• Lagos schools may not resume from break, says commissioner
• Medical doctor highlights role of inflation, poverty  
• 10 states account for 90% burden, experts advocate preventive measures 
• WHO: Estimated 4 million cases, 143,000 deaths globally every year

Nigeria is in a race against time to contain a cholera epidemic. Already, the current outbreak has claimed the lives of over 30 persons across 30 states in the country.

   
Cholera is an acute diarrhoea infection caused by ingestion of food or water contaminated with the bacterium, Vibrio cholera. As of June 17, 2024, 17 out of 350 suspected cases were confirmed in Lagos State amid 15 deaths.
   
The Nigeria Centre for Disease Control and Prevention (NCDC) on June 13, 2024, announced it found 1,141 suspected cases. Of the figure, 65 were confirmed while 30 deaths were said to have been recorded across 96 local councils in 30 states.
   
The data was collected between January 1 and June 11, 2024.  According to the centre, 10 states: Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, Nasarawa and Lagos bore 90 per cent of the burden in the country.
   
This came as Lagos State Commissioner for Primary and Basic Education, Jamiu Alli-Balogun, disclosed that not all primary and secondary schools in the state might resume from the mid-term/Sallah break because of the outbreak.  He said the ministry would have to wait for an advisory from its health counterpart for the next line of action.
   
The schools had been expected to resume today.  He said: “Our schools are fully prepared for resumption. The necessary steps have been taken, and we are on top of the situation. However, we are going to wait for the needed advisory from the Ministry of Health, which is mapping out areas affected by the outbreak.
   
“We hope to get the advisory later today. And if the Ministry of Health tells us that going by their assessment of the situation across the state, they have found out some endemic areas where it would not be appropriate for schools to resume, schools won’t resume in such places. We cannot endanger the lives of our children.”
   
The commissioner added: “Later today (yesterday), we will come out with the position of the government on the issue. If schools everywhere in the state are free to resume, no problem. The state government is not resting on its oars and has been taking steps to curb the outbreak.”
   
State Commissioner for Health, Prof. Akin Abayomi, had identified the strain in Lagos as highly aggressive and contagious, with significant potential for widespread dissemination.
   
Recall that the United Nations Children’s Fund (UNICEF), recently, urged the government to ensure the outbreak is not allowed to spread to schools.

Despite efforts to control it, cholera has remained a major public health problem in many developing countries.  In Nigeria, since the first appearance of an epidemic in 1972, intermittent outbreaks have occurred. The latter part of 2010 was marked by a severe outbreak that began in the North and then spread to the other parts, leaving a trail of about 3,000 cases and 781 deaths.
  
 Again, an outbreak was recorded in October 2020, which escalated to several parts of the country for most of 2021.  Despite being preventable and easily treatable, children continue to suffer from the potentially fatal disease.
   
According to the World Health Organisation (WHO), researchers estimate that every year, there are as many as four million cholera cases globally and about 143,000 deaths.
   
In response to this burden, a roadmap by the Global Task Force on Cholera Control (GTFCC) targets a 90 per cent reduction in deaths and an elimination of the disease in about half of the 47 cholera-endemic countries by 2030.
  
 Meanwhile, an internal medicine doctor at Federal Medical Centre Abeokuta, Dr Olusina Ajidahun, explained why an outbreak might have occurred at this time.  

  
 He said: “Cholera is on the increase because poverty levels have also increased due to inflation, and people can no longer afford three square meals. As things are getting more expensive, people no longer have access to basic amenities including water. Sachet water used to be sold at N5. It is now N100 for three sachets. Someone who cannot do this would drink water from a river or other unsanitary sources. And we know that people readily defecate in rivers. So, this kind of disease can spread easily due to poverty.
   
“This is also an indicator of our health indices. It shows we are doing poorly, health-wise, to still be having cases of cholera outbreak in 2024. We’ve not had famine, war or drought.”
   
This came as Chief of UNICEF, Lagos Field Office, Celine Lafoucrier, warned that recurrent Cholera outbreaks critically affect children and populations at large.
  
 She spoke while responding to the outbreak in Lagos and other parts of the country.  Lafoucrier noted that under-fives are the most vulnerable and are prone to severe dehydration and higher mortality rates.
  
