4th November, 2013
By Bilkis Bakare
Cholera is an acute contagious bacteria disease caused by the bacterium VIBRIO CHOLERAE, usually hosted by human beings. It can be of type 01 or 0139 affecting both adult and children. It has a short incubation period, producing enterotoxins that cause a copious, painless watery diarrhoea that can quickly lead to severe dehydration. Most persons infected with Vibrio Cholerae do not become ill immediately, although the bacterium is present in their faeces for 7-14 days. When illness does occur, about 80 to 90% of episodes are of mild or moderate severity and are difficult to distinguish clinically from other types of acute diarrhoea. 10 to 20% of cases develop severe diarrhoea and vomiting. It is important to note that the first 24 hours of manifesting the disease is the deadliest and riskiest because of severe fluid loss which might eventually lead to death if fluid loss is not replaced.
Cholera remains a global threat and is one of the key indicators of social development. The disease mostly affects countries, states or regions where safe drinking water is inaccessible and good sewage and general waste disposal is a luxury. It also affects overpopulated areas, displaced peoples settlements and refugee camps where access to standard hygiene practice is difficult. This aptly describes the situations in developing countries like Nigeria, where there are periodic cases of displacements due to natural disasters and inter ethnic or communal clashes. It is also rampant in third world countries like Mexico and Asian nations. In Nigeria, for instance, it is common for people to source water from the wrong source which often results in the quality of water they get being compromised, thereby increasing their chances of getting infected with diseases like cholera.
Statistics by the World Health Organisation, WHO, revealed that about three to five million cases of cholera are recorded each year , bulk of which occur in developing countries with negligible number of cases occurring in developed countries like the United States.
Cholera is transmitted through direct or indirect ingestion of contaminated water or food by faeces of infected individuals. Thereafter, the toxin released by this bacterium binds to the cell surface of the small intestine, secreting fluids and electrolytes into the lumen of the gastro intestinal tract. The onset of the disease is usually acute, catching the victim unawares. It is characterized by sudden onset of profuse painless watery rice water like stool, nausea and profuse vomiting, leading to weakness, low blood pressure and restlessness due to rapid loss of body fluids and electrolytes. Other signs and symptoms include irritability and dry mouth.
In the past three weeks, the disease has been in the news, affecting states like Zamfara, Sokoto and Plateau, with more than 74 deaths recorded across the country. Recently, Lagos State became one of the states in the country faced with frequent diarrheal outbreaks in rural and urban areas. A few days ago, at least three persons were confirmed dead, while few others were said to have been discharged after treatment following outbreak of cholera in about five local government areas. Surveillance and investigations by the state’s Ministry of Health had revealed that the reported cases were contracted from food sources such as the African food salad, popularly called ‘Abacha,’ well water sources, especially in areas like Ikate community, Amuwo Odofin Local Government Area and Badia area of Apapa Local Government Area, and infected foods from food sellers, and other unhygienic habits. This came barely three days after eight persons reportedly died in Plateau State, due to the outbreak of the disease.
Though the suspected cases were from Ajeromi, Apapa, Lagos Island, Oshodi-Isolo and Surulere local government areas but as at press time, the Local Government Areas affected in the state have risen to ten with Etiosa, Ikate, Agege, Amuwo Odofin and Lagos Mainland having reported cases, namely, Apapa, Ajeromi-Ifelodun, Lagos Island, Oshodi-Isolo and Surulere have had recorded cases. Other areas include Itire-Ikate, Etiosa, Agege, Lagos Mainland and Amuwo- Odofin.
In nipping the needless deaths from this preventable disease in the bud, massive public enlightenment campaigns by relevant agencies in charge of environmental health should be embarked upon to sensitise the public about the causes and prevention of cholera. And, perhaps most importantly, measure should be taken to discourage open defecation by the people. Fortunately, the state government has made efforts to build public toilets at strategic places across the state. It is, therefore, important that residents are encouraged to patronize these public toilets.
It is, however, important that governments at all levels endeavour to provide safe and potable drinking water for the people in order to control the quality from source and easily detect any contamination which may lead to water borne diseases like cholera which is ravaging some parts of the country presently. Similarly, frequent and correct washing of hands particularly after visiting the toilet should be adhered to while water which source is in doubt should be boiled before drinking. Other safety measures include washing of fruits and vegetables thoroughly before eating as well as thoroughly cooking of food before eating .
It is, equally, very important that all States Ministries of Health resuscitate if moribund, organisation of food handlers trainings or clinics for operators of food outlets, restaurants, fast foods and hotels so as to be able to provide guidelines that would serve as benchmark for measuring standards. Also, monitoring and unscheduled visits to sachet water factories or plants should be encouraged to promote adequate and proper hygiene while local butchers must be made to adhere to required sanitary standard.
Perhaps, more importantly, one would like to solicit for the re-introduction of sanitary inspectors, at least in places where they no longer exist. It was the norm during the colonial era and early post-independence period for sanitary inspectors popularly referred to as Wole-Wole and now known as Environmental Health Officers to move round to enforce sanitation laws and proper hygiene practices. But overtime, their impact were no longer felt in the communities as residents now break sanitation laws with impunity, culminating in the outbreak of cholera currently being experienced in some parts of the country. Unscheduled visits of Environmental Health Officers or Sanitary Inspectors to homes and other vulnerable locations would go a long way in changing the people’s sanitary habit. This is why Sanitary Inspectors need to be brought back to restore sanity in the environment by sensitizing and educating the public on various methods of hygiene.
We live in a world that is already endangered with numerous killer diseases, natural disasters and other dehumanizing conditions. It is, therefore, important that we all do everything within our power to ensure that we don’t , through unhealthy sanitary habits, inflict more pains on ourselves.
•Bakare is of the Features Unit, Ministry of Information and Strategy, Alausa, Ikeja.