Nigeria: Open Defecation - a Nation Under Threat of Epidemic

A young boy sits over an open sewer (file photo).
1 August 2019

Ayodeji Ake writes that with Nigeria ranked second in the world for practicing open defecation, which signifies that 47 million persons translating to 24 per cent of the population, are engaging in the anomaly, Nigerians are at the threat of an epidemic outbreak.

To many, open defecation might not be anything new but its attendant effect of epidemics is not. Therefore, it was with alarm that the news by the United Nations International Children Emergency Fund (UNICEF) that 761 local governments (LGAs) out of the total of 774 LGAs were at risk of epidemics was received.

According to world rating, 47 million Nigerians practice open defecation, thus, making it the second nation in the world practicing such anomaly.

'Dustbin Estate' is a popular area in Ajeromi Local Government, Ajegunle, Lagos State. It is also one of the 761 LGAs to look out for. It's a long and broad street marred with heaps of refuse dumps, located beside a canal, with an estimated population of over 2000 residents.

'Dustin Estate' is made up wooden house structures with no toilet and bathroom, consequently, the residents defecate in the open beside the canal, thus exposing them to health risks such as transferable infectious diseases, diarrhea, typhoid and cholera, and viral infections.

One of the residents who spoke to THISDAY on anonymity said life in Dustbin Estate is horrible and they hope for government's intervention. She explained that the area is often messed up with refuse and most importantly when it rains, the canal gets filled up as past defecations and heaps of refuse from the canal pops up and litters the environment.

"There is nothing to say, you can see where we live. I'm a trader. Problems we encounter are the refuse here and the carnal. People refuse to come patronise us because of our environment. Only those that live here patronise us, which crumbles most business. We want the government to come and help us clear our road and do something about the canal," she said.

Also speaking on anonymity, another resident said they have for a long time cried out to the government for help.

"Here we pay rent and still we don't have toilets and bathrooms which is why we defecate out there beside the canal and we try to make a small place out there to take our bath. We are tired of this environment but the government have refused to help us. They always remember us during election campaigns and they make empty promises," he lamented.

Meanwhile, breaking down the statistics, UNICEF has revealed during a media dialogue in Ibadan, that out of the 774 LGAs in Nigeria, only 13 states (Cross River, Benue, Jigawa, and Bauchi have six, two, four, and one local governments respectively) were certified open defecation-free with South-west taking 20.4 per cent.

Health Risks

As researched by health experts, the health risks in context of open defecation are those associated with human excrement linked infectious diseases. Infected human excreta contains several harmful organisms that are associated with a number of health problems.

Virtually, one gram of infected human excreta can contain a variety of microbes which includes 106 pathogenic viruses and infectious viruses, 106 to 108 bacterial pathogens, 103 protozoan cysts and 10 to 104 helminthes eggs.

Inappropriate human waste disposal also increases the risk of exposure to these pathogens, which can pose significant health risks such as transferable infectious diseases, diarrhea, typhoid, cholera, and viral infections. Human excreta is with a tendency to spread through eye discharge of infected person.

Open defecation is an issue that can affect everyone but women are often at more risk of experiencing violence and multiple health vulnerabilities.

Social Economic Effect

According to UNICEF's recent report, Nigerian government loses N455billion annually due to poor sanitation and with a third of that cost as a result of open defecation, in which Nigeria ranks second globally after India.

It added that in the latest Water Sanitation and Hygiene National Outcome Routine Mapping (WASH NORM) survey, 47 million people, which translates to 24 per cent of the population, practice open defecation.

In its 2019 latest bulletin which champions 'Clean Nigeria: use the Toilet', UNICEF disclosed that more than 100, 000 children under five years of age die each year due to diarrhea, of which 90 per cent was directly due to unsafe water and sanitation.

Epidemic in Lagos

With Lagos state, centre of excellence and a commercial hub with 20 local government areas with estimated population of over 21 million, shortlisted as open defecation area, wide chances of diseases like; diarrhea and cholera will be on the rise.

As investigated by environnewsnigeria, areas in lagos state with high cases of open defecation includes; the Lagos-Badagry, which has become easily accessible for defecation by unpatriotic residents. Areas without street lights b and market places like; Ijora,Iganmu Flyover near the National Theatre, Iganmu, through Orile to Mile 2 Bus Stop, daily open defecation activities of about 15 people is a common sight as researched. The Alakija Bridge, Trade Fair Bridge, Abule-Ado, Iyan-Iba, Maza Maza, all on the expressway, and the popular Agboju Bus Stop, which is on the second gate of Festac town, are worst hit by open defecation, among others.

With increased volume of defecation areas in Lagos, residents are prone to transmitted diseases most especially diarrhea and cholera.

