Cholera: No end in sight? - TRIBUNE

• Written by  Ruth Olurounbi
• Tuesday, 29 October 2013 

The judgement has been delivered and the verdict is as unsavory as it is grim. Nigeria remains vulnerable to further cholera outbreaks, several health officials have concluded. And as things stand in the country, the future continues to be bleaker, as the nation’s rising population density and poor sanitation continue to grow.
Just when the official report from Plateau State claimed that only eight people were killed by cholera in Namu village, the acting district head has said that the actual number of the deceased was 30. Alhaji Abubakar Sadiq,said that the number had been down-played, revealing that most of those killed were women. “I can count over 10 of the indigenes that have died from this disease including my brother’s wife, my neighbour and her daughter,” Sadiq was quoted to have said.
But, an official of the Disease, Surveillance and Notification of Quan Pan Local Government Area, currently overseeing Namu, Damar Wapnan, was reported to have contradicted Sadiq, saying “what is presently on record is that we have nine deaths and 68 cases. As of last week, we recorded 61 cases with eight deaths but since yesterday, we recorded new cases bringing the total to 68 and another death which raised the mortality figure to nine.”
In Zamfara State, hospital records showed that so far, over 536 cases have been recorded since the outbreak of the disease, according to the Chief Medical Director, Shagari Hospital, Dr Labaran Lawan Anka.
The state’s acting governor, Sanusi Garba Rikiji, attributed the cholera outbreak to the burst water pipes in Gusau and its environs. It is on record that the acting governor said the outbreak was “due to the ongoing rehabilitation and construction works in parts of Gusau, where some water pipes were damaged, causing the water to be contaminated. Some residents drank the contaminated water out of ignorance of the danger associated with such practice.”
Earlier on Thursday, last week, three people were of 13 reported cases confirmed dead by the Health Commissioner, Jide Idris, in the wave of cholera outbreak that hit Lagos State.
Before the end of the day, more than 20 people were alleged to have died. The worst affected areas in the state included Apapa, Ajegunle, Surulere, Oshodi, and Lagos Island, according to Idris.
Osun, Ogun and Oyo have had their own tales of woe  following cholera outbreaks and health officials are worried that the epidemic is not showing signs of abating.
Although Nigeria is currently being placed under the blinding glare of the world’s spotlight, just recently, other African nations suffered the same outbreak and if the World’s Health Organisation (WHO)’s prediction could be believed, Africa is in for cholera’s long haul. In its cholera epidemiological analysis conducted recently, WHO said cholera remains a major public health issue in Africa. The body said that between January 1 and June 3 this year, “a total of 25, 762 cholera cases and 490 deaths were reported from 18 countries resulting in a CFR of 1.9 per cent.”
The most affected country during the period under review, WHO claimed, was the Republic of Congo, which accounted for 71 per cent of cases and 68 per cent of deaths. Mozambique recorded nine per cent of cholera cases, while there were 1.7 per cent of deaths in the country.
As far as Angola went, WHO said there were seven per cent cases of cholera outbreak, with four per cent of cases of deaths. “The cases reported from DR Congo are mostly occurring along the borders with Congo, Tanzania, Zambia, Burundi, Rwanda and Uganda, heightening the risk of cross-border transmission of V. Cholerae,” WHO said.
In April this year, the Uganda Ministry of Health reported an outbreak of cholera in the eastern districts of Hoima, Nebbi and Buliisa. According to the Pan African Medical Journal, the cumulative number of cases reported from the cholera-affected districts has reached 216 cases and seven deaths, since the beginning of this year. Currently, reports have it that the national overall case fatality rate from the afore-mentioned districts stands at 3.2 per cent, with an estimation that 217, 350 persons (38,128 households) in the affected sub-counties are at high risk of cholera infection during this outbreak, with a wider population of 900, 500 people in the districts also seen as at risk due to the high mobility of people in the area.
As of April 6, 2013, 15 deaths and 656 cases had been registered in Congo, while the cumulative cases stood at 1,036 and 16 fatalities, as of May 26, this year. South Africa recently called for help when it experienced the onslaught of cholera outbreak which left thousands of people ill and about 59 dead.
The Zimbabwean cholera outbreak has been an ongoing epidemic since August 2008, Wikipedia said. It has since swept across the country and spread to Botswana, Mozambique, South Africa and Zambia. By January 10, 2010, there had been 98, 741 reported cases and 4, 293 deaths, making it the deadliest African cholera outbreak in the last 15 years. The Zimbabwean government declared the outbreak a national emergency and requested international aid.
