Filthy environment – Photo: Sodiq Ojuroungbe
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As the federal and state governments intensify efforts to combat the latest cholera outbreak, medical experts have warned that it may spread to many more communities and states during the Eid-el-Kabir celebration if necessary measures are not quickly taken.
Speaking in separate interviews with Sunday PUNCH, they noted that an increase in travel over the holiday season might result in a rise in cholera cases.
This comes as the Lagos State Government confirmed 15 deaths from the infection.
Cholera is a food and water-borne disease caused by the ingestion of the bacteria— Vibrio cholerae— in contaminated water and food.
The Nigeria Centre for Disease Control and Prevention also warned the public of the increasing trend of cholera cases across the country as the rainy season intensifies.
The centre stated that from January 1 to June 11, 2024, over 1,141 suspected and over 65 confirmed cases of cholera, resulting in over 30 deaths, had been reported from 96 LGAs in 30 states.
It noted that the 10 states contributing 90 per cent to the burden of cholera include Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, Nasarawa, and Lagos states.
In Nigeria, cholera is an endemic and seasonal disease, occurring annually mostly during the rainy season and more frequently in areas with poor sanitation.
There were 473,000 cholera cases reported to WHO in 2022 – double the number from 2021. A further increase of cases by 700,000 was estimated in 2023.
The latest data from the World Health Organisation showed that a cumulative total of 145,900 cholera cases and 1,766 deaths were reported from 24 countries across five WHO regions, with Africa recording the highest numbers, followed by the Eastern Mediterranean Region, the Region of the Americas, the South-East Asia Region, and the European Region.
Speaking on the possibility of further spread during the Sallah celebration, the President of the Nigerian Association of Resident Doctors, Dr Dele Abdullahi, stated that the surge in holiday season travel could lead to an increase in cholera cases.
Abdullahi said, “Cholera is a bacterial infection, so there is a possibility of it spreading to other states during the festive season.
“Because of the Sallah celebration, a lot of migration is going to occur. People will move from one place to the other, and many of them, possibly in the incubation period, will change location. The key here is for our healthcare facilities to maintain a high index of suspicion when they encounter any cases of vomiting and diarrhoea.
“I am confident that the outbreak will not spoil the Sallah celebration,” he added.
To curb the spread, the NARD President stressed the need to maintain optimal and high standards of hygiene.
“We need a high index of suspicion. Whenever we encounter patients with vomiting, we must quickly take them to health facilities. It is better to arrive there and find out that it’s just food poisoning than to be uncertain about the health condition we’re dealing with.
“People should also avoid self-medication and refrain from using unorthodox methods to manage their health issues at home. All these measures will help in curbing the spread of the disease,” he said.
Also, a former Chairman of the Association of Private Medical Practitioners of Nigeria, Dr Tunji Akintade, said, “If someone with the disease travels without taking care of themselves and defecates in an open place, their faeces could contaminate water sources and infect others. Thus, there is a possibility of the disease spreading due to its transmission through water and poor hygiene.”
Akintade further emphasised that individuals who maintained good personal and environmental hygiene and were mindful of what and where they ate were less likely to be infected.
“If I live in the same house with someone who has cholera but we’re not eating the same things, and I’m careful about what I consume, I may not contract it. Therefore, when people travel, it’s crucial to advise them against drinking water from areas where cases have been reported.
“People need to maintain good hygiene, wash their hands after using the toilet, and ensure their surroundings are clean,” he concluded.
Also, a consultant family physician and Head of Department, Family Medicine Department at the University of Ilorin, Kwara State, Dr Ibrahim Kuranga-Suleiman, affirmed that the infection could spread as people travelled if precautionary measures were neglected.
Kuranga-Suleiman said, “The disease may spread during the Sallah period. To curb this, we must enhance our hygiene practices and ensure fruits are thoroughly washed and foods well-cooked. Even the water we drink must be sourced from safe and clean sources.
“By taking these precautions, we can prevent not only cholera but also travel-related diarrhoea, which is common among travellers.”
NCDC urges prevention
Speaking on a programme on Channels Television on Saturday, the Director General of the NCDC, Dr Jide Idris, stressed that prevention was key in fighting the disease.
Idris noted that as the rainy season intensified, there were possibilities of increasing cases of cholera in the country.
“The Nigerian Meteorological Agency has said that the rains this year are going to be heavier, and when you have rains, you’re going to have floods, and this leads to contamination of our water sources, so the chances are that cholera cases will increase.”
