Victims, relations cry for help
From Desmond Mgboh, Tunde Omolehin, Mohammed Munirat Nasir, Ahmed Abubakar and Olanrewaju Lawal
The swift mortality associated with it––even with quick diagnosis, 10% of patients typically die within 48 hours of symptom onset––is what makes Cerebro Spinal Meningitis (CSM) the dreaded disease of the moment. Saturday Sun investigation in Sokoto, Kebbi and Zamfara found traumatic relatives who are reeling from the sudden demise of their loved ones. Unable to fathom the deadly swiftness of the disease, some grief-stricken relatives implicitly attributed the death of their loved ones to supernatural causes. Others displayed absolute ignorance of the disease before it tragically affected them.
Nura Abdullahi, who lost a 15-year-old to the disease in Bodinga Local Government Area, claimed ignorance of the outbreak until her daughter’s death. “We were not aware of any outbreak of meningitis, not until the health team arrived and informed us of the epidemic.”
Musa Abubakar, too, had no idea about it: “We have lost five people to this disease. Initially, we thought it was malaria, not until we were told it was meningitis.”
A still-traumatised Abubakar said: “But I believe in Allah’s will, not in any scientist.”
A 56-year-old father of eight, Mallam Nasiru Daniyan, who lost a seven-year-old daughter to the outbreak, took solace in Allah, too––but he also took the necessary precaution: “I have since immunised the rest of the children against the disease.”
Weeks after her tragic loss, a Kebbi mother remained inconsolable. “She ate before she left home for school on that day,” she said of her daughter. “She didn’t show any sign of sickness. Then suddenly, we just received emergency calls that we should come to the school.”
The broken woman lamented: “What can I do? She is a brilliant and obedient child. We had hoped she would become somebody in future. Now this disease had taken her away from us.”
Their pathetic case offers a glimpse of the river of sorrow the outbreak of meningitis is leaving in its wake as it continues to ravage northern parts of Nigeria. Those in the northeast, who are just returning to their homes after the Boko Haram holocaust, are already overwhelmed by fear of an epidemic threatening to disrupt their hard-won freedom and send them back to another camp.
The worrisome situation was made gloomier by Zamfara State Governor Abdulaziz Yari’s apocalyptic assumption that the Type C virus was a scourge from God to punish “people who refused to stop their nefarious activities.”
Cerebro Spinal Meningitis, a disease that infects the thin covering between the brain and the spinal cord (with evident symptoms such as stiff neck, high fever, rash, headache, vomiting and confusion) kills its victim within hours of infection, if not properly diagnosed and managed. The disease is a seasonal affliction that sweeps across a large swathe of areas known as the “Meningitis Belt” of sub-Sahara Africa.
While three other West African countries––Niger, Burkina Faso, and Mali––are also battling with the outbreak, Nigeria is reportedly the most affected.
Chief Executive of Nigeria Centre for Disease Control (NCDC), Dr. Chikwe Ihekweazu, spotlighted Zamfara, Katsina, Sokoto, Niger and Kebbi States as the worst-hit states, while Kano and Jigawa have also recorded low-count cases.
By the first week of April, national death toll has risen to 336 with 2,997 suspected cases spread across 90 local governments of 16 states of the federation.
State governments are battling with the grim reality before them, with the objective to curb a looming epidemic.
Sokoto and the missed opportunity
Zamfara is the worst-hit state. Data from NCDC indicated no fewer than 216 deaths with many of the estimated 1860 (67 laboratories confirmed) cases still being treated across the state.
Commissioner of Health, Alhaji Suleiman Gummi, in his briefing, disclosed that the disease, first reported in one local government area, has spread to all the 14 local government areas of the state.
However, it was in Sokoto the opportunity to curb the scourge was first missed. Before it became a full-blown epidemic sweeping across the north, the first fatality had been reported in Sokoto State as far back as early January. Statistics available to Saturday Sun indicated that between January and February this year, no fewer than 10 fatalities were recorded, with many cases treated in health facilities in the state.
An anonymous but reliable health personnel told Saturday Sun the first few cases of Cerebro Spinal Meningitis were “recorded in Gada Local Government Council, a border town between Nigeria and Niger Republic, where it claimed 10 deaths which were recorded by local government authorities.”
A total of 77 cases were logged by health officials between January and February among the inhabitants of Wauru, Kyadawa, Kaffe, Kaddi and Duka-maje communities of the local government. From February, the disease spread to seven other local government areas.
The latest update on Sokoto State is grim: 41 persons out of the 600 clinically confirmed cases had died of the disease, according to the Commissioner of Health, Dr. Balarabe Kakale. Eight local governments, Rabah, Kebbe, Tureta, Gada, Dange/Shuni, Wamakko, Kware and Bodinga are the most affected in the state.
Since March 20, the Sokoto State Government has responded with an epic statewide mass vaccination against Cerebro Spinal Meningitis. The exercise, involved 15 medical teams comprising over 150 medical personnel across the 23 local government areas of the state. Equipped with ambulances and free drugs for victims, the teams’ objective is to immunise over 700,000 persons, from age 1 to 30, across all local governments, alongside thousands of other cases being treated at the primary health centres by the respective local government areas.
So far, 400 mixed cases of severe malaria and meningitis have been treated across the seven top-hit local governments, with 16 fatalities recorded and 56 of the cases confirmed in the laboratories as meningitis.
Benefits of early alert
Kebbi took an early cue from the outbreaks in neighbouring northwest states of Sokoto and Zamfara to put its health officials on high alert. According to Health Commissioner Alhaji Usman Kambaza, only three confirmed deaths were recorded out of the seven confirmed cases from Birnin Kebbi, Bena and Anguwar Nabo town of Danko Wasagu Local Government Area.
