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By Jude Ezeh Ogechukwu

Healthy people are those who live in healthy homes on a healthy diet in an environment equally fit for birth, growth work, healing, and dying... Healthy people need no bureaucratic interference to mate, give birth, share the human condition and die. -Ivan Illich

It has been three months since cholera started ravaging many states sporadically, and the Federal Ministry of Health and the NCDC had kept on paying incommensurate attention to the situation. Coronavirus keeps getting all the attention, while hundreds of thousands suffer and thousands die of vomiting and purging from the cryptic Vibro Cholerae in the deep recesses of our countrysides.

Perhaps, FG needs to be reminded of the epidemiology, prevalence, pathophysiology, and mortality rates of cholera in Nigeria, otherwise, there is no justification on why they have not raised a distress alarm and waved a red flag about the epidemic.

Cholera is an acute bacterial infection of the intestine caused by ingestion of food or water containing Vibrio cholerae, serogroups O1 or O139. Symptoms include acute watery diarrhea and vomiting which can result in severe dehydration or water loss. When left untreated, death can occur rapidly – sometimes within hours.

Cholera is transmitted through contaminated food or drinking water, as well as by person-to-person contact and through the faecal-oral route. Sanitary conditions in the environment play an important role since the V. cholerae bacterium survives and multiplies outside the human body and can spread rapidly where living conditions are crowded and water sources unprotected and where there is no safe disposal of faeces.

For the past decade, cholera has been largely confined to developing countries in the tropics and subtropics, especially in parts of Africa, Asia, and South and Central America where clean water and sanitation measures are lacking. The global incidence of cholera has been on a steady increase in recent years. In 2009, a total of 45 countries reported 221,226 cases to the WHO, an increase by 16% compared with 190,130 cases in 2008.

Uncontrolled water sources such as wells, lakes, ponds, streams, and rivers pose great danger. Fruits and vegetables washed with contaminated water can be a source of infection. After preparation, cooked food may be contaminated through contaminated hands and/or flies.

Anyone can become sick with cholera. However, a few factors as stated above may make you more likely to catch cholera and more likely to have a more severe case.

An untreated cholera patient may produce several gallons of diarrhoeal fluid a day. Due to this rapid loss of fluids, severe dehydration and shock can occur in these individuals. Shock occurs due to the collapse of the circulatory system and if the fluid is not replaced, the patient may die within several hours. Now the question is how do we improve the living conditions of the people to prevent this epidemic? From the crowded ghettos of Lagos, the uninhabitable slums of Abuja to the swampy grasslands of Taraba, up to the dusty suburbs of Kano and the waterlogged savannah of Bayelsa, etc. It has been a tale of polluted environments as well as the prevailing unguarded water sources. How will these susceptible conditions be improved upon?

Nigeria has a culture of poor sewage treatment. Our sense of hygiene and sanitation still ranks poorly among developing nations. And open defecation remains a common sight both in cities and in the hinterlands. Any wonder why cholera is endemic here?

Between January and July this year, a total of 22,130 Nigerians of varied genders, ages and occupation have contracted cholera in about 18 states and Abuja, recording about 526 deaths, according NCDC. And the danger is that these figures keep widening. More worrisome is the fact that of these numbers, 6, 196 representing 28% of the whole, were children aged 5-14 years; and the north accounts for over 70% of the total cases.

Cholera has case fatality rate of 2.5% with a little less than 93% recovery rate, while Covid has 1.1% with over 97% recovery rate. Nigeria's health authorities should refocus its attention from the 'exaggerated' media hype given to Covid and see within its borders a mortal epidemic secretly decimating her population. People need to be reoriented on the menace of Cholera and how to prevent and treat it. Rural dwellers need to be acquainted with rudiment knowledge of some home remedies and few domestic first aid protocols to arrest it while they go to healthcare providers. NCDC should go beyond highlighting the deadly infection on its weekly/monthly reports, and attach actionable attention similar to the one they did/do Covid. While the President jetted off to UK for the dual causes of choice medical checkups and participation in international education summit, a chunk of his subjects back home is dying helplessly of a preventable epidemic. Such discomfiture can only be seen in Africa. Are the people to result to self-help? Yes, but they still need to be guided, because this is a public health crisis.

And so, it is expected that our TV screens, radio waves and print/social media timelines no more than our GSM phones should be inundated with health awareness jingles on the best preventive, diagnostic and treatment measures against this merciless enemy within our hoods.

This media campaign should be sponsored by the relevant public health authorities in the land. But we are not seeing any. Different cadres of Community Health Extension Workers ought to have been deployed on emergency salvage assignment to the 774 local government areas across the country to sensitize and save the situation. Each of the 36 states’ commissioners of health should be in constant liaison with the local government supervisory councilors for health in their respective states and the federal Minister of Health, for integral alleviation of the burden of this disease. If we can apply the sincerity and conscious efforts deployed in 2014 to eradicate Ebola virus disease, cholera will soon a thing of the past.

May daylight spare us!

...Eze Jude .O is a Medical Laboratory Scientist, a Columnist and Public Affairs Analyst. NNL.

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