Cholera Outbreaks: Public health expert Dele-Olowu urges investments in WASH systems, infrastructure

Cholera, an age-old public health menace, continues to ravage communities across Nigeria, exposing gaps in infrastructure and amplifying the struggles of vulnerable populations. Yet, according to Dr Shola Dele-Olowu, a renowned public health expert and Director of Regional Initiatives at Aspen Management Partnership for Health (AMP Health), Nigeria has the tools and capacity to eradicate cholera. It requires a coordinated, multi-sectoral approach rooted in prevention, timely treatment, and systemic reforms.

Cholera, Dr Dele-Olowu explains, is an acute diarrheal disease caused by ingesting food or water contaminated with the *Vibrio cholerae* bacterium. Its symptoms, ranging from acute diarrhoea, severe dehydration, muscle cramps, sunken eyes, and dry mucous membranes, among others, reflect the body’s loss of critical fluids and electrolytes. Left untreated, the disease can cause death within hours, yet prompt treatment can save lives.

The disease thrives in environments with poor water, sanitation, and hygiene (WASH) infrastructure and has long plagued Nigeria. When flooding exacerbates these conditions during the rainy season, outbreaks become more frequent and severe. In 2021 alone, Nigeria recorded over 100,000 suspected cases of cholera and nearly 3,500 deaths. This sobering statistic underscores the devastating impact of cholera not just on health but also on the economy, society, and progress toward achieving Sustainable Development Goal (SDG) 6, which focuses on clean water and sanitation.

Dr Dele-Olowu highlights the financial toll of cholera on affected families and the health system. “The cost of treatment can drive already impoverished families deeper into cycles of poverty,” she explains. With fewer than 20 million Nigerians covered by health insurance, over 100 million people rely on out-of-pocket expenses for healthcare. For many, the rising costs of treatment due to inflation render life-saving interventions inaccessible. Furthermore, the stigma associated with cholera often leads to social exclusion, further marginalising those in need.

Despite these challenges, Dr. Dele-Olowu is optimistic. She believes ending cholera in Nigeria is achievable but requires robust investment in prevention and treatment infrastructure. Prevention, she asserts, is the cornerstone of eradication.

” The lack of proper WASH facilities is a major contributory factor in the spread of cholera.,” she says. “To tackle this, the government must prioritise investments in clean water systems, proper sanitation, and hygiene infrastructure in vulnerable communities. This is not just about public health; it’s about dignity and equity.”

Dr. Dele-Olowu advocates for a multi-pronged approach to prevention. Public health education campaigns are critical to raising awareness about cholera’s transmission, symptoms, and prevention. Environmental sanitation, including regular drainage cleaning, waste management, and proper disposal of human faeces.

Oral cholera vaccines (OCVs) also play a vital role in prevention. “OCVs provide short-term immunity and are especially effective during outbreaks and in high-risk areas. Scaling up vaccination campaigns in vulnerable regions can significantly reduce the incidence of cholera,” she explains.

Treatment, according to Dr. Dele-Olowu, must focus on rapid rehydration therapy. Oral Rehydration Solution (ORS), a simple and cost-effective remedy, can be administered at home or in healthcare facilities. Severe cases may require intravenous rehydration and antibiotics like doxycycline or azithromycin to shorten the disease’s duration. Zinc supplementation, particularly for children, helps reduce the severity of diarrhoea.

However, access to these treatments remains challenging in rural and underserved areas, where healthcare facilities are either absent or poorly equipped. To address this, Dr Dele-Olowu emphasizes the need to strengthen Nigeria’s healthcare system. “We must train healthcare workers, ensure the availability of cholera treatment kits, and develop a rapid response system to manage outbreaks,” she says.

She emphasizes that eradicating cholera requires collective action. “The government cannot do it alone. Local governments and community leaders must mobilise resources and ensure that interventions reach vulnerable populations. The private sector can invest in sanitation technology and water supply systems, while civil society organizations and the media must amplify advocacy efforts and hold stakeholders accountable.”

Dr. Dele-Olowu’s message is clear: cholera is preventable and treatable. With coordinated efforts, Nigeria can break free from the cycle of cholera outbreaks, safeguarding the health and well-being of its citizens. “The time to act is now,” she concludes.

Her words serve as a call to action, urging all stakeholders to unite against cholera. Nigeria can make cholera a thing of the past by addressing the root causes, improving healthcare access, and fostering a culture of collaboration.