Towards the end of last year, this blog carried an essay on cholera and wondered whether October should be referred to as cholera month in Nigeria.
Below are updates by two institutions – Weekly Trust and UNICEF.
The causes given for the outbreak have been adduced in previous in both learned and general publications. Yet the situation is not improving from year to year. What should the three tiers of government do? If we cannot control cholera, God help us if there is Ebola outbreak.
Cholera Ravages Nigeria
by Ruby Leo, Lami Sadiq & Onimi Alao, Abubakar Auwal, Isa Liman & Ahmed Mohammed, Bauchi, Weekly Trust, Nigeria, Saturday, 12 April 2014
… kills over 100 since January A new wave of cholera epidemic blowing across the country may have claimed hundreds of lives since January and does not seem to be abating anytime soon with the onset of the rainy season, Weekly Trust findings reveal.
The Nigerian Centre for Disease Control (NCDC) has confirmed an outbreak of the infectious disease in 14 states, where it said 9,006 cases were reported, with 106 deaths in the first quarter of 2014, adding that the situation was not this critical last year. But state health officials say the casualty figures for the last three months could be much higher as some deaths that happened outside health facilities, which are many, are not officially reported, while many others do not even know the cause of death.
Cholera, according to experts, is an acute infectious disease caused by a bacterium, Vibrio cholerae (V. cholerae) which results in painless diarrhea (the main symptoms are watery stool and vomiting); and infection in most cases comes primarily from drinking water or eating food that has been contaminated by the faeces of an infected person, including one with no apparent symptoms.
The NCDC report shows that Bauchi, where 6,910 cases were reported with 48 deaths, is the worst hit of the 14 states; Kano had 1,270 cases with 16 deaths, while three of the 28 cases in the Federal Capital Territory (FCT) ended in fatalities.In Kaduna State, 350 cases were recorded with 19 deaths, while four died from the 97 cases reported in Benue, six died in Taraba from the 190 cases reported and six again in Ebonyi from 16 recorded cases. The NCDC report said the lot of the country turned for the worst in the 12th week.
Between weeks 1 and 12 of 2014, 9,006 cholera cases with 81 lab-confirmed and 106 deaths from 58 local government areas (13 States and FCT) were reported. But Bauchi State Commissioner for health, Dr. Abubakar Sani Malami, told a news brief on Thrusday that 59 people died of cholera in the state in the last three months. He said 54 of them died in their homes and five in hospital. “The state recorded a high casualty figure because some of the victims were treating themselves at home,” he said.
Local health workers and Medicine San-Frontiers (MSF) told Weekly Trust in Zamfara that over 1,117 cholera cases were reported in at least five local government areas of the state within two weeks. These are Gusau, Durumi, Gukkuyum, Sakura and Maradu. At least 72 of the victims died of the infection, not including those who gave up the ghost before they could get medical help, local officials said. But reports by MSF indicate that the death toll from the epidemic could be as high as 350 people in Zamfara alone.
Hospital sources said about 90 fresh cases were reported at the Shagari Primary Health Care Center among other health facilities in the state this week alone. Many more are being expected. Balira Bello, who is receiving treatment at the Shagari facility, blamed her infection on the unavailability of clean drinking water to the people in the Birnin Ruwa area of Gusau, the state capital. Two other residents, Balkisu Mamman and Shafa’atu Garba, said they fetch their drinking water from broken pipes which usually pass through unsanitary environments.
One of the worst hit communities in Plateau State is Anguwan Yashi, in Namu area of Qua’an Pan Local Government Area, which recently saw the influx of thousands of refugees from neighbouring Nasarawa State fleeing from communal crisis, putting pressure on the only source of drinking water and other facilities in the village. The Plateau State government has confirmed that 11 people died of cholera while the community puts the casualty figure at more than 30. None could, however, dispute that over 100 people had been infected and treated from the disease. The district head of Namu, Alhaji Abubakar Sadiq, said mortality numbers have been down-played, adding that most of those killed by the scourge were women nursing their children. “Both indigenes of the village and the displaced have been affected because we now live together. And I can count over 10 of the indigenes that have died from this disease, including my brother’s wife, my neighbour and her daughter,” said Alhaji Abubakar Sadiq, the district head of Namu.
