[ad_1]
Thousands of cholera cases were reported in Nigeria between January and June 2021. The northern states of Bauchi, Gombe, Kano, Plateau and Zamfara are among those affected.
Cholera is an acute diarrheal disease caused by Vibrio cholerae bacteria. It is transmitted in feces through contaminated food, drinks and unsanitary environments, and causes severe dehydration. Infected people can die if their illness is not treated promptly with oral rehydration.
In the past, cholera infections were common in many countries around the world. Now they are mostly confined to developing regions because the disease is associated with poor nutrition, poor water quality and poor sanitation.
The proportion of people who die from reported cholera remains higher in Africa than elsewhere. In Nigeria, huge epidemics were recorded in 1991, 2010, 2014 and 2018. In 2018, there were 43,996 cases of cholera and 836 deaths: a case fatality rate of 1.90%.
Cholera drivers
Susceptibility to cholera is associated with demographic and socio-economic factors, including age and nutritional status. Malnutrition causes transmission and severity. Vitamin B12 deficiency and gastritis are risk factors for infection.
The bacteria that cause cholera are passed in the stool for almost two weeks after infection. They can be released into the environment to infect other people.
Lack of access to safe drinking water and poor personal and environmental hygiene are fundamental factors that favor the spread of cholera. Infection also occurs when people eat or drink something that is already contaminated with the bacteria. Evidence from the 1995-1996 outbreak in Kano state revealed that poor hand hygiene before meals and water being sold played a role.
The congestion of the population is also a factor in the spread of cholera. This can happen through migration to commercial hubs such as Kano. It can also happen when humanitarian disasters force displaced people to live in camps. There they often have an insufficient water supply and may be unable to observe good sanitation practices. Over 2.9 million people are currently living as internally displaced persons in northeast Nigeria. At least 10,000 cholera cases and 175 related deaths were reported in Yobe, Adamawa and Borno states, mostly in overcrowded camps in 2018.
Living in urban and peri-urban slums also promotes cholera. This is because the regular water supply and sanitation facilities are not sufficiently available. Only 26.5% of the Nigerian population use drinking water sources and improved sanitation facilities, and 23.5% defecate in the open.
Fighting cholera in Nigeria
The Nigerian government has made efforts to control the disease. It implements programs to improve water supply, basic sanitation and good hygiene practices, but these are usually implemented after epidemics. Under the leadership of the Federal Ministry of Water Resources, the government provided 510,663 liters of water per day to 39 localities in Adamawa State, which accounted for 50% of cholera cases in 2019.
It also provided mobile solar powered boreholes. The International Organization for Migration maintains 58 solar boreholes in Borno State and drilled 11 new ones in 2019. It also rehabilitated 10 and connected them to solar power.
In response to an outbreak in IDP camps in Borno State in 2017, the National Primary Health Care Development Agency and other partners conducted oral cholera vaccination campaigns.
Oral cholera vaccine is not part of routine immunization in Nigeria. It is not 100% effective against cholera and does not protect against other food or waterborne illnesses. It is not a long-standing solution to cholera and only bridges the gap between emergency response and long-term cholera control. In 2017, reactive oral cholera vaccine campaigns were implemented in Borno to stop an epidemic. Investments in water, sanitation and hygiene infrastructure are still needed.
Health education campaigns are carried out by outbreak investigation teams of the Nigerian Center for Disease Control after confirmation of cholera outbreaks. UNICEF has encouraged water chlorination among communities in cholera hot spots. This has benefited an estimated 4.5 million people in Borno, Adamawa and Yobe states, including 680,000 displaced people in urban centers.
What remains to be done
Much remains to be done because cholera has not been completely conquered.
Cholera has been described as a “disease of poverty” because social risk factors play an important role in its transmission.
In line with multisectoral control best practices, we recommend the following:
National governments of cholera-affected countries should take the lead with the support of partners of the Global Cholera Control Working Group. Multisectoral interventions to effectively control cholera are based on a set of measures that must be well coordinated. They include creating access to safe drinking water and sanitation; improve surveillance, reporting and preparedness; and community engagement to raise awareness and promote good hygiene practices.
Regular health education during and after epidemics is necessary. Community engagement would help identify the people who would be responsible for the timely notification of suspected cholera cases. Teams that manage outbreaks at the local, state, and federal levels need to be well coordinated and respond quickly when notified of a cholera outbreak.
These measures have worked in South Sudan and Tanzania, but require political will to bring different sectors together.
Olayinka Stephen Ilesanmi is not working, consulting, owning stock, or receiving funding from any company or organization that would benefit from this article, and has not disclosed any relevant affiliation beyond his academic position.
By Olayinka Stephen Ilesanmi, Senior Lecturer, Department of Community Medicine, University of Ibadan
Source link
