Open defecation worsens cholera outbreak
By Ebele Orakpo
Cholera is one of the diseases we are currently looking into. We have gone into the homes of the relatives of four people who died of cholera to find out the practices that caused such a high number of cases which is currently (September 23, 2019) 770 suspected cases in Adamawa, mainly Yola North, parts of Yola South and Girei and there was one case in Song but the person had travelled from Yola to Song so it was actually an imported case.
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At the moment, diagnoses by culture is 580 positive cases which is very high and there are obviously more cases because the intervention by the Ministry of Health and supporting partners such as WHO, UNICEF, ICRC, IRC etc., had come after the outbreak so there were actually cases that had not been recorded. It usually happens in Mubi but Yola, being a capital city, has caused the number of cases to increase exponentially because of the mobility within the city.
As I said, it is usually in Mubi but this time around, it has been very active in Yola, particularly Yola North.
The main problem is that due to open defecation and lack of wash water, sanitation is a big issue.They lack basic toilets, so they don’t put the human excreta in the right place or even if they collect the excreta in a bucket, they just dump it in areas where people are preparing and eating food and where children play. It has really been a nightmare and it’s embarrassing in a way because most of the populace is actually right here in Yola North which is the main local government that is affected. Usually when the outbreaks occur, particularly in Mubi, there is quick mobilisation and it’s a smaller area. It increases during the rainy season and towards the end of the rainy season, it tapers off but in this case, it is still increasing so that’s a battle. My team had gone out into the homes and interviewed the family members of those who had passed away
The main problem that is recurrent is access to healthcare so even if a hospital is right at the doorstep, not having the money to get to the hospital is an issue.
Luckily there is a cholera treatment centre so when people start to have the symptoms, it is time for them to go there and also it’s free. But sometimes, getting the transport fare to come is an issue also so the teams have been going into the homes so there has been a lot of awareness. Also, one of our students volunteered over the summer, going into homes and creating awareness on open defecation and proper water hygiene.
Fear of chorination Some people don’t want to use the chlorination tablets; they say it’s something to stop their fertility. So there has been sensitization on using chlorination and also teaching them basic hygiene. But the main thing that has not been addressed is building toilets and also if they are using pit toilets, making sure evacuation is done before it is full so the Ministries of Health and Water Resources are working with the homes proactively, to evacuate the excreta.
Why can’t government come up with a legislation, making it mandatory for every house to have a toilet?
Yes, but at the moment, people build homes without toilets. Even when you are travelling and need to use the toilet, there is none, it’s not healthy. The facilities have to be in place.
Onchocerciasis or River blindness is another study we are doing currently. It’s really interesting because although there has been interventions with Ivermectin but there hasn’t been anything proactive in seeing the effects particularly on the Internally Displaced Persons, IDPs, in Mubi. Interestingly, I realised it actually affects women’s menstrual cycle and fertility. It is amongst the group of what is called Neglected Tropical Diseases so there has not really been a lot of investigations and that’s the new area we are looking into.
Health in conflict zones
We studied reproductive, maternal, child/neonatal health and nutrition in three states in conflict – Yobe, Borno and Adamawa, using Kwara as baseline state because it basically has not been in a state of conflict.
Major health indicators
We looked at the major health indicators – maternal mortality, infant mortality, neonatal mortality, nutritional status such as wasting, stunting, mid-upper circumference, the percentage of women that attend antenatal clinic in terms of reducing maternal mortality and other health indicators such as malaria. We looked at it state by state and then compared the three states in relation to Kwara. We also looked at it within the local government areas. Adamawa is the main state bordering Borno which has been hard hit. So we looked at Michika, Madagali, Mubi etc.
The heads of primary healthcare agencies, particularly Dr Bello, former executive chairman of Primary Healthcare Agency for Adamawa State, pulled in the executive chairmen for Yobe and Borno and we had full cooperation at the local government level. Yobe is far behind in terms of healthcare delivery, particularly for health outcomes.
The infrastructure is not as robust. Even in Borno, with all the conflicts, they have proactive interventions, they are doing very well. Adamawa has recovered very well, particularly in reference to its collaboration with Atiku Center in development projects. It has been working with the Food and Agricultural Organisation, giving out seeds to the farmers and working with women and AUN itself; so basically, there has been a good recovery in Adamawa but Yobe is far behind.
This was a 10-country study with 10 different countries in state of conflict. The countries are Colombia, Iran, Iraq, Pakistan, Afghanistan, and within Africa – DRC, Mali, Somalia Nigeria and Sudan. We met about two years ago in Dubai and set up our parameters and then went back to our respective countries, looking at health in conflict zones.
High lead/manganese content
This is one of the areas covered in the study. We looked at the water in a dumpsite, analysed it, did the microbial activities as well as the metal content. The lead content was high, above the permissible level which will affect children’s learning ability and then some manganese which affects the kidney.
Another thing is the microbes in an area where fruits and vegetables are grown right by the dump site. Usually, on the edge of the dumpsite, they clear the rubbish away and plant. The soil is rich but the microbial activity is very high; we found parasitic worms, protozoan parasites and pathogenic bacteria. In fact, that area is one of the areas where the cholera outbreak had occurred and also along the river bank, you have a lot of transient communities. In another study, we will find out how these communities are affected by cholera and onchocerciasis, the facilities they have and access to healthcare. People move in and out and there is no real way of tracking them and they are sometimes the reservoir of the infections and the spread of the diseases and they are sometimes overlooked particularly in terms of vaccinations.
The research in polio during the insurgency at the end of 2017, Nigeria was almost declared polio-free, (free of transmission, not the actual disease, that means ongoing active infections) but during the insurgency, that changed, it was really sad.
A lot of the agencies involved in polio eradication were so demoralised. There are only three countries in the world with active transmission of polio – Afghanistan, Nigeria and Pakistan.
Nigeria was supposed to come off the list. The Ministry of Health was going from door to door, vaccinating proactively, but again, Yobe, that is where one of the polio cases occurred in an IDP camp.