Cholera has been having a toll on the lives and economy of the country in recent times. In this report, IDACHABA SUNNY ELEOJO takes a look at the challenge and response activities by NCDC.
The Nigeria Centre for Disease Control (NCDC) is leading the national response to an outbreak of cholera across states in Nigeria exacerbated by poor access to clean water, open defecation, poor sanitation, among others.
Between the January 1 and August 1 2021, 31,425 suspected cases of cholera, 311 confirmed cases and 816 deaths have been reported from 22 states and FCT.
According to NCDC, The affected states are Benue, Delta, Zamfara, Gombe, Bayelsa, Kogi, Sokoto, Bauchi, Kano, Kaduna, Plateau, Kebbi,
Cross River, Niger, Nasarawa, Jigawa, Yobe, Kwara, Enugu, Adamawa, Katsina, Borno and FCT.
Following an increase in the number of cholera cases, the National Cholera Emergency
Operations Centre (EOC) was activated on the 22nd of June 2021. The EOC which is hosted at NCDC includes representation from the Federal Ministries of Environment and Water
Resources, National Primary Health Care Development Agency (NPHCDA), World Health
Organisation (WHO) and partners.
The EOC has led the deployment of Rapid Response Teams to support the most affected states like Benue, Kano, Kaduna, Zamfara, Bauchi and Plateau States. Additionally, NCDC and its partners have provided states with commodities for case management and laboratory diagnosis, materials for risk communications, response guidelines among other support.
A reactive oral cholera vaccine (OCV) campaign led by NPHCDA was conducted in Bauchi LGA of the state from July 24 to 28 2021, but none of these medical interventions solved the underlying issues leading to cholera.
It is a waterborne disease and the risk of transmission is higher when there is poor sanitation and disruption of clean water supply. The wrong disposal of refuse and practices such as open defecation endanger the safety of water used for drinking and personal use. These lead to the spread of water-borne diseases such as cholera.
Without proper Water Sanitation and Hygiene (WaSH), Nigeria remains at risk of cholera cases and deaths.
According to NCDC, “The long-term solution for cholera control lies in access to safe drinking water, maintenance of proper sanitation and hygiene. We continue to advocate to state governments to prioritise action for solutions that ensure access to and use of safe water, basic sanitation and good hygiene practices in communities.
“Additionally, we urge Nigerians to keep their environments clean, only drink or use water that is boiled and stored safely, ensure food is cooked and stored in a clean and safe environment, avoid open defecation and wash hands regularly with soap and running water.
“Cholera is preventable and treatable; however, it can be deadly when people who are infected do not access care immediately. Nigerians are advised to visit a health facility immediately, if they have sudden onset of profuse watery diarrhoea, nausea, vomiting, and weakness.”
As the NCDC continues to work with partners to lead the health-sector response to cholera outbreaks, there are calls for urgent improvement in access to clean water, proper sanitation and hygiene.
Cholera is a water-borne disease characterised by sudden onset of profuse watery diarrhoea,
which can lead to sudden death as a result of dehydration, if not managed on time. Other symptoms include nausea, vomiting, and weakness.
Most infected people may only show mild symptoms or have no symptom at all. The time between an infection and appearance of symptoms of the disease is usually two hours to five days, but the disease is easily treatable, if detected early.
According to NCDC, most infected people can be treated successfully through prompt administration of oral rehydration solution (ORS) with the goal to replace lost fluids and electrolytes. The ORS solution is available as a powder that can be reconstituted in boiled or bottled water.
“Without rehydration, approximately half the people with cholera die. With treatment, the number of fatalities drops to less than one percent. Severely dehydrated people may also need intravenous fluids.”
According to NCDC, people most at risk are
Those who live in places with unsafe water, poor sanitation, who consume potentially contaminated food or fruits without proper cooking, people who do not perform hand hygiene when appropriate, relatives who care for sick person with cholera at home and health care workers like doctors and nurses.
How to reduce spread
To reduce the risk of cholera, NCDC advises that water should be boiled and stored in a clean and safe container before drinking, ensure personal hygiene by washing hands frequently with soap under clean and running water, use of alcohol-based hand sanitiser if soap and clean water are not available, ensure that food is well cooked before consumption, avoidance of raw food such as fruits and vegetables except when washed in safe water, avoidance of open defecation, indiscriminate refuse dumping and ensure proper disposal of waste and frequent clearing of sewage.
Investigation shows that 22 states and the FCT have reported suspected cholera cases this year. Some of these include Benue, Delta, Zamfara, Gombe, Bayelsa, Kogi, Sokoto, Bauchi, Kano, Kaduna, Plateau, Kebbi, Cross River, Nasarawa, Niger, Jigawa, Yobe, Kwara, Adamawa, Enugu, Katsina, Borno and FCT.
“In the reporting week, seven states and FCT reported 1,162 suspected cases – Bauchi (773),
Niger (183), Katsina (120), FCT (64), Jigawa (13), Kano (4), Borno (4) and Adamawa (1).
“Of these, there were two confirmed cases from FCT. There were 30 deaths from Bauchi (11), Katsina (10), Niger (6), FCT (2) and Jigawa (1) states with CFR of 2.6%. No new state reported cases in epi week 30.
“A total of 1,162 suspected cases were reported this week representing a 44% decrease compared to 2,082 suspected cases recorded in week 29. The national multi-sectoral EOC activated at level 02 continues to coordinate the national response.
“As at 1st August, 2021, a total of 31,425 suspected cases including 816 deaths
(CFR 2.6%) have been reported from 22 states and FCT (Benue, Delta, Zamfara,
Gombe, Bayelsa, Kogi, Sokoto, Bauchi, Kano, Kaduna, Plateau, Kebbi, Cross River,
Niger, Nasarawa, Jigawa, Yobe, Kwara, Enugu, Adamawa, Katsina, Borno and FCT) since the beginning of 2021
“Of the reported cases since the beginning of the year, 27% are aged 5 – 14 years. Of all suspected cases, 51% are males and 49% are females. There has been a decrease in the number of new cases in the last two weeks.
Bauchi (773), Niger (183), Katsina (120), and FCT (64) account for 50.9% of 1,941
cases reported in the last two weeks (29 and 30)
“Since the beginning of the year, a total of 709 samples have been collected with positive cases as follows – 234 RDT positive only; 77 culture positive; 311 RDT and culture positive. The test positivity rate (TPR) for laboratory confirmation by culture is 25%.
Response activities cordination
Report shows that the coordination is done by the national multi-sectoral EOC hosted at NCDC, in collaboration with Federal Ministry of Water Resources (FMWR), National Primary
Healthcare Development Agency (NPHCDA) and partners.
“Currently, Zamfara, Kaduna, Bauchi, Plateau, FCT, Kano, Enugu, Jigawa, Niger, Sokoto and Katsina states-level EOCs are in response mode. The National Rapid Response Teams (RRTs) with response commodities were deployed by NCDC to support the response in six states – Benue, Kano, Kaduna, Zamfara, Bauchi and Plateau states.
“Mop-up OCV campaign was conducted in Bauchi LGA from 29 July 29 to 30 2021. There was participation in workshop on ‘Hazard Risk Analysis for Nigeria’ conducted by the National
Emergency Management Agency (NEMA) in collaboration with UNICEF.”
Ongoing surveillance in all states are through the routine Integrated Disease Surveillance
and Response (IDSR) as well as Event Based Surveillance (EBS).
There are WASH sector partners and Community Health Volunteers in the affected states.