Cholera: Fear, anxiety mount over rising deaths

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…1,178 die in 23 states, FCT – NCDC

‘… Deaths unnecessary, compounded by doctor’s strike’

 Poor hygiene, unsafe behaviour fuelling infection – Expert

‘… We’ve no business recording large-scale outbreak’

There has been mounting fear and anxiety over rising number of deaths from the resurgence of cholera in 22 states of the federation and the Federal Capital Territory (FCT), amidst rising cases of Covid-19, SAMSON BENJAMIN reports.   

The Nigeria Centre for Disease Control, (NCDC) said the country had recorded 37,819 suspected cases of cholera, 1,178 deaths in 23 states and the FCT as at August 14, 2021.

The NCDC Director-General, Dr Chikwe Ihekweazu, who made the disclosure in an interview with the News Agency of Nigeria (NAN), recently, listed the states to include: Benue, Delta, Zamfara, Gombe, Bayelsa, Kogi and Sokoto.

Others are: Bauchi, Kano, Kaduna, Plateau, Kebbi, Cross River, Niger, Nasarawa, Jigawa, Yobe, Kwara, Enugu, Adamawa, Katsina, Borno, Taraba and the FCT.

Ihekweazu said out of the reported cases, 26 per cent were aged 5 – 14 years, 51 per cent were males and 49 per cent were females.

The NCDC boss, however, noted that there had been a decrease in the number of new cases in the last two weeks.

He said, “Bauchi had 773 case; Niger 284; Zamfara 253; and Katsina 217; which accounts for 78.1 per cent of 1,956 cases reported in the last two weeks.

“Since the beginning of the year, a total of 1,938 samples have been collected with positive cases as follows: 277 Rapid Diagnosis Test (RDT), positive only; 82 culture positive; 359 RDT and culture positive.

“The Test Positivity Rate (TPR) for laboratory confirmation by culture is 23 per cent. No new state reported cases in epi week 31.

“A total of 770 suspected cases were reported this week representing a 34 percent decrease, compared to 1,162 suspected cases recorded in week 30.”

The scourge

According to the World Health Organisation (WHO), cholera is an acute diarrhoeal infection caused by eating food or drinking water that is contaminated with the bacterium vibrio cholerae. It remains a global threat to public health, an indicator of inequity and lack of social development.

Nigeria has witnessed several outbreaks of Cholera over the years. It occurs annually mostly during the rainy season and more often in areas with poor sanitation.

Blueprint Weekend findings show that the first series of cholera outbreaks was reported between 1970 and 1990. Major epidemics also occurred in 1992, 1995-1996, and 1997.

“The Federal Ministry of Health reported 37,289 cases and 1,434 deaths between January and October 2010, while a total of 22,797 cases of cholera with 728 deaths and case-fatality rate of 3.2% were recorded in 2011.

“Outbreaks were also recorded in 2018 with the Nigeria Centre for Disease Control (NCDC) reporting 42,466 suspected cases including 830 deaths with a case fatality rate of 1.95 per cent from 20 out of 36 states from the beginning of 2018 to October 2018.

… More deaths

Aside from the 1,178 deaths in 23 states and the FCT earlier recorded by the NCDC, seven people were killed on Monday in Tella Town in Gassol Local Government Area of Taraba state.

The Taraba state Commissioner of Health, Dr. Innocent Vakkai, who confirmed the outbreak to journalists in Jalingo, said several others  have been hospitalised in health care centres in the area following severe stooling and vomiting.

He noted that a team of medical experts from the ministry of health have been dispatched to the area to investigate the reported cases and report back.

Also, the Chairman, Gassol Local Government, Alhaji Musa Chul, told our correspondent on phone that at least 25 people were on admission at the Tella Maternity Clinic with symptoms of cholera.

He said the council received a report from Tella on Saturday evening that three people had died from vomiting and stoolling.

The council boss disclosed that he had  detailed the local government health team to the village to investigate the incident the following day, Sunday.

What drives infection?

Speaking with Blueprint Weekend on what drives the recurrence of Cholera, a public health physician and Secretary, Nigerian Medical Association (NMA) Kogi state, Dr Samuel Akojie, said findings had shown that the disease was mostly driven by a combination of biological, social, environmental and climatic, health systems, among others.

He said there is little or no awareness of good hygiene practices in most parts of the country fuels Cholera.

Akojie added that in some cases even when individuals are aware of good hygiene practices, they lack access to soap, safe water and washing facilities they need to make positive changes to protect themselves and their community.

He said, “Without improved sanitation, a facility that safely separates human waste from human contact, people have no choice but practice open defecation.

“In the immediate environment, the exposed faecal matter will be transferred back into people’s food and water resources, helping to spread cholera.

“Again, lack of effective waste disposal or sewerage systems can contaminate ecosystems and contribute to pandemics.

“And without access to improved drinking water such as a protected borehole well or municipal piped supply, people will rely on surface water, unprotected and possibly contaminated wells, or vendors selling water of unverifiable provenance and quality.

“In Nigeria today, even in the urban areas, access to safe water remains a problem. In communities, sources are usually far from their homes.”

Akojie emphasized the need for regular hand washing as it could reduce infection by 60 per cent.

He stressed the need for the government to intensify community education on cholera, especially on how to prevent cholera, provide a good environmental sanitation system, and maintain a strong community linked-surveillance system to alert the LGA by community members and subsequent investigation of suspected cases of cholera.

