Demystifying the Current Cholera Outbreak in Nigeria
On Sunday night, my friend in readiness for the new week decided to engage in an evening stroll in one of the poshest places in Abuja. A physical exercise buff work has left her leaving home relatively early for a place like the nation’s capital and leaving work late, so she felt she should enjoy some evening coolness before retiring for the night. On her way, she bought some suya from her usual spot and munched on them when she got home. By late evening as she was about to retire for the night, she started developing fever and nausea. Gradually, dizziness set in, and as the night turned pitch black, she began throwing up.
I wanted to be sure it started from the suya.
“Tosin, I have been drinking Swan and Nestle for more than 6–7 years now.”
This means that from the suya she ate, she had swallowed Vibrio cholerae. This bacterium reaches the body of humans through contaminated food or water. As it got inside her body, the cholera bacteria deposited poison which clings to the cells in the wall of her small intestine. As it does this, the channels in the cells expand and stay expanded. As this is not the way the intestine should be, the disrupted cells fill the gut — a long tube located just below the stomach that starts at the mouth and ends at the anus — with chloride and sodium ions. Then water. The gut then expels the fluid pumping into the gut through the mouth. This is what is called vomiting. Of course, as the person vomits, Vibrio bacteria go on to infect new hosts.
The average human has 60% of their body to be composed of water. A 72-kg body contains 40 litres of fluid. Most people can tolerate a 3–4% decrease in total body water without difficulty or adverse health effects. A 5–8% decrease can cause fatigue and dizziness. Loss of over ten percent of total body water can cause physical and mental deterioration, accompanied by severe thirst. Death occurs at a loss of between fifteen and twenty-five percent of the body water.
Cholera-related diarrhea comes on suddenly and can quickly cause dangerous fluid loss. As much as 1 litre an hour. According to Medical News Today, a person with cholera can lose up to 20 liters a day. Without treatment, a healthy person who gets infected with Cholera at nightfall can lose so much fluid that by daybreak he would be dead.
CHOLERA OUTBREAK IN NIGERIA
Two days ago, the Nigeria Centre for Disease Control announced that there have been a total of 65,145 suspected cases of cholera in Nigeria. Since the beginning of the latest outbreak in 2021, no less than 2,141 deaths have been reported from 23 states and the FCT, as of September 2, 2021.
As I have explained earlier, in its most severe form, cholera is one of the most fatal illnesses known because infected patients may die within a few hours if immediate medical treatment is not provided.
What’s unexpected about vibrio cholerae is that about 75 percent of infected carriers show no symptoms but remain contagious for up to two weeks. It’s difficult to eradicate because it can survive in aquatic environments, making it far harder to eradicate.
As my friend battled with her bout of Cholera on Sunday, Daily Trust reported that a man who had died from Cholera in Ojota, Lagos was being carried to be buried in his hometown by his friends. The five friends who chattered a bus to Sokoto got infected on their way and died before their arrival. According to CDC, the time between infection and appearance of symptoms for those who show them for the disease is just 2 hours to 5 days.
What is worrisome about the current outbreak is that as reported on the NCDC website is that thousands of cases are being suspected every week. In week 33, 2127 were suspected while 3,098 cases were suspected in 32. And according to the agency, children are most affected. 51 percent of those that have been affected are males and 49 percent females.
A DISEASE OF THE POOR
Echoing what other disease experts have said, the President of the Nigerian Medical Association, NMA, Prof. Innocent Ujah said that cholera is a disease of poverty. The European Centre for Disease Prevention and Control monitors cholera outbreaks globally through epidemic intelligence activities, and it reveals that the countries with the most cases are Bangladesh, Niger, and Nigeria. In the Americas, 2 countries have recorded outbreaks. In Asia, 3 countries. In Africa, 7 countries. In all these countries, Nigeria has the most deaths recorded.
From a vantage point, it is not hard to imagine why. Unsafe water is a major cause of Cholera. 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. It is therefore understandable that the places where there are outbreaks of cholera are places where the sources of drinking water are unsafe. People using open sources of water are particularly susceptible since open defecation is rampant in our clime.
Nigeria is right now the number one country in the world where people practice open defecation. in 2018, we overtook India with approximately 47 million people not having access to sanitation services in their most basic form in the country. Open defecation, especially during rainy seasons, washes faeces down into streams people drink. Clean running water is a big problem in almost all parts of the country. A Premium Times report reveals that two-thirds of Nigerians survive without potable water.
Even for those who rely on boreholes in their homes, a UNICEF WaSH specialist has said that because of the poor construction of boreholes, water coming from them can be easily contaminated. Apart from the fact that shallow boreholes can prove dangerous for human consumption because it could cause typhoid fever, shallow boreholes are not immune from the bacteria that causes cholera as a result of open defecation.
The insecurity situation in the country also contributes to the cholera outbreak. The top 10 states with the highest recorded deaths in the country are in the North; places bedeviled by grave insecurity. With humanitarian disasters forcing displaced people to live in camps, there have been complaints about inadequate water supply unsanitary practices. This correlated with observations in 2018 when over 175 deaths as a result of cholera were reported in Yobe, Adamawa, and Borno states predominantly in crowded IDP camps.
According to the World Health Organization, the long-term solution for cholera control lies in access to safe drinking water, maintenance of proper sanitation and hygiene.
WHAT SHOULD YOU DO ON AN INDIVIDUAL LEVEL
The bacteria that causes cholera can be expelled through the faeces for nearly two weeks after infection and then shed into the environment to infect other people, it is therefore important to take extra measures to protect yourselves at this time.
Evidence from an outbreak that happened in Northern Nigeria shows that poor hand hygiene before meals played a role. One of the habits I hope the COVID-19 pandemic would help Nigerians imbibe is that of washing their hands regularly with soap and running water. Make it a habit to wash your hands first thing when you get home, no matter how close where you went to.
Keep your environment clean. As much as depend on you, boil your water before drinking. Ensure that your food is well cooked before consumption. Don’t ingest fruits and vegetables until you have thoroughly washed them and peel your fruits yourself instead of allowing the hawker do it for you. It bears little repeating that you should avoid open defecation at all costs and ensure proposal disposal of waste and sewage.
Fortunately for my friend, she is recovering well as she did not self-medicate but made sure a health care worker attended to her urgently. While it is true that up to 80% of cholera cases can be successfully treated with oral rehydration solution (ORS), severely dehydrated patients may require the administration of intravenous fluids. These patients may also require appropriate antibiotics to diminish the duration of diarrhea, reduce the volume of rehydration fluids needed, and shorten the duration of V. cholerae excretion. All these would need to be determined by a medical professional so I cannot emphasize enough the need to go to a health care facility immediately you experience cholera symptoms.
Cholera is out there, folks. 2,141 deaths have been reported from 23 states and the FCT, as of September 2, 2021.
Please be safe!