Others like 21-year-old Jane Botof in Rukuba, Bassa local government area were luckier. She suddenly took ill; vomiting and stooling. “What could this be?” her mother, Lilian Bot, wondered aloud; and driven by a growing panic, bundled her daughter into a commercial tricycle and was off to the nearest clinic. Thus, Jane’s was one of the 28 reported cases in the area last week. Three of the victims, one of them a pregnant woman, died chiefly because they got to the hospital late.
Cholera outbreaks were reported in several other parts of the state with no official records of cases, sometimes due to the remote nature of such locations or just because of the lackadaisical attitude of the people to health issues. At least two local areas of Sokoto State have experienced an outbreak of cholera this year, Tambuwal and kebbe, where scores of people have died of infection, investigations by Weekly Trust revealed. But the state government said only 13 out of the 152 cases reported there ended in fatalities. In Barkeji alone, a village located along Sokoto-Jega road in Tambuwal local government area where the disease was said to have first surfaced, 31 cases and five deaths were recorded between October 10 and October 21, officials said. In kebbe local government area, about 20 kilometres from Tambuwal, the disease resurfaced in six riverine communites, including Bakin Dutse, Tuna, ‘Yar-Romo, Nabasa, Fakku and Bashi, with eight deaths out of 121 cases reported.
Scores of people in Kano metropolis are now bedridden and agonizing as a result of the sudden outbreak of cholera in some parts of the state. The cholera epidemic struck the communities 10 days ago and has so far claimed the lives of over 12 persons.
In Lagos state cholera outbreak in five local government areas has so far claimed at least three persons, while scores of victims were treated and discharged, state commissioner for health, Dr. Jide Idris, said. “Although, many of the cases have been treated and discharged in several health facilities, three have been confirmed dead. Most of the suspected cases are from Ajeromi, Apapa, Lagos Island, Oshodi_Isolo and Surulere local government areas,” Idris said.
Health officials say cholera can be easily prevented by washing of hands frequently with soap and water for at least 15 seconds especially before handling food and after using the toilet; drinking and cooking with safe water that has been boiled and disinfected and avoiding eating raw food, taking food that is completely cooked and hot and avoiding improperly cooked seafood or meat, among other measures. “Especially in this period of the early onset of rain, a clean environment and lifestyle is key against cholera infection,” Plateau state epidemiologist, Dr. Raymond Juryit advised, adding that when cholera occurs, what determines safety of life is not seeking treatment in the wrong quarters, such as a chemist or arriving hospital late, but arriving hospital as quickly as when its symptoms manifest.
NCDC project manager, Prof. Abdulsalami Nasidi, said the federal government has deployed Rapid Response Teams to affected states to help contain the outbreak. He explained that drugs are being distributed to states to cushion the effects of the disease while chlorine powder has been also distributed to treat well water.
UNICEF Nigeria Cholera Situation Report – 10 February 2014
• As of 31 January 2014, 855 cholera cases (17 lab confirmed) and 20 deaths (Case Fatality Rate 3.3%) were reported from 28 Local Government Areas (LGAs) in 9 States. During the same period in 2013, no cases or deaths were reported.
• In the last three weeks an upward trend of cases has been observed compared to the same period in 2012 and 2013.
• In week four, 288 cases and 10 deaths were reported in four LGAs from Bauchi, Ebonyi, Federal Capital Territory (FCT) and Kano States. The majority of these cases, representing 79.5% (237/298), were reported in Bauchi from Bauchi LGA.
• In the on-going dry season, water sources have been stretched, contributing to the already low access to water and sanition. Only 58% of Nigeria’s population has access to water and sanitation, which poses a high risk for the spread of cholera cases to states which have not previously reported any cases (Fedral Ministry of Water Resources).
• No cases of cholera have been reported in Borno and Yobe so far this year, however during week one, Adamawa state reported one case. The risk of cholera outbreak in these states remains high given their precarious humanitarian situation (a State of Emergency has been declared in these areas). UNICEF and partners continue to support the government to strengthen coordination at State and LGA level, and intensify communication to raise awareness.