09 August 2021 | Abuja – Cholera in Nigeria: Urgent call to strengthen Water, Sanitation and Hygiene (WaSH)
The Nigeria Centre for Disease Control (NCDC) is leading the national response to an outbreak of cholera across states in Nigeria. This has been exacerbated by poor access to clean water, open defecation, poor sanitation, and hygiene.
Between the 1st of January and 1st of August 2021, 31,425 suspected cases of cholera, 311 confirmed cases and 816 deaths have been reported from 22 states and FCT. The affected states are Benue, Delta, Zamfara, Gombe, Bayelsa, Kogi, Sokoto, Bauchi, Kano, Kaduna, Plateau, Kebbi, Cross River, Niger, Nasarawa, Jigawa, Yobe, Kwara, Enugu, Adamawa, Katsina, Borno and FCT.
Following an increase in the number of cholera cases, the National Cholera Emergency Operations Centre (EOC) was activated on the 22nd of June 2021. The EOC which is hosted at NCDC, includes representation from the Federal Ministries of Environment and Water Resources, National Primary Health Care Development Agency (NPHCDA), World Health Organization (WHO) and partners.
The National Cholera EOC has led the deployment of Rapid Response Teams to support the most affected states -– Benue, Kano, Kaduna, Zamfara, Bauchi and Plateau States. Additionally, NCDC and its partners have provided states with commodities for case management and laboratory diagnosis, materials for risk communications, response guidelines among other support. A reactive oral cholera vaccine (OCV) campaign led by NPHCDA was conducted in Bauchi LGA, Bauchi State from 24th to 28th July 2021.
But none of these medical interventions will solve the underlying issues leading to cholera outbreaks. Cholera is a waterborne disease, and the risk of transmission is higher when there is poor sanitation and disruption of clean water supply. The wrong disposal of refuse and practices such as open defecation endanger the safety of water used for drinking and personal use. These lead to the spread of water-borne diseases such as cholera. Without proper water, sanitation, and hygiene (WaSH), Nigeria remains at risk of cholera cases and deaths.
The long-term solution for cholera control lies in access to safe drinking water, maintenance of proper sanitation and 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 good hygiene practices in communities.
Additionally, we 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 people who are infected 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 sudden onset of profuse watery diarrhoea, which can lead to sudden death as a result 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 symptom at all. The time between an infection and 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), with the goal to replace lost fluids and electrolytes. The ORS solution is available as 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 percent. Severely dehydrated people may also need intravenous fluids.
People most at risk are:
• People of all ages living in places with unsafe water
• People living in areas with poor sanitation
• People who consume potentially contaminated food or fruits without proper cooking and washing with safe water
• People who do not perform hand hygiene when appropriate
• Relatives who care for sick person with cholera at home
• Health care workers including:
• Doctors, nurses and other health workers providing 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 safe container before drinking
• Practice good 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. Avoid raw food such as fruits and vegetables, except you have washed them in safe water or peeled them yourself.
• 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 health care facility immediately and take all sick persons with the signs or symptoms above to a health care 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.
About the NCDC
The Nigeria Centre for Disease Control is the country’s national public health institute, with the mandate to lead the preparedness, detection and response to infectious disease outbreaks and public health emergencies. The Bill for an Act to establish NCDC was signed into law in November 2018, by President Muhammadu Buhari. The mission for the NCDC (2017-2021) is ‘To protect the health of Nigerians through evidence-based prevention, integrated disease surveillance and response activities, using a One Health approach, guided by research and led by a skilled workforce’.
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Dr. Chikwe Ihekweazu
DG, Nigeria Centre for Disease Control