Last week in Sunday Sun, Enyeribe Ejiogu our Wardround Spreadsheet aficionado opened a Pandora box, when he discussed “Ways to protect your family from cholera”. I was inundated with requests for regular updates of cholera outbreaks in different States, what they should do in case of outbreaks, and what the Government is doing to assist them. Some asked me to name the States and Local Governments which have recorded cholera outbreaks.
Luckily for us we have a public release of four basic management guidelines, by Nigeria Centre for Disease Control(NCDC) to all local primary healthcare centers, for management of cholera. We all know that primary community health centers are usually the first points of call for all outbreaks.
Four basic management principles of cholera treatment.(NCDC)
1) Assessment of the Patient:
λ During an outbreak, flow charts are useful in carrying out a quick assessment of patients. It helps categorize patients based on severity of illness and for initiation of prompt medical attention.
λ It should be structured in a simple manner for use by any Cadre of health care worker. It must be readily available and accessible. The language used in the flow chart must be clear, preferably in local languages to improve understanding and interpretation.
λ The flow chart should also contain clear information on the treatment protocol to be followed after assessment has been carried out.
2) Rehydration of sick patients :
λ Rehydration through replacement of lost fluids and electrolyte is the cornerstone in the treatment of cholera.
λ Rehydration is usually through intravenous fluid or Oral Rehydration Solution(ORS). It is advisable that use of ORS should be sustained during and after intravenous fluid therapy. Close surveillance of cases is important during the early stages of treatment.
3) Antibiotics Use:
λ Use of antibiotics should be restricted to severe cases, particularly those passing large volumes of stools. Rationale for this is to reduce the duration of illness and carriage of the pathogens. With the increasing rates of antimicrobial resistance, it is advisable for health workers to request for sensitivity patterns of the causative organisms, which will inform choice of antibiotics to administer to affected patients.
λ Sensitivity and resistance patterns should be requested for, at the beginning and during an outbreak, as organism sensitivity to antibiotics may change over time.
4) Health Education
λ This is necessary so that family members of cases are enlightened on steps to avoid contamination and re-infection.
λ The messages provided should be hinged on personal hygiene, after attending to sick relatives, e.g. washing of hands after touching patients, their stool or vomitus or their clothes, as well as avoiding contamination of water source by washing patients’ clothes in the water.
λ In order to ensure cases are well managed, available manpower and resources must be mobilized in the containment of cholera outbreaks.
λ Please do not attempt to manage any case of cholera at home. It could be very disastrous, and the infection could spread to every member of the family. Again a baby could die within three hours of severe cholera. No matter how late, rush the person to the nearest primary health care center.
λ States are continuously enjoined to collaborate with all stakeholders, harnessing and utilizing resources together in outbreak management.
λ The Nigerian Centre for Disease Control ( NCDC) will continue to support outbreak response activities across States as its duty towards protecting the healthof all Nigerians.
λ Members of the public are advised to always seek care in a health facility if they or their children have watery diarrhoea.
If you have read me up to this point, please take this paper and go to your nearest health Centre. Ask the the health worker there whether he or she has received the cholera-flow-chart from Federal Ministry of Health, released by NCDC. If the answer is no, leave them with a copy of this paper, you can buy another one. Tell them to read the NCDC guideline on “Basics of case management in a cholera treatment unit”
Tell them to prepare their unit following the guideline, the first case of cholera, could be rushed in at midnight. He or she could be one of our daughters or sons. Without adequate stock of rehydration fluid the baby could die in an emergency, and life has no duplicate.
Tell the head of the health care centre to immediately rush to their head quarters and collect the cholera-flow-chart, for their unit. Delay could be dangerous. You know with these excessive floods which wreaks havoc on our sewage with attendant water pollution, we are on batted breath waiting for the next cholera outbreak. Will it be here or there?
The time to act is now. May God guide us.
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