There are at present jitters across the country over an outbreak of cholera. It first surreptitiously stole into Lagos as a few isolated cases. It then began to slither into homes. Now, lancing menacingly through other states, it is fast developing into a national hysteria.
At the last count, according to the report from the Nigeria Center for Disease Control (NCDC),from January1 to June11, 2024, over 1,141 suspected cases of cholera, 65 confirmed cases, resulting in over 30 deaths, had been reported in 96 local government areas in 30 states in the country.
Reeling off its own data, the Lagos State Ministry of Health reported that as at June11, 2024, it had recorded 350 suspected cases in 29 wards across multiple local government areas with 17 cases confirmed cases and 15 fatalities. But by last Thursday, about 10 days after, the suspected cases had risen to 401 and the death toll to 21.
According to the Special Adviser to the Lagos Governor on Health, Dr. Kemi Ogunyemi, Lagos Island, Kosofe and Eti Osa local governments recorded the highest figures. The fatality level was attributed to severe dehydration caused by delayed presentation. She said the rise in the death toll was not surprising because of Eid-el-Kabir festivities.
According to the World Health Organization (WHO), cholera presents generally as an acute diarrhoea infection usually caused by the ingestion of food or water contamination with the bacteriam Vibrio cholerae. It usually causes severe watery diarrhoea, which can kill within hours if left unattended to.
The identified cholera strain that is ravaging homes now, according to the Lagos State Commissioner for Health, Prof. Akin Abayomi, is the strain which is “highly aggressive and contagious with potential for widespread dissemination.”
Prof. Abayomi said in a post on his X, that laboratory investigation had confirmed the strain to be cholera sub-type 0-1, which is associated with more severe diseases. He said the common symptoms of the disease include severe diarrhoea, vomiting, dehydration, rapid heart rate, low blood pressure, thirst and muscle cramps.
“Symptoms can appear within few hours to five days after infection,” the commissioner explained. He identified the common causes as contaminated water and food, adding that transmission is common in areas with inadequate water treatment, poor sanitation and insufficient hygiene.
This is precisely the crux of the matter. This is our bother. Indeed, the high proportion of urban slums dotting many of our cities and the inveterate unhygienic practices among the vulnerable city-dwellers are veritable breeding grounds for a highly contagious disease like cholera. One of the blights of urban slums is the tendency to cause strains, wear and tear to public infrastructure.
In some of these slums, houses are built without providing toilet facilities. And where a modicum of toilet facilities exists at all, many of them are mainly latrines, pit toilets. In most cases, they ooze out putrid stenches because they are largely unkempt.
In some of these slums, the dwellers practise what they call ‘shot put,’ a practice whereby a person defecates openly on a piece of paper and throws the obscene wrap over the wall into the next space where flies and maggots feast on it to the detriment of environmental health.
Worse still, many urban centers across many states lack the provision of decent, public water system. In such instances, private house owners resort to digging boreholes to provide water for themselves and their tenants. This practice is actually pervasive in many of our cities, thus turning Nigeria into a borehole drilling capital of the world.
Many ‘emergency’ landlords among the vulnerable city-dwellers have no means of providing water. So, they do not even bother to, leaving their equally abjectly poor and hapless tenants at the mercy of shylock water merchants in the neighborhoods who ration water for them at outrageous costs.
The quality of hygiene in this kind of setting is better left to the imaginations. All these go on in spite of the prevalence of health control agencies who fail to enforce regulations, notably because they are manned by either incompetent personnel or competent personnel that are indolent or compromised. These are dingy settlements that are highly susceptible to cholera infections and rapid spread.
The big bugaboo is the parlous state of health care in most states, including the Federal Capital Territory(FCT). Many of our government hospitals lack adequate and modern medical equipment and quality drugs. The few private medical institutions that are fairly good are hardly affordable to the larger population.
Our leaders, rather than developing our medical institutions and facilities to address modern needs, prefer to junket abroad at the slightest headache. This is one of the reasons behind the increasing emigration of our best brains in the medical and other fields in quest of better fortunes.
