Cholera outbreak: Experts task Nigerians on personal hygiene

By Cosmas Omegoh

A lot more needs to be known and avoided as Nigerians grapple with the cholera outbreak, which has placed the country on edge.
At the moment, medical professionals are rallying round to provide essential tips to help all and sundry stay off the harm’s way.
Some doctors who spoke to Sunday Sun  said those foods and drinks already being accused of causing the spread of Cholera are not the harbingers of the virus after all. They are according to them, good to be eaten and relished, and not killers by themselves, empasising that it is the way and manner they are handled that are. And who prepares them matters too.
But do you know that the hardship in the land is also fuel to the spread of Cholera? That is also the position of the experts, who claimed that a sizable majority of the Nigerian people now consume anything that comes their way – just to survive the hardtime.

What is Cholera disease?
Cholera, according to Dr Abayomi Ogunbeku, of Horse Memorial Methodist Hospital, Yaba, Lagos, “is a bacterial infection whose major sources are water and food.
“It is a disease that can affect anybody especially those who have low immunity. Children are the most vulnerable.”
Describing how it feels to be infected, he said: “When someone contracts Cholera, he or she begins to suffer diarrhea. The individual experiences nausea and vomiting. There might be muscle cramp, and then hydration. There is loss of water through vomiting and diarrhea.
“For people who have low immunity, the situation might be so severe, leading to shock and then death.
“Because of the situation in Nigeria now, people are just eating anything they can lay their hands upon without cooking them. People are taking a lot of concoctions.
“People cannot afford even sachet water again. So, they resort to taking anything that comes their way as water. The said water might be contaminated. And so, anyone who takes such bad water will surely get infected, thus helping the spread of the disease. This is because much of our body composition is water.”
According to Dr Tajudeen Mobolaji, the immediate past chairman of Nigerian Medical Association (NMA) Lagos State chapter, “once  the Cholera virus gets into the body, it stimulates the intestine of the patient to start secreting fluid, forcing the person to have diarrhea, and to pass out loose watery stool. Once that becomes more frequent, a lot of fluid is lost; and that will be very disastrous. The patient can then go into shock, leading to loss of life.”
Ogun State Commissioner for Health, Dr Tomi Coker, while warning the residents, stated that “the risk factors for Cholera include eating contaminated food and drink, unhygienic sanitary conditions, and poor personal hygiene.
“Cholera can cause severe acute watery diarrhea, which can kill within hours if left untreated.”

Cholera is contagious
According to Dr Mobolaji, “Cholera is contagious. The word for that is transmissible. Some people get infected after improperly touching infected surfaces and putting their fingers mistakenly into their mouths or through the faeces of someone who is infected.”
He said that the disease might be seasonal, adding that “certain things we have been able to see demonstrate that.”
The giving hints that Cholera might as well be seasonal, the Chairman of the Forum of Health Commissioners of Nigeria, Dr Oyebanji Filani, reportedly said that poor sanitation, which had been fueled by the arrival of the rains, are often the cause of the spike in Cholera cases. This is because water sources get flooded and compromised too.

Duration of incubation
According to Dr Mobolaji, Cholera takes a couple of days, depending on the person’s immunity. If the affected person has higher immunity, that can curtail its impact.
“You can also notice that it differently affects people who contract it because everyone does not have the same level of immunity. So, the best thing is don’t let it affect you. That is why emphasis is laid more on prevention rather than cure,” he said.
Dr Ogunbelun equally agreed that Cholera manifests in the infected person in different ways. He said: ‘It depends on the individual affected and their immunity level. For some persons, it will take up to five days, some three days.”
But Dr Coker said: “It takes between 12 hours and five days for a person to show symptoms.”

A nation under Cholera threat
Already, Nigerians and the governments have a handful as Cholera – believed to be the worst in the recent and distant past threatens.
With 31 states and over 107 LGAs in the grip of the epidemic, concerns have continued to mount.
Day after day, the scourge continues to throw up grave challenges for the authorities and the citizenry to deal with.
So far, health professionals of various categories are mobilised to do battle almost like in the days of COVID-19 pandemic.
Doctors in the various private and public medical facilities are fighting to provide both care and advice under their belt.
Everyone is scrambling to ensure that the citizenry avoids the onslaught of the disease.
Last week, the Nigeria Centre for Disease Control and Prevention (NCDC) Director General, Dr Jide Idris, reported that “as of June 24, 2024, 1,528 suspected cases and 53 deaths have been recorded across 31 states and 107 LGAs with a case fatality rate of 3.5 per cent since the beginning of the year.”
Right now, the number must have climbed higher.
Dr Idris feared that the country faced another public health emergency after COVID-19, Lassa fever and Meningitis challenges.
He lamented that the outcome of a risk assessment by the centre saw Nigeria being at “high risk” of Cholera transmission and impact.
His fear became all the more palpable as Cholera continued in its ruthless march notably in Lagos, Ogun, Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, and Nasarawa states.
The Lagos State Commissioner for Health, Akin Abayomi, announced an increase in the number of deaths recorded from the disease, saying that cases had been recorded across 20 councils in the state.
Specifically, Special Adviser to the Lagos State Governor on Health, Kemi Ogunyemi confirmed 24 deaths and 350 suspected cases in the state, with the prospect of an increase in cases looking higher.
Ogun State government on its part confirmed 25 cases of Cholera in seven local government areas of the state, with one death at that time in Ijebu North local government.
According to the state Commissioner for Health, Dr Tomi Coker, Abeokuta South, Abeokuta North, Obafemi/ Owode, Ijebu North, Ado, Odo/ OTA local government areas were the areas in the state worse affected by the disease.

