The Director General (DG), of the Nigeria Centre for Disease Control and Prevention (NCDC), Jide Idris, has raised concerns about under-reporting of cholera outbreaks in the country, citing reluctance among some state governments to fully disclose their status.
According to him, the reluctance may stem from concerns about stigma or the desire to avoid governance issues that could put the state in a negative light.
However, it is unclear why the NCDC has not provided updates since Sunday, June 23, 2024, despite the increasing trend in cases this month compared to previous months.
Recall that in its June public health alert, the agency reported that between January and June 11, 2024, there were 30 deaths from 1,141 suspected cholera cases, with 65 confirmed cases across 96 Local Government Areas (LGAs) in 30 states.
By that period, 15 states accounted for 90 percent of the disease burden. By June 21, 2024, the number had risen to 34 deaths from 1,288 confirmed cases, with 15 states responsible for over 80 percent of the cases.
However, between June 21 and June 23, the figures surged to 53 deaths (an increase of 19 in three days) from 1,528 suspected cases across 107 LGAs in 31 states.
In the June 23 update, Lagos led the 15 states that contributed 90 percent of the disease burden, with 29 deaths.
The breakdown of the fatalities is as follows:
Lagos: 29, Bayelsa: 2, Abia: 4, Zamfara: 0, Bauchi: 0, Cross River: 1, Ebonyi: 0, Rivers: 8, Katsina: 3, Delta: 4, Imo: 0, Nasarawa: 1, Ondo: 0, Kano: 1.
Meanwhile, Muntari Hassan, Incident Manager of the agency’s Emergency Operations Center (EOC), revealed during a televised interview on Wednesday, June 26, 2024, that the death toll had risen to 54 from 1,579 suspected cases reported across 32 States and 115 local government areas.
However, as of the time of filing this report, there had been no further update from the NCDC despite the activation of its Emergency Operations Center (EOC) and the appointment of an Incident Manager to coordinate day-to-day activities.
These include surveillance (data collection, analysis, and dissemination), case management, oral cholera vaccine issues, coordination, infection prevention and control (IPC), logistics support, and research.
Also, the agency had earlier constituted a National Cholera Technical Working Group, which has been involved in prevention and response efforts, including repositioning and distributing medical supplies for case management, IPC, and laboratory diagnosis, among other interventions, to all 36 states plus the Federal Capital Territory.
The DG, Idris, told The Nation that the delay in releasing updates might be intended to prevent unnecessary panic, as the situation is being closely monitored in real-time across the country with active participation from state incidence management mechanisms.
However, he expressed concerns about some States’ reluctance to disclose information, warning that non-disclosure could be fatal for the entire population in the long run.
Some States had recently denied the incidence figures attributed to them, with some out rightly denying any outbreak within their domain.
Idris opined that governance issues surrounding the outbreak might be a factor in some state government’s reluctance to reveal the severity of the situation.
He said: “Why I say the cholera outbreak is a case of development, which can be politicized because people tend to get very sensitive.
“Once the news gets out that there’s an outbreak in an area, the State government gets sensitive because some people can make an issue of development out of it.
“In some States, if you ask if there are incidences of cholera, they say no. They deny it because of the stigma, that the State government probably neglected its responsibility of providing basic public sanitary utilities that would have prevented a mass infection of the people.
“We find out that most of these cases occur in slum areas or urban slums where water supply is limited, where they don’t have good drainage systems, waste disposal systems, in States where physical planning is poorly done.
“So once it rains, those places are flooded and once you have floods, the source of water, whether it’s boreholes or wells, gets contaminated.
“So, they erroneously think that by reporting the outbreak, they have openly indicated themselves.
“But again, the implications of not reporting the outbreak because of stigma is that if one person dies, if you don’t report it, and action is not taken, the chances are that it could spread.
“So you are doing your people a disservice by denying the situation”.
He said this should be an opportunity for governments at sub-national levels to prioritize basic health for the benefit of the people.
“For the government, efforts must be made to ensure that all those facilities are available for the people.
“Though this is related to the budget and it is a fact that health is an expensive business, whether it’s preventive or curative, more emphasis should be put on public health because that’s population health.
“Where the State cannot provide pipe borne water from the waterworks, at least for those vulnerable communities, like Internally Displaced Persons (DPs) or slum areas, provide boreholes or water tankers from good sources that people can use for their domestic chores and whatever they want to do.
“The States and Local Government authorities can also provide public toilets, mobile toilets or even construct latrines for people to use rather than opening defecation.
“And more importantly again, which is for the longer term, good physical planning for any State or region is key.
“This is because when people move into a particular area, which is not a controlled movement and settle, there is a high probability of unavailability of a correct water source, drainage system, and other public utilities if the place is properly planned.
“So, that’s where the government comes in because all this comes together to the benefit of the people.
“That’s why the Federal government must be commended for laying more emphasis on health considering deliberate measures taken to rejuvenate our health sector, from the Health Sector Renewal Compact to the unprecedented funding of primary healthcare from the reviewed Basic Health Care Provision Fund (BHCPF) among others steps.
“It is now left for the States and LGs to step up and work for the people at the grassroots by prioritizing public health, for the sake of the citizens”.
The DG said there is a need for the populace as well to take charge of their health, saying, “Health is everybody’s business.
“The Federal, State, Local governments, development partners, and the people as well, all have roles to play.
“For the people, behaviour is key, with the adoption of good health practices, personal hygiene, hand washing, and good water sources. Hand washing is good. Ensure that whatever water you are going to use to cook your food or to wash your vegetables is from good sources.”
However, there is a ray of hope as GAVI, the Vaccine Alliance, responsible for procuring vaccines has expressed concern about the cholera outbreak in Nigeria.
It was reported that the Nigerian government has submitted a procurement request to GAVI in response to the cholera outbreak and GAVI’s Chief Executive Officer, Sania Nashtar, expressed optimism on her X microblogging account on Thursday, that GAVI and its partners are ready to support Nigeria.
She noted: “Deeply concerned about the ongoing #cholera outbreak in Nigeria. @Gavi and partners are closely monitoring the cholera outbreak, and stand ready to support the government to quickly respond, including to request emergency vaccine doses where needed.
“The global cholera stockpile, which is funded by Gavi, is currently fully replenished and ready to help contain outbreaks and protect those at highest risk.”
No life will be lost in Bayelsa, says govt
The Bayelsa State Government has given an assurance that no lives will be lost to cholera in the state.
The government, through the Commissioner for Health, Dr. Seiyefa Brisibe, said at a press conference yesterday in Yenagoa that it had put measures in place to tackle the menace should it occur in the future.
Brisibe, however, acknowledged that Bayelsa was in the “endemic belt of tropical diseases such as cholera and yellow fever” and stressed the need to be proactive going forward.
He said the ministry had built systems, surveillance, capacity and employed the use of rapid detection test instruments.
He said the ministry had also embarked on inter-agency collaboration, community sensitisation and mobilised resources for training and retraining of medical workers to tackle any outbreak.
The commissioner stated: “We built very strong feedback and coordination mechanisms through our primary healthcare facilities. So, we are hopeful that we’ll keep it at that point of suspected cases.
“But, even if it becomes an outbreak for any reason, with what we have done, we will be in a position where we are not going to lose any life to the outbreak.
“And for me, that is the most critical and most important thing because we are in the tropics and these are disease entities that we cannot holistically eliminate.
“So, we have built resilient health systems where even if we have this risk we don’t lose lives – the outcomes for those who are affected are perfectly all right.”
Brisibe disclosed that the Douye Diri-led state government would collaborate with traditional rulers and employ a sector-wide approach to address health issues in the state.
