Cholera: Exposing Underbelly Of Poor Sanitation, Potable Water Supply

USUALLY, the dotting of the map of Africa with marks that depict areas of rich mineral resources presents a picture of potential wealth. However, the continental canvass is currently being painted negatively in six different countries by cholera, a devastating water-and-food-borne scourge that is yet to be tamed. It has claimed lives in these countries. 

  Unfortunately, of the 2,959 cases and 74 deaths recorded as recent as three weeks in the West and Central Africa region, Nigeria has had its own share of the pains.

    On the whole, the figures in Nigeria could be much more than the regional figures as a report from only a community in Panda Local Government Area of Nasarawa State posted as many as 60 recently. Though, it would be argued that such mortality might not be caused only to cholera, but other water-borne diseases such as typhoid and diarrhea.

Death toll of about 23 in Bayelsa State and as many as 25 people in Anambra State has been reported. 

  A resurgence of cholera cases in the northern states primarily in Kano and Kaduna has been reported, but now it is becoming widely spread as it has penetrated states like Rivers, Nasarawa and Ebonyi. Communities like Innoma in Anambra West Local Government Area of Anambra State and Igbomotoru II, Southern Ijaw Local Government Area of Bayelsa State have also been affected.

  In the last quarter of 2014, the devastating infection left its footprint in Lagos, Ogun, Plateau, Plateau and Zamfara States

According to WaterAid Nigeria, an international non-governmental agency that tackles issues of access to water, sanitation and hygiene, about 63 million people in Nigeria do not have access to clean and safe water. 

  WaterAid Nigeria has continued to raise awareness of water, sanitation and hygiene issues through a number of media programmes. 

  Nigeria’s Minister of Water Resources, Mrs. Sarah Ochekpe affirms to the reality of these figures when she revealed that about 70 million Nigerians lacked access to good drinking water.

“The current water supply service coverage in the country is 58 per cent, which is about 87 million people. This translates to lack of potable water for about 70 million people. In the rural areas, only 42 per cent have access to potable water supply.

“Many of our children are also dying of diseases associated with water borne infections…the current administration is therefore, focusing more attention on the water sector,” Mrs. Ochekpe said.

  Expressing government’s concern about poor access to good drinking water by Nigerians at a meeting with the Japanese envoy to Nigeria, Ochekpe said more collaboration with stakeholders would be encouraged.

  The statistics do not leave anyone happy: over 112 million people don’t have access to adequate sanitation, and that is about two thirds of the population. Diarrhoea caused by unsafe water and poor sanitation in the country leads to the death of over 97,000 children annually.

  Recent figures from Lancet Journal, a leading publication in global medical statistics, show that diseases like diarrhoea (a water-borne and poor sanitation health condition, “is now the greatest cause of death in children under five years of age in Africa. Indeed, of the 211 million without access to improved sanitation in West Africa, 104 million are living in Nigeria.”

  UNICEF paints even a more intense picture that “an estimated 335,000 children die annually from waterborne illnesses.”

  Water and waterborne pollutants have continued to pose great challenges in Nigeria. 

Public affairs analysts say though the country is relatively wealthy due to its hydro-carbon resources, governments can be put to blame for the current state of water and sanitation. 

  The management of the nation’s oil wealth has not seen enough investment in such infrastructure that would supply adequate potable water and improvement in sanitation even as government has recently adopted a national water policy to provide clean drinking water in Nigeria by 2020.

  It is a different ball game with the rural dwellers, who share largely unhygienic surface water like ponds and streams with cattle. Even at that, some of these water sources dry up during the dry season thereby causing the people to cover many kilometres more in search of water.

  In a megacity like Lagos, though surrounded by body of water from the Atlantic ocean and rivers, there is paucity of drinkable water from the public supply network. 

