Cholera, Nigeria’s perennial scourge, which bears testimony to the deplorable hygienic conditions in the country, has struck again, with the usual devastating consequences. In Nigeria, it is a disease that kills in hundreds – sometimes in thousands – every year, even though it is curable and preventable. For instance, over 1,500 fatalities were reported from close to 40,000 cases in 2010. But cholera can, and should, be kept at bay by introducing positive changes to people’s living conditions, particularly through improved access to sanitation and adherence to adequate hygienic practices.
In this year’s epidemic, reports have it that 209 deaths have already been recorded; but with the wet season when cholera normally flourishes still very much around, it may not be possible to rule out more deaths. In what appears to be one of the most widespread in recent times, the Nigerian Centre for Disease Control has reportedly confirmed 12,881 suspected cases of the water-borne disease across 22 states of the country.
So far, the worst hit areas have been in the North, particularly Zamfara, with 228 cases; Katsina (122 cases) and Kano (119 cases). But states such as Kaduna, Ebonyi, Yobe, Adamawa, Borno and Ekiti have also reported cases ranging from one to 24. In a polity of 36 states, an outbreak in 22 states is already an emergency that calls for prompt response by the authorities, not only to stop further spread but to curb future outbreaks.
The casualty figure may not be alarming to Nigerians who have in recent times become accustomed to seeing people die in droves from either Fulani herdsmen attacks, Boko Haram onslaughts or other man-made disasters; but in climes where a high premium is placed on human lives, it is serious enough to cause a major disquiet. It is supposed to be a major issue that should continually engage the attention of the government until it has been effectively tackled.
Cholera is an acute diarrhoeal infection caused by the bacterium, vibrio cholerae. An extremely virulent disease, it is transmitted through direct faecal-oral contamination or ingestion of contaminated food or water. It is capable of killing a normal adult within hours if there is no urgent medical intervention. An acute case of cholera infection is characterised by profuse watery diarrhoea, vomiting, leg cramps and sometimes kidney failure. The heavy loss of body fluids could easily result in shock and death, in the absence of medical assistance.
Experts advise that, in every case of cholera, medical assistance should be sought from qualified sources; but pending the arrival of such help, efforts should be made to replace lost fluid through a process of oral rehydration. This, basically, involves preparing a solution of water, salt and sugar, which is administered on the person. Although usually administered orally, as the name suggests, it could also be done intravenously in severe cases.
Conditions in Nigeria favour regular cholera outbreaks. Usually common in slums and overcrowded areas, the country boasts a good number of such places, both in cities and in towns; and with the advent of Boko Haram extremism and Fulani herdsmen attacks, there has also been a mushrooming of internally displaced persons camps, especially in the North-East of the country and the Middle Belt. More than two million IDPs are currently living in squalid conditions in those areas.
But cholera is a global phenomenon. The World Health Organisation puts the number of cholera cases worldwide at between 1.3 million and four million yearly, spawning between 21,000 and 143,000 deaths. For instance, in Congo DR, where about four million IDPs have produced massive humanitarian challenges, the WHO said more than 500 fatalities were recorded as of September last year. An online report by The Guardian of London has it that the outbreak in Yemen, which started in 2016, became the “largest and fastest-spreading” in modern history; it was expected to hit the one million mark by the end of last year.
In many of the communities in Nigeria, open defecation remains the only known means of faecal waste disposal. Since vibrio cholerae multiplies in the intestine and can stay dormant for years, the faeces of a carrier are usually contaminated. Open defecation offers opportunity to release the bacterium into the environment. Through this source, contamination of farm products, especially fruits, is common. From there, human beings are infected by the contaminated food, if not properly handled.
The situation is further compounded by floods that usually accompany the rainy season. Many Nigerians still drink from shallow wells and open rivers or streams, and it is easy for floods to wash the bacterium into these sources of drinking water. Flooding also causes septic tanks to contaminate water sources. This is why an upsurge of cholera infection is usually witnessed during the rainy season.
There is no gainsaying the fact that cholera can be contained by tackling the conditions that favour its outbreak and spread. The government has to start by providing basic amenities such as potable water and ensuring better ways of disposing of sanitary waste. The government has to understand that water and sanitation are fundamental human rights under the United Nations General Assembly Resolution 64/292 of 2010. In India, the country with the largest number of people practising open defecation, the adoption of Swachh Bharat Mission, a movement that promotes sanitation, has brought about a mass change of attitude towards open defecation.
Oral vaccines could be used to attack the bacterium in carriers. Government agencies must ensure that every house built has a standard toilet and a sewage system. There should also be response teams that could act in times of emergency. At the personal level, general cleanliness, especially washing of hands with clean running water after visiting the toilet is very important. It is also important to wash hands after returning from an outing, particularly if it involved shaking hands with many people. Food should be protected from flies which could be a source of infection.