Anxiety as cholera returns

Cholera has returned with many unsuspecting persons as its victims. In this report, ELEOJO IDACHABA writes on what now appears like a wild fire ravaging many states.

For nine-year-old Ibrahim, it started like a normal abdominal discomfort until this son of Danmagaji of Dutse in Jigawa state suddenly developed complications leading to death in the wee hours of May 16, 2021. While that report was yet to get the attention of relevant authorities, it was also reported in Bauchi that an entire family of five died after what appeared like ceaseless vomiting and passing of watery stool. Until it was discovered that these two cases were cholera-related, no one knew that the ailment had returned unannounced.

Just when Nigerians thought that the era of communicable diseases were over, like another pandemic, cholera is back choking the nation and in recent times has claimed several lives.

Although it came like a thunderbolt in many remote communities, especially in the Federal Capital Territory (FCT), relevant government agencies have been attacking it.

NCDC’s action

In the wake of the recent resurgence, the Nigeria Centre for Disease Control (NCDC) promptly responded by activating a multi-sectoral national cholera Emergency Operations Centre (EOC). This was after the agency received a report about an increase in cases of the disease across the country.

Blueprint Weekend’s investigation showed that since the beginning of the year, a total number of 10,833 suspected cases have been reported with 112 confirmed and 289 deaths.

For instance, between May and June, there were increasing cholera cases in many states like Plateau, Bauchi, Gombe, Kano, Zamfara, Bayelsa and Kaduna.

The EOC, according to the report, is in conjunction with the Federal Ministries of Environment and Water Resources. This is because of the associated link between cholera and water as well as sanitation and hygiene. EOC, therefore, is aimed at supporting states towards ensuring a coordinated, rapid and effective response to the ongoing outbreak in the form of deploying Rapid Response Teams (RRT) to support states with medical and laboratory supplies in order to tone down the risk of further spread.

According to NCDC, “Additionally, the resources that have been developed as part of Nigeria’s Covid-19 response are being used to strengthen the response to the cholera outbreak. This includes the digitisation of the national surveillance system, establishment of laboratories and treatment centres, training of health workers, among others.”

NCDC, therefore, urged members of the public to be aware of the risk associated with the disease. It noted that, “The general public should adhere to the following precautionary measures to ensure safety: Boil and store water in a clean and safe container before drinking, preparing, cooking and storing food safely.”

It declared that cholera “is a preventable and treatable epidemic-prone disease which is transmitted by eating or drinking contaminated food or water.” The number of cases associated with cholera tends to increase in the rainy season. Therefore, with a high risk of death from the disease, authorities in the nation’s health monitor are warning that whenever any case is diagnosed in this season, treatment should not be delayed.

“It is very important to visit a health facility if you have symptoms such as watery diarrhea and vomiting.”

Cholera morbidity and mortality data for each of the thirty-six states and the FCT from 1997 to 2013 were obtained from the NCDC of the Federal Ministry of Health, Abuja. According to NCDC, reported cholera cases were based on the World Health Organisation (WHO) standard case definition of patients within five years of age or older with acute watery diarrhoea, with or without vomiting. Population data for each state and the FCT were obtained from 1991 and 2006 National Population Censuses conducted by National Population Commission (NPC). In it, the population was projected for the years with unavailable population census figures. From 2007 to 2013, population data for the thirty-six states and the FCT was projected at 3.2% growth rate while population data for 1997 to 2005 was projected at 2.8% growth rate from the 1991 population census figures.

The FCT example

In the meantime, there are reports that the FCT has recorded a total of 91 suspected cases of cholera with seven deaths in Abuja Municipal Area Council (AMAC) alone as at June 23. The territory’s acting secretary, FCT Health and Human Services Secretariat (HHSS), Dr. Mohammed Kawu, disclosed this at a news conference in Abuja.

“Other affected area councils are Bwari and Gwagwalada; however, no death was recorded in Gwagwalada and Bwari,” he said.

He said out of the 91 suspected cases, three were tested positive through the use of Rapid Diagnostic Test Kits, adding that as from May 2021, the FCT health authorities began to receive reports of sporadic cases of gastro-enteritis in some concentrated communities like Wassa Internally Displaced Persons camps, Dei Dei, Zuba, Shenagun and Kubwa.

Consequently, he said the health secretariat through the public health department intensified surveillance in those communities and directed the area councils to ensure they do the same.

To that extent, he disclosed that the secretariat provided some Rapid Diagnostic Test Kits drugs and consumables in some of the health facilities with the case.

He revealed that the secretariat was in the process of distributing drugs and consumables to the remaining health facilities including some key primary health facilities.

Kawu, therefore, advised residents of the territory to report any case related to diarrhoea to the nearest health facility for prompt response in order to avoid any escalation. He advised further that all food should be properly cleaned and well- cooked before consumption, adding that wastes, especially faeces, should be disposed of properly.

