By Enyeribe Ejiogu
The pictures of Lekki, a swanky part of Lagos metropolis, which was recently flooded, following a downpour, swamped the internet. They were seen around the world by Nigerians, even students studying in Ukraine.
One of the Nigerian students who returned last week, after graduating as a medical doctor(identity concealed) told Sunday Sun that she gasped and was awe-stricken by the sight of two vehicles parked in a compound, which were submerged up to the level.
However, the pictures did not show the contents of the sewage tanks that mixed with floodwater. The flood also carried off the generous deposits of feacal matter dumped on the ground by people who habitually defecate outside. Part of the floodwater flowed into boreholes and bathed the feet of people who waded it through it in different parts of Lagos. In some other parts of the country, the heavy rains exposed people to contact with dirt floodwater.
So it was a foregone conclusion that news of a cholera outbreak would soon be heard. And it was not long in coming when the Lagos State Commissioner for Health, Dr. Jide Idris announced that two people died and 25 others quarantined following an outbreak of cholera in the Shomolu, Oshodi-Isolo and Surulere local government areas of the state. Most of the cases presented with the typical diarrhoea and vomiting associated with cholera. Because the victims came to the hospitals late, two of them died.
On its website, the World Health Organisation states that “cholera is an acute diarrhoeal disease that can kill within hours if left untreated.”
According to the global health intervention agency of the United Nations,rResearchers have estimated that each year there are 1.3 to 4.0 million cases of cholera, and 21,000 to 143,000 deaths worldwide are due to cholera.
“Most of those infected will have no or mild symptoms, and can be successfully treated with oral rehydration solution. Severe cases will need rapid treatment with intravenous fluids and antibiotics.
Provision of safe water and sanitation is critical to control the transmission of cholera and other waterborne diseases.
How infection happens
Generally, cholera infection happens when a person eats food or drinks water contaminated with the bacterium known as Vibrio cholerae.
It takes between 12 hours and 5 days for a person to show symptoms after ingesting contaminated food or water. Cholera affects both children and adults and can kill within hours if untreated. Most people infected with V. cholerae do not develop any symptoms, although the bacteria are present in their faeces for 1-10 days after infection and are shed back into the environment, potentially infecting other people.
Among people who develop symptoms, the majority have mild or moderate symptoms, while a minority develop acute watery diarrhoea with severe dehydration, which can lead to death if left untreated.
As the Lagos State health commissioner noted, outbreak in the particular areas was attributed the primary water sources in the area contaminated with faecal matter from faulty septic tanks and soak-away in the community. Persistent rainfall in Lagos which lasted for about a week, made septic tanks to fill up and overflow, thereby contaminating low-lying tops of boreholes, in these areas where poor sanitation is still a major issue.
Cholera is an easily treatable disease. The majority of people can be treated successfully through prompt administration of oral rehydration solution (ORS). The WHO/UNICEF ORS standard sachet, which is sold in most pharmacies is dissolved in 1 litre of clean water. Adult patients may require up to six litres of ORS to treat moderate dehydration on the first day.
Severely dehydrated patients are at risk of shock and require the rapid administration of intravenous fluids. A 70-kg adult will require at least seven litres of intravenous fluid, plus ORS during their treatment. These would equally be given appropriate antibiotics to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed, and shorten the amount and duration of V. cholerae excretion in their stool.
Mass administration of antibiotics is not recommended, as it has no proven effect on the spread of cholera and contributes to increasing antimicrobial resistance.
Rapid access to treatment is essential during a cholera outbreak. Oral rehydration should be available in communities, in addition to larger centres that can provide intravenous fluids and 24-hour care. With early and proper treatment, the case fatality rate should remain below one per cent.
Prevention and control
At the family level, individuals need to be careful about what they eat and where they buy what they eat. You should be doubly cautious about eating in roadside eatries, commonly known as “Food Is Ready” which are located in places that are not sanitary, close to open drains with dirty stagnant water. The hygiene level in such places may not be acceptable. So don’t eat food prepared in such places.
Oral cholera vaccines are an additional way to control cholera, but should not replace conventional control measures. Safe oral cholera vaccines should be used in conjunction with improvements in water and sanitation to control cholera outbreaks and for prevention in areas known to be high risk for cholera.
Promotion of appropriate hygiene practices such as hand-washing with soap, safe preparation and storage of food and safe disposal of the faeces of children is vital to the prevention and control of cholera.
Institute a practice of boiling water drawn from a borehole, which meant for drinking for a least 10 minutes, when the water reaches boiling point. Let it cool down. Then chlorinate it with a measured volume of any of the WHO approved water-purification chemicals, which can be bought from any good pharmacy nearby. Some of the brand names include:
At the level of the government and non-governmental organisations, awareness campaigns should be organized during outbreaks, and information should be provided to the community about the potential risks and symptoms of cholera, precautions to take to avoid cholera, when and where to report cases and to seek immediate treatment when symptoms appear. The government should publicise the hospitals and health centres adequately equipped to handle cases of cholera infection with a view to containing the outbreak.