Definition

Cholera is an acute diarhoea disease caused by the bacteria Vibro Cholerae. It is a potentially life-threatening, primarily waterborne disease that continues to cause death in children in endemic areas such as Nigeria.

It is often described as a classic water-borne disease because it is commonly associated with contaminated water, though transmission can also occur through contaminated food.

The bacteria Vibro Cholerae causes intestinal infection and severe watery stool that results in the loss of large volumes of this stool, leading to severe and rapidly progressing dehydration and shock. Without adequate and appropriate rehydration treatment, severe cholera kills about half of the affected individuals.

Historical Review and Epidemiology

Once common throughout the world, the infection is now largely confined to developing countries in the tropics and subtropics areas. It is endemic in Africa, parts of Asia, the Middle East, and South and Central America. In its endemic areas, outbreaks usually occur when war or civil unrest disrupts public sanitation services, examples of this include the Boko Haram crisis in the North Eastern part of Nigeria. An annual estimation of 3 – 5 million people is affected each year, causing over 100,000 deaths globally.

Also, in endemic areas, the highest attack rates are in children aged 2 – 4 years.  However, the illness is generally first seen in adult men due to exposure to contaminated food and water.

Cholera in Nigeria

In Nigeria, cholera is an endemic and seasonal disease, occurring annually mostly during the rainy season and more often in areas with poor sanitation, such as open defecation.

The first series of cholera outbreaks were reported between 1970 and 1990. Major epidemics also occurred in 1992, 1995 – 1996, and 1997. The Federal Ministry of Health reported 37, 289 cases and 1,434 deaths between January and October 2010, while a total of 22,797 cases of cholera with 728 deaths and a case-fatality rate of 3.2% were recorded in 2011. Outbreaks were also recorded in 2018 with the Nigeria Centre for Disease Control (NCDC) reporting 42,466 suspected cases including 830 deaths with a case fatality rate of 1.95% from 20 out of 36 States from the beginning to the end of October 2018.

The 2010 outbreak of cholera and the number of deaths recorded in some regions in Nigeria brought to the forefront, the vulnerability of our poor communities and children, to this disease. The outbreak was largely caused by the heavy rainfall recorded that year, and thus affected States like Jigawa, Bauchi, Gombe, Yobe, Borno, Adamawa, Taraba, FCT, Cross River, Kaduna, Osun, and Rivers. Even though the epidemic was recorded in these areas, it showed that the country was at huge risk before the 2018 outbreak.

The Northern States, most especially the North–Eastern region are now known to be endemic for cholera disease due to the civil unrest and socio-cultural conflicts which has left so many families displaced across the region.

In 2018, various reports were made regarding the situation of things in most IDP (Internally Displaced Persons) camps that harbored thousands of individuals who had fled for safety due to the Boko Haram attacks. It was reported that Overcrowded displacement camps coupled with a lack of basic sanitation facilities and hygiene will cause another cholera outbreak in northeast Nigeria if measures are not taken to prevent it. For instance, 466 people were sharing one latrine at a particular displacement camp in Borno State, Nigeria. As a result, people chose to openly defecate, exacerbating an already vulnerable situation and increasing the likelihood of the spread of disease.

So far, a total of 2,523 suspected cases including 78 deaths (CFR 3.1%) have been reported from 31 states in the year 2022. Of all the suspected cases since the beginning of the year, the age group below 5 years old was the most affected for both male and female children (50% male; 50% female). Six (6) states – Taraba (639 cases), Cross River (591), Katsina (141 cases), Kano (155 cases), Ondo (117 cases), and Benue (101 cases) all account for 69% of all cumulative cases in Nigeria.

The National multi-sectoral Cholera Working Group continues to monitor response rates across states in the country.