‘…Without prompt, adequate treatment, it can lead to shock, death within hours’
…Disease has already claimed 350 lives this year – NCDC
…Avoid locally made drinks such as kunu, zobo, fura da nono, others – Agwai
‘…It’s risky treating ailment with carbonated drinks, seasoning cubes’
In this report, BENJAMIN SAMSON speaks with a cross-section of Nigerians, including experts, stakeholders on the incessant outbreaks of cholera in many parts of the country and how the trend could be halted.
Cases
An outbreak of cholera in Sokoto state has claimed 25 lives, with 15 individuals currently receiving treatment across three local government areas of the state. A total of 1,160 cases have been reported in the state.
The Sokoto state Commissioner for Health, Hajiya Asabe Balarabe, who disclosed this during a press briefing, noted that the outbreak had primarily affected Sokoto North, Silame, and Kware local government areas.
She said, “Out of the 1,160 reported cases, 25 people have succumbed to the disease. Rescue teams, in collaboration with the state government, are working tirelessly to manage the outbreak and prevent its further spread.”
She said further that the 15 active cases were confirmed through laboratory tests, while the state government had distributed drugs free-of-charge to 18 local government areas as part of its intervention strategy.
Hajiya Balarabe acknowledged the persistent challenges facing the state’s health care sector, including inadequate infrastructure and resources, but expressed optimism that Governor Ahmad Aliyu would revitalise the sector, citing his recent recruitment of 864 nurses and midwives to address manpower shortages.
Our correspondent gathered that the worst-hit areas included Bazza and Gidadawa communities in Sokoto metropolis, where several fatalities occurred, and others are still receiving treatment at health centers in Bazza and Kofar Rini in Sokoto North local government area.
Significantly, Sokoto is not the only state that has witnessed large outbreak of cholera this year. Other states included Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, and Nasarawa as well as Adamawa, Lagos Ebonyi, Yobe, Kano, and Jigawa.
The disease
Speaking with this reporter, a public health physician, Dr. Mustaoha Paiko, said, “Cholera is an acute intestinal infection that spreads through contaminated foods and water. Communities with limited access to sanitation are the most affected.
“Conflicts, climate change, inadequate safe water and sanitation, poverty, underdevelopment, and population displacement due to emerging and re-emerging conflicts and disasters from natural hazards all contribute to the rise in cholera outbreaks.
“This acute diarrhoea illness is characterised by the sudden onset of profuse watery diarrhoea which can lead to severe dehydration and, if untreated, death.
“The causative agent, a bacterium called Vibrio cholerae, is typically found in areas with poor sanitation, making cholera outbreaks common in areas with inadequate sewage treatment and unclean drinking water. Most individuals get infected when they take water or other food substances contaminated with faeces from an infected person.”
Also, a medical doctor and the convener of Child Health Africa, a non-governmental organisation, Mrs. Blessing Atuche, said, “The World Health Organization (WHO) estimates that cholera affects 1.3 to 4 million people worldwide annually, resulting in up to 143, 000 deaths.
She said, “Cholera manifests very rapidly, with symptoms appearing between 12 hours and five days after ingestion of the contaminated substance. Without prompt and adequate treatment, the illness can lead to shock and death within hours.
“However, proper rehydration can reduce the mortality rate to less than one per cent, offering hope in the face of this deadly disease.
“The primary symptoms to watch out for include severe watery diarrhoea; often described as ‘rice-water stools’ due to its appearance, vomiting, which could further lead to loss of fluids and electrolytes, leg cramps due to severe dehydration and electrolyte imbalances.”
2024
This outbreak in Sokoto is the latest in a series of cholera outbreaks in different parts of the country. Figures from the Nigeria Centre for Disease Control (NCDC) revealed that as of October over 359 people had died from cholera during the first 10 months of 2024, marking a 239 per cent increase compared to the same period in 2023.
In its report, the NCDC disclosed that 359 deaths were recorded between January and October, which indicated a significant rise from the 106 deaths during the same period last year.
“The number of suspected cholera cases, according to the data, also revealed a spike to 10,837, up from 3,387 in 2023. Children under the age of five make up the majority of those affected and Lagos, the nation’s commercial hub, reported the highest number of cases in 2924,” NCDC said.
Reasons for spike in cases
Experts who spoke with this reporter attributed the country’s worsening and yearly cholera epidemic to significant neglect of basic health needs, poor living conditions, and widespread poverty.
They said that instead of investing in preventive measures and infrastructure, successive governments both at federal and state levels often scramble to respond to outbreaks only after they have spiraled out of control.
Lamidi Adeleke, a medical doctor, criticised governments’ response to public health issues as largely reactive.
“Nigeria’s health care sector remains persistently underfunded, with many public health care facilities in poor condition, lacking essential supplies, equipment, and trained personnel.
“In the hardest-hit areas, hospitals and clinics are overwhelmed, often facing shortages of beds, rehydration solutions, and antibiotics, leading to high mortality rates.
“Their failure to invest in health care infrastructure and preventive measures has left the population vulnerable to cholera and other preventable diseases. This neglect is costing lives and causing unnecessary suffering,” he said.