‘We’ve no business recording large-scale outbreak’

In a chat with Blueprint Weekend, a public health expert Dr Francisca Oyedele said Nigeria has no business recording such a large-scale outbreak of cholera, blaming the development on the fact that the conditions that bring about the disease were still much in the country.

She said, “These conditions are poor personal hygiene, poor knowledge and unsafe behaviour by communities on how to keep good hygiene such as regular hand washing, how to boil and filter water for use, proper faecal waste disposal, poor housing with lack of toilet facilities and community hygiene hence the common practice of open defecation and lack of potable water.

“Cholera is caused by bacteria that is ingested from food or water contaminated by faecal matter.

“For food or water to be contaminated by faces, it is, therefore, a disease common where there is poor hygiene and lack of access to potable water. It is a disease of water, sanitation and hygiene.”

Attention to state, LGA panacea – Expert

While noting that the disease was more common in slums and refugee camps, including areas where hygiene and sanitation was poor and there was poor housing, Oyedele said to put the disease in check, Nigeria’s focus should be more on educating affected communities early enough on hand washing and food hygiene to reduce contamination.

“This is where the press can help to get correct and consistent information to the people and give feedback to the government.

“There is a need for the government to ensure provision of potable water across communities and good housing with functional toilets for proper waste disposal. A well-constructed pit latrine with proper safety measures to prevent flies from access to it can be a start.

“There should also be proper and good governance, using the SDGS and Goals in the National Plans as benchmarks.”

On his part, the Convener of Development Connect, a Non Governmental Organisation (NGO), Hamzat Isah, stressed the need for the government to fund and strengthen the Primary HealthCare system where a system of community disease surveillance and response can be made to work properly.

He said NCDC cannot be in every ward or in all 774 LGAs in Nigeria but can only coordinate at the national level

“The real work is at the community, wards and Local Government Areas. The NCDC and States Emergency Operation Committees are to support, coordinate and give technical assistance to these Local Government Area Emergency Response (EPR) teams.

“This is the bottom-up approach called Integrated Disease Surveillance and Response (IDSR) part of the Health System.

 “At the PHC level in the 774 LGAs as designed, there should be 774 functional Emergency Preparedness and Response (EPR) Committees of Community representatives that work through 774 Rapid Response Teams (RRTs) of technical health teams that work on outbreak prevention and response together.”

Isah regretted that little or no work was being done at the state and local government levels where sensitisation in the markets, amongst CDAs, religious places and most especially amongst schools should be carried out.

Doctor’s strike

Equally, further checks by Blueprint Weekend revealed that the ongoing strike by the Nigerian Association of Resident Doctors (NARD) was affecting response to the outbreak in the country.

Speaking on the implications of the strike, a medical doctor Michael Ukonu, who is part of the striking NARD, admitted that the strike was affecting response to Cholera.

Ukonu said the country’s health sector is in a “fragile state” and called on the federal government to ensure that promises made to health workers are fulfilled.

“No doubt the ongoing strike by medical doctors is affecting the response to the ongoing response to the outbreak of Cholera. However, if promises have been made they should be fulfilled and it should not get to the point where doctors will down tools. Nobody wants that,” he said.

Speaking further Ukonu said, “There are needless deaths. The national government needs to pay more attention to health workers as a whole, not just doctors. The developed countries have made it so easy for nurses and doctors to come to the UK, US and Canada.”

FG’s response

Meanwhile, the Minister of Environment, Mohammad Mahmood Abubakar, has said the federal government would soon inaugurate National Environmental Sanitation Response Intervention to Cholera Outbreak.

Addressing journalists on the cholera outbreak, Monday in Abuja, the minister said it has become urgent to sensitise the general public on the outbreak and efforts made by the ministry to contain the scourge.

He said as part of efforts to combat the diseases, the ministry would be flagging off the National Environmental Sanitation Response Intervention to Cholera Outbreak in Kubwa, Abuja which is currently the epi-centre in the FCT.

The minister, therefore, charged state and local governments and other stakeholders to step up their sanitation and hygiene programmes and activities to curb the spread of the disease.

He said that the ministry in collaboration with relevant stakeholders including Environmental Health Officer’s (EHO’s) in the states and local government areas would embark on nationwide intervention response activities.

Abubakar also said that the ministry had activated sanitation desks in the 36 state offices of the ministry, including the FCT, adding that the effort was for effective response to the outbreak.

He urged the head of the desks to carry out environmental sanitation activities in their various states aimed at containing the outbreak.

“The purpose of this briefing is to sensitise the media and general public on the cholera outbreak in the country and the efforts being made by the ministry to contain the scourge.

“As you are aware, Nigeria is currently experiencing a cholera outbreak in several parts of the country with reported cases of fatalities.

“The ministry had requested the EHOs in the states and local governments across the country to intensify their efforts in carrying out sanitary inspection of premises and abatement of nuisances,” he said.

 According to him, the ministry with the relevant stakeholders in the states and local government areas will embark on nationwide intervention response activities.

He said this would cover the areas such as sanitary inspection of premises/environmental health surveillance of hotspot communities.

“Sanitary inspection of schools primary and secondary in affected communities as well as training of community volunteers on safe water handling, environmental sanitation and hygiene practices.

“Also, sanitary inspection of food business premises of affected communities advocacy, sensitisation and community town hall meetings on control of open defecation practices and its health impact, among others,’’ the minister added.

Abubakar also urged all levels of government, including the commissioners for environment, across the country to step up their sanitation and hygiene programmes to control and prevent further outbreak and spread of cholera.

He assured that the ministry was committed to ensuring a clean and healthy environment for all Nigerians.