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Cholera loves poverty: the case of Nigeria

2021-08-09T15:47:51.894Z


What to do to stop it? Something basic: have drinking water and adequate sanitation. But millions of people lack it and the disease abounds in extremely poor areas, especially in Africa.


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Nigeria has registered thousands of cholera cases so far in 2021. Among the affected areas are the northern states Bauchi, Gombe, Kano, Plateau and Zamfara.

This acute diarrheal illness, caused by the bacterium

Vibrio cholerae

, is

transmitted in feces through contamination of food, drink, or unsanitary environments, and causes severe dehydration.

The infected person can die if not treated quickly with oral rehydration.

More information

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Before, cholera infections were common in many countries around the world.

Now they are concentrated in developing regions, because they are associated with poor nutritional, water quality and sanitation conditions.

The proportion of people dying from cholera continues to be higher in Africa than anywhere else.

Large outbreaks were recorded in Nigeria in 1991, 2010, 2014 and 2018. In the past year, 43,996 cases and 836 deaths were recorded, representing a mortality rate of 1.90%.

Bacteria through stool

Vulnerability to cholera is associated with demographic and socioeconomic factors, such as age or nutritional status. Malnutrition favors transmission and severity, and vitamin B12 deficiency and gastritis are factors that increase the risk of infection. The bacteria that cause cholera are shed in the stool about two weeks after infection. In this way, they spread into the environment and affect other people.

Lack of access to clean water and poor personal and environmental hygiene are key factors facilitating the spread of cholera.

People also become infected when they eat or drink something that already contains the bacteria.

A test conducted during an outbreak from 1995 to 1996 in Kano State revealed that poor hand washing before meals and the sale of water played an important role in transmission.

Cholera is known as the “disease of poverty” because social risk factors play a key role in transmission.

Population concentration is another factor that favors its expansion, for example, due to migration to commercial regions such as Kano. And it can also occur when humanitarian disasters force the displaced to live in camps, where they often have an inadequate water supply and there are difficulties in carrying out good sanitary practices. Around 2.9 million people are currently living as displaced people in northwestern Nigeria. In 2018, at least 10,000 cholera cases and 175 deaths were recorded in Yobe, Adamawa and Borno states, mostly in camps with overcrowded residents.

The living conditions of urban and peri-urban suburbs increase the spread of the disease, because they do not have a regular supply of water and adequate sanitary facilities.

Only 26.5% of the Nigerian population use drinking water sources and improved sanitation facilities, and 23.5% defecate in the open.

Official measures

The Nigerian government has taken some steps to control the disease.

It is implementing programs to improve water supply, basic sanitation and good hygiene practices, but these are usually implemented after outbreaks.

The Government, and more specifically the Federal Ministry of Water Resources, supplied 510,000 liters of water per day in 39 towns in the state of Adamawa, where 50% of the cholera cases in 2019 were registered.

In addition, it has provided mobile wells that are powered by solar energy.

For its part, the International Organization for Migration maintains 58 solar energy wells in Borno state, drilled 11 new ones in 2019, and rehabilitated 10 and connected them to solar energy.

In response to an outbreak in IDP camps in Borno state in 2017, the national health care development agency and other partners conducted oral cholera vaccination campaigns.

This immunization is not part of routine vaccination in Nigeria, it is not 100% effective, and it does not protect against other diseases in food or water.

It is not a long-term solution and only narrows the gap between an emergency response and durable cholera control.

Outbreak investigation teams at the European Center for Disease Prevention and Control in Nigeria conduct health education campaigns following confirmation of outbreaks.

UNICEF promoted the chlorination of water in communities that are sources of cholera, which has benefited some 4.5 million people in Borno, Adamawa and Yobe states, including 680,000 people displaced in urban centers.

What remains to be done

There is much to do.

Cholera is known as the "disease of poverty" because social risk factors play a key role in transmission.

Along with best practices for multi-sector assistance, the recommendations indicate the following:

  • Governments of countries affected by cholera should take the lead with the support of partners in the Global Task Force on Cholera. Multisectoral interventions to control cholera effectively are based on a series of measures that must be well coordinated. These include creating access to safe water and sanitation, improving surveillance, reporting and preparedness, as well as collective participation to raise awareness and promote good hygiene practices.

  • Regular education is necessary during and after outbreaks.

    Collective engagement would help identify the people who will be responsible for reporting possible cholera cases in time.

    Teams managing outbreaks at the local, state, and federal levels need to be well coordinated and respond quickly when reported of an outbreak.

These steps have been shown to work in South Sudan and Tanzania, but political will is needed for other sectors to collaborate.

Olayinka Stephen Ilesanmi

is Professor in the Department of Community Medicine at the University of Ibadan, Nigeria.

This article was

originally published in English on The Conversation.

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Source: elparis

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