Experts blame current Cholera outbreak on bad water, sanitation

…Disease spread to 3 states
The recent outbreak of cholera in some states in Nigeria has led to several casualties. Cholera is an intestinal infection characterised by watery stool and diarrhoea. It is caused by the Vibrio cholerae, a bacterium, which releases toxins in the human intestine.

This toxin activates excess secretion of water from the intestinal lumen that often lead to severe dehydration and sometimes death. Conditions that can lead to outbreaks include a disruption in water supply, poor basic sanitation and poor hygiene.

Infected people show symptoms within two to five days. They can spread the disease even when they are not ill themselves by shedding the bacteria in their faeces.

People show symptoms within two to five days. They can spread the disease even when they are not ill themselves by shedding the bacteria in their faeces, Dr. Wale Adedipe, a medical health expert was quoted as saying.

According to him, ‘’as in other developing countries, cholera outbreaks occur mainly during the rainy season in Nigeria although they also sometimes occur in dry season.

Flooding can cause septic tanks to contaminate surface water, especially open wells used for drinking and food preparation. Contaminated flood water from the rains can also flow to vegetables and fruits which, if not properly washed, can cause an outbreak.

‘’Cholera outbreaks happen when groups of people share infected water or food. When this happens, many people will require help at the same time. Health facilities and resources are often inadequate and ill-prepared to deal with such pressure’’.

The outbreaks in different parts of Nigeria are often driven by different factors. What they all point to, however, is that the country has not yet taken sufficient steps to address the “epidemiological triangle” that drives cholera outbreaks host, agent and environmental factors.

This includes early detection, better and stronger sanitation infrastructure that can withstand heavy rains as well as basic health infrastructure.

Another medical heath expert, Mr, Augustine Abidemi said that for a cholera outbreak to occur there must be significant breaches in the water, sanitation, and hygiene infrastructure used by groups of people, permitting large-scale exposure to food or water contaminated with Vibrio cholera organisms; and cholera must be present in the population.

He said that Cholera has been proven to be transmitted through faecal-oral route via contaminated food, carriers of the infection and inadequate sanitary conditions of the environment. The principal mode of transmission however remains ingestion of contaminated water or food.

He recalled the 1996 cholera outbreak in Ibadan (Southwest) Nigeria where he attributed the cause to contaminated potable water sources.

‘’Street vended water and not washing of hands with soap before eating food were possible reasons for the 1995-1996 cholera outbreaks in Ibadan. Drinking water sold by water vendors was also connected with increased risk of contracting the disease’’.

In Katsina State however, Abidemi linked the outbreak of the disease to faecal contamination of well water from sellers but added that the 2010 outbreak was speculated to be directly related with sanitation and water supply.

‘’The hand dug wells and contaminated ponds being relied on by most of the Northern states as source of drinking water was a major transmission route during the outbreak. Perhaps, these wells were shallow; uncovered and diarrhoea discharge from cholera patients could easily contaminate water supplies’’.

For his part, a pharmacists, Mr. Osayamen Olaye who stressed the need to ensure a clean environment always identified population movement as a factor that may greatly contribute to risk of cholera transmission.

According to him, the movement of persons enhances spread of the infectious agent to others and to different sites. ‘’all the surviving residents that fled a two month outbreak in Kebbi state (North-north) became indices for subsequent infection in the north and southern part of a neighbouring state.

Additional overcrowding increases risk of contact with vomitus, excreta and contaminated water or food. Since early detection and containment of cases (isolation facilities) are paramount in reducing transmission, poor access to health services and poor diagnosis may become major barrier to controlling the infection.

Lack of safe water and poor sanitation are important risk factors. All these features have contributed greatly to cholera infections in Nigeria’’ he added.

The recent outbreak in Mubi in Adamawa State according to the World Health Organisation (WHO) killed at least 16 people while about 176 others. The WHO said that had deployed 39 staff to contain the cholera outbreaks in Mubi North and South local government areas of Adamawa State.

The WHO through a statement it made available to journalists said that plans were also underway to engage additional 15 ad-hoc personnel for the affected local governments.

’’We have swiftly deployed technical staff to coordinate partners’ response to the current outbreak, support case management, surveillance and contact tracing of suspected cases to guide interventions and ensure that the outbreak does not spread to other locations,” Dr Wondimagegnehu Alemu, WHO Representative to Nigeria said.

434 suspected cases of cholera and 13 deaths have been reported in the affected areas as at May 26, necessitating the health authority to activate an Emergency Operations Centre for concerted response and rapid decision-making.

