WITH over 27,000 infections and 653 deaths recorded in 22 states and the Federal Capital Territory in the past seven months, Nigeria has now slipped into a cholera epidemic. In Jigawa, over 100 persons have died of the disease while 5,000 have been hospitalised, according to the state government. Indeed, the rising cases of cholera infections amid the third wave of the COVID-19 pandemic could spell doom for the country’s decrepit health system, which is being worsened by a fresh doctors’ strike.
Cholera is a highly infectious disease that is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae. Symptoms include watery diarrhoea and sometimes vomiting. Severe cases can lead to death within hours due to dehydration. Case fatality ratios can be up to 50 percent, especially in people without access to treatment, but it could be as low as one percent with adequate treatment like Oral Rehydration Therapy.
Despite being a preventable disease, Nigeria has continued to witness incessant outbreaks in the past 30 years. According to the Nigerian Centre for Disease Control, between January and November of 2018, the country recorded 43,996 cholera cases and 836 deaths across 20 states with an attack rate of 127.43/100,000 population and a case fatality rate of 1.90 percent. Also, between January and October 2010, Nigeria recorded 37,289 cases and 1,434 deaths, while a total of 22,797 cases of cholera with 728 deaths and a case-fatality rate of 3.2 percent were recorded in 2011.
But the cholera epidemics should not come as a surprise given how the disease is spread, which is primarily through unsanitary habits and consuming contaminated food. The Federal Government says over 46 million Nigerians still practise open defecation, the highest in the world. The Minister of Water Resources, Suleiman Adamu, said in June that Nigeria had only 61 open defecation-free local government areas, out of the country’s 774 local government areas since the inception of the Sustainable Development Goals. This implies that only 7.9 percent of all LGAs in Nigeria donot practice open defecation.
WaterAid, an international non-profit organisation, says 116 million people in Nigeria lack basic sanitation, while 55 million people are without clean water. It adds that 110 million people do not have basic hygiene facilities and around 60,000 children under the age of five in Nigeria die from diseases caused by the poor levels of access to water, sanitation, and hygiene. With such worrisome statistics, it is not surprising that over 100 million Nigerians are susceptible to cholera.
Experts say the statistics may even be worse when the conditions of Internally Displaced Persons in the various camps across the country are factored in. According to the Norwegian Refugee Council, the overcrowded camps coupled with the shortage of sanitation and hygiene facilities boost the spread of cholera. About 466 people share one latrine at one of the IDP camps in Borno State, the Humanitarian Office for the Coordination of Humanitarian Affairs said in 2019. This is nine times above the agreed humanitarian standard, which is set at 50 people per latrine in emergencies.
Indeed, there is a clear nexus between open defecation and cholera. For instance, Plateau and Kwara – which the FMWR identified as the states with the highest population of persons engaging in open defecation — are also among the 22 states witnessing a cholera outbreak.
Like COVID-19 and many other diseases, cholera could be prevented by practising personal hygiene like washing hands, using alcohol-based sanitisers, and taking vaccines. The government should therefore resist the temptation of relegating cholera and prioritising COVID-19. Rather, a deliberate effort should be made to merge the COVID-19 response with that of cholera as this could prove effective.
Epidemiological trends show that in Nigeria, cholera occurs mostly during the rainy season when floods are more prominent. The recent inauguration of 774,000 youth volunteers as hygiene ambassadors by the FMWR towards scaling up sanitation and hygiene is, therefore, a timely and welcome development but local communities must take ownership of such initiatives and ensure mechanisms that promote salubrious habits are put in place.
For decades, Nigeria has failed to invest in disease prevention, which has also deepened poverty with about N455billion lost annually to poor sanitation, according to the FMWR. The President, Major-General Muhammadu Buhari (retd.), had in 2018 revealed that 46 percent of all water schemes are non-functional and Nigeria’s spending on sanitation and water had been declining from 0.70 percent of the GDP in 1990 to about 0.27 percent in 2015, which is far below the 0.70 percent at the West African regional level. It is disgraceful that Nigeria has failed to take such critical issues seriously. States and local governments should not continue to rely on the Federal Government and donor agencies for help.
Buhari had while declaring a state of emergency on Nigeria’s water supply, argued that the poor investment in the sanitation and hygiene sector was responsible for the high prevalence of water-borne diseases in different parts of the country, which has caused preventable deaths. Inaugurating the National Action Plan for Revitalisation of Water Supply, Sanitation and Hygiene codenamed ‘WASH’, he said the Federal Government would back states with counterpart funding to boost their capacity. Sadly, many states have failed to take up this challenge with fears rising that Nigeria may not meet the clean water and sanitation SDG target by 2030.
Nigeria must improve investments in water and sanitation. According to the World Bank, Nigeria will need to earmark at least 1.7 percent of its current GDP to water and sanitation. It adds that household contribution is needed to eliminate open defecation despite low family incomes. The government must note that access to clean water is not just one of the SDGs, but a human right. The United Nations says, “Lack of access to safe, sufficient and affordable water, sanitation and hygiene facilities has a devastating effect on the health, dignity and prosperity of billions of people, and has significant consequences for the realisation of other human rights.”
The UN argues that access to safe water will improve health and improve school attendance, both of which contribute to alleviating poverty. Improved access to water and a cleaner environment are the panacea for defeating cholera and many other diseases.
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