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Waterborne diseases: Personal and environmental hygiene key to prevention

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Recently, the Nigeria Centre for Disease Control (NCDC) confirmed casualties in many states across the country due to cases of gastroenteritis’ cholera outbreak.

Gastroenteritis has been described as inflammation of the lining of upper and middle digestive tract, predominantly the stomach and the small intestine, typically resulting from bacterial toxins or viral infection.

To prevent further outbreaks, a gastroenterologist with Lagos State University College of Medicine (LASUCOM), Lagos, Dr. Rufina Igetei advised people to focus on personal and environmental hygiene. She said: “There is need for provisions of adequate toilet facilities in public places, as well as adequate potable water, sewage disposal and treatment system.

“Food handlers and vendors should be trained on food hygiene. They should also be screened regularly for pathogens that are transmitted through food and drink contamination. The appropriate regulatory body should carry out regular and sporadic checks on common food and drink products to ensure safety.”

She explained that individuals should practise good standard of personal hygiene and toilet habits. And that drinking water and food should be sourced from safe places.

“At home, drinking water should be boiled or adequately treated,” she said. “A trained task force may be set up to ensure that food vendors have necessary equipment to keep their utensils clean, so that the food is fresh and safe for consumption. Encouragement of health education is also very important.” Igetei said government should assist affected communities by raising public awareness on the epidemic, symptoms, immediate first aid measures, and other predisposing risk factors and behaviours.

She said: “The affected community (ies) should be provided with adequate drugs, equipments and qualified personnel to treat infected persons.“The government can also assist with such long-term measures as provision of potable water, waste and sewage disposal system and food storage facilities. Health education and food hygiene should be taught in schools.

“The main symptoms of gastroenteritis include nausea, vomiting and diarrhoea, frequent passage of watery stool, which may contain blood. There may be fever, abdominal pain or cramps and general body weakness. “Severe cases could be accompanied by such complications as reduced urinary output and alteration in the level of consciousness. Depending on the severity, there are also such signs of dehydration as sunken eyes, dry mouth, low blood pressure, rapid pulse rate, which may be hardly palpable and cold extremities.”

According to Igetei, the more susceptible are those at the extremes of age, incarcerated or institutionalised persons, where sanitary conditions are poor, living in places with inadequate potable water, waste and sewage disposal systems, areas where open defecation is practised, and use of human faeces as manure. Epidemics could occur by contamination of the common source of water supply or inadequate water treatment or contamination of an item sold in the community.

She said: “The immediate treatment of gastroenteritis is replacement of lost fluid and electrolytes, either orally using oral rehydration solution, which can be done at home at onset of symptoms or intravenously using intravenous fluids, especially if the individual is vomiting or has lost a lot of fluids.

“Some may require antibiotics. Zinc may also be used. In epidemic situation, affected persons should be admitted and isolated from the rest of the community in equipped hospitals with qualified personnel.

“In cases of epidemic, health education should be carried out in the community to alert people of the symptoms, especially the predominant one seen in affected members. The identified source of infection should be avoided and substitute(s) provided. Gastroenteritis can be prevented by personal hygiene. Good toilet habits, using appropriate facility and leaving it clean for the next person and hand washing with soap and clean water after each use.“Adequate washing of fruits and vegetables before consumption is very important. Adequate cooking and storage of food is also important to avoid contamination.”

Senior Registrar, Gastroenterology and Hepatology Unit, Lagos State University Teaching Hospital (LASUTH), Dr. Cara Cookey said fever, severe abdominal pain and bloody diarrhoea suggest more severity and should prompt immediate clinical evaluation and treatment.She said: “Treatment involves evaluating the patient, taking a good clinical history, especially the food eaten and contacts with others with diarrhoeal illness and travel history.

“A thorough physical examination is done to assess the level of hydration. In cases of mild to moderate dehydration, where the patient can still tolerate oral fluids, you give Oral rehydration solution (ORS). However, in severe dehydration, patient would require intravenous fluid administration in a hospital. “Stool and blood samples would be taken to the laboratory for analysis. If specific organisms were isolated, appropriate antibiotics would be administered. The patient’s vital signs are closely monitored until they recover from the diarrhoeal illness.“Vaccination should be given especially to children in cases of vaccine preventable diarrhea, for instance, Rota virus, cholera, Typhoid, and Hepatitis A and E. Although gastroenteritis is a serious condition that can become life-threatening, it is highly preventable.”


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LASUTHNCDCRufina Igetei
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