   The net result of all these is that commercial production of drinking water in PET bottles and sachet (‘Pure Water’) is big business. Though the microbiological and physical attributes of many of the water brands cannot be guaranteed, consumers are torn between the quality of that from state water pipes and that which is easily available and ‘nicely packaged’- ‘pure water.’

  Authorities of the State Water Corporation say the coverage is steadily rising, but for a city that is bursting at the seams with residents, it is still a far cry. 

  And Lagos has had outbreaks of cholera often, and the attendant toll on the teeming population.

   Commissioner for Health, Dr. Jide Idris, at a recent briefing explained that, “cholera is acquired through the ingestion of an infective dose of contaminated water or food and can be transmitted through many mechanisms like direct or indirect contamination of water or food by faeces of infected individuals.”

  Idris counseled that people should avoid possible backflow connection between water and sewer system, adding that if people were not sure of the source of the water, it should be boiled before drinking. 

  In a sustained public enlightenment, he said mothers should also continue to breastfeed their babies having watery diarrhea, while an individual, who has come in contact with a cholera patient should wash his or her hands thoroughly after touching any item or surface that may have been contaminated. Contaminated items should be properly disposed, he added.

  Dr. Omojowolo Olubunmi, former President, Association of Resident Doctors (ARD) Lagos University Teaching Hospital (LUTH) explained further that cholera is a communicable disease caused by bacteria known as vibro cholerae. This bacteria produces toxin, which causes watery and life threatening diarrhoea, the so-called ‘rice water’ stool. The disease is transmitted majorly through consumption of contaminated water or food, it can also be contracted faeco-orally; it can be rapidly fatal especially in children if not promptly attended to. 

  For government at all levels, Olubunmi said there is need to strengthen the primary health care system in the country, as this is the backbone of any meaningful disease prevention strategy. Collaboration is needed, he canvassed to ensure provision of potable water, provision of efficient sewage disposal system, alleviation of poverty, general improvement of infrastructure, proper disaster management preparedness and responsiveness and above all, regular public enlightenment programmes. 

  Former president, Pharmaceutical Society of Nigeria (PSN), Pharm Anthony Akhimien said: “It is quite unfortunate that more than 50 years after independence, we still talk about cholera outbreak. It shows we have not done well in terms of healthcare delivery. Poor hygienic condition in particular; an average Nigerians do not have access to potable water, and even in the big cities, people do not have clean water.”

  Akhimien said people have had to rely on borehole water that is not treated and that did not exclude the fact that Lagos State government, for example, has put in so much in waste disposal. 

  He stressed awareness of good hygienic practice of hand washing when there is contact with people infected by the disease. 

On vaccination and control

 Olubunmi said an affected individual should seek medical attention immediately. He noted that adequate rehydration with Oral Rehydration Solution or Intra venous infusion and appropriate antibiotics remain the mainstay of treatment.

  On vaccination, he said while it is desirable, it does not confer lifelong protection against the infection. “Oral vaccine has been shown to provide short-term protection in all age groups and may prevent severe disease. Increase availability of the vaccine and coverage especially for high risk groups is however advocated,” he said. 

  Akhimien, on the other hand said immunisation is very good, but wondered how many people would have access to it. “Many people even believe that immunisation would reduce their population. This has been happening until the recent Minister of Health created awareness that it would not reduce population but would protect and prolong life, and to ensure that children are free from childhood diseases.”

  In healthcare delivery, the former PSN President said there is disconnect between federal, state and local governments, noting that sometimes when there is a federal health policy, the state and local level do not list that as their priority.   

“But in local level, we do not have regard to healthcare delivery. I think that local government has not done well in that respect. You can imagine after 10 years of inaugurating National Health Insurance Scheme (NHIS), we still talk about 10 per cent having access to the scheme.” 

  It is generally and commonly recommended that the outbreak and spread of cholera can be stopped or reduced to the barest minimum, but the emphasis should be on prevention which entails personal and family hygiene such as proper and regular hand washing, appropriate disposal of sewage and other waste, boiling and or treating water before drinking.