Likewise an environmentalist, Dr. Attah Eboh, pointed out that multidimensional poverty in the country “is a significant driver of the cholera epidemic.”
He said, “When people live without access to clean water, proper sanitation, and adequate housing, they are more susceptible to waterborne diseases like cholera.
“The prevalence of open defecation and inadequate waste management systems in many urban slums and rural areas forces residents to rely on contaminated water sources.
“During the rainy season, flooding exacerbates the contamination of water supplies, spreading cholera bacteria more widely.
“This also makes the impact of the cholera epidemic on Nigerian publics more devastating. In states severely affected by the outbreaks, residents share distressing stories of loss and despair.”
Also, Doyin Odubanjo, a public health expert, emphasised that diseases like cholera are diseases of poverty and underdevelopment because it is expected that it is the poor that do not (or are unable) to maintain a hygienic environment that contract the disease.
“Cholera happens when feaces get into the food or water consumed by people. I said underdevelopment also because, apart from maintaining personal hygiene, we can’t even guarantee the safety of water/food even in highbrow areas in most of our cities as there is no pipe-borne water from the government and the people use water from various uncertified sources.
“There is also no centralised waste disposal system. Cholera is deadly, but the current outbreak in Sokoto is caused by a strain of the bacteria that is even quite deadlier.
“The only way to be proactive with cholera is to ensure proper urban and rural development with good waste disposal and pipe-borne water. Health education, generally, will also help,” he said.
Vigilance
In an interview with this reporter, a virologist in the department of public health, Collage of Health Science Technology, Kaduna, Dr. Musa Agwai, called on Nigerians in areas experiencing outbreaks to avoid locally made drinks such as kunu, zobo and fura to prevent cholera disease.
He also urged the public to be more vigilant and to imbibe good sanitation and hygiene practices at home and in their workplace.
He further charged all and sundry to embrace preventive measures such as keeping their environment clean always and disposing waste properly at designated places.
He said, “Ensure the use of clean and safe water. Water from suspicious sources should be well boiled or treated by adding chlorine solution.
“Avoid locally prepared drinks like kunu, zobo, fura da nono, koko, fruit juice among others except it is certain that the preparation was done in a hygienic and safe manner.
“Wash hands regularly with soap under running water, especially after using the toilet, clean a child who has gone to the toilet, before preparing food, before and after eating, and after playing with animals,” he said.
“States and local governments must put measures in place to increase environmental health surveillance in places where food and drinks are sold nationwide.
“These places include markets, garages, schools, restaurants, stadia, religious and sporting event venues. The measures would help avert the further spread and transmission of cholera and aid in the prevention and control of the disease.
“Commissioners for Environment and the Local Government chairpersons in areas affected must support environmental health officers to step up sanitation and hygiene activities through enhanced community-led total sanitation. They should also strengthen collaboration with the health authorities and other stakeholders in line with the one health approach of the federal government.”
Admonition
Atuche warned Nigerians against using a combination of carbonated drinks and seasoning cubes to prevent and treat cholera. She said the warning came in response to several social media posts touting the use of Coca-Cola and Maggi combination as strong cocktails for the treatment of cholera.
Atuche said the mixture was not a medical solution, noting that toxicology tests from the combination might be harmful to the health and well-being of individuals.
“That combination I believe is risky and more expensive than using Oral Rehydration Salts (ORS). Why would anybody want to substitute ORS for Maggi and Coca-Cola? That’s alarming. ORS is a solution that’s tested, proven and trusted to treat cholera or diarrhea or gastroenteritis disease.
“If somebody has hypoglycaemia (low sugar), of course, the individual can be given Coca-Cola, Pepsi, Sprite, Miranda or Fanta, or any of those carbonated drinks, but in measured doses. Combining Coca-Cola with Maggi for cholera treatment is not a medical solution.”
The public health expert emphasised that cholera could be easily treated through prompt administration of ORS or preparing the salt and sugar solution to help individuals.
She recalled that during the Covid-19 and Ebola outbreaks, some people promoted the use of salt water to bathe as a cure for the diseases, stressing that it was a hoax that caused complications and death to some individuals.
Atuche cautioned the public against practising the things they see online, stressing that health advisory from physicians and health regulators should be strictly adhered to, to ensure health safety.
On the preventive measures against cholera, she advised people to always wash their hands with soap and running water before and after eating, and after using the toilet.
“Washing our hands with soap and water alone is a huge step in controlling and preventing this viral outbreak. Apart from that, people should ensure they keep their waste safely in containers away from flies because flies pick up germs and bacteria from the waste or faecal matter and drop them when they perch on food items.
“We should also dispose of refuse properly, maintaining good hygienic practices is critical to reducing the transmission of cholera.”
She advised further that vegetables and fruits should be washed thoroughly before being consumed, while water should be boiled before drinking.
Atuche still advised Nigerians to ensure proper washing of utensils such as spoons, cups, plates, glass cups, mugs, before use.
“Cholera is transmitted from contaminated hand to mouth. So, if we can clean our hands, utensils and any item containing things that we put in our mouth, then we can prevent cholera from spreading.”