Cholera is a severe diarrheal disease caused by ingesting food or water contaminated with the bacterium Vibrio cholerae. This waterborne illness leads to severe diarrhea and vomiting, resulting in acute dehydration that can be fatal if not promptly treated. Cholera remains a threat to public health and an indicator of inequity and lack of social development.
The Africa Centres for Disease Control and Prevention (Africa CDC), the continent’s chief health advisory body, linked the worst cholera outbreak in recent years to climate change. It stated that adverse weather is increasing the risk of this disease faster in Africa than in the rest of the world.
“Cholera in Africa is a climate change issue,” said Jean Kaseya, Director- General of Addis Ababa-based Africa CDC.
History of Cholera
In the 19th century, cholera was primarily confined to the Indian subcontinent. The disease spread to Asia in 1961, reached Africa in 1971, and arrived in the Americas by 1991. Today, cholera is endemic in many countries, including Nigeria. The first recorded case of cholera in Nigeria was in 1970. Since then, outbreaks have increased in both frequency and severity, resulting in high mortality rates.
Recent report by the World Health Organization (WHO) indicates that between January 1 and May 26, 2024, a total of 194, 897 deaths and 1,932 cases of cholera globally.
The cases were reported from 24 countries across five WHO regions. The Eastern Mediterranean Region recorded the highest numbers, followed by the African Region, the Region of the Americas, the South-East Asia Region, and the European Region.
Cholera Outbreaks in Nigeria
Cholera outbreaks are not new to Nigeria. Since the 1970s, cholera has caused numerous deaths, especially among children, many of which could likely have been avoided.
In June, the Nigeria Centre for Disease Control and Prevention (NCDC) warned about the increasing trend of cholera cases, especially as the rainy season intensifies. According to the NCDC, in the first five months of 2024, 1,141 suspected cases of cholera were reported, with 65 confirmed cases and 30 deaths across 30 states.
The ten states, including Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, Nasarawa, and Lagos, account for 90% of the cases. In Lagos, the Ministry of Health confirmed 15 fatalities.
Fortunately, with effective coordination, the disease can be contained quickly. But the real challenge is to work towards its total eradication from Nigeria as it has been done in many other countries. According to World Health Organisation (WHO), no human should die from preventable diseases like cholera.
Health experts say cholera has been on the rise majorly due to extreme poverty and lack of good potable drinking water.
Factors Exacerbating Cholera Outbreaks
Cholera spreads more easily in unclean environments, with untreated water systems and poor sanitation. Sadly, many rural areas in Nigeria rely on streams for drinking water and lack waste disposal systems. In most cases also, the people rely on stagnant water for washing their clothes and other items.
Recurrent cholera outbreaks in Nigeria are exacerbated by several factors, including climate change, poverty, conflict, and underdevelopment.
Climate Change: Global temperature rises and changing precipitation patterns have a direct impact on cholera outbreaks. Warmer temperatures create favorable conditions for Vibrio cholerae to thrive in water bodies. Increased rainfall and flooding can overwhelm water and sanitation infrastructure, leading to contamination of drinking water sources. Conversely, droughts force communities to rely on unsafe water sources, increasing the risk of cholera transmission.
Poverty and Underdevelopment: Many Nigerian communities lack access to clean water and adequate sanitation facilities. Poor hygiene practices, combined with insufficient health infrastructure, contribute to the rapid spread of cholera. Overcrowded living conditions in urban slums and rural areas further exacerbate the problem.
Conflict: Internal conflicts and insurgencies, particularly in the Northeast, have displaced large populations into overcrowded camps with inadequate water and sanitation facilities. These conditions are ripe for cholera outbreaks, as seen in the ongoing humanitarian crisis in Borno and Yobe states.
Addressing Cholera in Nigeria
Combating cholera in Nigeria requires a multifaceted approach that addresses the underlying factors contributing to outbreaks.
Strengthening WASH infrastructure is essential. This includes building and maintaining proper sanitation facilities, ensuring access to clean water, and promoting good hygiene practices. International organizations like UNICEF and WHO are actively supporting these efforts in Nigeria.
Improving disease surveillance and early warning systems is crucial for detecting and responding to cholera outbreaks quickly. The NCDC is working to enhance these systems to provide timely alerts and facilitate prompt responses.
Integrating climate adaptation measures into public health planning is vital. This involves developing infrastructure that can withstand extreme weather events, promoting sustainable water management practices, and educating communities about the risks associated with climate change and cholera.
Community engagement: Beyond what government should do, Nigerians should not neglect the issue of personal hygiene. Communities are part of the process of developing and implementing programmes.
Local culture, practices and beliefs are central to promoting actions such as good hygiene practices including hand washing with soap, safe preparation and storage of food and safe disposal of the faeces of children. Funeral practices for individuals who die from cholera may need to be adapted to prevent infection among attendees.
Writing by Ngozi Otu; editing by Annabel Nwachukwu
