A few months after a major cholera outbreak between June and July this year that killed hundreds of Nigerians, over 25 people have been confirmed dead in a fresh outbreak in Adamawa and Evonyi states. BENJAMIN SAMSON in his report seeks reasons for the reoccurrence of the disease.
Fifteen people were confirmed killed in Adamawa state in a fresh cholera outbreak. The figure could rise as no fewer than 300 other affected people are still in hospitals. The epidemic has so far ravaged four local government areas of the state.
Confirming the outbreak, in Yola, the Commissioner for Health and Human Services, Felix Tangwami, said seven of the casualties were recorded at a government facility while the eight others were recorded in communities.
He disclosed that the four affected local government areas include Yola South, Yola North, Fufore and Girei.
Ebonyi
Likewise, 10 people have also been confirmed dead in another cholera outbreak in Ndibokote village, Ezza Inyimagu in Izzi local government area of Ebonyi state in the South-east region of the country.
The outbreak, according to a statement by the Public Relations Officer of the state Ministry of Health, Lucy Anyim, claimed the lives of men, women and children, especially a nursing mother who left a nine-month-old baby behind in the epidemic that was said to have started on Monday, September 23, 2024.
Anyim quoted the Commissioner for Health, Dr. Moses Ekuma, to have confirmed the deaths during a rapid response.
Reoccurrence
Nigeria had earlier in June and July this year witnessed outbreaks of cholera in many states across the country.
According to the data from the Centre for Disease Control (NCDC), the number of deaths from the cholera outbreak this year as of August was 156.
Similarly, an analysis of the weekly cholera situation reports released by the NCDC between 2021 and 2024 indicates that no fewer than 4, 364 people have died out of the 139, 730 Nigerians suspected to have been infected with the disease across the country in the last four years.
What the experts are saying
Speaking with this reporter on reoccurrence of the disease across the country, an epistemologist, Dr. Zeyanu Abdulkadir, said what this means is that cholera is a communicable disease that always lies in wait ready to pounce once the situations that conducive to it apply.
He said, “Cholera has been a recurring problem in Nigeria for decades, with significant outbreaks recorded throughout the country’s history, often linked to poor sanitation, the lack of clean water, and displacement due to conflicts or natural disasters.
“Given its recurrence history, Nigeria should have developed better ways to prevent or mitigate its impact. We should have learned numerous lessons from previous outbreaks that would position us well to tackle this epidemic. Unfortunately, this has not been the case as it appears we have not learnt lessons from previous outbreaks. The factors contributing to these outbreaks persist, and little or nothing has been done about them.
“We only react when faced with an outbreak. We implement immediate measures, and once the outbreak subsides, we revert to our old ways, neglecting the long-term actions necessary to prevent outbreaks. How can many cities in Nigeria lack clean, safe pipe-borne water for public use?”
Also, the convener of Access to Vaccines, a non-governmental organisation (NGO), Ijeoma Ajeoro, said, “Clean water is a luxury in Nigeria. The middle-class can afford the so-called ‘pure water’ or bottled water that is anything but pure, given its sources and the poor hygienic conditions under which some of them are produced. The working class and the poor still consume highly contaminated water, and many need to be educated on how to treat this contaminated water. The inevitable outcome is cholera outbreaks.
“Many poor Nigerians cannot afford safe water. One liter of bottled water costs about N300. For a family of six, consuming at least three liters per day, the family would spend N3, 600 per day and about N108, 000 per month on drinking water alone. As of my last check, the minimum wage in this country has just been increased to N30, 000, excluding the cost of cooking water and other uses. It’s no surprise that there is a persistent and recurring outbreak of waterborne diseases like cholera.
“It is my opinion that improper waste disposal practices have significantly contributed to the recent cholera outbreak in Nigeria. Contaminated water sources due to inadequate waste management have facilitated the spread of Vibrio cholerae bacteria, leading to increased cholera cases across various communities.
“Improper waste disposal practices can lead to numerous diseases apart from cholera. They can cause typhoid fever, dysentery, hepatitis A, respiratory infections, skin infections, and vector-borne illnesses like malaria.”
Conflicts
In the same vein, an Adamawa state-based virologist, Dr. Bukus Taru, said multiple factors contribute to the recurring cholera situations in the state.
He said, “Cholera is a severe diarrhoeal disease caused by the bacterium Vibrio cholerae, which can lead to dehydration and death if not promptly treated. Nigeria has faced recurring cholera outbreaks, often exacerbated by conflicts, displacements and natural disasters.
“A multitude of factors contributes to the persistence and severity of these outbreaks. First, conflicts and displacements exacerbate the issue. On-going conflicts, particularly in the North-east region, have displaced millions. Internally Displaced Persons (IDPs) camps often lack proper sanitation facilities and clean water, thus creating ideal conditions for cholera to spread.
