EXPLAINER: Why children are likely to be more threatened by Nigeria’s cholera outbreak

By solacebase.com On Jun 24, 2024

A boy walks past sewage around houses in Abuja, as Nigeria battles a cholera outbreak. Credit: AP Photo/Gbemiga Olamikan

By Quadri Adejumo

Nigerian health authorities have issued several warnings over a cholera outbreak that has killed at least 40 people, a significant number of them in the commercial capital Lagos.

Cholera is a severe intestinal infection that can spread through contaminated food and water. It typically results in severe diarrhea, vomiting, and muscle cramps, and it can even result in death.

The Nigerian Center for Disease Control and Prevention informed the general public this past week of the country’s rising number of cases. The nation has reported at least 40 deaths and more than 1,141 suspected cases since January 1, according to the NCDC.

With the latest incidence rate, 4,364 deaths had been recorded out of the 139,730 people suspected to have been infected by the disease across the country since 2021, reports showed.

Children are vulnerable to cholera

Cholera is one more threat amongst many that children in Nigeria are facing. With the cholera outbreak, concerns about children’s health and well-being are growing.

A perfect storm for cholera outbreaks exists in Nigeria, where access to safe drinking water and proper sanitation is a daily struggle. The absence of clean water implies that kids are continually in danger, their young bodies especially helpless against the illness.

Caused by the bacterium Vibrio cholerae, cholera is a swift and deadly disease, particularly in children. It leads to severe dehydration through diarrhea and vomiting.

Researchers conservatively estimate that every year, there are as many as 4 million cholera cases globally and as many as 143,000 deaths. Small kids, particularly those younger than 5, bear the worst part of the infection. Statistics from the Nigerian Centre for Disease Control (NCDC) lay out a grim picture: kids younger than five record for a huge piece of cholera-related passouts.

In Nigeria, clean water is a precious commodity. In rural areas, many rely on streams, rivers, or shallow wells for their water supply. These sources are often contaminated by sewage and waste, creating a breeding ground for cholera.

The lack of proper sanitation facilities exacerbates the situation for children, making it nearly impossible to prevent contamination.

“Nigerians need to develop and uphold appropriate sanitation infrastructure, such as toilets and latrines, to deter the practice of open defecation,” Abdullahi Tunde Aborode, Research Director for Healthy Africans Platform told our reporter.

Access to clean water, one of the main interventions that can protect children from deadly waterborne diseases and offer some protection against threats, is essential in an effort to curb the spread of the disease.

Abdullahi noted; “It is important to establish the availability of uncontaminated and pure drinking water through proper upkeep of water supply systems.”

Since the outbreak was confirmed, experts have called for a closely coordinated water, sanitation and hygiene (WASH) and health rapid response.

Israel Oni, a pharmacist, explains the gravity of the situation. He said it is very important for authorities to provide basic water and sanitation.

“We’ve already established that cholera is a waterborne disease. Therefore, preventive measures to reduce the incidence of cholera in children should focus on improving Water, Sanitation, and Hygiene (WaSH) practices. Every community should have access to safe and clean water through well-maintained water supply systems,” Israel told our reporter.

He further spoke about awareness being a key part of the solution to the crisis. He explained; “Raising awareness about the importance of washing hands regularly with soap and running water is vital. Children should be taught these hygiene practices both at school and at home.”

The United Nations Children’s Fund has also called for extensive measures to protect school children. The UN organisation called for concerted efforts to prevent disruption in the academic calendar over the spread of the disease.

The Chief of UNICEF Lagos Field Office, Celine Lafoucrier, in a statement, said that the cholera outbreaks critically affected children and the young population. According to Lafoucriere, these vulnerable groups face substantial health risks particularly children and young adults attending schools.

“There is, therefore, an urgent need for good sanitation, hygiene practices, improved access to clean water, regular handwashing with soap and clean water in order to combat the outbreak in schools,” she noted, adding that children were prone to severe dehydration and high mortality rate.

