•Experts say open defecation is chief
•Sea food such as crabs, crayfish natural habitat for bacteria
With the recent confirmation of 25 new cases of cholera at the Kirikiri Correctional Centre, it seems the spread of the dreaded killer disease is not about to be abated or go away, despite all efforts. Gboyega Alaka in this piece explores the common habits that causes spread as well as simple measures that could help curtail it.
Just as the media was celebrating a lull in new discoveries of the ongoing Cholera outbreak across the country, out came the damning revelation that 25 new cases were discovered, weekend, at the Kirikiri Correctional Centre in Lagos.
According to the Lagos State Commissioner for Health, Prof. Akin Abayomi, Sunday, 25 cases of gastroenteritis were reported. Although he stated that measures had been put in place to curtail its spread, it nevertheless brought home the reality that it is not yet uhuru nor is it time to relax efforts towards arresting the disease’s spread.
Notably, the number of death as at Tuesday the 2nd of July (2024), the number of recorded deaths had risen to 63 out of 2,102 cases, a sharp rise from the 53 recorded deaths out of 1,528 suspected cases the previous week.
Lagos alone had recorded 500 cases and therefore remained the hotspot of the disease.
Figures are according to the Nigeria Centre for Disease Control and Prevention (NCDC), which also affirmed that the outbreak has affected 33 states.
However, when juxtaposed with 2023 outbreak, which as at August 2023 put total confirmed cases at over 3,000 (3,683 by December and 128 deaths), it may seems like there is a slight improvement in the management of the outbreak – although Dr Idris insisted that “we’ve seen more cases in more states than we did last year.”
One significant argument by observers, however, is that August is still a future and we don’t know how worse it’s going to get by then or by the end of the year.
But the big question is: must there always be a yearly outbreak? Isn’t it time the country got her acts together and bade the disease final farewell?
The Kirikiri Correctional Centre revelation confirmed fears that the number of suspected cases and death may keep increasing, undermining the awareness efforts as well as reactive and preventive efforts the NCDC, the Federal Ministry of Health and affiliate health ministries in all states have been putting in place. With 63 recorded fatalities, the disease this year has again made the number of fatalities during the Ebola incursion into the country look like child’s play. Yet it seems not many people, aside the government agencies and the communication media such as radio, Television and newspapers gives a hoot.
Old habits dying hard
People, it appears, are finding it hard adopting the simple hand-washing routine that they all keyed into during the Ebola and Covid 19 outbreaks.
A foray into slum or densely populated areas like Ajegunle, Makoko in Lagos, showed that people are still carrying on as if nothing was amiss- a far cry from the tension and compliance effort demonstrated by everyone during the Ebola outbreak or even the more recent Corona virus incursion into the country.
In Ajegunle Apapa for instance, this reporter was alarmed to see noodles vendors and other food vendors carrying on their activities without caution. A particular noodles seller was spotted cooking right by a stagnant and smelly drainage oozing thick odour and buzzing with thick green bottle flies. Before this reporter’s very eyes, a fly landed on a plate of noodles the vendor was already packing and she merely chased it away with a wave of the hand, covered it, bound it with a rubber band and sent her daughter to go deliver it to the customer. She cared less whether the fly was carrying the dreaded bacterium Vibrio cholera, which cause cholera or some other disease causing bacteria. As far as she was concerned, she had delivered, got her payment and that was all.
Further down on the same street, a group of women were preparing meals, apparently for some function. Various food items, especially fried meat and fish, were left exposed, even though houseflies were buzzing all over with excitement. A few meters away was a refuse filled gutter; while on the main road was muddy, stagnant water, occasion by the recurrent rain in recent days. At another end, some women were seen cutting lettuce and other vegetable in preparation for salad. The buzzing flies did not spare them. The women could also be seen intermittently throwing pieces of this and that into their mouth. Are they aware of the danger of what they were doing? Maybe yes, maybe not.
Beverage sellers carry on unabated
Despite news that the outbreak may have been caused by consumption of ill-prepared beverages such as tiger-nuts by unlicensed manufacturers and contaminated water supply, vendors of tiger-nut drink and zobo, kunu and other local drinks, as well as several sachet ‘pure’ water produced from unlicensed sources could still be seen carrying on and doing their businesses unhindered.
The Lagos Commissioner for Health had explained that samples taken from some popular street beverages purchased by undercover environmental officers from Environmental Protection Agency, and the Ministry of Health in the affected areas confirmed the presence of cholera causing bacteria.
Prof. Abayomi also stated that interventions were yielding results, as residents were adhering to public health information, while also stressing the need for early presentation to health facilities once symptoms are identified.
Shame of open defecation on Lagos-Ibadan Expressway
According to health experts, one of the major enhancers of cholera spread is open defecation, whether in the bush, in gutters or in moving water as many prefer.
Unfortunately this abominable habit has remained with us despite a pervading civilisation and the cosmopolitanism of our cities. While such habit in rural areas may be understandable, though not acceptable, it remains embarrassing that some undesirable elements still opt for the uncivilised habit in towns and city centres.
For instance, many have adopted the median between the newly rebuilt Lagos-Ibadan Expressway as their toilet. A drive by the expressway, especially as you approach or exit the Lagos axis, perpetually presents obscene spectacles of men, especially, baring their butts and defecating openly along the median. The perpetrators, it seem, have become so emboldened, probably because nobody apprehends them, that they do it even in broad daylight, presenting drivers and passengers of moving vehicles with nauseating views.