 “Educational disruption is yet another critical consequence of cholera outbreaks, as illness and the need to care for sick family members lead to school closures and reduced attendance, hindering children’s learning and development. Similarly, post-recovery issues in children can include malnutrition, stunted growth, and weakened immune systems, increasing susceptibility to other diseases.”
   
According to her, outbreaks underscore the urgent need for improved access to clean water and sanitation in many areas. “Despite the state government’s efforts to provide water to its population, the current outbreak demonstrates the need for an urgent government focus on ensuring the water provided to the population is clean and risk-free.” 
   
She said addressing the challenges of cholera outbreaks requires a deliberate focus on state policies to provide high-standard water and sanitation facilities, as well as strengthened healthcare systems capable of responding to demand in times of outbreaks, and state-led educational campaigns on cholera prevention to protect children and the population at large.
   
Explaining the roles communities could play in creating sustainable solutions to outbreaks, Lafoucrier said cholera originates and spreads within communities, making community-led and participatory approaches essential for sustainable prevention. She said communities and local governments could play crucial roles by leveraging communication channels to educate and protect public health. 
   
She added: “Prevention is more cost-effective than cure; thus, communities should establish systems that promote key hygiene practices, transforming them into a cultural norm. Community-led surveillance can enforce sanitation practices, with empowered local monitors ensuring compliance. 
   
“Ultimately, access to clean water and sanitation is critical in preventing outbreaks. Communities must take collective action to ensure clean water access and maintain good hygiene. Identifying and empowering positive role models within the community can encourage the widespread adoption of healthy practices.”
   
Also, a public health physician with the University of Nigeria, Nsukka (UNN) and an honorary consultant at the UNTH Enugu, Prof. Emmanuel Aguwa, explained to The Guardian that the epidemic spikes due to poor sanitation, and once it gets to one person, a household could easily be infected. 
   
He gave an instance: “A child might have diarrhoea, and you think it is like any other. Then you clean up the child without washing your hands. You are indirectly getting infected from the bacteria that caused the child’s diarrhoea if it is cholera.”
   
Aguwa advised Nigerians to stop eating uncooked foods and vegetables for the period “because you don’t know where they are coming from, and the hygiene practice of those people.”
   
He added: “Wash your hands as frequently as possible, maintain appropriate hygiene, be sure of the sources of your drinking water, and if you are eating outside, you have to be sure that it is well-cooked.”
   
Another public health physician at the Lagos University Teaching Hospital and Public Relations Officer of the Association of Public Health Physicians of Nigeria (Lagos branch), Dr Blossom Maduafokwa, told The Guardian: “Cholera is a disease that is a respecter of persons. Cholera respects personal hygiene and sanitation. So, the reason we see this outbreak, this time, is because cholera usually happens around the rainy season when sources of water are contaminated by infected materials that are washed into it by flood and the rains.”
   
She particularly noted that in a city like Lagos, at times, “when you get to the markets, you see people washing fruits and vegetables with water that is questionable. Sometimes, people can inadvertently wash vegetables with water that is infected with cholera. People buy them and can get infected.”
   
Maduafokwa added: “Personal hygiene is very important. People should frequently wash their hands with soap and clean water. Wash your hands before and after you eat, and after using the toilet. That way, you protect yourself and others around you. If you are unsure of the source of your drinking water, boil it before drinking. 
   
“When you want to eat fruits and vegetables or anything raw, make sure you wash them with clean water. If you are unsure, peel off the skin. Also, communicate with people around you, so that they will also be aware of what to do as a community to discourage open defecation, and ensure that we have proper sanitation facilities.”
   
On his part, Country Director of Nutrition International, Dr Osita Okonkwo, stressed the need to ensure health workers and caregivers are well informed about oral rehydration for victims, using zinc and oral rehydration solutions. He also urged the government to set up early warning mechanisms to identify potential hotspots, and regularly provide situation updates to the population, while intensifying mitigation plans and community surveillance measures.
 
By Nkechi Onyedika-Ugoeze  (Abuja), Ijeoma Nwanosike  and Musa Adekunle (Lagos)