Worsening economic crunch spikes cholera cases

• Nigeria must prevent spread in schools – UNICEF


From Fred Ezeh, Abuja

Health experts have raised the alarm about a possible spike in cases of cholera and other water-borne diseases like diarrhoea, typhoid and dysentery, largely due to increased access to unclean sources of food and water for consumption and other household use by Nigerians.

Recent inflation has resulted in a sharp rise in the cost of potable water packaged in sachet, pet and dispenser bottles, among others, which a large percentage of Nigerians rely on. The high cost has pushed many to alternative sources of water for drinking and cooking. More households have also resorted to eating out in unhygienic places because it is more cost effective than home cooking.

The Nigeria Centre for Disease Control and Prevention (NCDC), in a statement, last week, confirmed that cholera has hit 30 states, adding that more cases were being reported in different parts of the country as the rainy season peaks.

It noted that between January 1, and June 11, 1,141 suspected and 65 confirmed cases with 30 deaths were reported from 96 LGAs in the affected 30 states, noting that 10 states that contributed 90 percent to the burden of cholera include Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, Nasarawa and Lagos states.

Chairman of the Association of Resident Doctors (ARD), FCT chapter, Dr. Roland Aigbove, predicted the recent outbreak of cholera, adding that there might be increased hospitalisation as a result of the development.

“Unarguably, Nigerians are resilient people and no matter what lies ahead, they always create an avenue to get going. Due to the present precarious economic crisis that has bedevilled our country with so much uncertainty and class widening, in terms of wealth and living standards, many people, especially the downtrodden, have resorted to alternatives to meet their daily needs, hence, quality and safety are being compromised.

“The dangers of such practices will be sales and consumption of unwholesome products that would endanger the lives of citizens vis-a-vis their health. For instance, there are already reports of sales of water in polythene bags that are obviously packaged in an unhealthy environment, and without standards. This will, definitely, lead to increase in water-borne diseases and increased hospitalisation, thus resulting in loss of valuable manpower/work hours due to the poor hygienic conditions of packaging and untreated water from any source.”

On his side, Dr. Ken Ozoilo, former president of Medical and Dental Consultants Association of Nigeria (MDCAN), described the situation as a catastrophic and pending public health challenge, considering the fact that potable water is central to the issue of public health management in Nigeria and beyond.

He said the campaign for Water, Sanitation and Hygiene (WASH), which was championed by the United Nations Children Fund (UNICEF), local and international donor partners, and other state governments, has been intensified for a long time with visible positive results being recorded.

 “Fortunately, many Nigerians have picked, and imbibed the message of hand washing for healthy living. But, the situation in Nigeria today is scary and could affect the gains achieved over the years. Public health challenge is looming if something urgent is not done to salvage the situation.

“We are currently battling with the outbreak of cholera as being reported from different states in Nigeria. Soon, other epidemics might follow. So, there’s a need to take precautionary measures to avoid additional public health issues that could overwhelm our system and manpower.

“Sadly, governments prefer reactionary measures/interventions, which are more costly and often result in avoidable loss of lives, to proactive measures which are cheaper and affordable. But, that should change if we want to achieve the desired gains.”

Dr. Gabriel Adakole, public health expert based in Abuja, cautioned the public against cholera bacteria, which is passed through faeces (poop), shed back into the environment.

The public health expert said the primary route for cholera transmission is through the consumption of food or water contaminated with the faeces of an infected person.

“The bacteria can survive in the environment for extended periods, making it easier for the disease to spread in areas lacking proper sanitation and hygiene.

“When a person ingests contaminated water or food, the bacteria colonise the intestines, leading to the rapid onset of symptoms,” he said.

On the impact on underdeveloped states, Adakole said cholera would be more prevalent in underdeveloped states, where infrastructure for clean water and sewage disposal was insufficient.

“In these states, the lack of access to safe drinking water and proper sanitation facilities creates an environment conducive to the spread of cholera.

“Natural disasters, conflicts, and overcrowded living conditions can exacerbate the situation, leading to outbreaks that can affect thousands of people,” he said.

He added that preventing cholera required a multifaceted approach.

According to him, states should ensure access to clean drinking water and adequate sanitation facilities.

“This involves building and maintaining infrastructure for safe water supply and proper sewage disposal.

“Educating communities about the importance of hand washing with soap and safe food handling practices can significantly reduce the risk of transmission.

“Cholera vaccines can provide temporary protection, and are particularly useful during outbreaks or for people travelling to high-risk areas.

“Early diagnosis and treatment of cholera with oral rehydration salts (ORS) and, in severe cases, intravenous fluids and antibiotics, can save lives and limit the spread of the disease,” he advised.

He said it was time for the NCDC and other relevant agencies, including various non-governmental organisations (NGOs), to assist the affected states to combat cholera.

“These efforts should include providing emergency relief during outbreaks, supporting infrastructure projects, and conducting vaccination campaigns. However, the persistent challenges of poverty, political instability, and climate change continue to hamper progress.”

He also said cholera remained a serious threat in many parts of the world, including Nigeria, primarily due to lack of clean water and adequate sanitation. Addressing these fundamental issues is key to preventing the spread of cholera and improving public health outcomes globally, he said.

However, UNICEF has called for extensive measures to protect school children.

The UN organisation also called for concerted efforts to prevent disruption in the academic calendar over the spread of the disease.

The Chief of UNICEF Lagos Field Office, Celine Lafoucrier, who made the call yesterday in a statement, said the cholera outbreaks critically affected children and the young population.

According to Lafoucriere, these vulnerable groups face substantial health risks, particularly children and young adults attending schools.

She noted that children were prone to severe dehydration and a high mortality rate.

“There is, therefore, an urgent need for good sanitation, hygiene practices, improved access to clean water, regular hand washing with soap and clean water in order to combat the outbreak in schools,” she said.

Lafoucrier, however, solicited for adequate awareness across the country to sensitise the populace on cholera outbreak, and preventive measures as part of efforts to address the issue.

Meanwhile, the multi-sectoral National Cholera Technical Working Group led by the NCDC and Federal Ministries of Environment and Water Resources; the National Primary Health Care Development Agency (NPHCDA); the World Health Organisation (WHO); UNICEF, and other partners, has been providing support to the affected states.

The NCDC Director General, Dr. Jide Idris, said the supports were in the form of risk communication, active case search, laboratory diagnosis, case management, provision of response commodities, WASH interventions, and dissemination of cholera awareness jingles in both English and local languages.

He advised health workers and state health officials to always practise standard safety precautions, notably, wearing gloves while handling patients, or providing care to an ill patient/relative, and in addition to that, intensify surveillance efforts to promptly report suspected cholera cases.

He also advised the state governments to prioritise action for solutions that ensure access to, and use of safe water, basic sanitation, and proper hygiene practices in communities.

“As the NCDC continues to work with partners to lead the health-sector response to cholera outbreaks, we call for an urgent improvement in access to clean water, proper sanitation, and hygiene,” he added.

Lagos State government confirmed a cholera outbreak, with the highly aggressive strain identified. The epicentre is Lagos Island, with 106 cases, followed by other local government areas.

Out of 350 suspected cases, 17 are confirmed, and 15 deaths have occurred.

The state, supported by the NCDC, WHO, UNICEF, and local NGOs, is enhancing public health campaigns, especially with the Sallah celebrations.

Suspected cases receive free treatment. Cholera spreads through contaminated food and water, and severe cases can cause rapid death due to dehydration.

In 2022, there were 473,000 cholera cases reported globally, with numbers rising in 2023. Africa has the highest numbers, followed by other WHO regions.

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