ANALYSIS: Evaluating Nigerian government’s response to cholera outbreak amid gaps in public health system
By Quadri Adejumo
As a devastating cholera outbreak spreads across the country, Nigeria, Africa’s most populous nation, is dealing with a dire health crisis. The outbreak has highlighted gaps in the country’s public health
Cholera is endemic in Nigeria. Northern Nigeria has a long history of being a cholera-endemic region. States like Bauchi, Jigawa, Kano, Zamfara, Katsina, and Borno, among others, are hit the hardest. The rise in cases is also being felt in other parts of the country.
According to the Nigeria Centre for Disease Control and Prevention (NCDC), 96 local governments in 30 states have reported 65 confirmed cases of cholera, resulting in 30 deaths between January and June.
As per the NCDC, a sum of 1,141 suspected cases have been recorded in 2024. Ninety percent of the total came from ten states: Zamfara, Bayelsa, Katsina, Abia, Bauchi, Cross River, Delta, Imo, Nasarawa, and Lagos.
This follows a reported outbreak in Lagos State which caused five deaths and 60 hospital admissions in 48 hours. According to the state ministry of health, there have been 17 confirmed cases and 15 deaths in Lagos so far. Akin Abayomi, Lagos commissioner for health, said five individuals had died while around 60 residents were hospitalized because of a suspected cholera outbreak in certain parts of the state.
The current outbreak can be followed back to early last year when cases started to spike following the stormy season. Heavy rains, flooding and inadequate access to clean water exacerbated already poor sanitation conditions in numerous locales, prompting widespread contamination of water sources.
The public had recently been notified by the NCDC of the rising incidence of cholera as the rainy season intensifies. NCDC uncovered this in a public health advisory distributed to caution society of the rising pattern of cholera cases across the nation.
Cholera and its effects
Cholera, caused by vibrio cholerae bacterium, causes extremely watery diarrhoea and rapid dehydration that actually kills people if untreated. It is a water and food-borne disease and thrives in areas with poor sanitation.
Many communities in Lagos appear to be vulnerable as a result of the flooding and rain that appears to paradoxically accelerate it.
Symptoms of cholera include acute, painless watery diarrhea of sudden onset, with or without vomiting. It may be associated with nausea, profuse vomiting and fever. By ensuring access to clean water, proper sanitation, and proper hygiene, cholera can be avoided.
The disease can be easily treated if caught early, and most infected people can be successfully treated through prompt administration of oral rehydration solution (ORS) to make up for lost fluids and electrolytes.
Knowing the oral rehydration solution
In the middle of all this chaos emerges one easy and cost-effective fixed-dose treatment – Oral Rehydration Solution (ORS).
ORS is an oral rehydration solution with clean water, salt, and sugar that has just the right mix to help replenish the amounts of lost fluids and salts, including electrolytes lost in water with diarrhoea. This simple solution was found to reduce cholera death rates drastically in areas affected by cholera.
The science behind ORS
The speed with which the body is rehydrated is ORS’s strength. The glucose in solution helps the retention of sodium and water in the digestive organs and is, consequently, extraordinary for battling lack of hydration.
Studies by the World Health Organization (WHO) shows that ORS can reduce mortality rates by up to 93% in cholera patients. Its cost-effectiveness makes it an indispensable tool in managing cholera outbreaks.
Adeyemi Adekemi, a pharmacist at Pharmasolutions, explains the crucial role of Oral Rehydration Solution (ORS) in saving lives. “ORS contribute to helping in the fight against cholera in the sense that help to restore electrolyte loss,” she says. “Electrolyte losses can have serious consequences. They can affect your heart, lungs, brain and nervous system.”
Dehydration, a primary cholera symptom, can have dire consequences and progress quickly. “Dehydration also stresses your kidneys and can lead to kidney disease,” Adekemi continues. “And it can also be life threatening if not treated.”
Adekemi’s words resonate with a profound comprehension of the delicate balance that exists within the human body and the devastating effects that result when that balance is disturbed by cholera. “Rehydration is the first priority in the treatment of cholera. The goal of the rehydration phase is to replace the water and electrolytes lost as stools,” she reiterates.
“ORS solution can be administered via a nasogastric tube if the patient has some signs of dehydration and cannot drink, or if the patient has severe dehydration and IV therapy is not possible at the treatment facility.”
