How cholera outbreak cases thrive in Nigeria
Despite the long experience with cholera in Nigeria, an understanding of the mechanism aiding its persistence in outbreak situation is still lacking. OBOKOH ANTHONIA writes on targeted approaches to control the infection.
The burden of cholera outbreaks remains high in many African countries with at least twelve countries reporting active transmission in sub-Saharan Africa, Nigeria inclusive.
In Nigeria, since the first appearance of epidemic cholera in 1972, intermittent outbreaks have continued to occur.
Despite the long experience with cholera in Nigeria, an understanding of the epidemiology of the disease aiding its persistence in outbreak situation is still lacking.
“Nigeria is currently the most impacted country with some 90 per cent of cholera cases,” says the United Nations Children’s Fund (UNICEF).
Cholera is a serious bacterial infection that causes severe watery diarrhoea and stomach cramps which can lead to dehydration and even death.
Studies revealed that the immune-pathogenesis of the pathogens would promote understanding of the infectious disease development and improve prospects for effective diagnostics, drugs, treatment and vaccines.
According to the latest update of situation report by the agency, since the beginning of 2018, a total of 14,762 suspected Cholera cases with 389 laboratory confirmed and 258 deaths have been reported from twenty two states and 135 Local Government areas compared with 1198 suspected cases and 32 deaths from 47 local government areas in twenty-three states during the same period in 2017.
The current outbreak has already reached a number of major states following weekly epidemiological report week 34(August 26, 2018), identifies the highest burden from Zamfara with about 222 cases (two hundred and twenty- two), Katsina (one hundred and twenty two), Kano -169(one hundred and sixty nine), Borno- 38 (thirty eight), Kaduna- 20 (twenty) and Bauchi-3(three) making it five states.
“A total of 452 suspected cases have been reported with ten laboratory confirmed cases and 22 deaths were reported from 34 Local Government areas in eleven states,” says the report.
Recently, Zambia, Uganda, Malawi, South Sudan and Nigeria benefited from the Africa largest cholera vaccination drive in history with more than two million people across the continent set to receive oral cholera vaccine (OCV) funded by Gavi, the Vaccine Alliance.
Tedros Adhanom Ghebreyesus, World Health Organisation director-general said, WHO and our partners are saving lives every day by improving access to clean water and sanitation, establishing treatment centres, delivering supplies, distributing public health guidance, training health workers, and working with communities on prevention.
“Oral cholera vaccines are a key weapon in our fight against cholera, but there are many other things we need to do to keep people safe,” said Ghebreyesus.
However, public health experts have harped on the need to check and invest heavily in tackling disease outbreaks, stressing that Nigeria must do more to improve the country’s infrastructure, logistics, commodities, technology, human resource and communication.
Muntaqa Umar-Sadiq, chief executive officer, Private Sector Health Alliance of Nigeria (PHN), said Nigeria’s epidemic preparedness and response capacity highlight six priority gaps required to enhance detection, prevention and management of an outbreak.
“Priority gaps include infrastructure, logistics, commodities, technology, human resource and communication.
“With more outbreaks on the horizon, Nigeria can’t afford to repeat this cycle of uncertain priorities, wasted time and investments. We need strong and clear leadership; effective deployment of new innovations,” he stressed.
Meanwhile a review on Cholera epidemiology research in Nigeria provides the knowledge gaps of the infection with the hope that it will help to develop targeted approaches to controlling the infection.
According to the research, about 75 per cent of people infected with Virus cholera do not develop any symptoms, although the bacteria are present in their faeces for 7-14 days after infection and are shed back into the environment, potentially infecting other people.
“Among people who develop symptoms, 80 per cent have mild or moderate symptoms, while around 20 per cent develop acute watery diarrhoea with severe dehydration.”
“In severe infections, more than one quart of water and salts is lost per hour and If dehydration is not treated, loss of water and salts can lead to kidney failure, shock, coma, and death,” research showed.
The research further revealed that in people who survive, symptoms usually subside in 3 to 6 days, adding that most people can be free of the bacteria in two weeks and some; the bacteria remain in a few people indefinitely without causing symptoms.
“Unsafe water sources and dirty environment contributed to the spread of the disease and yearly outbreaks in many states in Nigeria, says the agency while calling for better hygienic conditions,” Chikwe Ihekweazu, chief executive officer, NCDC said.
According to Ihekweazu, Cholera cases are being treated at designated treatment centres in affected states. “We have ramped up our risk communications campaign so that people are better aware of the risk factors and ways to prevent cholera outbreaks”.
“We are also strengthening the disease surveillance and laboratory systems so that cases are reported early, detected in time and response measures initiated.”
“States are encouraged to prevent cholera outbreaks by improving access to water, sanitation and hygiene (WaSH); this remains the best way to prevent cholera”, said Ihekweazu.
Similarly, Haruna Mshelia, commissioner for health, Borno state recently activated the Emergency Operations Centre for coordination of partners’ response, he urged all partners, based on comparative capacities, to support the state ministry of health to establish and manage cholera treatment centres by intensify house-to-house case search, risk communication activities, improve water, sanitation and hygiene facilities as well as other interventions to ensure that the transmission is interrupted on record time.
However, for Nigeria to response effectively, according to WHO, at the core of any response to outbreaks is how well the country’s health system is functioning on a regular basis, before the disease strikes.
“A strong health system capable of providing effective primary care to its citizens will be much more resilient when an unexpected crisis hits.
“Conversely, countries with weak health systems, which often also face a range of governance and poverty issues and multiple disease burdens, will struggle to provide basic health services. These challenges are worsened during severe disease outbreaks,” says the agency.