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Cholera outbreak looms in Lagos communities, as residents use canal, lagoon as toilet

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As cholera outbreak claims over 325 lives across the country, health experts are warning that Lagos – Nigeria’s commercial city – may soon see a sudden rise in the number of cholera cases in some of its communities due to poor sanitation and hygiene practice. ANGELA ONWUZOO reports

The Nigeria Centre for Disease Control said that between January 2021 and June 27, a total of 14,343 suspected cases of cholera were reported from 15 states and the Federal Capital Territory.

The acute diarrhoeal infection, NCDC said, has also killed 325 people.

The agency equally revealed that 27.6 per cent of victims across the country are those in the five to 14 years age bracket.

The affected states, NCDC said, are Benue, Delta, Zamfara, Gombe, Bayelsa, Kogi, Sokoto, Bauchi, Kano, Kaduna, Plateau, Kebbi, Cross-River, Nasarawa, Niger and the FCT.

However, PUNCH HealthWise gathered that since the NCDC released its report about two weeks ago, more deaths have been recorded from cholera in the listed states and the FCT.

The FCT Minister of State, Dr.RamatuTijjaniAliyu, had on Thursday announced that the death toll from cholera had reached 60 in Abuja.

The minister also said suspected cases of cholera had risen from 604 to 698 within 72 hours.

Also, the Enugu State Ministry of Health recently confirmed that there is a cholera outbreak in New Artisan Market, Enugu, which resulted in the death of seven people in the market, with 19 persons identified with the symptoms of loose stool and vomiting.

According to the NCDC and the Lagos State Ministry of Health, Lagos State has not officially recorded any cholera case so far.

Health experts are, however, warning that Lagos may not escape the cholera outbreak already ravaging many states in the country, noting that poor sanitation and blocked drainage channels that have become a common sight, making the state prone to an outbreak.

Our correspondent’s visit to some communities in Lagos revealed that there are still many areas in the city without toilet facilities and access to potable water.

Not aware of cholera outbreak in Lagos –Government

Speaking in an interview with PUNCH HealthWise, Chairman of Lagos State Primary Healthcare Board, Prof. Akin Osibogun said that he won’t be surprised if there are reported cases of cholera in the state.

Prof. Osibogun who is a former Chief Medical Director, Lagos University Teaching Hospital, Idi-Araba, however, added that he is not aware of any confirmed case.

WHO on cholera outbreak

According to the World Health Organisation, cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae.

This bacterium, the United Nations health agency said, is usually found in water or food sources contaminated by faeces from a person infected with cholera.

WHO notes that cholera is most likely to be found and spread in places with inadequate water treatment, poor sanitation, and inadequate hygiene.

It warns that cholera can kill within hours if left untreated.

Lagos communities without toilet facilities

A visit by our correspondent to Ezeagu community, Ajegunle, Lagos, located in the Ajeromi-Ifelodun Local Government Area of the state, revealed that many residents of the area do not have access to clean water and toilet facilities.

Borehole located in a dirty and flooded environment in Ilaje, Lagos
Borehole located in a dirty and flooded environment in Ilaje, Lagos

Our correspondent also found that the Ezeagu community environment is a breeding ground for cholera and other hygiene-related infections. The area is surrounded by a canal covered with overgrown grasses and refuse.

Worst still, heaps of refuse occupied good portions of the environment, with the few available gutters in the area blocked with refuse.

PUNCH HealthWise further observed that most of the bathrooms in the area are located on top of a heap of refuse and close to the stinking canal that contains human and animal faeces.

Some of the residents of the area who spoke with PUNCH Healthwise, however, claimed there are no suspected cases of cholera in the area.

No building in Ezeagu community has toilet facilities- Residents

A 45-year-old resident and father of three, Mr.FataiLamide told PUNCH HealthWise that no building in the community has toilet facilities.

The Oyo State-born mechanic said, “We don’t have toilet in this area, including our compound. This canal that you see serves as toilet to all of us living in this area. We defecate inside nylon and throw it inside the canal.

“For people that don’t want to use nylon, they have a special bucket that they use after which they pour it inside the canal too.

A toilet located on a heap of refuse and flooded area in Ilaje, Lagos.
A toilet located on a heap of refuse and flooded area in Ilaje, Lagos.

“Children use a potty or defecate by the side of the refuse.”

Lamide, however, acknowledged that their action comes with lots of health consequences, especially during the rainy season.

“I have not heard of anyone with cholera in this area but what I know is that children in this community are always down with diarrhoea, while adults are always experiencing malaria and typhoid. It is usually worse during the rainy season.

“Now, when it rains, the canal overflows and its contents enter into houses. You will see faeces and waste floating in the room. It is not a good sight to behold or a nice experience at all. As the rains are here again, we are all worried.

“We’re begging the government to come to our rescue by clearing the refuse and dredging the canal”, he said.

Another resident of the area and a hairdresser, Mrs.Arike Salami told our correspondent that the odour oozing out of the canal is killing.

The mother of four, and an indigene of Kwara State, said, “Apart from lack of toilet facilities, we do not have access to potable water supply. We don’t have drainage channels and the few available gutters are shallow and blocked with refuse.

“We have been begging the government to help us, all to no avail. As I speak with you, I have malaria and my children are always sick because of the dirty and unhygienic environment.”

At Tolu Medical Centre, a major private health facility in the area, a General Practitioner with the hospital, Dr. Ola Oluwatobi told our correspondent that an outbreak of cholera in the area is just a matter of time, citing an unhygienic environment.

Oluwatobi said, “We have not recorded any case yet but now that the rains are here, the possibilities are high. This environment is very dirty and poor sanitation is synonymous with poor health. Last year, we had a lot of cases.