The tiger nut causative narrative
Earlier, some controversy had erupted over the true cause of the Cholera outbreak especially in the Southwest.
The Special Adviser to the Lagos State Governor on Health, Kemi Ogunyemi, had insinuated that some of the cases were traceable to tiger nut consumption.
She was quoted as saying: “So, when we noticed an increase in cases in Eti-Osa Local Government Area of Lagos specifically, we went there to investigate. We carried out a survey and found that the common denominator, which was one of the deadly factors, was a tiger nut drink.
“People who came to the hospitals all identified that they had drank tiger nut drink. We couldn’t just take their word for it, so we had to take that drink and test it to see what was in it. We immediately sent people out to look for those selling it so we could take a sample.
“We found empty bottles with a name on them, but we discovered that it wasn’t even registered with the National Agency for Food and Drug Administration and Control (NAFDAC), the regulatory body that ensures the safety of consumables.”
However, Mrs Ogunyemi added that since Cholera is a water-borne disease, the government had continued to test the water, food, and stool of patients who present the symptoms, particularly those who had not taken anti-biotics before approaching the hospitals.
Even the Ogun State health commissioner alluded that the nine confirmed cases in the state were traced to consumption of tiger nut milk by the victims, who had a history of travelling from Lagos State to Ogun State.
However, the Lagos State Director of Public Affairs at the state’s Ministry of Health, Tunbosun Ogunbanwo, said Ms Ogunyemi did not disclose any conclusion of the state’s investigations into the causes of the outbreak.
Mr Ogunbanwo was quoted to have said that Mrs Ogunyemi was misrepresented, adding that the various possible sources, including the tiger nut drink, were being investigated to determine the cause of the outbreak.
But medical experts said that tiger nut could not cause Cholera outbreak; rather what could have caused the situation was the way the drink was produced, adding that other foods poorly handled could present similar challenge.
Dr Ogubekun who is the Lagos State Chairman of Christian Health Association of Nigeria (CHAN) said there is nothing wrong with tiger nut and its consumption as it was speculated to be source of the spread of Cholera.
He noted that “the issue might be the water used in preparing it. It might have been contaminated. Even pap or ogi can be a harbinger of Cholera if the water used in preparing it is contaminated. If in the course of preparing pap, the hot water is not able to kill the virus in there, that can be a source of the problem.”
Equally, Dr Mobolaji said that “the point to note is that most of the food we eat: rice, if they are not boiled like up to 100 degrees, they can be a source of the problem.
“Foods that are not cooked such as salad, fruits – especially if you are not the one who handled it, can be potentially dangerous.
“You see people hawking fruits that have been cut already which you might not know the condition in which they were handled – whether those who prepared them were wearing gloves, or simply presented the food/fruit unwashed, nobody knows that.
“Now, note that tiger nut in itself is not the cause of Cholera, but the way it might have been be prepared poses a valid danger to all of us. You cannot take the pill out, and you cannot boil its water either. That makes it a lot dangerous for the matter at hand.
“The preparation of tiger nut drink doesn’t give any room for boiling before presentation for drinking. And so, if the Cholera bacteria are there, that is a lot dangerous. Any other food or drink can follow that sequence and leads to the transmission of the disease.
“Therefore, it might not be the tiger nut itself that triggered the virus. What matters is the way and manner it was prepared. And the drink is becoming very common. Many people are consuming it to get by and that is why it is being mentioned as a possible causative factor.”
Dr Mobolaji disclosed that vegetables that can be cooked do not have much chance of transmitting Cholera. “This is because if such vegetables have been touched by someone infected, you can boil it; the bacteria cannot survive the heat. But if it is vegetable salad whose leaves are eaten just like that – if that is touched by someone who has been infected – and you know it is not going to be cooked, whoever eats it has high chances of been infected.”
Therefore, Dr Mobolaji said that the first line in dealing with Cholera is to avoid it completely.
“I will just tell everyone not to try to get infected.
“If you introduce salt into tiger nut drink, for instance, that will change its taste. And if you are not sure of the water that was used please stay away from it.
“Mangos, cucumber, carrot among other fruits fall on the same danger list of fruits that can be infected. So, what we can do is to wash and wash them thoroughly.
“If you look at mango, banana, and cucumber to an extent, the covering might protect the eater. If they wash their hands first, and wash the fruits again and then take the peel come off, the eater might be protected.
“It is here again that tiger nut come to mind. You cannot take the peel out because the outer side forms part of the content that will be consumed. That is where it becomes tricky to take it out and that is why you have to wash it properly.”