Curbing Disease Outbreak

Curbing disease outbreak from open defecation recently is on the high side in Lagos. Lagos-based Epidemiologist, Dr. Lawal Bakare, told THISDAY that poverty and housing need to be put into consideration.

He said it's important that houses in Lagos have adequate toilets and facilities such as water and soap for hand washing to prevents diseases from feces.

"As a country we already have an administrative opportunity of fixing these problems. There is a big issue of poverty and housing. However, there are also issues of housing and home inspection. It's surprising that there are some houses that don't have toilets; some have toilets but do not have enough to cater of the tenants. If you go to some schools, they will have two water closets for over 200 students. Some of these are within the back end of an existing environmental health service to inspect and enforce that toilets are enough. We need to work as a country that access to toilet is guaranteed. Nigeria has policies on sanitation and it's as old as 2004.

"Those days in Lagos we have the town councils but today they are called urban planners who also have a role to inspect houses for livability and most importantly, make toilets available. And good enough, our governor has been channeling efforts towards environmental pollution.

"Another thing to be considered is that, a house may have a toilet but lacks facility in terms of water, which automatically means it's not for use. So inspecting toilet for physical structure is not enough but also to ensure it has water and soap for people to wash their hands, that will enable users" he said.

Epidemic Preparedness

On epidemic preparedness in Lagos State, he noted that although the state has both federal and state-owned laboratories for detection and test on sampling, but because of population dynamics, there is need for annual review and improvement.

He said: "In terms of epidemic preparedness, I think Lagos State is one of the best in Nigeria if not in West Africa. As we speak now, Lagos has what it requires in preparation for any outbreak. Outbreak preparedness can be broken to components; we first look at it from the ability to detect an outbreak. Lagos has an international airport and seaport. So if a state wants to curb an outbreak, it's best they have mechanism that will help them in detecting.

"A state should have a laboratory where they can take their samples and test and Lagos has the capacity. It's either in the federal laboratory, Lagos State University Teaching Hospital (LUTH), NIMA. The state owned laboratory on special disease hospital in Yaba, where there are currently on bio-banking, and if we also look at the facility of the state owned teaching hospital and other smaller facilities and the NCDC lab. There are also private laboratories who are trying advanced testing. The capacity is there but however, there are still rooms for improvement".

Bakare who emphasised on awareness and healthy literacy to keep the people inform said, "One of the key areas that needs improvement is the community perception and awareness. This is because what can lead to outbreak is not totally known to everybody. Sometimes what people eat maybe unsafe but because they have been eating that same food for a long time, they wouldn't know if it is harmful or not. So, there is need for amplified awareness in a way that it won't cause panic. There should health literacy that will caution people.

"Overtime, Lagos has had the opportunity of tackling the outbreak of Ebola which also helped the state to build capacity in terms of human capital. The Infectious Disease Hospital in Yaba is another high-level infectious disease centre which caters for highly infectious diseases. The centre also serves as a quick response facility whenever there is a case that needs urgent response. Despite all these, there is also need for improvement because the scenario for Lagos is always changing because the population dynamic is complex which also means that the system should be dynamic too towards preparedness."

Bakare further noted that the cases of open defecation should be channeled towards curtailing contaminated food and water, which easily could lead to widespread of diseases.

"Lagos is like a hub for migration in Nigeria. Talking about open defecation and health risk factors, open defecation is a case on itself. Open defecation can be related to poverty. The health risk of open defecation is diseases that are transmitted from the feces to the mouth. There are so many diseases that can be transmitted but the ones that are seriously public spoken are usually the diarrhea disease and especially cholera because of children that are under five. Not that adults don't die from diarrhea but chances for children under five is very high.

"The issue of open defecation is the direct and indirect implications. Surface water that is contaminated may flow into food people want to eat, it could also flow into their storage water from the pump. There are water pipes passing through gutters. The real health factor that we should worry about is the food contamination and water contamination" he said.

Epidemic Funding

One of the key factor in epidemic preparedness is funding. According to Bakare the Lagos State Government over the years has endeavoured to increase funding for epidemic preparedness and prevention, yet there is still need for improvement.

He said the current administration has seen priority in environmental sanitation to prevent diseases in the state.

"That's what we have been seriously working on in Lagos State. Sometimes you will discover that there is funding but sticks to one areas. For example, immunisation may be getting a lot of funding, while sanitation may not be getting enough. And the funny case is that there are sine areas that are hidden. So I believe a lot of thing should be put in place which we are currently on to ensure proper funding of epidemics in Lagos state, considering the state budget.

"As it is today, we will continue to push for state commitment because no matter how much Lagos State is spending today, there will always be the need to spend more. And I'm also sure that Lagos is far ahead of other states. Lagos has hired more doctors and other health officers more than other states," he added.

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