…Experts list four factors fueling diseases
Amid increasing COVID-19 cases, Nigeria is facing a concurrent outbreak of cholera which is spreading like wildfire. Currently, in 22 states and the Federal Capital Territory, FCT, Abuja, no fewer than 653 Nigerians have lost their lives to cholera as of July 25, 2021. Also, there are indications that more cases and deaths from the disease are imminent following the poor state of sanitation, hygiene practice and unsafe water sanitation.
According to the World Health Organisation, WHO, cholera is an acute diarrhoeal infection caused by eating or drinking food or water that is contaminated with the bacterium vibrio cholera and remains a global threat to public health, an indicator of inequity and lack of social development.
Every year, researchers have estimated that there are 1.3 to 4.0 million cases of cholera, and 21 000 to 143 000 deaths worldwide due to the infection.
Meanwhile, Nigeria is among the countries consistently hit annually. With a total of 27,186 suspected cases reported in Nigeria as of July 25 by the Nigeria Centre for Disease Control, NCDC, public health experts fear that the spread of the disease is unavoidable in more states as poor access to water, sanitation and hygiene – collectively known as WASH, remains a huge problem.
According to the experts, poor sanitation, access to safe water and hygiene practices has continued to fuel outbreaks every year.
They insist that unless there is access to clean water, sanitation facilities and good hygiene practices among Nigerians, it will be difficult to eliminate cholera.
According to WHO, cholera can cause severe acute watery diarrhoea with severe dehydration and takes between 12 hours and 5 days for a person to show symptoms after consuming contaminated food or water.
As of the reported period, the life-threatening disease is in Benue, Delta, Zamfara, Gombe, Bayelsa, Kogi, Sokoto, Bauchi, Kano, Kaduna, Plateau, Kebbi, Cross River, Nasarawa, Niger, Jigawa, Yobe, Kwara, Adamawa, Enugu, Katsina, Borno and FCT since the beginning of 2021.
According to the report from the NCDC, of the reported cases since the beginning of the year, 27 per cent are aged 5 – 14 years.
Although the NCDC report shows that there has been reduction in new cases of cholera in two weeks, Bauchi has recorded the highest number of cases with 1,354, followed by Kano (514), Jigawa, 201, Zamfara-73, and Enugu – 30 account for 96 per cent of 2,273 cases reported in the last two weeks. Since the beginning of the year, a total of 616 samples have been collected with positive, cases as follows-232RDTpositive only; 77 culture-positive; 309 RDT and culture positive.
In a report, the Kano State epidemiologist and deputy director of public health, Dr. Bashir Lawan Muhammad, said the rainy season was making the situation worse while insecurity in the North, where the authorities have been battling Islamist militants and armed criminals, was also hindering the ability to respond.
At least 186 people have died in Kano of cholera since March, Muhammad said. The state accounts for the biggest share of the 653 cholera deaths recorded in the country.
Large scale outbreak
In a chat with Sunday Vanguard, the Chairman, School Health Committee, Lagos State Branch of the Nigeria Medical Association, NMA, Dr Oladapo Asiyanbi, said Nigeria has no business recording such a large scale outbreak of cholera, blaming the development on the fact that the conditions that bring about the disease were still much in the country.
“These conditions are poor personal hygiene, poor knowledge and unsafe behaviour by communities on how to keep good hygiene such as regular handwashing, how to boil and filter water for use, proper faecal waste disposal, poor housing with lack of toilet facilities and community hygiene hence the common practice of open defecation and lack of portable water.”
According to Asiyanbi, cholera is caused by bacteria that is ingested from food or water contaminated by faecal matter. For food or water to be contaminated by faces, it is, therefore, a disease common where there is poor hygiene and lack of access to potable water. It is a disease of Water, Sanitation and Hygiene.”
Noting that the disease was more common in slums and refugee camps, including areas where hygiene and sanitation is poor and there is poor housing, he said to put the disease in check, Nigeria’s focus should be more on educating affected communities early enough on hand washing and food hygiene to reduce contamination.
“This is where the press can help to get correct and consistent information to the people and give feedback to the government”, the expert said.
He said there is the need for government to ensure provision of potable water across communities and good housing with functional toilets for proper waste disposal.
“A well-constructed pit latrine with proper safety measures to prevent flies from access to it can be a start”, Asiyanbi said.
“There should also be proper and good governance, using the SDGS and Goals in the National Plans as benchmarks”.
He stressed the need for government to fund and strengthen the Primary HealthCare, PHC, system where a system of community disease surveillance and response can be made to work properly.
Noting that NCDC cannot be in every ward or in all 774 LGAs in Nigeria but can only coordinate at the national level, he said: “The real work is at the community, wards and Local Government Areas, LGAs. The NCDC and States Emergency Operation Committees are to support, coordinate and give technical assistance to these Local Government Area Emergency Response, EPR, teams.
“This is the bottom-up approach called Integrated Disease Surveillance and Response (IDSR) part of the Health System.
“At the PHC level in the 774 LGAs as designed, there should be 774 functional Emergency Preparedness and Response (EPR) Committees of Community representatives that work through 774 Rapid Response Teams (RRTs) of technical health teams that work on outbreak prevention and response together.”
Asiyanbi regretted that little or no work was being done at the state and local government levels where sensitisation in the markets, amongst CDAs, religious places and most especially amongst schools should be carried out.
The expert said professional bodies like the NMA are also in the mix.
As part of these efforts, he said the school health committee of NMA will be visiting schools to intensify hygiene education in schools as soon as they resume especially the handwashing campaigns.
Speaking on drivers of recurrent cholera disease, a public health physician and Secretary, NMA Lagos, Dr Imeh Okon, said findings have shown that the disease is mostly driven by a combination of biological, social, environmental and climatic, health systems, among others.
WASH and cholera
On how WASH fuels outbreaks, she explained that for hygiene in some parts of Nigeria, there is little or no awareness of good hygiene practices.
Also, in some cases even when individuals are aware of good hygiene practices, Okon said they lack access to soap, safe water and washing facilities they need to make positive changes to protect themselves and their community.
According to WHO, without improved sanitation – a facility that safely separates human waste from human contact – people have no choice but practice open defecation.
In the immediate environment, the exposed faecal matter will be transferred back into people’s food and water resources, helping to spread cholera.
Again, lack of effective waste disposal or sewerage systems can contaminate ecosystems and contribute to pandemics.
And without access to improved drinking water such as a protected borehole well or municipal piped supply, people will rely on surface water, unprotected and possibly contaminated wells, or vendors selling water of unverifiable provenance and quality.
In Nigeria today even in the urban areas, access to safe water remains a problem. In communities, sources are usually far from their homes.
Okon emphasized the need for regular hand washing as it can reduce infection by 60 per cent,
She stressed the need for the government to intensify community education on cholera especially on how to prevent cholera, provide good environmental sanitation system, and maintain a strong community linked-surveillance system to alert the LGA by community members and subsequent investigation of suspected cases of cholera.