The cholera epidemic, which has been silently growing nationwide since beginning of the year, is currently taking its toll across communities in the country, with 2,035 deaths, 58,698 suspected cases and a case fatality ratio, CFR, of 3.5 per cent reported in 305 local government areas in 23 states and the Federal Capital Territory, FCT.
The World Health Organisation, WHO, describes cholera as an acute diarrhoeal infection caused by eating or drinking food or water contaminated with the bacterium, vibrio cholerae and remains a global threat to public health.
It also described the disease as an indicator of inequity and lack of social development.
Nigeria is one of the countries consistently hit annually. Investigations by Vanguard showed that although the NCDC reported 23 states, almost every state has reported one case or the other.
As the situation gradually worsens, Minister of Environment, Mohammad Abubakar, and Director-General of the NCDC, Dr Chikwe Iheakweazu, have warned that Nigeria will continue to experience large cholera outbreaks in the absence of clean water, poor sanitation practices and open defecation.
But in a reaction, President of the Nigerian Medical Association, NMA, Professor Innocent Ujah, charged the Federal Government to take immediate steps towards containing the disease, saying Nigeria created the environment for the diseases to thrive.
Cholera ravaging 23 states, FCT -- NCDC
Disclosing the development in its weekly epidemiological cholera situation report 10, Epi Week 33: 16 - 22 August, 2021, the Nigeria Centre for Disease Control, NCDC, listed affected states as Benue, Delta, Zamfara, Gombe, Bayelsa, Kogi, Sokoto, Bauchi, Kano, Kaduna, Plateau, Kebbi, Cross River, Nasarawa, Niger, Jigawa, Yobe, Kwara, Adamawa, Enugu, Katsina, Borno, Taraba and the FCT.
Although Bauchi State has recorded the highest number of suspected cases (16,217) compared to 8,620 in Jigawa State, the agency observed that more deaths, 600, had occurred in Jigawa State, compared to 219 in Bauchi.
The 10 most affected states, the agency noted, are Bauchi with 16,217 suspected cases and 219 deaths, followed by Jigawa with 8,620 cases and 600 deaths; Kano (8,605, 231); Sokoto (5,352, 209), and Zamfara (4,234, 65). Others are Katsina (4,102, 144); Kebbi (1,965, 136); Niger (1,724, 109); Kaduna (1,432, 116); Plateau, (1,430, 19).
In the last one week, according to the NCDC, 83 LGAs in 12 states reported 3,098 suspected cases, including Bauchi (1,145), Katsina (691), Zamfara (454), Yobe (216), Sokoto (196), Jigawa (187), Kano (80), Niger (79), Borno (30), FCT (11), Adamawa (6) and Kebbi (3).
Of this number, there were 35 rapid diagnostic tests (RDT) confirmed cases from Katsina (14), Yobe (7), Adamawa (6), Zamfara (4), Borno (2), Jigawa (1) and FCT (1). Also, 13 culture confirmed cases are from Yobe (6), Adamawa (6) and FCT (1), the report stated.
Although the NCDC confirmed that as at midnight of August 27, 2021, there was a 44 per cent decrease in the number of new suspected cases from 5,476 the previous week to 3,098 currently, it stated that in the week under review, 63 deaths were recorded from Katsina (19), Bauchi (16), Niger (7), Zamfara (6), Jigawa (4), Sokoto (4), Borno (4), Yobe (1), Kano (1) and Adamawa (1) states. Bauchi with 1,145 cases, Katsina (691) and Zamfara account for 73.9 per cent of the cases recorded within the week.
Children, 5-14yrs old most affected
The agency also said that of the suspected cases since the beginning of the year, the age group 5-14 years has been most affected for both male and female, and of all suspected cases, with 51 percent males and 49 percent females. On Sunday, the Lagos State Government alerted residents about the possible outbreak of the disease in the state, calling for wholesome hygienic practices.
The State Commissioner for the Environment and Water Resources, Tunji Bello, admonished residents not to wait for cholera outbreak before taking preventive action or measures.
As of the 32nd week, a total of 1,999 samples had been collected with positive cases as follows - 314 RDT positive only; 113 culture positive. The test positivity rate (TPR) for laboratory confirmation by culture was 5.7 per cent, the NCDC confirmed.
35 deaths in Borno
On Monday, 35 people reportedly died of the disease within two days in Pulka community, a town housing Internally Displaced Persons, IDPs, in Borno State.
Chairman, Gwoza Local Government Area of Borno State, Prof. Ibrahim Bukar, who confirmed the death toll said most sources of water in the destroyed border communities have been polluted with corpses, and chemicals unfit for human consumption.
"My area, Pulka, has been affected by diarrhoea and vomiting. We have lost 35 people within two days and over 156 are on admission right now. This is attributed to poor nature of water. With over 100,000 households, Pulka is over-populated like several other host communities where IDPs are kept in most northern local government areas of the state.
144 die in Katsina
Although the NCDC reported 2,035 cases, data from the Katsina State Government showed that a total of 2,100 persons had been hospitalised, while death toll rose from 75 to 144 in the current week.
The State Commissioner for Health, Engr. Yakubu Danja, who confirmed this to Vanguard, said the outbreak had affected 31 local government areas of the state.
Kaduna records 132 deaths
In the preceding week, the NCDC recorded 1,421 cases in Kaduna State. However, the state government confirmed that 1,665 cases have been recorded within the last five months in 19 LGAs of the state. Health Commissioner, Dr. Amina Mohammed Balonih said the disease has killed 132 persons till date.