Other sources of Cholera infection
Dr Mobolaji said it is not impossible that Cholera can be transmitted through the boreholes which get infected.
“If the water source is contaminated by the Cholera virus, anyone who uses the water might get infected.
“Therefore, the best way out is that whatever the water source is, boil it to be pretty sure it is Cholera-free. One should not be drinking water that is in an open place. Therefore, store water in air-tight vessels.”

Governments’ responses
NCDC’s DG, Jide Idris, said that his agency had activated an emergency centre to address the challenge across 31 states.
He disclosed that the Federal Government has activated the National Cholera Multi-Sectoral Emergency Operations Centre (EOC) following the threat of epidemic in the country.
Idris further noted as part of interventions to halt Cholera, NCDC was launching a coordinated approach with the states to identify and deal with the disease spread in their own areas.
He equally noted that NCDC would be collaborating with other stakeholders, such as state governors, to try to find a lasting solution to the challenges.
He said: “In response to the rapidly increasing Cholera cases, a dynamic risk-assessment was conducted by subject matter experts on Cholera outbreak situation in Nigeria last week.”
He added that an incident manager had been appointed, whose duty would be to “coordinate the day-to-day activities involving several pillars, such as surveillance (data collection, analysis and dissemination), case management, oral Cholera vaccine issues, coordination, Infection Prevention and Control (IPC), Logistics support, and Research.”
At the state level, Ogun State Commissioner for Health, Dr Coker, said free surveillance and emergency treatment had been activated in all 20 local government areas of the state.
Dr Coker said before the outbreak, the state government had prepared for a robust surveillance system in all 20 local government areas to ensure prompt detection of cases.
She added that the state’s Epidemiology Unit had been put on high alert, adding that local government Disease Surveillance and Notification Officers had also intensified surveillance across all 20 council areas in the state.

How to avoid Cholera
Dr Coker, while assuring the public of the preparedness of Ogun State government and its development partners to fight the outbreak, asked residents to maintain a high level of personal and public hygiene to contain the disease.
She maintained that “as a way of warning, the risk factors for Cholera, include eating contaminated food and drink, unhygienic sanitary conditions, and poor personal hygiene.
“Cholera can cause severe acute watery diarrhea, which can kill within hours if left untreated.
“The prevention and control of Cholera in a multifaceted approach are key with a combination of surveillance, potable water, sanitation and hygiene, social mobilisation, treatment, and oral cholera vaccines are used.”
For Dr Ogunbekun, what the people need to emphasise upon right now is thorough hygiene. “Everyone must ensure that anything they are taking must be properly boiled. In the areas where people still have pipe-borne water, they should desist from drinking from it.
“If you are taking vegetable, also ensure that it is well cleaned and well cooked. Doing that will ensure that we kill the bacteria.”
He advised all those who buy food at the bukateria to be a lot more careful now “because the water used in cooking and even washing the dishes may be infected.
“Even those who go out to buy fruits have to be more careful. When you get home, ensure that your fruits and vegetable are well washed, and where possible well cooked before consuming them.
“And for those who buy water regularly on the road, the way to go now is to take your water along with you. Boil it at home to be sure of what you are taking.”
He also tasked those who can afford it to go for the cholera vaccine, saying “it is every essential,” noting: “Although it is expensive, but it is available.”
Then he called on the government to roll out the vaccine for the generality of the people. “That will benefit people in vulnerable areas, he reasoned, adding: “Taking the vaccine will help a lot this time.”
He further emphasised that “everyone must know that prevention is better than cure. Personal and environmental hygiene is of utmost importance right now. People are enjoined to watch they eat and drink outside.
“And in case there is someone who is frequently vomiting and defecating, they should be taken to the hospital immediately!”
Dr Mobolaji, equally emphasised on the need for personal hygiene. He said: “This is most important in treating cholera. People must learn to wash their hands with soap and water now, especially after toilet use; they must ensure that they properly dispose of their stool. That way, more people will not be infected, and the whole community will be free.”