Innovative Approaches to Combat Cholera in Nigeria: Success stories and challenges

Oreka Titi Akerejola, Adeshina Michael, Omaraye Grace and Yaya Mariam

It may seem like the buzz surrounding curbing the spread of cholera in Nigeria is dying off, but have we reached the point of saying we have defeated the disease?

Here, we pay a close look at the initiatives and the innovative strategies being employed to tackle cholera and we consider if they are unproductive or efficacious.

By WHO’s definition, Cholera is an acute diarrheal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae.

Despite being both preventable and treatable, cholera is very dangerous as it can kill an individual within hours without intervention. It remains a global threat to public health and an indicator of inequity and lack of social development.

A litany of discussions have been woven around the poor state of the Nigerian public health system as it looms over like a virulent giant amidst the myriad of problems facing the country.

It is no wonder that cholera wasted no time in ravaging many parts of the country, affecting a large number of communities and leaving hundreds of patients dead within a very short time.

How are we then combating this menace, and how have we fared so far in the fight? Are we losing or winning?

The Nigeria Centre for Disease Control and Prevention in a Punch Newspaper report dated 24^th June, 2024 claimed that the country had recorded 1,528 suspected cases of cholera and 53 deaths in 31 states across 107 Local Government Areas.

As of June 2024, Nigeria reported 1094 new cholera cases and 41 associated deaths, resulting in a CFR of 3.7%. This marks a 1143% increase in cases and a 1950% increase in deaths compared to the previous month. Since January 2024, Nigeria has reported a total of 2102 cases and 63 deaths with a CFR of 3% across 33 states.

Nevertheless, there have been concerted efforts by the Federal Government in collaboration with the WHO to combat cholera. Since the start of the outbreak, WHO field volunteers and local government facilitators have been deployed to bolster the overall outbreak response across hotspots. Ordinarily, their work is to ensure that local coordination is strengthened and suspected cases of vaccine-preventable diseases are reported in a timely manner.

In the bid to combat the disease, the Nigerian government continues to implement policies to control the spread of cholera. Promoting basic sanitation, improving hygiene practices and providing clean water.

Commendably, the Federal Government, has series of collaborations with NGOs like IOM (International Organisation of Migration), MSF (Medecins Sans Frontieres), otherwise known as Doctors Without Borders, whose main focus is to provide medical aid in areas where it is most needed across the world since the 1980s till date.

The MSF has responded to cholera epidemics across the world and has expedited new and more effective ways to eradicate cholera. The International Organisation of Migration (IOM) has specifically introduced and has partnered with the Nigerian Government to provide solar powered boreholes to ensure clean and constant water supply.

Between 2019 and 2024, the IOM has maintained more than 58 of these boreholes in Borno state and created 11 new boreholes. This feat has been replicated across several communities in the North thereby recording a slight improvement in the combat against cholera.

Positively, there are similar initiatives spanned across Nigeria, not without community education, water treatment, distribution of purification kits and other sensitization measures employed by the Federal Ministry of Health, Environment, NGOs and students, especially those involved in development communication.

Disputably and in spite of the interventions engaged by the Government and civil society, the public health system continues to deteriorate thereby negating the effects of community health involvements and medical programmes. Contaminated water, poor education, lack of awareness and inadequate sanitation facilities are critical factors in the spread of the disease. Effects of climate change and environmental degradation are also cumulative factors that hinder the curtailing of the cholera scourge.

As climate change continues to alter weather patterns, such outbreaks may become more frequent and severe, posing significant challenges to healthcare systems.

However, there is more to be done.  Provision of safe water and basic sanitation, and hygiene practices is vital to prevent and control the transmission of cholera and other waterborne diseases.

In addition, some notable innovative strategies are also being implemented to combat cholera in Nigeria such as:

Mobile health technology: these are mobile apps and SMS based systems used to track cholera outbreaks in real-time, providing warnings, enabling rapid response. Health workers and community members report cases and data is analysed to identify hotspots. This helps in the quick containment of the disease directing resources to the most affected areas.

Wash, Santitation, and Hygiene (WASH) programmes: These initiatives focus on improving access to clean water, promoting hand washing, and constructing latrines in vulnerable communities. Some Organisations such as the IOM mentioned earlier, use solar-powered water purification systems and distribute purification tablets.

Another innovative strategy is Community-Led Total Sanitation (CLTS) which involves mobilizing communities to completely eliminate open defecation by raising awareness and encouraging the construction and use of latrines. The communities are thereby encouraged to take control of their sanitation, significantly reducing the risks of cholera outbreaks.

Oral Cholera Vaccination (OCV) Campaigns are also effective. These mass vaccination campaigns are conducted in cholera prone areas using OCVs to provide temporary immunity during outbreaks or before the cholera season.

Other innovative strategies include Public Health education and Social Media campaigns using digital platforms to spread awareness about cholera prevention, symptoms and treatment. Interactive and multi-media content engages a broader audience including youth.

Point-of-use Water Treatment Technologies, partnership with local leaders and influencers i.e. traditional, religious and community leaders, strengthening the health systems and infrastructure like cholera treatment centres in affected regions, training health workers, ensuring supply of rehydration salts and other essential medicines are similar innovations that have also proven to be effective.

All of these strategies provide a comprehensive approach to combat cholera, and they go to show that cholera, though often predictable and preventable, can be eliminated totally from our country.

The enlightenment and public awareness campaigns must continue as we interface daily with a largely uneducated public. It is an ongoing battle and I daresay that cholera may have a formidable opponent on the Nigerian battlefield but has it met its match? I believe that the next couple of months or years will determine this, as the success of these initiatives is yet to be principally evident.