Hygiene and Sanitation Panacea for Cholera out Breaks

By Blessing Amos

The Nigeria Centre for Disease Control (NCDC) earlier this year reported in its national monthly update for Cholera in Nigeria that eight states have suspected cholera cases. These were Benue, Delta, Zamfara, Gombe, Bayelsa, Kogi, Sokoto and Nasarawa.

Thereafter, the national multi-agency cholera Technical Working Group (TWG) at Nigeria Centre for Disease Control (NCDC) continues to monitor the national situation.
According to NCDC, as at March 28th, 2021, a total of 1,746 suspected cases including 50 deaths were reported from the eight states (Benue, Delta, Zamfara, Gombe, Bayelsa, Kogi, Sokoto and Nasarawa) since the beginning of 2021.
Recently, in July, 2021 the agency reported eighteen states and FCT had suspected cholera cases. These are Benue, Delta, Zamfara, Gombe, Bayelsa, Kogi, Sokoto, Bauchi, Kano, Kaduna, Plateau, Kebbi, Cross River, Nasarawa, Niger, Jigawa, Yobe, Kwara and FCT.

However, within the period eight states and FCT reported 1,885 suspected cases – Bauchi (1,364), Kano (231), Jigawa (99), Niger (70), Plateau (42), Zamfara (35), Kaduna (17), Kwara (14) and FCT (13). Of this, there were seventeen RDT confirmed cases from Kwara (12), Plateau (3) and Kaduna (2) States.
It became more alarming within the month, when the Federal Capital Territory Administration (FCTA) reported that 60 persons have died from Cholera outbreak in the FCT as published in Thisday Online couple of weeks.

This was revealed by the FCT Minister of State, Dr. Ramatu Tijjani Aliyu who gave the update during the continuation of the community sensitisation on cholera and severe acute diarrhea outbreaks in Pyakasa and Gwagwa respectively.

The minister, who was represented by the acting Executive Secretary of FCT Primary Health Care Board, Dr. Iwot Ndaeyo, also revealed that suspected cases had risen from 604 to 698 in last 72 hours, while the death toll had also climbed from 54 to 60.
She noted that Abaji Area Council recorded three suspected cases and no death, while Abuja Municipal Area Council (AMAC) has 281 suspected cases with 22 deaths. Meanwhile, Bwari Area Council recorded 134 suspected cases with 22 deaths.

Others are Gwagwalada Area Council, 220 suspected cases and nine deaths; Kuje Area Council, 23 suspected cases with four deaths, and Kwali Area Council, which recorded 37 suspected cases with three deaths.
Obviously, in spite the efforts by the Nigeria Centre for Disease Control (NCDC) to contain the current outbreak, Cholera is still spreading rapidly across the country. As such, it is paramount necessity to take a look at the nature, causes, preventive measures and remedies to dreaded disease of Cholera.

Scientifically, Cholera is an acute, diarrheal illness caused by infection of the intestine with the toxigenic bacterium Vibrio cholerae serogroup O1 or O139. An estimated 2.9 million cases and 95,000 deaths occur each year around the world.
The infection is often mild or without symptoms, but can be severe. Approximately 1 in 10 people who get sick with cholera will develop severe symptoms such as watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

According to NCDC, Cholera is a preventable and treatable epidemic -prone disease which is transmitted by eating or drinking contaminated food or water. The number of cholera cases tends to increase with the onset of the rainy season. The risk of death from cholera is higher, when treatment is delayed. It is very important to visit a health facility if you have symptoms such as watery diarrhea and vomiting.

World Health Organisation (WHO) in recent times revealed that Nigeria has the highest burden of the water-borne disease in Africa. “Cholera is life-threatening. If you get contaminated with cholera bacteria and you do not receive appropriate treatment within 24 – 48 hours, you can pass on.
NCDC stated that Cholera infection is often mild or without symptoms, but can be severe. Approximately 1 in 10 people who get sick with cholera will develop severe symptoms such as watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

It also revealed that it usually takes 2-3 days for symptoms to appear after a person ingests cholera bacteria, but the time can range from a few hours to 5 days. Dysentery can give you some time to take care of yourself but not cholera,” said the United Nations Children’s Fund (UNICEF) water, sanitation and hygiene specialist, Mr Drissa Yeo. Symptoms include severe cramping, diarrhea, vomiting and dehydration.

It is indeed sad that for more than four decades, a preventable disease like cholera is still a recurring epidemic in Nigeria and has led to the death of thousands of people, especially children. NCDC report on Cholera indicates that 27.6 per cent of victims across the states are those in the five years to 14 years bracket.
While there have been some efforts by the federal government to deal with the challenge, there is no corresponding commitment from the state governments. Yet cholera appears to be mostly synonymous with rural communities.
Indeed, the spread of cholera is helped when the environment is dirty; when water system is not treated and when sanitation is not taken seriously. In many of our states, villagers and rural dwellers rely on streams as their source of drinking water.