Addressing root causes and providing long-term solutions
The Nigerian government has been working to contain the cholera outbreak. Nonetheless, these endeavours face critical difficulties. Distribution of ORS are hampered by poor infrastructure, logistical difficulties, and an absence of awareness among the affected populaces. Insecurity in certain locales hampers the delivery of aid, and misinformation about the disease and its treatment persists.
While ORS is a basic part in dealing with the cholera outbreak, long-term solutions are expected to address the underlying drivers. Improved sanitation, access to clean water, and strong public health framework are fundamental to forestall future outbreaks.
“The government needs to take decisive steps to curb this public health crisis,” Abereijo Azeezat, a public health specialist from Nottingham Trent University, noted steps to curb the outbreak. “Eradicating vendors who sell food in unkempt environments is essential. These areas are breeding grounds for the bacteria that cause cholera.”
Azeezat’s expertise shines through as she outlines practical measures for the government to implement. “Running quality control tests on food sellers is critical,” she emphasizes. “Ensuring that the food being sold meets health and safety standards can prevent the spread of this deadly disease.”
Her words carry the weight of experience and urgency. The cholera outbreak, exacerbated by poor sanitation and inadequate infrastructure, has claimed countless lives. Azeezat’s call for improved drainage is more than just a suggestion; it’s a request to forestall future events. “Good drainage systems can ward off these diseases. Without proper drainage, we’re simply setting the stage for the next outbreak.”
“People must practice proper intake of food and water,” she adds. “Boiling water before drinking and ensuring food is thoroughly cooked can make a significant difference.”
Her insights reflect a comprehensive understanding of the multifaceted approach needed to combat cholera. It’s not just about immediate response but also about long-term preventive measures that involve both government action and individual responsibility.
Government action and response
The NCDC has pledged to invest in areas to fight the outbreak. Leading a multi-sectoral National Cholera Technical Working Group, NCDC said it has been providing support to the affected states. The technical working group comprises the Federal Ministries of Environment and Water Resources, the National Primary Health Care Development Agency (NPHCDA), the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), and other partners.
Akin Abayomi, Lagos commissioner for health said that the state government is receiving support from the Nigeria Centre for Disease Control and Prevention (NCDC), and international partners, including the World Health Organisation (WHO) and United Nations Children’s Fund (UNICEF), while the local Non-Governmental Organisations (NGOs) are actively raising awareness and conducting community-based surveillance efforts.
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The commissioner further noted that suspected cases are receiving free treatment at the public health facilities in the state in line with public health response protocols.
The Lagos Water Corporation (LWC) also announced measures to safeguard public health following the cholera outbreak. Kehinde Fashola, LWC head of public affairs, urged residents to follow safety measures and avoid consuming water from unreliable sources.
In Osun State, the government has activated rapid response centres across the 30 local government areas in the state to prevent the outbreak of cholera. Likewise in Ogun State, the Commissioner for Health, Dr Oluwatomi Coker, confirmed three reported cases of cholera in the state.
Sokoto State Government disclosed that it had set up a monitoring team in all the schools and public places, including hospitals. The state Commissioner for information, Sambo Danchadi, said the state government was doing everything humanly possible to avert any outbreak of diseases in the state.
Benue State Commissioner for Health and Human Resources, Dr Yarman Ortese, revealed that the state had an emergency operation that dealt with any eventuality. He said the emergency operation had been activated to tackle any contaminant anywhere in the state, adding that the state has not recorded an outbreak of cholera.
Delta State government said it had put under control the recent cholera outbreak in the state. The state Commissioner for Health, Dr Joseph Onojaeme, said currently there was no cholera in the state, adding that the two cases recorded two weeks ago had been put in check.
The role of international aid
A robust health infrastructure that can withstand the cholera outbreak requires international support.
In relation to the outbreak, assistance is being provided by international organisations such as the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), and various others.
The World Health Organization (WHO) has long cautioned of cholera’s true capacity for quick spread in unsanitary conditions, and Nigeria’s current outbreak is a distinct demonstration of those alerts.
The United Nations Children’s Fund has called for extensive measures to be taken following the outbreak. The Chief of UNICEF Lagos Field Office, Celine Lafoucrier, solicited for adequate awareness across the country to sensitise the populace on cholera outbreaks and preventive measures as part of efforts to address the issue.
A call to action
The cholera outbreak is a stark reminder of the importance of basic healthcare and infrastructure. It is essential to address the underlying issues of access to clean water and sanitation.
The NCDC said the disease is easily treatable if detected early. It has urged state governments to prioritise action for solutions that ensure access to and use of safe water, basic sanitation, and proper hygiene practices in communities.
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