"We treated 842 and discharged them, while we still have 14 active cases now on treatment," he disclosed. We identified a secondary health facility in each of these LGAs for management of the disease while all patients had been evacuated to these facilities and are being managed. "
800 suspected cases in Nasarawa
In Nasarawa, the state government said 800 cases had been recorded across the13 LGAs of the state. Director of Public Health in the state Ministry of Health, Dr. Ibrahim Alhassan, explained that some of the 800 confirmed cases, had been treated and discharged, even as he blamed the outbreak on open defecation.
13 deaths, 500 cases in Niger
In Niger State, more than 500 cases were recorded in at least 10 LGAs with 13 lives lost since the outbreak about a month ago. State Director of Public Health, Dr Ibrahim Idris said the deaths occurred at the early outbreak of the disease. Three more lives have been lost to the ailment in Sofa village, Lavun LGA.
483 cases, 11 deaths in Yobe
There were 483 cases and 11 deaths in Yobe state, according to the Director, Disease Control of the state Ministry of Health, Dr. Umar Chiroma. Vanguard learnt that the outbreak hit parts of Damaturu and Potiskum LGA with several casualties.
195 cases, 20 deaths in Borno
In Borno State, NCDC report showed that 195 cases and 20 deaths have been recorded. The state Commissioner for Health, Juliana Bitrus said cases were recorded in Hawul, Kaga, and Gwoza LGAs of the state.
In Hawul communities, eight people died of the disease, while two also died in Kaga, with another reported case in Pulka town of Gwoza LGA where one person died with 23 others infected and are currently receiving treatment from our Response Team with support from officials of the Public Emergency Operation Centre (EOC).
28 die as 127 cases reported in Kogi
In Kogi, the NCDC reported 127 cases and 26 deaths, but the state health authorities confirmed 28 deaths, according to the Chairman, Kabba/Bunu local government council, Moses Olorunleke
Taraba records 46 cases, 5 deaths
In Taraba State, a total of 46 cases and 5 deaths have been recorded even as Vanguard investigations showed the outbreak is gradually taking its toll in parts of the state.
With open defecation, poor sanitation, absence of clean water, large outbreaks will keep recurring - NCDC DG
In a chat with Vanguard, Director-General of the NCDC, Dr Chikwe Ihekweazu, said with practice of open defecation and absence of clean water and proper sanitation Nigeria will continue to experience a large outbreak of cholera.
Ihekweazu said over the last five years, Nigeria had significantly improved its surveillance and diagnostic capacity for the prompt detection of infectious diseases due to significant investments in establishing laboratories across states.
"For cholera, this means improved access to clean water, sanitation and hygiene infrastructure and practice across all states. In the absence of clean water, proper sanitation and where practices such as open defecation are prevalent, we will continue to experience large outbreaks of cholera.
"The NCDC has activated a multi-sectoral and multi-disciplinary National Emergency Operations Centre (EOC) to ensure a coordinated, rapid and effective response to the ongoing outbreak. We have been supporting states including the deployment of Rapid Response Teams, provision of laboratory and medical supplies, guidelines, and training for health workers, scaling up of risk communications activities and so on.
However, these medical interventions are not the solution to prevent cholera outbreaks," he lamented.
Poor environmental sanitation, hygiene practices responsible for cholera - Environment Minister
On his own part, Minister of Environment, Mohammad Abubakar attributed the cholera outbreak in the country to poor environmental sanitation and hygiene practices.
Abubakar, who noted that the Ministry of Environment over the years has collaborated with stakeholders to deliver adequate sanitation and hygiene services to the citizenry, regretted the incessant cholera outbreaks and other sanitation-enabled diseases every year.
"This is largely due to our collective behaviours and attitude towards environmental sanitation and hygiene practices which are very poor," he argued.
To respond to the recent outbreak, he said the Federal Ministry of Environment has activated the Sanitation Desks in the 36 state ministries of environment and FCT, urging them to carry out environmental sanitation activities in their various states aimed at containing the outbreak.
"The Ministry has also requested the environmental health officers in the states and local governments across the country to intensify their efforts in carrying out sanitary inspection of premises and abatement of nuisances that could result in diseases outbreak such as cholera, Lassa fever" among others.
Nigeria created environment for cholera to thrive -NMA president
In a response to the situation, President of the Nigerian Medical Association, NMA, Prof. Innocent Ujah who described cholera as a disease of poverty and underdevelopment stressed the need for the Federal Government to check the spread of the disease before it gets out of hand.
According to Ujah, a study by the Nigerian Institute of Medical Research, NIMR, revealed that no state in Nigeria, including Abuja has 24-hour running water.
"Anywhere there is cholera, it is caused by underdevelopment. In Nigeria, water is a major problem, clean, potable water is not available to all. If you map the country, you'll find out that the places where there are outbreaks of cholera are underdeveloped areas where people do not have water to drink and people fetch water from dirty places and drink.
"Also, because of open defecation during rainy seasons, all those faeces will then be washed down into the stream and people drink from some of these streams. It's largely as a result of dirt and it's very sad. Clean running water is a big problem in almost all parts of the country.
"I say so because when I was Director-General of Nigerian Institute of Medical Research, NIMR, I tried to do a study of the state capitals of the country that has running water supply for 24 hours and there is none, including the FCT. If we look at all the indices, it points to the fact that we created the environment for such disease. Cholera is an infectious disease," he argued.
States, LGs have a lot to do
Noting that the Federal Government as well as other levels of government have a role to play, he admonished the state and local governments to rise to the challenge, even as he decried the lack of functionality of the local government system as required by law.
"The part that the Federal Government should play is in creating an enabling environment, creating awareness, educating people and then as a pilot for the state and local government dig boreholes and wells that are protected for the Nigerian people because Nigerian people do not have good water to drink. The state government and local government should provide clean drinking water.
"As we know, local governments are non-functional as far as we are concerned in terms of providing healthcare for the people. We think that if we are able to make the local governments work and then early intervention, we can begin to address this problem."