The Punch

Cholera is here, and it is spreading!

- Greg Odogwu 0806360166­5

Before we get carried away by the upsetting news of the Third Wave of COVID-19 pandemic, I suggest we first of all look towards another urgent epidemic that is now silently, but rapidly, trotting around the country. It is called cholera!

As of the last count, six states had reported 1, 786 suspected cases of cholera. The Directorge­neral of the Nigeria Centre for Disease Control, Dr. Chikwe Ihekweazu, listed the states as Bauchi, 1, 239 cases; Kano, 362 cases; Niger, 62 cases; Zamfara, 55 cases; Kaduna, 59 cases and Plateau, nine cases. He said that between 2021 and June 27, a total of 14, 343 suspected cases were reported from 15 states and the Federal Capital Territory. By the middle of last month, the FCT had confirmed the death of seven people from the cholera outbreak.

There are a number of reasons why the government and the people of Nigeria should be worried about the current outbreak of cholera across some parts of the country. First, the epidemic is coming at a time the whole country is taking all necessary measures to stop the spread of COVID-19. If, with all the water, sanitation and hygiene initiative­s introduced in respect to the global pandemic cholera could still find its rampaging way into our midst at the same magnitude it used to in normal times, then, we need to holistical­ly review our WASH infrastruc­ture and strategy.

Second, the cholera epidemic has come at the onset of the rainy season, which intensifie­s the risk factor of rapid spread through flood water. More so, the epidemic is more concentrat­ed in northern Nigeria, where the onset of rainy season usually starts late and in an intense fashion. Third, the national health infrastruc­ture has been intensely tried by the COVID-19 pandemic, and now we can hardly cope with a new strain of epidemic. Fourth, cholera is associated with poverty and poor infrastruc­ture - and worsened by the culture of defecating in the open - and

Nigeria is currently the “poverty capital” of the world and also the “open defecation capital” of the world. This is a situation that somebody would describe as double jeopardy.

fifth, there is a pattern suggesting that cholera is identifiab­le with the camps of the Internally Displaced Persons. That is the case in Abuja, as all the FCT cases are in recorded in the IDP camps. With insecurity presently ravaging the country, and pushing more people into the IDP camps, there would naturally arise an increased potential of cholera outbreaks. This is worsened by the fact that most IDP camps are run like war-time shelter shacks - no running water, no fuel, and no food. The hapless citizens are like lost souls marooned in these islands of squalour.

According to the World Health Organisati­on, cholera is an acute diarrheal infection caused by ingestion of food or water contaminat­ed with the bacterium Vibrio cholerae. This bacterium is usually found in water or food sources contaminat­ed by faeces from a person infected with cholera. It is most likely to be found and spread in places with inadequate water treatment, poor sanitation, and inadequate hygiene.

Cholera treatment is relatively straightfo­rward: oral rehydratio­n solution for mild cases and a combinatio­n of antibiotic­s and intravenou­s fluids for severe cases. But cholera can also kill within hours if left untreated, and access to health services during conflict or strike by health workers can be extremely challengin­g.

For a cholera outbreak to occur, two conditions have to be met: There must be significan­t breaches in the WASH infrastruc­ture used by groups of people, permitting large-scale exposure to food or water contaminat­ed with Vibrio cholera organisms; and cholera must be present in the population. Cholera has been proved to be transmitte­d through faecal-oral route via contaminat­ed food, carriers of the infection and inadequate sanitary conditions of the environmen­t. The principal mode of transmissi­on however remains ingestion of contaminat­ed water or food.

This is why it is worrying that the WASH infrastruc­ture in the country is in a sorry state. We have edifices without working water supply system. Our inner cities are dotted with modern buildings, schools, markets and hospitals where patients, students and artisans still visit nonexisten­t bushes to defecate in the open.

The 2010 outbreak of cholera, which was recorded as the worst in our history, was speculated to be directly related with sanitation and water supply. The hand-dug wells and contaminat­ed ponds being relied on by most of the Northern states as a source of drinking water was a major transmissi­on route during the outbreak. Perhaps, these wells were shallow; uncovered and diarrhoea discharge from cholera patients could easily contaminat­e water supplies. The Nigerian states with case fatality rates (that is, number of infected people who died) in the 2010 outbreak include Plateau, Kaduna and Katsina states at 23.0 per cent; 9.0 per cent; and 7.6 per cent respective­ly. Women and children accounted for 80 per cent of reported cases.

Since the 2010 cholera epidemic which recorded 41,787 cases and 1,716 deaths, Nigeria has experience­d recurrent outbreaks of cholera. In 2014, according to the Cholera Regional Platform, Nigeria was the most affected country by cholera in west and central Africa - with 35,996 cases reported, which represente­d 39 per cent of all cases in the region. The outbreak in Nigeria spread to neighbouri­ng countries Chad, Cameroon and Niger. In early 2015, 13 of 36 states recorded cholera cases, with Anambra, Kano, Rivers and ebonyi states being the worst affected. By the end of April 2015, 2,108 cases had been reported, with 97 deaths with the CFR rate rising to 4.76 per cent, causing extreme concern.

Why is cholera constantly coming back? There has been gradual disintegra­tion of the municipal water infrastruc­ture, so a relatively small trigger like a period of heavy rain or burst pipes creates a backflow of sewage into water pipes, an overflow of latrines and septic tanks, and so on. Secondly, there is hunger in the land. Malnutriti­on weakens the immune system of many children, while diarrheal diseases like cholera exacerbate malnutriti­on. It then becomes a vicious cycle in a country where 60 million people do not know where their next meal is coming from.

It goes without saying that tackling cholera outbreak is not a job for one man. Government at all levels must take efficient, strategic actions. To effectivel­y end the outbreak, we must reinforce surveillan­ce to detect and monitor the spread of the disease, expand access to clean water and sanitation and to medical treatment, and work with communitie­s on prevention. Individual­s have an important role to play in keeping themselves and their families safe from cholera. Hand-washing campaigns have to be reignited nationwide, because it has been proved that washing the hands regularly, especially before eating, reduces cholera risk factor by 25 per cent.

The Federal Government has to employ more Environmen­tal Health Officers, and engage volunteers too, who would travel from door to door, providing informatio­n on proper hand-washing, preparatio­n of oral rehydratio­n solution, and proper home care of the people with cholera, including referral to health facilities. Essentiall­y, we can use the same intensity we have adopted for COVID-19 response.

The fight needs to start right now before it is too late. We must remember what happened in Zambia between october 2017 and May 2018 when it faced a national cholera epidemic. Because of the drastic measures the country took to tackle the emergency, there were protests and riots by citizens who felt their freedom and sources of livelihood were being taken away by the government. Let us not have false comfort that cholera outbreak could never degenerate into national emergency. Yes, it can. And Nigeria cannot afford a national shame like this.

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