Lagos is shivering under the outbreak of cholera. A vicious intestinal illness has gripped the state, adding a layer of fear to the already bustling streets. With 24 deaths, 35 confirmed cases and 417 suspected cases across the state as of Friday, July 21, 2024, experts say the outbreak isn’t just a national concern but a local fight for survival, particularly in areas where access to clean water and proper sanitation remains a luxury.

Apart from poor water and sanitation challenges, the plight of citizens leaves much to be desired.

17-year-old Bayo was rushed-in with his frail body racked with chills. His worried mother, Dolapo, wiped his face, a deep fear etched on her face. “Please admit him, don’t reject us. Today is a public holiday, please help, it started yesterday,” Dolapo murmured. “Just stomach cramps at first, but now…” Bayo unfortunately lost his life in one of the private hospitals in the Ago area of Lagos. His case is among the rising number of cholera infections plaguing Lagos.

With limited resources and a densely populated city to contend with, Lagos grapples with controlling the outbreak.

Sadly, water and sanitation remain a challenge in the state. From the end of Makoko to the highbrow areas of Victoria Island in Lagos, potable water remains a challenge despite having water all around the city.

A situation report issued by the state Commissioner for Health, Prof Akin Abayomi, last Friday (EPI Week 25), as of 19th of June, 2024, revealed that the outbreak has swept across the 20 LGAs.

While the highest outbreak occurred in Ajeromi, Kosofe, Epe, Ikorodu, Alimosho and Eti-Osa LGAs, as of 10th of June, 2024, the Commissioner said there was the need to adhere strictly to personal and environmental hygiene to stay safe from infection risk.

However, in what seems like an attack on cholera in countries, the World Health Organisation (WHO) announced a resurgence of cholera worldwide.

WHO said in May 2024, a total of 46,364 new cholera cases were reported from 19 countries, showing 58 per cent increase from the previous month.

It said from January 1, 2024 to May 26, 2024, a total of 194,897 cholera cases and 1,932 deaths were reported from 24 countries across five regions.

WHO said the Eastern Mediterranean region recorded the highest numbers (98,003 cases; seven countries), followed by the African region (92,789 cases; 14 countries), the Americas (2,672 cases; one country), the South-East Asia region (1,328 cases; two countries), and the European region (105 cases; one country).

WHO added that during this period, the African region reported 1,698 deaths; the Eastern Mediterranean region, 256 deaths; the region of the Americas, 13 deaths; the Southeast Asia region, four deaths; and the European region, one death.

The global body’s report comes as Lagos, Nigeria’s most populous city and commercial capital, battles a cholera outbreak.

Blame

However, while the disease continues to sweep across countries and states in Nigeria, experts have continued to blame the Nigerian government for paying lip service to water and sanitation.

Today, most communities across Nigeria cannot boast of adequate safe drinking water. The affordability of bottled water, often used as a safer alternative, is also a challenge for many families.

For instance, in Lagos, sachet water, the presumed alternative to borehole water, is sold, in many areas, for N50 and, in others areas, it goes for N30. Five bags of water are sold for N1,500 and in some areas N2,000.

Bottle water goes for N200 per bottle. Sadly, many Nigerians who have resorted to borehole water can no longer boil before drinking due to the hike in electricity tariff.

Public health experts have warned that without improved water, sanitation and hygiene, cholera will remain endemic in Lagos and Nigeria in particular.

According to the United Nations Children’s Fund (UNICEF) Chief, Lagos Field Office, Celine Lafoucrier, safer water could save 1.4 million child deaths from diarrhoea, 500,000 deaths from malaria, 860,000 child deaths from malnutrition, as well as protect 10 million people from serious illnesses like lymphatic filariasis and trachoma.

She said the current outbreak demonstrates the need for an urgent government focus on ensuring water provided to the population is clean and risk-free.

According to her, good water and sanitation infrastructure play a crucial role in reducing disease outbreaks such as cholera, which causes an estimated 100,000 deaths annually.

Lip service

In an interview with Sunday Vanguard, a public health disease expert, Dr Casmir Ifeanyi, said the country has continued to pay lip service to water, sanitation and hygiene.

“I challenge you to go and dig it up. Of the 30 states already reported to have the outbreak, how many of them have a public potable water supply in place? I can categorically tell you, none. So, we do know that cholera is a disease that thrives where water, sanitation and hygiene are at its low rate,” Ifeanyi stated.

He emphasised the need for improved water, sanitation and hygiene (WASH) practices, including addressing open defecation and ensuring access to clean water which are essential for preventing future outbreaks.

The public health expert warned that the outbreak, particularly severe in developed areas of Lagos, highlights deficiencies in sanitation and water quality.

According to him, schools with proper hygiene facilities and access to clean water could reopen, after mid-term holiday, with heightened public health education on hygiene practices.

However, expressing concerns about densely populated areas with limited access to clean water, Ifeanyi said: “It must be said that the situation that will sustain this outbreak is quite high. I give you an example. I do not know how much a bag of sachet water is sold in Lagos, but, in most of Nigeria, it is now between N400 and N600 and, if you buy that it should be either 20 sachets. I do not know how long it would sustain families and, besides, the source of this sachet water and also bottled water is also questionable because their conformity to water processing is still very unsure.”

Increased Public Health Measures

Ifeanyi, who is also the National President of the Association of Medical Laboratory Scientists of Nigeria (AMLSN), urged Lagos State government to prioritize improved detection and surveillance of cholera and cholera-like illnesses. “This includes contact tracing, increased access to cholera testing kits, and a thermal risk factor analysis specific to Lagos,” he said.

Noting that food safety is another critical area, he stressed that the state government should implement stricter food safety protocols, including lab testing of imported and commercially sold water.

“Public health authorities must beef up to detect cholera and cholera-like illnesses and also to put in place a surveillance system that promotes disease tracking. That is to say, if you have an individual whose case is confirmed, then there’s a need to do contact tracing and to evaluate the contact,” the expert said.

Expressing disappointment in the description of the Lagos cholera as aggressive without the proper name of the type, he pointed out that the government has failed to provide infrastructure and facilities for diagnostic testing and typing whenever there is an outbreak.

According to him, there was a need to identify the biotype of the cholera responsible for the outbreak and not use ominous words like aggressive.

Glimmer of Hope

Ifeanyi said the state government should immediately deploy cholera vaccine particularly for school children, adding that individual vigilance remains paramount.

He advised Lagosians to boil or treat drinking water, avoid raw fruits and vegetables, and practice frequent and thorough handwashing.

Corroborating his views, a public physician, Dr Femi Oyekan, who spoke to Sunday Vanguard, stressed that cholera outbreaks originate and spread within communities, making community-led and participatory approaches essential for sustainable prevention.

According to him, citizens also have a lot of things to do to help combat cholera outbreak by ensuring proper hygiene, keeping their environment clean, avoiding open defecation, and ensuring proper waste and sewage disposal.

“Ultimately, access to clean water and sanitation is critical in preventing outbreaks. Communities must take collective action to ensure clean water access and maintain good hygiene. Identifying and empowering positive role models within the community can encourage the widespread adoption of healthy.