The recent outbreak of cholera in 23 states of the federation and the Federal Capital Territory, FCT, is a worrisome public health crisis, coming amid the emergence of the highly infectious Delta variant which signposts the third wave of the Covid-19 pandemic. Since the latest outbreak, no less than 2,035 deaths and 58,698 suspected cases have been recorded with a case fatality ratio, (CFR), of 3.5% reported in 305 local government areas across the nation, according to the Nigeria Centre for Disease Control, (NCDC). No part of the country is immune from the threat of cholera as the disease is a seasonal epidemic mostly during rainy seasons. The spread of the disease in the last two weeks is a reflection of the poor sanitary and environmental degradation in many parts of the country. With over 2000 lives lost, the country is certainly vulnerable. Worrying as this is – because of the high fatality associated with it – what it calls for is concerted efforts by the health and other authorities to arrest it and stop further spread. It is doubtful whether these measures have been adequately explored to counter the seriousness of the situation.
The fact that up to 23 states have been affected, with potential for more fatalities should serve as a wakeup call to government at all levels to mobilize materials and personnel to stop further spread, and prevent the disease from wreaking greater havoc. The NCDC in its weekly epidemiological cholera situation report 10, Epi Week 33: 16 – 22 August, 2021, listed affected states as Benue, Delta, Zamfara, Gombe, Bayelsa, Kogi, Sokoto, Bauchi, Kano, Kaduna, Plateau, Kebbi, Cross River, Nasarawa, Niger, Jigawa, Yobe, Kwara, Adamawa, Enugu, Katsina, Borno, Taraba and the FCT. Although Bauchi has recorded the highest number of cases (16,217) compared to 8,620 in Jigawa, the NCDC observed that more deaths, 600, had occurred in Jigawa, compared to 219 in Bauchi.
The 10 most affected states, the agency noted, are Bauchi (16,217 cases and 219 deaths), Jigawa (8,620 cases and 600 deaths); Kano (8,605 cases and 231 deaths); Sokoto (5,352 cases and 209 deaths), and Zamfara (4,234 cases and 65 deaths). Others are Katsina (4,102 cases, 144 deaths); Kebbi (1,965 cases, 136 deaths); Niger (1,724 cases, 109 deaths); Kaduna (1,432 cases, 116 deaths) and Plateau, (1,430 cases and 19 deaths). In the last one week, according to the NCDC, 83 LGAs in 12 states reported 3,098 suspected cases, including Bauchi (1,145), Katsina (691), Zamfara (454), Yobe (216), Sokoto (196), Jigawa (187), Kano (80), Niger (79), Borno (30), FCT (11), Adamawa (6) and Kebbi (3). The figures are estimates as “trickles of incidents and mortalities may still be coming,” the NCDC noted.
Cholera is an acute infectious and often fatal intestinal disease that produces severe gastrointestinal symptoms, which is usually caused by Vibrio cholerae. The bacterium generates a soluble toxin in the intestinal tract that activates watery diarrhea resulting in extreme loss of fluid, dehydration and collapse. The fatality rates are very high when untreated, especially among children and infants. Deaths can also occur in adults in a matter of hours. Discovered in 1883 by a great German bacteriologist, Robert Koch (1843-1910), cholera has wreaked havoc in different parts of the world, especially in poor developing countries. Every year, there are an estimated 5 million cases of cholera and 143,000 deaths worldwide. Nigeria is among countries that are hard-hit annually.
In Nigeria, cholera epidemic has been occurring for over 30 years due to poor sanitation and inadequate water treatment. Nigeria suffers a severe cholera epidemic every year resulting in thousands of deaths. Despite this annual recurrence, sadly, the country lacks progress in human development index in this 21st century. People commonly urinate and sometimes defecate in the open while the wastes are washed down open drains. Propensity for contamination is high from roadside food vendors and people eating with dirty hands under unhygienic condition. The preponderance of sachet water, popularly called “pure water”, the quality of which is not assured, may also predispose people to cholera.
The disease can only be minimized through improved sanitary condition. The federal government can do more to provide citizens with potable water in line with its statutory responsibility. There should also be regular public enlightenment on observance of personal hygiene by regular washing of hands, especially after visiting the toilet; and keeping the surroundings clean. Few homes have potable public water, while millions of impoverished Nigerians, preoccupied as they are with eking out a living, care little about the sanitary condition of the food and water they consume. Millions live in blighted environments that are disease prone.
Cholera is not endemic to humans. The bacterium finds its way into humans through contaminated food and water, and poorly cleaned vegetables, especially, those irrigated with polluted water. Also, places with sanitation challenges such as refugee camps and communities without potable water are fertile grounds for cholera. Within six hours to five days of exposure, the cholera symptoms may range from being mild, asymptomatic to severe. In severe cases, the victim will present huge volumes of explosive watery diarrhea, vomiting, dehydration and leg cramps, which manifests in sudden and painful involuntary contraction of the muscles. The most effective way to combat cholera is early detection and treatment. Cholera diagnosis should be considered in all cases of severe watery diarrhea, vomiting and rapid dehydration. There should be laboratory tests to determine the species of the cholera. In all cases, it is advised that people should begin treatment even before the diagnostic tests are done.
Death from cholera is caused by dehydration rather than by the bacteria. Replenishing the body fluid, therefore, is the surest way to counter the infection. This can be achieved through oral rehydration therapy (ORT), made with large volume of water blended with sugar and salt. Severe cases of cholera require intravenous fluid replacement. Antibiotics are used to target the bacteria but it is advised that anti-diarrheal medicines should not be used because they prevent flushing of the bacteria out of the body. The latest outbreak is as much a challenge to government to address basic social amenities that make for good hygiene in an improved environmental condition, as it is to the populace to observe simple hygiene and to be proactive on health matters.
Anti-cholera campaign should necessarily be holistic, targeting short-term measures as well as long-term improvement in human development indices. The conditions that bring about the disease are all preventable, but the authorities are doing little to provide them. The spread of the disease is promoted by poor access to water, sanitation and hygiene – aka WASH. Without access to clean water, sanitation facilities and good hygiene practices among Nigerians, it will be difficult to eliminate cholera. After over three decades of battling cholera, Nigeria should no longer be recording such large-scale outbreaks. This is an international embarrassment and an unbelievable national shame for a country that is supposed to have outgrown primordial health challenges.