Treating children

Most children who have cholera can be successfully treated by quickly administering oral rehydration solution (ORS), which is a salt-and-sugar mixture.

Treatment beyond oral rehydration solution is required for children who are severely dehydrated. The child may need antibiotics to shorten the duration of their diarrhea, and intravenous fluids should be given as soon as possible.

During a cholera outbreak, it is crucial that these treatments are readily accessible. That requires distributing oral rehydration solution to treatment clinics in communities that are significantly impacted. If treated early and properly, the fatality rate can be reduced dramatically.

For children under the age of 5, zinc is an important adjunctive therapy. Zinc is a vital micronutrient that becomes drained during diarrhoea. When given as a supplement, it reduces the duration and severity of the illness, and can also reduce the risk of recurrences in the short term.

Lack of adequate vaccines

As the death toll from the outbreak hits 40, the Nigeria Centre for Disease Control has also reported that the country does not have enough vaccines.

According to the Director General of the Nigeria Centre for Disease Control and Prevention, Dr Jide Idris, Nigeria has placed an order for more cholera vaccines from donor agencies, even though the date of delivery is still unknown.

The NCDC boss said he is aware the health minister has requested more vaccines from donor agencies. “I know that the minister has requested more vaccines. But, I don’t know when they will come,” he told Saturday Punch.

Dr Idris also noted that the demand for cholera vaccines outpaces supply, adding that to consistently have adequate vaccines to curb diseases, the nation must plan ahead. He also stressed that Nigeria must embrace a combination of preventive measures to curb cholera outbreak, noting that cholera vaccines are not long-lasting.

“Cholera vaccine demand is far ahead of supply so most people who need them place orders and plan ahead. It is the same thing with all vaccines, not just cholera.”

The NCDC boss stressed the need for the country to embrace the use of vaccines and other preventive measures to curb the spread of the acute diarrhoeal infection.

He added; “We also know that cholera vaccines are not long-lasting. They only work for some time, so a combination of vaccines where necessary and all other preventive measures are the mainstay of the effort to curb the infection.”

This cholera outbreak is worsened by what many consider to be reasons due to 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.

Locals where flooding and poor sanitation are the highest, increases the risk of transmission.

The Lagos State ministry also opined this claim, as the Lagos Water Corporation said in a statement; “According to the Lagos State Ministry of Health, the primary cause of the cholera outbreak has been linked to the consumption of contaminated water and inadequate sanitation.”

An endemic?

Cholera is endemic and seasonal in Nigeria, where only 14% of the population of more than 200 million have access to safely managed drinking water supply services, according to the NCDC, open defecation is still practiced by at least 30% of residents in 14 states.

“Every community should have access to safe and clean water through well-maintained water supply systems. Additionally, it’s crucial to avoid open defecation by using constructed latrines or toilets and ensuring proper waste disposal to prevent contamination of water sources,” Israel further advised.

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.

Long term solutions are needed to address the underlying drivers. “Improved vaccine campaigns and a strong public health framework are fundamental to forestall future outbreaks. “Implementing vaccination campaigns can help prevent and control cholera outbreaks, especially in high-risk areas,” Israel added.

He continued; “Policies that support cholera control measures, such as regulations on water quality in communities, should be put in place. Investing in research is also very important, this will help develop evidence-based measures to prevent and control cholera in the future.”

Abdullahi understands that knowledge is power. He advised government officials and NGOs to launch public health campaigns.

“It is recommended for the government and non-profit organization to organize public health campaigns to provide information to communities on the transmission, symptoms, and prevention of cholera,” he said.

These initiatives inform the community about cholera transmission, symptoms, and prevention methods. Posters, flyers, and community meetings help spread the message.

By implementing these strategies, Nigeria can protect itself from cholera. In the words of Abdullahi, “By implementing this in a coordinated manner, a complete approach to cholera prevention may be established, resulting in a considerable reduction in its occurrence among children and the wider community in Nigeria.”