In a new development, a statement issued on Friday last week by the senior special assistant to the FCT minister on media, Abubakar Sani, on the disease, indicated that, “As at July 8 2021, the FCT has recorded 514 suspected cases. Out of this number, eight laboratory investigations were confirmed to be cholera.

“The FCT administration is also working very closely with the National Primary Healthcare Development Agency on all the important interventions to end the scourge of the disease in the territory.”

Spike in Plateau

Just when the NCDC was battling to address reported cases, like a spike, its impact was heavily felt in Plateau state. The state government just announced that not less than 14 people had died of cholera in the last two months, adding that a total number of 953 cases had been recorded within the same period.

While revealing that a total of 910 patients had so far been discharged, the government said 29 were still receiving treatment at various health facilities across the state.

The Commissioner for Health, Nimkong Lar, said the disease, which was previously recorded in Jos North local government area, had spread to 13 local government areas. He disclosed that the development required concerted efforts to address the pandemic “which is a diarrheal disease notorious for killing within hours, if not promptly treated.”

According to a recent report by NDDC, a total of 289 Nigerians have so far died from the disease between January and June, 2021. It added that at least eight states of the federation had been ravaged by the diarrheal disease. However, the situation has since further degenerated with more than 13 states now being ravaged.

It said about the situation in Plateau that, “Jos South and Bassa local government areas follow with 307 and 57 cases, respectively.”

Lar, however, said the NCDC’s representatives visited the state to lend a helping hand where a total of 100,154 doses of vaccine were administered in the state out of the 105,600 doses supplied by the federal government.

He said 5,000 doses of the vaccines were returned the federal government as they had expired on June 28.

Historical perspective

While writing on ‘Cholera Epidemiology; An Overview’ published in Pan African Medical Journal, Ajoke Adegbada and Solayide Adesida both noted that in Nigeria, the infection is endemic and that outbreaks are not unusual.

“In Nigeria, the first series of cholera outbreak was reported between 1970- 1990. Despite this long experience with cholera, an understanding of the epidemiology of the disease aiding its persistence in outbreak situations is still lacking.

“In the last quarter of 2009, it was speculated that more than 260 people died of cholera in four northern states with over 96 people in Maidugari, Biu, Gwoza, Dikwa and Jere council areas of Bauchi state. Most of the northern states of Nigeria rely on hand dug wells and contaminated ponds as source of drinking water. Usually, the source of the contamination is other cholera patients when their untreated diarrhoea discharge is allowed to get into water supplies.

“The 2010 outbreak of cholera and gastroenteritis and its attendant deaths in some regions in Nigeria brought to the forefront the vulnerability of poor communities and most especially children to the infection. The outbreak was attributed to rain which washed sewage into open wells and ponds where people obtain water for drinking and household needs. The regions ravaged by the scourge include Jigawa, Bauchi, Gombe, Yobe, Borno, Adamawa, Taraba, FCT, Cross River, Kaduna, Osun and Rivers.”

While still tracing the history of cholera in Nigeria, a health watch monitor group, BMC Public Health, wrote, “Historically, Nigeria has experienced several cholera outbreaks characterised by high CFRs, notable ones being the epidemic of 1991 which resulted in 59,478 cases and 7,654 deaths and the CFR of 12.9% reported for that outbreak remains the highest for the country to date.

“Furthermore, another major cholera outbreak occurred in Kano state in March 1999 with cases spreading to Adamawa and Edo states by May of that year. The outbreak resulted in 26,358 cases and 2,085 deaths.

“From January to December 2010, Nigeria reported 41,787 cases and 1,716 deaths across 18 states. The last major cholera outbreak prior to 2018 was in 2014 during which the number of cases recorded surpassed over half of the number of cases recorded between 2012 and 2013 as well as between 2015 and 2017.”

It added: “In line with global evidence, however, it is likely that cholera burden in Nigeria is underestimated due to factors ranging from differences in case definitions and completeness to social, political and economic disincentives for reporting the pandemic.

“Nonetheless, in response to the increasing global cholera burden, the Global Task Force on Cholera Control (GTFCC) in 2017 launched the Global Roadmap Strategies which seek to reduce cholera-related deaths by 90% as well as eliminate cholera infections in at least 20 out of the 47 endemic countries by 2030.

“Nigeria has taken fundamental steps towards attaining these goals by deploying Oral Cholera Vaccines (OCVs) in cholera hotspots. Since the first deployment in September 2017 to date, million doses of OCVs have been deployed, albeit in a reactive context, across several hotspot areas, predominantly in the northern states like Borno, Bauchi, Yobe and Adamawa.”

It wrote further, “Also, in line with the GTFCC recommendations, Nigeria is finalising its National Strategic Plan of Action on Cholera Control. Despite the aforementioned efforts towards cholera prevention and control, the outbreak of 2018 however reaffirms the serious public health threat of cholera and, importantly, the need for the country to adopt holistic counter-measures.”

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