Opinion: Why Cholera Remains Persistent In Nigeria And The Way Forward

In recent weeks, media outlets have reported a resurgence of cholera in Nigeria. This disease, primarily caused by consuming contaminated water, food and inadequate sanitation, is exacerbated by flooding and compromised water sources, which are features of the rainy season.

Consequently, cholera has become endemic, posing a recurring threat each year. The current outbreak has affected several states, including Ogun, with Lagos recorded as an epicenter.

In response to the outbreak, the Nigeria Centre for Disease Control (NCDC), has activated the National Cholera Emergency Operations Centre (EOC).

According to the NCDC’s social media updates, there were 1,528 suspected cases and 53 deaths nationwide as at June 24. The EOC’s coordinated response aims to interrupt disease transmission and mitigate the outbreak’s socio-economic impact. Historically, NCDC’s prompt actions have yielded remarkable results, demonstrating their effectiveness in public health crises.

Key drivers of cholera include the demographic and socio-economic landscape.

Children and the elderly, particularly those suffering from malnutrition, are more vulnerable to severe cholera outcomes. Malnutrition not only increases transmission rates but also worsens the severity of the disease. Cholera’s persistence is further fueled by bacterial shedding from infected individuals. Infected persons shed the bacteria through their faeces, leading to widespread environmental contamination.

Another critical factor in cholera spread is the lack of safe drinking water and poor hygiene practices. Many Nigerian communities face daily realities of consuming contaminated food or water. Historical outbreaks, like the 1995-1996 cholera outbreak in Kano, underscore the need for proper hygiene and safe water. Population congestion, particularly in urban centers and internally displaced persons (IDP) camps, further drives cholera outbreaks. Overcrowded conditions strain existing water and sanitation facilities, as seen in the 2018 cholera outbreaks in IDP camps in Yobe, Adamawa, and Borno states. Improving living conditions in these areas are essential for cholera prevention. Lagos, with over 20 million residents, is currently the epicenter of the outbreak, recording significant mortality rates.

Living conditions in Nigerian urban and peri-urban slums remain dire, contributing to recurrent cholera outbreaks. Inadequate water supply and sanitation make these areas hotbeds for transmission. Shockingly, only a quarter of Nigeria’s population has access to improved water sources and sanitation facilities, with many practicing open defecation.

Improving living conditions through better urban planning and infrastructure development is crucial.
Fortunately, there is political will to eliminate cholera. At the federal level, the Coordinating Minister for Health and Social Welfare, Professor Ali Pate, has prioritised improved governance and harnessing interventions across sectors. This foundation could support a nationwide effort to combat cholera. Stakeholders such as the media, development partners, community leaders, and non-governmental organisations are essential in the fight to eradicate cholera.

The media plays a crucial role in raising awareness, educating the public on preventive measures, and highlighting the importance of hygiene and sanitation practices. Development partners can provide both technical and financial support to strengthen health systems, improve water and sanitation infrastructure, and fund public health campaigns.

Addressing nutritional deficiencies through robust public health campaigns and support programmes is essential to reducing susceptibility to cholera and improving overall health outcomes. Breaking the re-occurrence of cholera outbreak in Nigeria requires effective waste management and sanitary conditions. Communities must be educated about proper waste disposal, and governments must invest in sanitation infrastructure.

Significant investments in water infrastructure and comprehensive hygiene education campaigns are necessary to address these issues. Agencies like the Nigerian Agency for Food, Drug Administration and Control (NAFDAC) must also enforce strict compliance to prevent unauthorised or contaminated food and water from reaching markets.

The impact of community leaders cannot the overstated. They are pivotal in mobilising local efforts, ensuring community engagement, and fostering a sense of ownership and responsibility in public health initiatives.

Likewise, non-governmental organisations can offer on-ground support through health education, resource distribution, and direct assistance to affected communities. Their support and efforts often go a long way in amplifying the impact of government efforts.
It is important to mention the need for sustained collaboration among these stakeholders. This can significantly enhance the effectiveness of cholera eradication programmes. For example, media campaigns can drive behaviour change, while community leaders can facilitate local-level implementation of health interventions. Both of these stakeholders are closer to the masses than anyone can imagine.

In Ogun state, Governor Dapoe Abiodun has made healthcare a top priority. The State has implemented a robust surveillance system across its 20 local government areas for prompt detection and response. Public and private health facilities have been sensitised to report suspected cases immediately, and treatment is free at government facilities. Rapid-response teams have been trained, and cholera test kits and treatment supplies distributed to all LGAs and designated centers.

The Ministry of Health, in collaboration with various stakeholders including the Ministries of Environment, Information, Education, and emergency services, is coordinating Ogun state’s outbreak response. This multi-sectoral approach is crucial, as public health responses cannot rely solely on health MDAs and hospitals. Effective epidemic response requires all hands on deck.

The strengthened disease control mechanisms at both national and subnational levels, bolstered since the COVID-19 pandemic, suggest that this cholera outbreak will be contained soon.

However, Nigeria must aim to eradicate cholera entirely.

Overall, Nigeria requires a multi-sectoral approach to end cholera’s persistence. It is not only a public health matter but also a step towards improving the overall quality of life for its citizens. Through coordinated efforts across various sectors, Nigeria can build a resilient health system capable of preventing future outbreaks and ensuring a healthier population.

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