Cholera remains a threat to public health and an indicator of lack of social development.
The disease, caused by the bacterium Vibrio cholera, is an endemic and seasonal disease, occurring usually during the rainy season.
Cholera is prevalent in communities where open defecation practice is common, with lack of clean water and poor hygiene practice.
This is because the bacteria is found in the stool of an infected person and spreads to other people when they consume water contaminated by stool from infected people.
Meanwhile, the Sustainable Development Goals (SDGs) target 6.1: is to achieve universal and equitable access to safe and affordable drinking water for all by 2030. Target 6.2 is to achieve access to adequate and equitable sanitation and hygiene for all by 2030. However, UNICEF, during the 2021 World Water Day, said sustainable and equitable access to safe drinking water remains a challenge in Nigeria, with over 86 per cent of Nigerians lacking access to a safely managed drinking water source.
“The problem is compounded by poor drinking water quality and lack of equity in access.
“Although about 70 percent of Nigerians are reported to have access to a basic water services, more than half of these water sources are contaminated. And although 73 percent of the country’s population have access to a water source, only nine litres of water on average is available to a Nigerian daily.
“At the current rate, the country will miss the SDG targets on people’s access to water, unless there is a strong commitment and appropriate action taken by all stakeholders, said UNICEF.
Symptoms of cholera
The disease is characterised by sudden acute watery diarrhoea in children and adults with or without vomiting. Other symptoms include nausea and weakness. Cholera is highly contagious and in severe cases, can lead to death within hours.
Cholera outbreaks in Nigeria
In 2018, Adamawa, Borno and Yobe states reported close to 11,000 cases including 175 deaths with a case fatality ratio of 2.1 per cent across the three states as of 15th January 2019.
According to the World Health Organisation (WHO), the outbreaks affected close to 11,000 people across 28 Local Government Areas (LGAs) with Borno contributing 58 per cent, Adamawa, 25 per cent and Yobe state 17 per cent.
Between weeks one and 20, 2018, the Nigeria Centre for Disease Control (NCDC) recorded 4,827 suspected cases with 154 laboratory confirmed and 76 deaths from 56 LGAs in 18 States. During the same period in 2017, 83 suspected cases and four deaths from 15 LGAs in 11 States were reported.
As at 31st October, 2019, a total of 1,583 suspected cholera cases and 22 deaths were reported from seven States (Adamawa, Bayelsa, Ebonyi, Delta,Kano, Katsina and Plateau).
The risk factors
While cholera remains endemic in the country, community health experts have identified some factors promoting infectious diseases as poor personal hygiene, poor environment hygiene, lack of infrastructure, illiteracy, poverty, flooding, lack of Infection, Prevention and Control (IPC) guidelines in hospitals, limited access to health care, humanitarian crises as well as environmental degradation.
Meanwhile, a resident doctor in Abuja, Dr Ogbona Joshua, says insurgency is also promoting recurrence of disease outbreaks in the country. He therefore urged government to confront the crisis with sincerity so that those internally displaced can return home and have a better life, “as long as humanitarian crisis persist in the country, outbreaks of diseases like cholera will remain unabated,” he says.
Treatment for cholera
Cholera is an easily treatable disease. According to WHO, the majority of people can be treated successfully through prompt administration of oral rehydration solution (ORS). The WHO/UNICEF ORS standard sachet is dissolved in 1 litre (L) of clean water. Adult patients may require up to 6 L of ORS to treat moderate dehydration on the first day.
Severely dehydrated patients are at risk of shock and require the rapid administration of intravenous fluids. These patients are also given appropriate antibiotics to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed, and shorten the amount and duration of V. cholerae excretion in their stool.
Prevention and control
The World Health Organisation (WHO) says that a multifaceted approach is key to control cholera. “A combination of surveillance, water, sanitation and hygiene, social mobilisation, treatment, and oral cholera vaccines are used,” it says.
Meanwhile, the director-general of NCDC, Dr. Chikwe Ihekweazu, says 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.
He urged 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, ensure safe food preparation techniques and if you experience sudden fever or diarrhea, you 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 public health institution also urged states to begin to prioritise public health interventions towards cholera control. Priority should also be given to early reporting of suspected cases, provision of WASH facilities, medical supplies, and the institutionalisation of proper case management practices.
Government’s commitment
The National Cholera Technical Working Group coordinated by NCDC says it will continue to work closely with all states, relevant stakeholders and partners, to provide the necessary support for cholera control in Nigeria.
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