What makes the Nigerian cases of cholera outbreak worrisome, as health officials put it, is that Nigeria remains a country with high population density and poor sanitation in many areas.
And the numbers are growing by the day, said an analyst who said one needed to visit the hospitals and midwifery homes across the country to confirm the growing population of the country of more than 160 million people.
Epidemiologists have also attributed the death toll of the cholera epidemic in Nigeria to poor management of the disease by health workers. But in their defense, the health officials said their numbers are simply not enough to help cater for the needs of the people in the country.
Doctors say outbreaks occur when there is a spread of cholera disease among a group of people. The bacteria, they said, is transmitted when it is passed through human feaces, which then contaminate food or water supplies. Experts say food and water supplies often times, serve as ideal breeding grounds for the cholera bacteria.
Cholera, a popular epidemic disease across the globe, is caused by a typical bacterium called vibrio cholerae, a typical microorganism associated primarily to feaces; it results to cholera when human beings come in contact with this bacterium mostly through ingesting of drinking water and eating food that has been contaminated by the feaces of an infected person, WHO said.
Abiodun Awoyode, a health environmentalist, told the Nigerian Tribune that the recent cholera outbreak in Nigeria “can be greatly associated with poor sanitation and scarcity of water in some areas.”
The epidemiological studies carried out suggested that, during the period of this outbreak in Nigeria, there was also a simultaneous occurrence of it in Cuba and Mexico respectively. All these outbreaks are strongly linked to poor environmental sanitation and poor water facilities. For example, the cholera outbreak in the United States of America was traced to seafood imported from Mexico.”
Doctors and health environmentalists believe that a severe case of cholera occurs mostly when there is rapid accumulation of about a million bacterial cell of vibrio cholera in a human’s small intestine. This disease is usually associated with excessive watery diarrhea and vomiting. The severity of these symptoms can lead to rapid excessive dehydration and death, in some cases, Dr Abbas Gbolahan, the Oyo State deputy epidemiologist with the state Ministry of Health told the Nigerian Tribune, in an interview in his office on Saturday.
In 2010, it was recorded that three to five million people were infected and 100,000 – 300,000 deaths were recorded worldwide, making the disease one of the famous epidemics known in the world. According to the deputy director of Pan American Health Organisation (PAHO), Dr Jon Andrus, cholera is widely associated to poor sanitation and hygiene.
“Since it was introduced to Haiti, allegedly by the United Nations peace keeping troops who were billeted at a camp with poor sanitary facilities 715, 000 people were infected in Haiti and Dominican Republic and nearly 9,000 were feared dead,” he said, adding that “700 children were infected in Cuba and three deaths were recorded,” Andrus said.
Cholera outspread is mostly prevalent in developing and under developed nations, where open defecation and defecation into water bodies are prominent activities, health officials have said. “Blue Death” as cholera is popularly known in years back, due to the blue grey colouration of dead people infected with the disease, is associated with loss of body water or fluid.
In Oyo State for instance, the state Ministry of Health’s epidemiologist confirmed that the recent record of this outbreak in the state occurred around Egbeda and Irepo Local Government Areas and that it occurred during a period of pipe water breakdown around that area which resulted to the death of about seven people.
When consulted, Mr Owolabi Imoleayo, an environmentalist in Osun State suggested that cholera “is actually caused by poor hygiene and that it is only by proper hygiene and maintaining higher environmental standards that developing countries escape the wrath of this killing disease which in his words, “spreads like wild fire.”
Doctors believe that raw, unpeeled fruits and vegetables are a frequent source of cholera infection in areas where cholera is endemic. In developing nations, un-decomposed manure fertilisers or irrigation water containing raw sewage contaminate produce in the field.
According to Ife Asekun-Olarinmoye, an epidemiologist, common sources of cholera infection include surface or well water, seafood, raw fruits and vegetables, and grains. Asekun-Olarinmoye said eating raw or undercooked seafood, especially shellfish originating from certain locations could expose people to cholera bacteria. He said leaving cooked foods such as rice contaminated after cooking and allowed to remain at room temperature for several hours can become a medium for the growth of cholera bacteria.
To control cholera, WHO said, there should be proper and timely case management in cholera treatment centres; specific training for proper case management, including avoidance of nosocomial infections; sufficient pre-positioned medical supplies for case management (e.g. diarrheal disease kits); improved access to water, effective sanitation, proper waste management and vector control; enhanced hygiene and food safety practices and improved communication and public information.
Dr Gbolahan said “washing of hands is very important if we want to combat this disease. We should know and monitor sources of the food we take, the water we drink should be from clean sources and most importantly, our personal hygiene and proper environmental sanitation is vital.”