The Borno cholera outbreak

The recent cholera outbreak in Borno State has risen to over 135,000 cases with death toll of 198 people. Doctors Without Borders or Medecins Sans Frontieres (MSF) has raised the alarm over the worsening cholera cases in the state. The disease has also spread to Yobe, Bauchi and Plateau states. According to Doctors Without Borders, the outbreak, which was first reported on May 1, has spread rapidly across the North-East, overwhelming healthcare facilities. The organisation, which had treated over 24,000 suspected cholera patients, had increased its emergency response, in conjunction with health authorities and other humanitarian organisations.

The World Health Organisation (WHO) says that cholera is an acute diarrheal infection caused by consuming food or water contaminated with bacterium Vibrio Cholerae. It is a global public health threat. Researchers estimate that there are 1.3 million to 4.0 million cases and 21,000 to 143,000 deaths from cholera worldwide annually. The disease is triggered by absence of public water supply system. It is also caused by lack of safe water, basic sanitation and hygiene (WASH).

Cholera outbreak can occur in places of conflict or in overcrowded environments, such as the Internally Displaced Persons (IDP) camps. Poor hygiene and malnutrition can also trigger the spread of the disease. Eating contaminated food can cause the disease. In Nigeria, the rainy season, which leads to flooding, worsens the matter as water sources can be easily compromised.

The symptoms of the disease appears 12 hours to five days after ingesting contaminated food or water. It can kill within hours if untreated. Prevention and control of the disease can be achieved by consuming clean water and food as well as providing proper hygiene conditions and access to basic sanitation services.

Since the disease is prevented by drinking safe water, washing of hands and eating thoroughly cooked food, we urge Nigerians to imbibe these practices. They should avoid raw or uncooked seafood and food from street vendors unless cooked fresh. It has been advised that people should wash hands using soap and running water often, especially before eating or preparing food and after using the toilet.

They are further enjoined to use proper toilets or latrines and avoid open defecation to keep germs away from water sources. Unfortunately, Nigeria is among the top countries where open defecation is brazenly practised even in urban centres like Lagos and Abuja. The United Nations Children’s Fund (UNICEF) had projected that Nigeria would need about 3.9 millions toilets annually to meet the open defecation-free target by 2025.

Regrettably, we missed this target to end open defecation and revised the timeline to 2030. We may also not meet this target, which is four years away, because an estimated 48 million to 50 million Nigerians still practise open defecation, Jigawa remains the only fully Open Defecation-Free state out of the 36 states in the country.

The agency’s Chief of Water, Sanitation and Hygiene (WASH), Dr. Jane Baven, had said that the current toilet construction in the country stood at between 180,000—200,000 annually. This is grossly inadequate in a country with over 200 million people. According to 2021 WASH National Outcome Routine Mapping on Nigeria’s sanitation status, about 48 million Nigerians practise open defecation, while 95 million were without access to basic sanitation services.

Also, 179 million Nigerians lack access to safely managed drinking water. While a larger portion of the population uses basic or improved water sources like boreholes or public taps, only about 10 to 13 per cent of the country has access to reliably safe water at home.

We call on state governments to provide public water system and curb the rising cases of drilling boreholes by almost every household in the country. Access to safe water will likely enhance public health and reduce the annual outbreak of cholera in the country. It is laudable that the WHO and the Nigeria Centre for Disease Control and Prevention (NCDC) emphasise clean water access and good hygiene to stop cholera outbreaks.

We commend the MSF, the Borno State Ministry of Health, the NCDC and other agencies for their joint efforts to curb the cholera menace in the state and adjoining areas. There is need for more interventions in Yobe, Bauchi and Plateau states to contain the outbreak and ensure that it does not spread further.

Other states in the federation should have public water system that will ensure access to safe water for the citizens. They must have a functional WASH structure and provide the much-needed toilets to end open defecation by 2030. It is not good that only Jigawa State has been certified open defecation free in the country. We urge the remaining states to emulate the Jigawa example.