The appalling state of health care in Nigeria is further seen in the current doctor-to-patient ratio. The World Health Organization (WHO) puts the standard ratio at 1-to-600. But Nigeria’s ratio of 4-to-10,000 falls far below the global standard. In other words, only four doctors are available to treat 10,000 Nigerians who need medical attention per time.
The dearth of qualified medical personnel has partly contributed to the alarming deterioration in the health care delivery in the country. It is estimated that at least 2,000 medical doctors leave Nigeria yearly and no fewer than 5,407 Nigerian trained doctors are currently working with the British National Health Service in the United Kingdom alone.
Other countries poaching our trained doctors and other medical personnel like pharmacists, nurses, medical laboratory scientists, among others, include the United States of America, Canada, Saudi Arabia, United Arab Emirates, Australia, Qatar, among others.
The President of the Nigerian Medical Association (NMA), Dr. Francis Faduyile, has identified “a high rate of insecurity, unemployment, low remuneration, bad roads and poor health care system” as among the reasons doctors are leaving the country in search of better fortunes.
He lamented that out of the 75,000 Nigerian doctors who registered with the NMA, over 33,000 have left the country. This is the deplorable level our sub-medical sector, that is expected to manage the cholera outbreak should it escalate into an emergency or epidemic level, has sunk. It is a scary bugger!
As the health authorities are still monitoring the cholera outbreak with a view to declaring an emergency should a push become a shove, we believe that the heavy investments of the Coalition Alliance Against COVID-19 (CACOVID) in medicare during the COVID-19 pandemic should come in handy now. CACOVID was the initiative of the Bankers Committee, comprising the Central Bank of Nigeria (CBN), the Deposit Money Banks (DMBs) and some key stakeholders in the private sector, which came together to set up the alliance in March, 2020 during the COVID-19 lockdown.
The alliance was able to raise about N39.6 billion through donations, but they ended up committing a whopping N40 billion to building 39 isolation centers across the 36 states of the federation, including the Federal Capital Territory (FCT) and equipping them with world class medical facilities that tremendously aided the government in managing the pandemic then.
This was in addition to providing food palliatives for 1.7 million vulnerable Nigerians through the state governments, among other other things CACOVID did, a bold initiative that earned members of the alliance rare commendations from WHO and the United Nations (UN).
Since virtually all the 36 states and FCT benefited from the CACOVID initiative, it is expected that the state governments would by now have developed those world class medical centers in their domains into model medical havens that could effectively manage any medical emergency, should the cholera outbreak that has already slithered into 96 LGAs in 30 states at the last count, graduate into an epidemic.
The hysteria about the disease coincided with the Eid-el-Kabir festivities and the usual public carousing that went with the season, prompting fears of possible spread. And as schools were resuming last Wednesday after the long Sallah break, the ministries of education and health in many states have rolled out guidelines in form of advisories on how to contain further spread, especially given the high level of camaraderie that normally radiates among pupils/students.
The kernel of most advisories to schools includes the need for food handlers to maintain a high level of hygiene to avoid contamination; making available oral rehydration salts to school clinics or bays to manage dehydration cases promptly; ensuring hand washing facilities, including soaps, in strategic places in schools.
Others include the need for parents to daily monitor their children’s health for possible suspected cholera symptoms, keep them at home should they exhibit any symptoms and seek medical advice; ensuring pupils/students carry hand sanitizer and encouraging them to wash their hands frequently, among others.
There are also general guidelines for members of the public on how to avoid being victims. The 14-point medical advisory developed by Prof. Tinuade Ogunlesi are particularly useful and comprehensive.
Members of the public are enjoined to wash their hands frequently with soap or use alcoholic hand rubs; not to eat outside their houses if the food and meat are not hot; not to drink water or juices from open containers like bowls or cups; ensure the source of the water they drink is clean, safe and not likely to have been contaminated; avoid locally brewed street drinks like Tiger nuts, Pito and street herbal mixtures.
Others include the need to wash all fruits and vegetables thoroughly before eating and avoid fruits they cannot wash before eating; they should avoid dirt because in the case of cholera, it (dirt) kills, among others.
Parents, teachers and Nigerians generally are admonished to religiously observe those guidelines to avoid being caught napping because cholera, according to experts, kills fast!
