Godwin Moses
Cholera is an acute diarrhoea disease that often takes advantage of under management of water sources in developing countries. It is actually a waterborne disease characterised sudden onset of profuse watery diarrhoea, which can lead to sudden death as a result of dehydration. The time between an infection and appearance of symptoms of the disease is 2hr to 5 days. The risk of transmission is higher when there is poor sanitation and disruption of clean water supply.
Nigeria, Africa’s largest oil producer, suffers from a high rate of waterborne diseases as a result of dilapidated infrastructure and under-investment. The wrong disposal of refuse and practice such as open defecation endanger the safety of water used for drinking and personal use.
These lead to spread of water- borne diseases such as cholera. Between the 1st of January and 1st of August 2021, a cholera outbreak has killed 816 people and 31,425 suspected cases reported from 22 States and FCT according to Nigeria Centre for Disease Control, (NCDC cholera situation report as at 6th August 2021).
The affected states are Benue, Delta, Zamfara, Gombe, Bayelsa, Lagos,Sokoto, Bauchi, Kano, Kaduna, Plateau, Kebbi, Cross River, Niger, Nasarawa, Jigawa, Yobe, Kwara, Enugu, Adamawa, Katsina, Borno, and FCT.
Nigeria has previously experienced large cholera outbreaks, including those in 1991, 2010, 2014, and 2017, however, epidemiological patterns of the current outbreak threaten to outpaced the death toll from previous outbreaks. Though there has been a decrease in the last two weeks. Cholera outbreaks in Nigeria, including the 2018 outbreaks, targeted inventions such as safe water provision, were implemented just after the outbreak.
However, researchers have observed from earlier outbreaks that once disease data demonstrated a downward trend, provision of water sources dwindled, leading to future outbreak occurrences. In tropical, coastal areas, poor sanitation, open drainage systems, and contaminated water sources are symbolic of cholera-prone, endemic areas. For inland areas, spatiotemporal differences point to certain factors contributing to recent outbreaks.
Though Nigeria has abundant surface and underground water, management of these resource has led to water scarcity, particularly in the northern part of the country. Lowering water levels during the dry season, aided climate change and evapotranspiration have added additional pressure on the water system. In the south and tropical rainforest zone, coastal floods and saline water intrusion have compromised water quality in the region.
In recent month health officials have warned that unless the increasing number of outbreak is treated as national emergency and robust efforts to mitigate the risks posed inadequate sanitation services and practice are put in place, this current outbreak could place the country in a much more serious situation.
People mostly at risk include: People of all ages living in places with unsafe water, people who do not perform hand hygiene when appropriate, relatives who care for sick person with cholera, health care workers providing direct patient care in absence of standard precautions, people living in areas with poor sanitation and people who consume potentially contaminated food or fruits without proper cooking and washing with safe water.
Cholera is easily treatable if dictated on time, ensure to visit a health facility immediately, if you have sudden onset of profuse watery diarrhoea, nausea, vomiting and weakness. Most infected people may only show mild symptoms or have no symptoms at all. Most infected people can be treated successfully through prompt administration of oral rehydration solution (ORS), with the goal to replace lost fluids and electrolytes.
It behoves on relevant stakeholders in the health sector to prioritise action for solutions that ensure access to and use of safe water and basic sanitation. State actors should make prompt medical intervention to solve the underlying issues leading to cholera outbreaks. Without rehydration, approximately half the people with cholera die.
The National Primary Health Care Development Agency should procure more and refocus on reactive vaccination strategy to successfully dissolve the outbreak mostly in the displaced persons camps across the country and also increase the number of vaccine available in the country.
The local health officers, community health volunteers with media partners should embark on an aggressive campaigns on oral cholera vaccination to educate people on the importance of the vaccines with a view to increase acceptances of the vaccines.
There is need for proactive measures and intensify surveillance in all local government areas across the country in order to strengthen surveillance activities including sample collection, training and retraining of laboratory scientists, ensure adequate supply of commodities for case management and laboratory diagnosis, material for risk communications, response guidelines among other support.
Nigerians should keep their environments clean, only drink or use water that is boiled and stored safely, ensure food is cooked and in a clean and safe environment, avoid open defecation, regularly wash hands with soap and running water (WaSH) and ensure good hygiene practices in communities.
Overall, the strategic role of a multi – sectoral approach in the design and implementation of public health interventions aimed at preventing and controlling Cholera in Nigeria cannot be overemphasised.