“Secondly, the rainy season (usually from May to October) frequently leads to flooding, contaminating water sources and increasing the risk of cholera. Flood-prone areas and communities living along riverbanks are particularly vulnerable.
“Thirdly, while urban areas might have better health care infrastructure, rural communities often lack health care, clean water, and sanitation infrastructure. This disparity increases the disease’s impact in less accessible regions.”
The expert said further that, “Nigeria’s health care system faces significant challenges, including limited resources, inadequate infrastructure, and shortages of medical supplies and personnel. During outbreaks, these weaknesses hinder effective response and treatment.”
On the efforts being made by Adamawa state to curb the current outbreak, Dr. Taru said, “Current efforts in affected areas are primarily focused on seeking medical solutions rather than a combined approach.
“If people continue to consume unhygienic food and water, the risk of infections increasing to epidemic proportions and disease strains becoming more resistant is high. A combination of vaccination, access to potable water, food security, improved hygiene, enhanced nutritional value, and extensive public awareness is necessary.
“We must combat this cholera outbreak as if it were a war. Each of us has a role to play in this fight, from maintaining personal hygiene to advocating for better public health policies.”
Govt’s response
Tangwami said the Adamawa state government in partnership with development partners is already on top of the situation.
He said “so far the state government has secured 200, 000 cholera vaccines from UNICEF, isolating patients, administering treatment on the patients and conducting the required laboratory tests to ascertain the organism causing the acute watery diarrhea as part of the containment measures.”
He added that so far the proactive measures taken by the government “has substantially helped in curbing the spread of the epidemic in the state, and urged families to invest heavily in personal hygiene and sanitation as their contributions in tackling the epidemic.
The commissioner also said the delay in announcing the epidemic “stems from the fact that best practices have to be employed in isolating the organism causing the acute watery diarrhoea before announcing it.
According to the commissioner, announcing the epidemic without confirmation was a gross ethical malpractice which portends severe consequences on the state.
He said, “We have received results of the samples sent to the NCDC for confirmation; as to what we are dealing with, it is Acute Watery Diarrhea or Cholera. Unfortunately, out of the 38 samples sent to the National Reference Laboratory (NRL) in Abuja, 30 samples returned positive for cholera, six came back negative, two still on-going isolation and 12 still pending.
“With these results, therefore, I want to confirm to the public that there’s an outbreak of cholera in Adamawa state, and people should be cautious of their movements, interactions, personal hygiene, and the source of water they drink.
“So far, no fewer than 308 people have been admitted, 244 treated successfully and discharged; 15 deaths were recorded, six at the facility and six at home.
“However, the public are assured that the government through its health workers is doing everything possible, by the grace of God, to contain the situation as done in the past with other similar outbreaks in the state.
“We enjoin the people to continue to pray for us as we face this monster; they should remain calm and not panic, cooperate with health workers as they go around giving professional advice on how we should conduct ourselves.
“The government has given all the necessary support to ensure that this is prevented from spreading to other areas. We shall continue.”
Ebonyi
Also, Dr. Ekuma enumerated the efforts made by the Ebonyi state government to bring the condition under control and appreciated the Governor Francis Ogbonna Nwifuru for approving funds for the procurement of medical commodities for the outbreak.
“Three treatment centers including Iziogo health center, Sudan Mission, Onuenyim and Ndibokote villages have been established in the affected areas,” he said, advising the people to take precautionary measures to prevent the spread of the disease.
Vaccination/treatment
A public health physician at the Federal Medical Centre, Keffi, in Nasarawa state, Dr. Istifanus Kauna, said, “Vaccination offers immediate protection against cholera, reducing the likelihood of outbreaks and saving lives while also complementing long-term solutions.
“We must address the root causes of the issue – severe poverty, hunger, and the lack of clean water in 34 of the country’s 36 states. These factors make people more susceptible to outbreaks like cholera.
“To break this cycle, we need targeted policies and initiatives to protect vulnerable populations while expanding health and social welfare services. It’s not just about treating the symptoms but addressing the underlying issues to prevent future outbreaks. It is also time we ramp up public health education as a crucial strategy for combating cholera.
“Apart from educating, it empowers people to take preventive measures and change behaviours that lead to a reduction in the spread of epidemics.”
Surveillance
A researcher at the Center for Disease Control and Prevention, University of Nigeria, Nsukka, Bamidele Ademola, urged the federal government to mainstream surveillance in tackling cholera epidemic in the country. He said surveillance system is the first line of defence in managing outbreaks
He identified several key components of an effective surveillance system to include early detection, data analysis, resource allocation, and public communication.
“Analysing data helps understand the spread and impact of the disease, identifying hotspots, tracking the progression of the outbreak, and predicting future trends.
“With accurate data, resources such as medical supplies, clean water, and sanitation facilities, as well as human resources like healthcare workers, can be directed to where they are needed most.
“Effective communication with the public is essential to keep people informed about the outbreak and preventive measures, reducing panic and encouraging practices that limit the spread of the disease,” he said.