Tuesday, 3 February 2015

Nigeria battles to curb cholera spread

By: Chioma Umeha

As six states in the country struggle with cholera which has already affected 373 persons with 74 succumbing to the disease, action has commenced to initiate sanitary precautions to control it. This is even as 30 other states, including the Federal capital territory (FCT) is now on alert to prevent cross infection. The action is coming on the heels of warnings by government authorities and experts for the public to do everything to stop open defecation and ensure access to clean water. For instance, the Minister of Health, Prof Onyebuchi Chukwu, on Monday, assured that the ministry had proffered ways of checking the infection, just as experts on Tuesday, urged governments at all levels to reintroduce sanitary inspection to control further outbreak of cholera and other communicable diseases. Prof Chukwu, gave the assurance at the 2013 Physicians’ Week, organised by Nigerian Medical Association (NMA) in Abuja, while addressing journalists, confirming that the six states where the disease had been recorded are; Lagos, Oyo, Ogun, Zamfara,  Katsina and Plateau.

The Health Minister who urged Nigerians to ‘henceforth stop and control open defecation,’ further called for the provision of portable and clean water and the improvement of personal hygiene in homes and public places. According to World Health Organisation (WHO), cholera is caused by acute enteric infection through the ingestion of a bacterium known as vibrio cholerea found mostly in water and food that has been faecally contaminated. Also, Wikipedia, the free online dictionary, describes cholera as an infection of the small intestine caused by the bacterium `Vibrio cholerae’ with the main symptoms as watery diarrhoea and vomiting. Transmission occurs primarily through drinking water or eating food that has been contaminated by the faeces of an infected person, including one with no apparent symptoms. 


In separate interviews, experts agreed that the fight against cholera required concerted efforts by all tiers of government and Nigerians in general. Dr Femi Balogun, the Medical Director, Sheffi Private Hospital, Egbeda, Lagos, urged Lagos residents to provide standard toilet facilities in their respective homes for healthy living. He said that regular sensitisation and awareness campaigns to educate residents on good hygienic practices were being carried out by health personnel. Balogun said that sanitary inspectors should be mandated to ensure that every house had toilet facility. Also, Dr Femi Afolabi, a dietician at the Federal Medical Centre, Ido-Ekiti, said that more efforts should be made to educate food vendors on appropriate and hygienic ways of food preparation. Afolabi advised the public to boil their drinking water and also wash their vegetables before consumption, to avoid contacting the disease. The dietician also urged people to maintain clean and healthy environment to prevent cholera epidemic and outbreak of other communicable diseases. 

Dr Adewunmi Alayaki, a general physician at Isolo General Hospital, Lagos, stressed the need to strengthen the sanitary inspectors for proper monitoring of the environment, to prevent cholera. “We know there are people saddled with the responsibility of sanitary inspection, not only in the North, but also in other parts of the country. “This has to be revived. There is the need for border surveillance, monitoring and inspection of our environments for early detection of diseases outbreak,” he said. Reports has confirmed that some parts of the country – Plateau, Sokoto, Zamfara, Ogun, Oyo and Lagos States – had at different times this year suffered the disease. In July, five people were reported dead in Ogun, while eight people died and 12 others hospitalised in Egbeda Local Government area of Oyo State in September. The disease also infected no fewer than 536 people and killed 46 in Zamfara in October. In Plateau State, nine people died out of the 136 in some parts of the State. The Lagos State Commissioner for Health, Dr Jide Idris, bemoaning the death of  three out of the 13 cases reported in more than five local government areas of the state said: “Although, many of the cases have been treated and patients discharged in several health facilities, three have been confirmed dead. “Surveillance and investigation discovered that a large number of the cases came from Amuwo-Odofin, Apapa, Lagos Island, Ajeromi-Ifelodun, Oshodi-Isolo and Surulere Local Government areas, Idris said. 

