Saturday, September 4, 2010

A nation on the brink of cholera outbreak

With over 517 deaths in eight weeks, resulting from 10, 134 cases of cholera attacks in over 10 states in the country, mostly in the North-west and North-east zones, the current outbreak is one of great concern to public health experts in the country given recent epidemiological survey which suggest that the entire country may be at risk of infection.
This warning no doubt should rally unaffected states to act fast against any possible spread that might likely increase the country’s health woes. This is as a total of about ten states have recorded cases of cholera outbreak- Bauchi, and Borno, recording high incidence of the epidemic followed by states like Gombe, Jigawa, Yobe, Taraba, Kaduna, Cross-River, Rivers and of course Adamawa.
In an interview with Innocent Ujah, Director General, Nigerian Institute of Medical Research (NIMR), Ujah regretted the unfortunate deaths of Nigerians in the states being ravaged by cholera outbreak. He stated that cholera is a disease of poverty and ignorance which can be prevented easily through simple hygiene and low technology. He hinted that many lives are needlessly lost largely due to intellectual poverty.
In the words of the Director General; “In response to the devastating pathology caused by outbreak of cholera in 11 states of the Federation, NIMR has dispatched a team of microbiologists to the affected states to work with other health team. In the meantime, the Institute has embarked on research component of the intervention with the sole aim of characterising the disease among others which should assist various governments to develop policies and strategies that will prevent or reduce the avoidable tragedy.”
Explaining the disease in its entity, Shilaj Chakravorty, Consultant Pathologist, BT Health & Diagnostic Complex, Lagos State University Teaching Hospital (LASUTH) Ikeja, Lagos, disclosed that cholera is an infection of the small intestine by which the bacterium Vibrio cholera releases toxin that causes increased release of water in the intestines, which produces severe diarrhea.
Chakravorty noted that though cholera occurs in places with poor sanitation, crowding, risk factors that predisposes people to get infected with the bacteria include exposure to contaminated/untreated drinking water, living in or travelling to areas where there is cholera. He hinted that symptoms associated with cholera include serious diarrhoea, vomiting, leading to dehydration as within a short incubation period, it can be fatal if not treated in time.
The consultant pathologist disclosed that “In India where infectious disease centers/hospitals exist, people who come down with such diseases like cholera are rushed to such centers. There, clinical examinations are done to ascertain the actual cause of the outbreak. In addition, people affected with the disease are isolated for proper observation so that they don’t infect others within the community.
“The objective of treating people with cholera is to replace fluid and electrolytes lost through diarrhea. The World Health Organization (WHO) has developed an oral rehydration solution that is cheaper and easier to use than the typical intravenous fluid. This solution of sugar and electrolytes is now being used internationally. Given adequate fluids, people can make a full recovery,” Chakravorty concluded.
Taking a cursory look at the cholera episode in the country, it will be recalled that Bauchi State Health commissioner Mohammed Jalem blamed the cholera outbreak on poor sanitation and contamination of open wells - the major sources of water in the rural communities. So far, Bauchi state has recorded the highest casualty figures. Going further, tales of prompt medication forced affected victims to resort to self-medication. Recent floods in parts of the North compounded the situation further as houses were destroyed; sewage bursting forth and merging with blocked drainages in the affected areas thus worsening water supply channel.
This current outbreak says a lot about the seriousness of health authorities that a disease whose cause is so well-known should be allowed to occur. It is obvious at this point that government should lay more emphasis on preventive health, than curative as a first step to stopping cholera scourge.
No doubt, if our leaders hold with high esteem the lives of the people they profess to serve, a multi-pronged approach to curbing incessant cholera outbreaks is needed. New strategies are required. Primary health care must improve; this level of healthcare and disease prevention must be strengthened. States may have to work closely with the National Primary Health Care Development Agency and seek the technical support of international agencies. The relevant departments in the states should also be proactive.
Since drinking of contaminated water is a known cause of cholera, state governments must commit themselves to the provision of potable drinking water for people both in rural and urban areas. Going further, sanitation must also be given top priority, with state governments not just naming one Saturday in a month as environmental sanitation day but actually enforcing the clean up exercise by making sure residents came out to clean their surroundings.
More importantly, a lot can be done in the area of public enlightenment and education, with special emphasis on basic hygiene practices. Local government councils must live up to their responsibility of clearing rubbish heaps that are gradually taking over most streets and roads in our towns and cities, by providing standard refuse disposal facilities and ensuring that these too are regularly emptied with refuse disposal trucks to a designated dump site.
Even as the country is already lagging behind in the implementation of the Millennium Development Goals (MDGs) with global target year of 2015, it is instructive that access to potable water is an integral part of the MDGs, a task in which the country must immediately address.

By Alexander Chiejina

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