The DG, who blamed the outbreak of the infection on poor sanitation, personal and environmental hygiene, and lack of access to clean water, noted that the agency was conducting a risk assessment and had alerted all the states about the outbreak.
“To me, it’s a disease that is related to basic sanitation. My observation is that prevention is very weak, which also strengthens your point that we seem to have forgotten the need for prevention, or are not taking it very seriously. In a situation where resources are limited, I think that’s the best approach.
“If you go back to this cholera case, it’s a problem of poor sanitation and good personal and environmental hygiene, as well as lack of access to water. The easiest way to ensure good personal hygiene is hand-washing, especially after using the toilet and before cooking your food.
“But in a situation where people are told to practice hand-washing and there’s no access to water, it’s a problem. So, I think everybody, including the Federal Government, state governments, different agencies, local governments, and even the community, have to come together.”
The DG said the state governments must ensure access to clean water and toilets for their citizens.
Biosafety agency calls for vigilance
Also, the National Biosafety Management Agency has called on the general public to exercise caution over the recent cholera outbreak.
The agency, in a statement issued by its Head of Information and Communications, Mrs Gloria Ogbaki, quoted the Director-General of the agency, Dr Agnes Asagbra, as saying there was a need for vigilance.
“As we approach the Sallah celebration, it is of utmost importance that we collectively prioritise the health and safety of our communities.
“Cholera, a highly contagious bacterial infection caused by the ingestion of contaminated food or water, has been reported in Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, Nasarawa, and Lagos States.”
Asagbra said NBMA, in collaboration with health authorities, was actively monitoring the situation and implementing measures to contain the spread of the disease.
Lagos records 15 deaths
Meanwhile, the Lagos State government has confirmed 17 cholera cases out of 350 suspected cases in 29 wards in the state. The state government, which confirmed this in a statement on Saturday, noted that it had recorded 15 fatalities from the cholera outbreak.
The statement, signed by the Director of Public Affairs at the state Ministry of Health, Tunbosun Ogunbanwo, noted that the government had activated its Public Health Emergency Operations Centre at Mainland Hospital, Yaba, Lagos.
It said the PHEOC was convened to address the increasing number of severe gastroenteritis cases across multiple LGAs in the state.
The statement said the Commissioner for Health, Prof Akin Abayomi, disclosed this while speaking on steps taken to control the outbreak in the state.
“He revealed that 350 suspected cases of cholera were reported in 29 wards across multiple LGAs in Lagos State, with 17 confirmed cases and 15 fatalities so far,” it read partly.
“The laboratory investigation and test results have so far confirmed cholera subtype O-1. The pattern of new cases per day varies across LGAs, according to our ongoing surveillance and monitoring updates.
“Although this is an increase from the numbers published three days ago, cases are now dramatically subsiding in previously affected LGAs due to our interventions and surveillance efforts. However, we are recording some new cases in previously unaffected LGAs, signalling the need for residents to adhere strictly to precautionary, personal, and environmental hygiene measures,” the commissioner said.
He added that “The Directorate of Environmental Health of the Ministry of Health, in collaboration with the Lagos State Environmental Protection Agency of the Ministry of Environment, had collected samples of water sources, food and beverage samples in all the affected LGAs, while inspections of facilities were ongoing.
Abayomi urged residents to support the state government’s efforts by adhering strictly to precautionary measures, cooperating with health authorities, and participating in community-wide sanitation activities to mitigate the spread of the disease.
“During this Sallah season, residents are advised to drink safe water, cook food thoroughly, maintain personal hygiene, wash hands regularly, use sanitiser, and avoid overcrowded places. Reporting symptoms such as watery diarrhoea or vomiting immediately is also crucial to save lives and prevent transmission to other members of the community. Treatment for suspected cholera is provided free of charge at all government facilities as part of the government’s standard public health response,” he said.
Embrace precautionary measures, Ogun urges residents
Also, the Ogun State government urged residents to embrace precautionary measures to prevent any possible cholera outbreak in the state.
The Special Adviser to Governor Dapo Abiodun on Media and Strategy, Kayode Akinmade, made this known in a statement on Saturday.
Akinmade stated that the governor was concerned about the development and the need to prevent a cholera outbreak, considering the proximity of Ogun to Lagos, and the level of interaction between the two states.
According to the statement, the precautionary measures include ensuring all houses have toilets, all petrol stations have functional public toilets with running water as part of their corporate social responsibilities, and all garages and parks have functional toilets with running water.
“All markets must have functional public toilets with running water, mechanic villages must have functional toilets with running water, and all schools should have public toilets with running water,” the statement read.
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