The cholera outbreak alarm
With the reported death of 526 people (still counting) from cholera outbreaks in 18 states and the Federal Capital Territory (FCT), the Federal and state governments ought to see the situation as a national emergency. This is more so even as the Nigeria Centre for Disease Control (NCDC) said 22,130 suspected cases of the disease have been recorded as of July 22.
The authorities should do everything possible to contain what could balloon into an epidemic if left unchecked, given that health facilities are already overstretched by the COVID-19 pandemic. Moreover, doctors are on strike in many parts of the country.
Beyond this, the outbreak signposts clear deficiency in overall public health, and living conditions of Nigerians. While education in general and specifically on public and personal hygiene may be inadequate, the fact that too many Nigerians are living in extreme poverty and in dehumanizing conditions is obviously instrumental to the health crisis. Government needs to be more proactive and take governance to the doorsteps of the average citizens.
If the nation could be on its toes over the suspected third wave of the COVID-19 epidemic, the same attention should be extended to the management of cholera, an acute diarrheal disease that is so virulent that it could wipe out hundreds of hapless folks within hours. In these circumstances, the outbreak requires drastic measures to stop its spread.
Cholera is as deadly as COVID-19 that the country is battling. A proactive step is required from the authorities to deal with the disease. So far, the states affected include Enugu, Plateau, Bauchi, Gombe, Kano, Kaduna, Zamfara, and Bayelsa. Researchers have estimated that each year there are over 1.3 to 4.0 million cases of cholera and 21, 000 to 143, 000 deaths worldwide due to the disease.
Most of those infected will have no symptoms, or have mild symptoms and can be successfully treated with an oral rehydration solution. However, severe cases will need rapid treatment with intravenous fluids and antibiotics.
The provision of safe water and sanitation is critical to prevent and control of transmission of cholera and other waterborne diseases. According to World Health Organisation (WHO), oral cholera vaccines should be used in conjunction with improvements in water and sanitation to control cholera outbreaks and for prevention in areas known to be high risk.
Given the rapidity of the spread and the lack of capacity in most states to contain the disease, a national emergency declaration is imperative to stem the further spread. All the affected states need support to deal with a recurrent nationwide public health emergency. The disease should be contained to prevent more casualties. The uncontrolled spread could worsen to pose a greater danger to the public.
What is needed, at this juncture, is not panic but precautionary hygienic measures by members of the public. All persons suspected of cholera symptoms should be reported immediately to the nearest health facility for proper attention. Cholera is curable if reported on time. The Federal Government in collaboration with the state Ministries of Health should develop a vibrant information dissemination mechanism to constantly educate members of the public. Information sharing, including daily updates, would help track the trajectory of the disease and the level of impact and containment.
Cholera is an acute diarrheal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholera. Simple precautionary steps should be taken at home to store food items properly, away from rats. Ingestion of infected tiny food particles could be potent means of exposure. Person-to-person transmission has not been established, hence, there is no danger posed to health workers and everyone who comes in contact with infected persons. Nevertheless, healthcare personnel should be extra careful.
The episodic outbreak of cholera over the decades shows that not much research has been done to establish the kind of response and stop it. That explains why a preventive vaccine is still being worked on. Quite often, diagnosis is mistaken for other illnesses such as malaria typhoid, thereby, delaying treatment and allowing the spread of the disease. Most health facilities in rural areas lack the proper equipment to diagnose the disease.
Controlling the spread is paramount, considering that food items, fruits, and vegetables are freely exposed and eaten everywhere in Nigeria. This is a challenge to the country’s research institutions. In the short term, the government should seek the support of Non-Governmental Organisations to sustain public enlightenment campaign, with emphasis on personal hygiene and proper handling, including appropriate cooking, of food items before consumption. In the long term, the government must step up its duty of improving the living conditions and standards of Nigerians across the country.
Why the disease has episodic occurrence needs to be established. It is possible that there is a different vector that is yet unknown. The NCDC and other medical research institutes should gear up and find solutions to the problem the cholera disease poses. All hands must be on deck to quickly end the ongoing strike by doctors in public health institutions.
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