases as poor personal hygiene, poor environment hygiene, lack of infrastructure, illiteracy, poverty, and flooding, limited access to health care, humanitarian crises as well as environmental degradation.

Also, Dr Godswill Okara, who is the director, Laboratory Services, Dr. Hassan’s Hospital & Diagnostic Centre, Abuja said that cholera is a water-borne infection caused by a group of bacteria known as Vibrio Cholera bacteria The major sources or causes of the disease according Dr. Okara are unsafe or contaminated water, eating uncooked seafood especially oysters, and drinking water contaminated with human faeces; poor sanitation, unsafe toiletry practices like open defecation and liter of faecal materials which often contaminate fruits, vegetables and other food items consumed by man; poor hygiene practices or habits, such as eating without washing hands or eating unwashed fruits and other raw food items that may have been contaminated by Vibrio Cholera bacteria. He informed that cholera disease is both preventable and fully curable, if adequate and prompt actions and measures are taken. The prevention and control of the disease he said is by promoting and ensuring basic water safety, personal and environmental sanitation services, personal and community hygiene practices, as well as taking Oral Cholera Vaccines to prevent infection. On tackling the infection, he said, when it occurs, early detection and quick response is very key to survival and containment of outbreak when the disease is contracted. “This is by prompt visit to a health facility for accurate diagnosis and treatment to be instituted before the complications that lead to death set in. Once it is diagnosed, fluid replacement therapy and antibiotics administration are commenced which usually cures the infection and restores normalcy to infected persons. “Because of the highly infectious nature of the disease, a targeted multi-sectoral approach to prevent Cholera outbreak in the community is desirable,” he urged speaking further, the physician advised that , given the ongoing World Health Organization (WHO) Global Roadmap 2030 programme which aims to reduce Cholera deaths by 90 per cent in all the 47 endemic countries by the year 2030, there is an urgent need for an effective national mechanism of collaboration with the WHO and a nationally coordinated action for health education and promotion at the rural community level, diagnostic capacity enhancement and Oral Cholera Vaccine utilization in Nigeria. Meanwhile, the Chief Executive Officer (CEO), NCDC, Dr. Chikwe Ihekweazu, had said that flooding for instance can cause disease outbreaks such as cholera, dysentery, typhoid fever, poliomyelitis and vector-borne diseases such as malaria and yellow fever. To reduce the spread of such infectious diseases, Ihekweazu advised that precautionary measures should be taken while urging Nigerians not to drink flood water, or use it to wash dishes, brush teeth, or wash/ prepare food.

“Communities should ensure chlorination of the public source of water supply and ensure proper disposal of waste and clearing of sewage. Nigerians should always remember to wash their hands frequently with soap and clean water and discard all medicines, food and bottled water contaminated by flood water. “In homes, we should ensure water is well boiled before drinking, avoid open defecation and indiscriminate refuse dumping, avoid mosquito bites by using an Insecticide Treated Net, ensure safe food preparation techniques and if we experience sudden fever or diarrhea, we should please visit a health care facility immediately.” According to him, the NCDC has been working assiduously towards ensuring that members of the public are adequately informed about epidemics and how to curtail them. The NCDC boss also urged health workers to observe universal care precautions at all times. Speaking on the recent cholera outbreak, the Head, Risk Communication, NCDC, Dr. Olufemi Oyoola, said even before the outbreak, the centre had sent out public advisories to all the states, advising them and training them on what they are supposed to do in preparation for raining season, knowing that cholera is usual common in raining season as a result of open defecation. In its epidemiological summary, NCDC said it has been supporting many states in the country to respond to outbreaks of cholera. The primary focus of the response, the centre said has been to improve access to water and sanitation in the affected states. Also, the centre said that vaccination campaigns led by the National Primary Health Care Development Agency (NPHCDA) have been carried out in the most affected LGAs in Adamawa and Yobe States. Adding that although cholera cases are still being reported from eight states including Adamawa, Bauchi, Kano, Katsina, Zamfara, Kogi, Plateau and Kaduna, there has been a general decline in the number of new cases as no cases have been reported from Anambra, Nassarawa and Yobe States. NCDC however identified poor water supply and hygiene facilities in the country as major challenges leading to outbreaks of cholera in many states. This, it said has contributed to the spread of the disease and yearly outbreaks in many states while encouraging states to prevent cholera outbreaks by improving access to WASH.

The World Health Organisation (WHO), also said that cholera is an acute diarrheal infection which can lead to dehydration and even death if untreated, adding that the disease remains a global threat to public health and an indicator of inequity and lack of social development. According to WHO, the long-term solution for cholera control lies in economic development and universal access to safe drinking water and adequate sanitation. The organisation said actions targeting environmental conditions include the implementation of adapted long-term sustainable WASH solutions to ensure use of safe water, basic sanitation and good hygiene practices to populations most at risk of cholera. In addition to cholera, WHO said such interventions prevent a wide range of other water-borne illnesses, as well as contributing to achieving goals related to poverty, malnutrition, and education. The UN Humanitarian Coordinator, Mr Edward Kallon in his response to the humanitarian crisis in the north east had said that cholera outbreaks can potentially impact and kill thousands of people, especially women, children and men who are living in overcrowded places such as camps for internally displaced persons. According to him, “surveillance and early detection are key to limiting the number of fatalities and the spread of the outbreak. Acting swiftly is pivotal if we are to prevent high mortality rates.” Whereas lack of access to clean water, open defecation and poor hygiene practice are highlighted as the major causes of cholera in the country, Nigeria is still ranked among the nations in the world with the highest number of people practicing open defecation It also ranks among the top five countries globally for having large numbers of people without access to safe water, improved sanitation and practicing open defecation. This worrisome situation has raised concerns in the country as the problem remain unabated despite combined efforts by states and federal government, international organisations, civil society organisations, faith based organisations and even individuals.



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