13 October 2022 | Abuja – STOP Cholera: Strengthening Water, Sanitation and Hygiene (WaSH) in Nigeria
The Nigeria Centre for Disease Control and Prevention (NCDC) is leading the national response to an ongoing outbreak of cholera in affected states in Nigeria. A total of 2187 confirmed cases of cholera have been reported from 31 states and 233 deaths recorded from the 1st of January to the 25th of September 2022.
Following a recent increase in the number of cholera cases, the multi-sectoral National Cholera Technical Working Group (TWG) in collaboration with partners has been supporting affected states in risk communication, active case search, case management, and water, sanitation, and hygiene (WASH) interventions. The NCDC-led multisectoral TWG includes representation from the Federal Ministries of Environment and Water Resources, the National Primary Health Care Development Agency (NPHCDA), the World Health Organization (WHO), United Nations Children’s Fund (UNICEF) and other partners.
The outbreak has been exacerbated by limited access to clean water and sanitation facilities, open defecation, and poor hygiene practices. In response, NCDC and its partners have supported the affected states with commodities for case management and laboratory diagnosis, materials for risk communications, and response guidelines among other things. However, medical interventions alone are not sufficient to address the root causes -water, sanitation, and hygiene (WaSH) - of cholera outbreaks.
Cholera is a waterborne disease, and the risk of transmission is higher in areas that lack adequate sanitation facilities and/or a regular supply of clean water. Unsafe practices such as improper disposal of refuse and open defecation endanger the safety of water used for drinking and personal use. These practices lead to the spread of water-borne diseases such as cholera. Without proper WaSH, Nigeria will continue to be at risk of cholera outbreaks along with the associated suffering and deaths.
The long-term solution for cholera control lies in access to safe drinking water, maintenance of proper sanitation (especially the discontinuation of open defecation) and the practice of hygiene. We continue to advocate to State Governments to prioritise action for solutions that ensure access to and use of safe water, basic sanitation, and proper hygiene practices in communities.
We also urge Nigerians to keep their environments clean, only drink or use water that is boiled and stored safely, ensure food is cooked and stored in a clean and safe environment, avoid open defecation, and wash their hands regularly with soap and running water.
Cholera is preventable and treatable; however, it can be deadly when infected people do not access care immediately. Nigerians are advised to visit a health facility immediately if they have sudden onset of profuse watery diarrhoea, nausea, vomiting, and weakness.
As the NCDC continues to work with partners to lead the health-sector response to cholera outbreaks, we call for an urgent improvement in access to clean water, proper sanitation, and hygiene.
Cholera is a water-borne disease characterised by the sudden onset of profuse watery diarrhoea, which can lead to sudden death because of the rapid onset of dehydration, if not managed on time. Other symptoms include nausea, vomiting, and weakness. Most infected people may only show mild symptoms or have no symptoms at all. The time between infection and the appearance of symptoms of the disease is 2 hours to 5 days. The disease is easily treatable if detected early. Most infected people can be treated successfully through prompt administration of oral rehydration solution (ORS), to replace lost fluids and electrolytes. The ORS solution is a powder that can be reconstituted in boiled or bottled water. Without rehydration, approximately half the people with cholera die. With treatment, the number of fatalities drops to less than 1 per cent. Severely dehydrated people may also need intravenous fluids.
People most at risk are:
People of all ages living in places with limited access to clean water.
People living in areas with poor sanitation.
People who consume potentially contaminated food or fruits without cooking properly or washing them with clean water.
People who do not perform hand hygiene at appropriate times.
Relatives who care for sick people with cholera at home.
Healthcare workers including doctors, nurses, and other health workers provide direct patient care in the absence of standard precautions.
To reduce the risk of cholera, the NCDC offers the following advice:
Ensure that water is boiled and stored in a clean and covered container before consuming.
Practice hand personal hygiene by washing your hands frequently with soap under clean running water. Use alcohol-based hand sanitiser if soap and clean water are not available.
Ensure that food is well cooked before consumption. Only consume raw food such as fruits and vegetables, after washing thoroughly with safe water.
Avoid open defecation, indiscriminate refuse dumping and ensure proper disposal of waste and frequent clearing of sewage.
If you experience sudden watery diarrhoea, please do not self-medicate, visit a healthcare facility immediately and take all sick persons with the signs or symptoms above to a healthcare facility immediately.
Healthcare workers are advised to practice standard precautions at all times i.e., wearing gloves while handling patients or providing care to an ill patient/relative.
The Nigeria Centre for Disease Control and Prevention (NCDC) is the country’s national public health institute, with the mandate to lead the preparedness, detection, and response to public health emergencies. The Bill for an Act to establish NCDC was signed into law in November 2018, by President Muhammadu Buhari. The mission of the NCDC is ‘To protect the health of Nigerians through evidence-based prevention, integrated disease surveillance and response, using a One Health approach, guided by research and led by a skilled workforce.
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Dr Ifedayo Adetifa
Nigeria Centre for Disease Control and Prevention.