Cholera outbreak: NCDC fingers poor sanitation, shortage of resources

Dr. Jide Idris, Director General of the Nigeria Centre for Disease Control (NCDC) has attributed the cholera outbreak in Nigeria to three key factors: poor sanitation, inadequate personal and environmental hygiene, and insufficient access to clean water.

While appearing on Channels Television program on Saturday, Dr. Jide Idris stated that the NCDC is currently conducting a risk assessment and has issued alerts to all states regarding the cholera outbreak.

Cholera is a highly infectious disease that is transmitted through the consumption of contaminated food and water.

NCDC had warned the public of the increasing trend of cholera cases across the country as the rainy season intensifies.

The centre said from January 1st to June 11th, 2024, a total of 1,141 suspected and 65 confirmed cases of cholera with 30 deaths have been reported from 96 LGAs in 30 states.

It noted that the 10 states that contributed 90 per cent to the burden of cholera include Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, Nasarawa, and Lagos states.

In Nigeria, cholera is an endemic and seasonal disease, occurring annually mostly during the rainy season and more often in areas with Poor sanitation.

There were 473,000 cholera cases reported to WHO in 2022 – double the number from 2021. A further increase of cases by 700,000 was estimated for 2023.

As of April, the World Health Organisation said a cumulative total of 145,900 cholera cases and 1,766 deaths were reported from 24 countries across five WHO regions, with the African Region recording the highest numbers, followed by the Eastern Mediterranean Region, the Region of the Americas, the South-East Asia Region, and the European Region.

“To me, it’s a disease that’s bordering on basic sanitation. My observation is that prevention is very weak, which also bolsters your point that we seem to have forgotten the need for prevention or we’re not taking it very seriously. And in a situation where resources are limited, I think that’s the best approach.

“If you go back to this cholera case, it’s a problem of poor sanitation, good personal and environmental, it’s a problem of lack of access to water. the easiest way for good personal hygiene is hand-washing, especially after using the toilet, and before you cook your food.

“But in a situation where you tell people to do hand-washing and there’s no access to water, it’s a problem. So, I think everybody, including the Federal Government, the state government, different agencies, local governments, even the people themselves, the community, have to come around.”

The DG said the state governments have to ensure access to clean water, and toilets for their citizens.

The former Lagos state health commissioner stressed the need to train more environmental officers to ensure compliance with environmental regulations and standards.

“I know there are many schools of health technology where these categories of workers are produced. But more importantly, I think, it’s also related to the issue of funding of the health sector. You have very poor funding, and human resources are getting worse. That’s the reality, Everywhere, at different levels.

“Something needs to be done, because it’s the same people that have to do this work, and the other thing is ourselves, we need to have positive health-seeking behaviour because there’s a limit to what the government can do. If we do not take our health very seriously. We need to change our behaviour.”

He, however, said the agency is assisting the states to respond to the outbreak.

“We’re sending people out now to do a rapid assessment. You have some experts who go to the States, assess their capabilities to manage the situation, what gaps they have, and what facets they have. Based on that, we determine how to assist.

“Meanwhile, we’ve sent out materials to different states, including what they need to use, IV fluids for people having diarrhoea, what they need to test, rapid test kits, and the Minister (the Coordinating Minister of Health and Social Welfare, Prof Muhammad Pate) is about to provide the necessary cholera vaccine. But, each state has to be responsible for its activities.”

He stressed that all hands must be on deck to fight the disease in the country.

He added that the present government is prioritising the health sector to address disease outbreaks in the country.

“Primary health care is one of the major focus, and I think it’s receiving serious attention. But the fact is that all over this country, there’s serious inequity. Some states have the resources, most states don’t have. You can have the facilities built and you don’t have people to man them. And this way again, primary health care comes.

“You have to use people within the communities to address these issues, but it also goes to the fact that you’ve got a community. So it’s not one size fits all.”

He emphasized the importance of tackling the pressing issues surrounding water, sanitation, and waste disposal.

According to the WHO, there are currently three WHO pre-qualified Oral Cholera Vaccines available: Dukoral, Shancho, and Euvichol-Plus. Notably, all three vaccines require a two-dose regimen to ensure full protection against cholera.

“Vaccines provide the fastest intervention to prevent, limit, and control cholera outbreaks but supplies have been at the lowest point amidst countries facing dire shortcomings in other areas of cholera prevention and management such as safe water, hygiene and sanitation,” the global health body noted.

however, It statedthat the cholera response continues to be affected by a critical shortage of OCV.