“Currently, we have those coming down with gastroenteritis. We also have cases of diarrhoea both in adults and children. Malaria and typhoid are too rampant. Until the environment is kept clean, we will continue to have these health issues.”

A health official at Ifelodun Primary Healthcare Centre who preferred anonymity told our correspondent during a visit to the PHC that they were yet to see any case of cholera.

Medical Director of Olamide Convalescent Home, another private health facility in the area, DaudaOmisere, also told our correspondent that he was yet to see a case of cholera this year in his facility.

We defecate inside nylon and throw it into the lagoon -Ilaje residents

At the Ilaje community in Bariga Local Council Development Area, our correspondent observed during a visit to the area that gutters were blocked with refuse.

Some of the residents who spoke with PUNCH HealthWise told our correspondent that no case of cholera had been reported in the area but decried government neglect.

In most of the houses in the area as of the time of the visit, residents were seen bailing water from their rooms from Friday’s flooding, occasioned by the heavy rainfall.

Residents of Egu, our correspondent gathered, have no access to toilet facilities. The borehole available to them is also located in a flooded area.

Speaking with our correspondent, one of the residents, Mrs. Rebecca Odonu said the regular flooding in the area and lack of toilet facilities remains a major challenge.

“We don’t have toilet facilities in this place. People defecate inside nylon and throw it inside the lagoon that is very close to us here.

“For those who do not want to use nylon, they use their canoe to go to the lagoon and defecate. The only makeshift toilet available here is located in a flooded area and also surrounded by refuse. Nobody can use it.

“And now that the rainy season is here, the lagoon is overflowing and bringing out a lot of refuse, including faeces back to us because the whole place is flooded.

“The government should please help us”, the expectant mother said.

Another resident, Mrs.ChinyereOkeke said the environment is always in a pitiable state, adding that things get worse during the rainy season.

“I have not seen or heard about any cholera outbreak here this year. It may still occur because the environment is very dirty. And we don’t have gutters in this area,” the businesswoman said.

Health officials at Ashogbon Primary Healthcare Centre and CMS Primary Healthcare Centre in the area, however, told our correspondent during the visit that they had not recorded cholera cases this year.

Flooding makes outbreaks inevitable

Osibogun, who is a Professor of Public Health, expressed concern over a possible cholera outbreak in Lagos state.

The public health physician stated, “It will not surprise me if we have reported cases.

“In general, flooding is one of the promoters of gastrointestinal disease outbreaks because it pollutes the drinking water sources and carries the bacteria that cause diarrhoeal diseases. It is a problem.”

On the state’s preparedness to tackle a possible cholera outbreak, he said the state has a vaccine for cholera.

“If there is a real outbreak, we mobilise. There are different ways that we conduct the vaccination”, he added.

Prof. Osibogun also noted that Lagos State is ahead of many states in the country in terms of health infrastructure.

The physician said, “To prevent diarrhoeal and gastrointestinal diseases, you need efforts that are beyond the health sector. We need a multi-sectoral approach.

“We need municipal water supply and that is not under the health sector. You need the drains to flow. But this flooding thing, I think is global now, and is a function of climate change. The state government is finding a solution to it.”

When contacted, the Lagos State Epidemiologist, Dr. Ismail Abdul-Salam told PUNCH HealthWise that there is no cholera outbreak in the state.

Abdul-Salam explained, “If you have two or three diagnoses done in the whole of the state, that does not mean we have an outbreak.

“Even if they are confirmed, it is still not a case of an outbreak. That is not the way to report epidemiological cases. It is when you get to a particular threshold that you can start talking about an outbreak.

“As an epidemiologist, what we are concerned about is when you have a trend that is beyond the expected occurrence.”

Abdul-Salam assured that the state is prepared and ready to manage an outbreak.

We have poor sanitation in Lagos –Experts

A general health practitioner in the state, Dr. Jimmy Arigbabuwo, told our correspondent that although he had not heard of any cholera outbreak in the state, the way and manner people dispose of their waste in open gutters and practice open defecation make the commercial city vulnerable to disease outbreak.

Arigbabuwo who is the National President, Healthcare Providers Association of Nigeria, said, “Cholera has its own pathognomonic features – specific symptoms and signs.

“We are still watching and observing. We have to confirm and get our figures right before we can say there is an outbreak in the state.

“You don’t just see diarrhoeal and vomiting cases and conclude that it is cholera. But I have not seen a single case in the state, likewise my members.”

Also, an expert with the Infectious Diseases Unit at LUTH, Dr.OluwafemiAkinpeloye, said his department was yet to see any case of cholera this year.

“If there is an outbreak, the hospitals that receive the patients will usually send some to us”, he added.

Akinpeloye, however, said, “But now that there is an outbreak in some states, Lagos State may be affected because the state is congested and highly populated.

“Again, the sources of water supply in the state are not completely potable and when people don’t have good hygiene, there is usually an outbreak.”

Also speaking, a public health practitioner, Dr.DumebiOwa, said the government should do the needful to avert a possible outbreak.

The physician, who was a former President, Medical Women Association of Nigeria, Lagos State branch, said, “With this global warming and volume of water increasing and Lagos being a state below sea level, certainly, there will be a problem.

“Now that the rains are here and with the kind of flooding we experienced on Friday if the government fails to do the needful, it is inevitable that the state will witness an outbreak of cholera.

“Apart from a cholera outbreak, we will also be having cases of diarrhoea and gastroenteritis.”

Continuing, Owa said, “Lagos is losing its beauty and there is poor sanitation in the state. And when you have poor sanitation, you are inviting diseases.

“The gutters and the drainage channels are blocked. Let us unblock them.

“I feel bad that Nigeria is still grappling with cholera that is preventable because the government fails to do the needful.”

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