Dr Alemu said the transmission rate of the cholera outbreak in the state was worrisome, adding “Notwithstanding, WHO is leveraging on its past experience and lessons learnt in controlling major cholera outbreaks in internally displaced persons camps and host communities, especially in Borno and Yobe states.”

Adamawa State Commissioner for Health, Dr Fatima Atiku Abubakar said the state health authority was collaborating with WHO and other partners to ensure that the outbreak currently reported from 12 wards of the two LGAs is controlled

Meanwhile, the outbreak has reared its ugly head in some cities in the country. A student of Government Girls Secondary School, Kawo, Kaduna State, has died of the disease while 42 others have been hospitalised at the General Hospital, Kawo, following the outbreak of cholera in their school.

Already, health workers have been deployed to the school to manage the situation, though officials of state’s Ministry of Health as well as the school principal declined commenting on the issue.

Officials of Red Cross Nigeria, who were at the school in collaboration with other emergency organisations to put the situation under control, said the affected 42 students were having diarrhea and vomiting as a result of the unhygienic environment.

Also, the Deputy Director, Disease Control Centre, Ibrahim Suleiman, told newsmen that he could only confirm 39 cases, which according to him have been evacuated from their hostels to the hospital.

He said, “We have 39 cases on admission due to diarrhea and vomiting. We are yet to confirm the real cause but there are a lot of contaminations around the water source the students are using, which may be a serious contributory factor. Apart from the 39 students already affected, we are also investigating another 89 cases, which are not diarrhea and vomiting.

A parent simply identified as Ibrahim said the surrounding of the well, which is the only water source for the students, was littered with excreta, as the overhead tank serving water to the school was not functioning. This, according to him, has made it difficult for the students to use the toilet facility in the school.

“My daughter was affected. The school hygiene was too poor. There is excreta around the well where these children are getting water from”, he added.

This is coming at the time the state government is trying to revamp the educational sector in the state to providie qualitative education for Kaduna children.

In a related development, the Plateau Commissioner for Health, Kunden Deyin, had confirmed that at least three persons out of 90 suspected cases in the state were confirmed to have contacted the disease.

Deyin, who confirmed the development in Jos, the Plateau State capital added that three other persons had died with symptoms suspected to be cholera.

The commissioner said the deaths were caused by the non-availability of the Rapid Response Diagnostic Kits, which would have been used to confirm the diagnosis. He added that the recently suspended strike by the Joint Health Sector Unions (JOHESU) was also contributory to the mortality.

“Initially, we had 93 suspected cases of cholera, however, three persons died without our confirming if they had the disease or not.

Fortunately, the Nigeria Center for Disease Control (NCDC) provided us with Rapid Diagnostic Kits, with which we carried out test on five patients from the 90 suspected cases. Three test samples came out positive,” Deyin said.

The commissioner expressed optimism that the outbreak would be contained with the suspension of the strike by JOHESU and with the provision of the test kits by the NCDC.

He called on the public to ensure that they always wash their fruits and vegetables thoroughly before eating them, adding that they should also boil their drinking water to kill the organism causing cholera.

It could be recalled that the first series of cholera outbreak was reported between 1970- 1990. Despite the long experience with cholera, an understanding of the epidemiology of the disease aiding its persistence in outbreak situations is still lacking.

In Nigeria, the infection is endemic and outbreaks are not unusual. In the last quarter of 2009, it was speculated that more than 260 people died of cholera in four Northern states with over 96 people in Maidugari, Biu, Gwoza, Dikwa and Jere council areas of Bauchi state.

Most of the Northern states of Nigeria rely on hand dug wells and contaminated ponds as source of drinking water. Usually, the source of the contamination is other cholera patients when their untreated diarrhoea discharge is allowed to get into water supplies.

The 2010 outbreak of cholera and gastroenteritis and the attendant deaths in some regions in Nigeria brought to the forefront the vulnerability of poor communities and most especially children to the infection.

The outbreak was attributed to rain which washed sewage into open wells and ponds, where people obtain water for drinking and household needs.

The regions ravaged by the scourge include Jigawa, Bauchi, Gombe, Yobe, Borno, Adamawa, Taraba, FCT, Cross River, Kaduna, Osun and Rivers. Even though the epidemic was recorded in these areas, epidemiological evidence indicated that the entire country was at risk, with the postulation that the outbreak was due to hyper-virulent strains of the organism.