“People should henceforth stop and control open defecation and ensure provision of portable and clean water and the improvement of personal hygiene in homes and public places,” the Commissioner said. He said that further surveillance and investigation, especially in Oshodi-Isolo and Surulere Local Government areas, identified African food salad, popularly called `Abacha’, as the suspected source of the disease. “Water was the source in Ikare community in Amuwo-Odofin, and Apapa Local Government areas,” Idris said. Meanwhile, the Lagos State House of Assembly on Monday urged the federal government to direct the relevant agencies to sensitise the public on how to safeguard themselves against the spread of cholera, which had claimed some lives in the last few weeks. The State Assembly also called on the state ministries of health and Information and strategies to put measure in place to ensure that residents observe proper hygiene in order to curb the spread of the disease. The issue came up under matter of urgent public importance which was raised by the Chairman, Assembly Committee on Health Service, Hon. Suru Avoseh, representing Badagry constituency II. He said: “The outbreak of cholera in some parts of the country including Lagos State has been reported, and this needs to be properly managed to prevent it spread.” “It is a contagious disease, we have to guide against its spread because already 13 cases have been reported while three deaths have occurred. 

So prevention should be emphasised.” Avoseh pointed out that what people eat should be carefully prepared, adding that: “The African salad, ‘Abacha’ is regarded as a possibility of causing the disease.” The lawmaker explained that sensitization programme was not to intimidate the public but as a way of creating awareness of the danger inherent in the spread of the disease. In his comment, Hon. Rotimi Olowo who represents Shomolu constituency I said it was not only ‘abacha’ that is dangerous to eat but also that the environment where food is prepared should be in good hygiene. According to Olowo, “the local government authorities should begin to inspect all the food vendors to ascertain the environment as safe not to endanger the lives of the residents.” On her part, Funmilayo Tejuoso, representing Mushin constituency I, explained that “cholera had been eradicated in the 1960s. “So I see no reason why we cannot do the same now,” she added. The lawmaker advised the public to be wary of water they consume including the so called ‘pure’ sachet water and the one in bottle. 

Also, experts have urged governments at all levels to reintroduce sanitary inspection to control further outbreak of cholera and other communicable diseases. Governor Jonah David Jang of Plateau has also set in motion an effective disease surveillance team across the 17 local government areas of the state following the outbreak of cholera disease in Namu village of Quan’pan LGA of the state. Jang said 11 people were confirmed dead, while 136 others were infected by the dreaded disease. Commissioner of Information and Communication, Abraham Yiljap, stated this Tuesday, while briefing journalists on efforts of the Plateau State Government in combating the scourge, which is a result of congestion of Internally Displaced Persons following the unfortunate communal clash in Obi Local Government Area of Nasarawa State in September. Yiljap said “The Government of Plateau State has released N22 million for the purchase of relief materials and foodstuff for the IDP’s. In addition, the Commissioner of Health and the Interim Administrator of Quan’anpan Local Government were directed to provide drugs, medical personnel and more aids.” 

According to him, “For the purpose of clarity and context, the unfortunate communal conflict in Obi Local Government Area of Nasarawa State in September, 2013, resulted in a sudden and dramatic increase in the population of Namu, when 7,000 Internally Displaced Persons (IDPs) arrived the town following their displacement from Assakio. “Some of the IDPS kept moving within Plateau and settled with relations in Kwande, Kurgwi and Bakin Ciyawa, all in Quan’anpan LGA. Governor Jang immediately directed the State Emergency Management Agency under the Chairmanship of the Deputy Governor, Ignatius Longjan, to offer necessary assistance to the displaced.” Yiljap said, “Since then, more steps have been taken to mitigate the spread of the disease and ensure that those who had been on admission received the required medical attention. 

In the latest effort, a joint review and strategy meeting was held by the management agencies, including the Ministry of Information and Communication.” He added that among other measures, government has undertaken to curb the disease to provide clean and safe drinking water, engage in sanitation exercise to evacuate refuse sites within the town, while UNICEF is to provide health kits and undertake public education through sensitization and advocacy as more drugs is to be prescribed in the health centre to better manage the epidemic. The commission stressed that the health experts in the state has responded adequately to the health challenge that was reported over the weekend in Jengre community in Bassa Local Government Area of the state. 

He said about 24 patients who were on admission were diagnosed by the Epidemiology Unit of the Ministry of Health, adding that none of the reviewed cases was compatible or fitted the case definition of cholera, rather the cases, as presented, were mostly diagnosed of malaria. Yiljap called on people of the state to observe basic hygiene, keep away from unsafe water sources, fruits and vegetables which sources are uncertain, wash their hands and keep flies away as ways of promoting greater health.

This story was published in Newswatch Times on October 31,  2013.

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