There are no provisions for disposing waste in many homes. Since cholera is more prevalent in rural areas, the problem becomes compounded when and where there are no modern medical facilities to assist in the treatment of the disease.
Goal Six of the United Nations Sustainable Development Goals (SDGs) is on ensuring water and sanitation for all by 2030. This means that nine years from now, every person in Nigeria and other countries in the world should have access to safe drinking water and safe sanitation.

The UNICEF and the Federal Ministry of Water Resources not long ago signed a document called Partnership for Expanded Water, Sanitation and Hygiene (PEWASH), which aims at meeting the SDGs agenda on schedule. But having a plan is one thing, bringing in the resources and mustering the commitment towards its fulfilment is something else.
It is shameful that Nigerians are still afflicted with cholera, mostly contracted through drinking of contaminated water and eating of waste products. The systemic collapse of critical institutions and basic health facilities in many of the states across the country ensured that many of our nationals are still dying of the preventable disease common among the poor, but has been eliminated in many countries.

One of the factors that has worsened the outbreak of cholera in the country is open defecation which pollutes water sources. Millions of Nigerians use the outdoor as convenience. There must be conscious effort to stop this shameful and costly practice. The states must do more to check the practice in addition to providing potable water. These will save many of our children from cheap deaths.

Clean water, basic toilets and good hygiene practices are essential for the survival and development of children. See how UNICEF is supporting the Government of Nigeria to provide access to these basic needs for children.
More so, the role of environmental sanitation in preventing Cholera cannot be over said. Down memory lane, environmental sanitation was chosen as the theme for the fifth phase of the war Against Indiscipline (WAI), which was launched in Kano on 29 July 1985 by the then Chief of Staff, Supreme Headquarters, Major-General Idiagbon. He announced that a one million naira prize would be awarded for the cleanest capital.

The monthly environmental sanitation exercise was since then imbibed by most states in Nigeria was carried out on Saturdays as a compulsory exercise. This compulsory exercise, which is a directive by the federal government, is aimed at encouraging environmental cleanliness in the country.
Unfortunately, in most states there was low turn outs for the exercise, as only few states the exercise was done with a slightly encouraging number of turn outs.

Over the years, environmental sanitation in the country has been relegated to the background and is fast turning into a monthly ritual which is characterized by low compliance both on the part of citizens and the sanitation officials. Though the exercise was introduced about a decade ago by the military government, nothing appreciable can be shown for it till date. This is evident in the deplorable state of sanitation in the country today.

The poor sanitation condition of most states in Nigeria can be attributed to the nonchalance of some persons towards environmental issues coupled with low political will and commitment of the government. There is also the challenge of weak and ineffective government policies which has resulted in lapses in role definition as regards responsibility for environmental matters and failure in implementation of environmental laws.

Last year, the federal government reviewed the national environmental sanitation policy with the view of complying with best practices and harmonizing grey areas that are of concern to stakeholders. Although the policy review is a step in the right direction, implementation has to be devoid of sentiments and unnecessary bureaucracies for it to have reasonable impact in the society.

In order to improve the sanitation state in the country, individuals should see environmental sanitation as a way of life. There is the need for increased environmentally consciousness on a daily basis. Also, government at all levels should take environmental matters as issues of national interest.
However, the NCDC urges members of the public to be aware of the risk of the disease and adhere to the following precautionary measures to ensure safety; Boil and store water in a clean and safe container before drinking. Prepare, cook and store food safely.

Wash hands frequently with soap under clean running water to prevent infectious diseases including cholera. This is especially important after defecation and before handling food or eating.
Avoid open defecation and indiscriminate refuse dumping which contribute to the spread of cholera. Visit a health facility immediately if you have symptoms such as watery diarrhoea.
Healthcare workers should have a high index of suspicion for cholera, and maintain universal care precautions at all times. The NCDC continues to advocate for improved access to clean water, proper sanitation and hygiene as critical measure to prevent cholera cases and outbreaks.

It of most important at this time to call on State Governments to continue to provide access to clean water for citizens which can go a long way in stopping the spread of the disease as cholera bacterium is usually found in water or in foods that have been contaminated by feces (poop) from a person infected with cholera bacteria. Cholera is most likely to occur and spread in places with inadequate water treatment, poor sanitation, and inadequate hygiene.

On what to do when contacted with the disease or you think a member of your family might have cholera, seek medical attention immediately. Dehydration can be rapid so fluid replacement is essential. If you have oral rehydration solution (ORS), start taking it immediately; it can save a life. Continue to drink ORS at home and while traveling to get medical treatment. If an infant has watery diarrhea, continue breastfeeding, as advised by NCDC.