Rail tracks not spared
Unfortunately, this habit is not limited to motorways, as Mrs Adamu Blessing, who recently went on a tour to Ibadan with her friends, using the rejuvenated train system, said it was worse along the rail lines.
Adamu who told this reporter that she and her Federal Government Girls College Akure old schoolmates had opted for the rail to experience its much talked-about pleasure ride, said they were disappointed by the view that stared back at them as the big iron snake crawled along.
“What we say was appalling. Where the people were not seen doing the defecation, you saw their waste staring at you. It was so awful, that we all in the end had to limit our gazes to the inside of the train. Ordinarily, part of the experience should have been the lush green views of the vegetation and countryside life, but we learnt the hard way.
“For a country harping on developing tourism, let me just say we still have a lot to do amongst ourselves.”
Interestingly, Adamu, a businesswoman who is from a family of doctors, is not unaware of the health implication.
“Apart from the fact that flies could land on it and go visit people’s food, rain would eventually fall and wash off the mess into nearby streams and water bodies, which you won’t be surprised may be the only source of water for some of the remote communities along this rail routes. How then would we not have a cholera outbreak or should I call it resurgence?”
It is thus little wonder that the major hotspots for the outbreak have been Lagos and its neighbouring state, Ogun.
History of Cholera in Nigeria
According to the records, the first case of cholera in Nigeria was confirmed in 1972; and since then, it has become endemic, recurring on a regular basis to claim lives. The 1991 outbreak remains the most severe, as it affected a whopping 59,478 cases and claimed 7,654 lives – a fatality rate of 12.9%.
Cholera is a disease, which, when contracted, the small intestines releases a toxin which causes the body to secrete enormous amount of water, leading to diarrhoea and a rapid loss of fluids and electrolytes. The more a patient delays at getting treatment when dehydration and shock have set in, the higher the risk of death.
Speaking on a television breakfast show, YourView on TVC, the DG NCDC, Dr. Jide Idris said once you start having the symptoms of vomiting, stooling and fever, “the most important thing is to seek medical attention… because the diarrhoea is profuse and you lose a lot of fluid, which is not good. But once you get to a health facility, they would rehydrate you and every other thing can then be taken care of.”
As a preventive measure, Idris advised to “try and boil your water before drinking or cook your food well.”
He also recommended ‘hand washing as basic’, adding that the “culture should be passed onto our children.”
He dismissed a certain notion that placing water in the sun could help purify water and limit the spread, stressing that “to sterilise water, you have to boil it. I know that the Lagos State government with the support the WHO are providing disinfecting tablets for people to use in their water, just to remove the bacteria there. We’ve even sent some out to the various state governments; these include oral rehydration therapy, chlorine tablets for disinfection of water, etc…”
Apart from the above, he unequivocally said open defecation should be discouraged. And as for areas where they have no access to potable water, the DG recommended that the “Ministries of Water Resources should make arrangement for temporary water supply, using tankers. They should also provide mobile toilets or build potable latrines that can be properly maintained. Defecation is a physiological reaction, but we need to discourage open defecation still. “
On whether the government could adopt the use of cholera vaccines to curtail the spread, Idris said the demand for vaccines nationally and globally is so high and therefore very limited. He revealed that most countries usually pre-order, adding that he was aware that the Minister of Health had already contacted Gavy and CGI to that effect.
Nevertheless, he emphasised that “Vaccines only give limited immunity, hence the reason we generally say: ‘Use vaccine with other control measures, but address the issue of water, address the issue of sanitation and personal hygiene.”
Sea foods are natural habitat for cholera bacteria
Speaking in another TV monitored interview, Dr. Eniola Erinosho, Director, Medical Services and Disease Control, Lagos State Primary Health Care Board, warned that sea foods such as crabs, crayfish and the likes are natural habitat for the cholera bacteria, hence the need that they be properly cooked before consumption.
Like Idris, he stated that cholera vaccine is not one of the measures the government is adopting to curtail the spread of the disease, reiterating that the government is concentrating on creating awareness and has activated the Emergency Operations Centres (EOCs).
At 3.5 percent, he again concurred with Dr. Idris that epidemic is highly contagious and need concentrated efforts.
He therefore advised that all hands must be on deck: aside activating the emergency operation centres (EOCs), he said surveillance around water sources, food vendors, beverage vendors and all other sources that could increase spread of the disease must be increased and maintained.
For schools
While acknowledging that there has not been any outbreak in schools, he nevertheless reeled out measures that can help prevent its occurrence.
“First, he said there should be availability of clean water such as pipe-borne water or boiled and filtered water.
He also said pupils, students and teachers must maintain good personal and environmental hygiene, ensure proper disposal of sewage and refuse, because flies can move the cholera bacteria and deposit them in our food or drinks. No open defecation within schools or outside school premises. The other is to cultivate the habit of regular hand washing with soap and clean water, especially after visiting the toilet; before and after eating. Those serving food should also wash their hands regularly before they start sharing food, and make use of hand gloves while serving food.
“Above all, ensure that all foods are properly cooked,” he said.