Nonetheless, there is a possibility the casualty may be higher against the backdrop of the death of some secondary school students in the state. A parent of one of the deceased, Hajia Ramat Shehu, told journalists a poignant story of the last day of her 15-year-old daughter, Safiat, who was among the students who died of the disease at Fanah Secondary School. “She ate before she left home for school on that day. She didn’t show any sign of sickness. Suddenly we received emergency calls that we should come to the school.”
Jigawa, another state within the zone, is also not spared. But like Kebbi, it seized the opportunity to be pro-active. As the widespread was being reported in neighbouring states, Governor Abubakar Badaru called an emergency meeting with all stakeholders. They brainstormed and came up with a precautionary measure that drafted public health educators, social mobilisers and health personnel into community-based education campaign on meningitis.
The last update from Dutse, the state capital, affirmed one death and five cases of Cerebro Spinal Meningitis were reported to the ministry from four different local government areas––one case each in Kiri-Kasamma, Kiyawa, Maigatari and in Gwaram, where the disease killed a 13-year-old boy. Health workers have already treated four of the cases, and the patients are in stable condition, according to the Health Commissioner Dr. Zakari Abba.
“We also immediately created vaccination posts to vaccinate the populace with CSM Vaccine,” Dr. Abba revealed.
States caught unawares continue to battle the scourge with all the resources they could muster. Katsina (211 cases and 46 deaths) and Niger (93 cases with 33 deaths) joined the high-incident states. Elsewhere in Kebbi (69 cases, 12 laboratory confirmed and 11 deaths), Abuja (five cases and five deaths), Kano (36 cases, four confirmed, and three deaths), and Yobe (51 cases and nine deaths), the death toll continues to rise.
New strain vs scarce vaccine
By the first week of April, the entire North West is engulfed with cases of Cerebro Spinal Meningitis. It has crept into North Central states, notably Niger.
One fact about the disease troubles medical personnel the most. Dr. Chinasa Onyemkpa, Acting Principal Medical Officer, Gada General Hospital, Sokoto, told Saturday Sun the recent outbreak of meningitis in the area was caused by a new strain of the disease.
“The people of the area had developed immunity for the old strain of ailment. The current problem was aggravated by some formidable factors like traditional beliefs, over population, poor hygiene and congestion, among others,” he said.
Sokoto State Commissioner for Health, Dr. Balarabe Kakale explained further, the epidemic was caused by the Type ‘C’ strain of meningitis, not the Type ‘A’ strain which the people of the state had hitherto developed an immunity against.
He said: “This new strain of meningitis is deadlier than the dreaded Ebola disease as it kills within four to six hours of afflicting a patient. More than 80% of the victims also had not been immunised, hence, the aggravation of the epidemic.”
The biggest problem with “Stereotype C” is that there are not enough vaccines against it––a cold fact announced recently by the Nigeria Centre for Disease Control.
“There is a vaccine,” affirmed NCDC chief, Chikwe Ihekweazu, “but it is not commercially available for the stereotype involved in this specific outbreak, and we have to make application to the World Health Organization for the vaccines.”
Frantic efforts are ongoing on various fronts to secure enough doses of vaccine.
In his press release of April 1, Health Minister, Professor Isaac Adewole, disclosed an acquisition of 1.3 million vaccines––500,000 doses of the meningococcal vaccines from WHO to be used in Zamfara and Katsina states, and 800,000 units from the British government.
Permanent Secretary of Katsina State’s Ministry of Health, Dr. Kabir Mustapha, disclosed the government is trying to “get vaccines from Pfizer just like all the affected states.” He said: “We are made to understand there is limited stock of vaccines. We are trying to raise money to buy from them. The vaccines are scarce.”
In Zamfara, where 300 doses of vaccine was donated by the federal government, the Commissioner for Health Alhaji Sulaiman Gummi disclosed Governor Abdulaziz Yari had mandated each of the 14 local government areas to expend N3m on drugs to combat the meningitis scourge. The government, Gummi added, had inaugurated special camps.
Kano, with four deaths out of 20 cases spread over eight local government areas––of Bebeji, Dawakin-Kudu, Dala, Gwale, Kano Municipal, Kumbotso, Tarauni, Tudun Wada and Ungogo––has earmarked N19 million to tackle the disease.
Lest they are caught unawares, other states without confirmed cases are gearing up too. To prevent its emergence and spread, Bauchi State has flagged off vaccination against Cerebro Spinal Meningitis. The vaccination, according to head of the state primary health care agency, Adamu Ibrahim Gamawa, kicked-off on Monday March 3, 2017, at the Bauchi Central Prison where both inmates and jailers of the Nigeria Prisons Service were vaccinated.
Although the state has not recorded an outbreak, Gamawa noted that the disease is rampant during the hot season, thereby making it imperative to take the right measure without delay.
In Kwara, Commissioner for Health Sulaiman Atolagbe Alege, declared the state’s readiness.
“There’s no case of meningitis in the state yet but we have directed all the directors in the health sector to be on the alert,” he said.
He added: “We have also started educating our people on how to create avenues to get fresh air in homes, and also caution them on the need for prompt response by contacting the ministry if they notice any sign of the disease.”
According to him, the state’s ministry of health is already in touch with the World Health Organisation (WHO) and the Nigerian Centre for Disease Control in case of an outbreak.
Lagos, with two deaths and three suspected cases––none of them laboratory confirmed––has put all its 57 local government areas, and Local Council Development Areas, LCDAs, on red alert