By Sola Ogundipe

To ensure an effective and sustainable response to the cholera outbreak in the country, the Academy of Medicine Specialties of Nigeria, AMSN, has called for swift and decisive action to contain the ongoing outbreak. 

In a statement signed by the President of the Academy Prof Oladapo Ashiru, the Academy acknowledged the recurrent nature of cholera in Nigeria and emphasized the need to nip it in the bud using proven prevention strategies.

The Academy notes that The National Cholera Technical Working Group, led by the Nigeria Centre for Disease Control and Prevention (NCDC) and comprising the Federal Ministries of Environment and Water Resources, the National Primary Health Care Development Agency (NPHCDA), the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), and other partners, has been providing support to the affected states.

“This support includes risk communication, active case search, laboratory diagnosis, case management, provision of response commodities, water sanitation and hygiene (WASH) interventions, and dissemination of cholera awareness jingles in both English and local languages according to the DG of the NCDC.”

Emphasising several key areas for intervention including public awareness, Ashiru, who is also Secretary-General International Federation of Fertility Societies (IFFS), and President African Reproductive Care Society (ARCS),  noted that social mobilization is crucial to raising awareness about the disease, its transmission routes, and essential preventive measures.

Noting that community engagement is key through social mobilization, the statement calls for increased public awareness about the disease, its transmission routes, and essential preventive measures.

It said the long-term goal is to prevent not just cholera but other waterborne diseases, saying this requires ensuring access to clean water, proper hygiene practices, and good sanitation – all aligned with Nigeria’s commitment to the Sustainable Development Goals (SDGs). Healthcare workers were urged to be more aware of cholera symptoms and the importance of early reporting and treatment of cases.

The Academy stresses the importance of active disease surveillance to identify cases quickly, including asymptomatic ones common in cholera outbreaks. Rapid diagnostic tests (RDTs) should be used for quick results, alongside confirmatory PCR testing in labs for strain identification and outbreak characterization.

On vaccination and treatment, AMSN called for targeted vaccination of high-risk populations with the Oral Cholera Vaccine (OCV) as essential for control. Treatment involves oral rehydration solution (ORS), antibiotics, and intravenous fluids.

According to the Academy, the fight against cholera requires effective coordination of manpower and resources across federal, state, and local governments, as well as healthcare agencies. This collaborative approach should be based on evidence to ensure the most effective response.

The Academy acknowledges the social determinants of health, highlighting the need for multi-sectoral action. This includes addressing factors outside the health system contributing to the outbreak and its solutions. Additionally, the statement calls for identifying and overcoming challenges related to properly coordinating resources and organizations across various sectors to effectively manage future outbreaks.

The Academy recommends strengthening existing health agencies like the National Center for Disease Control (NCDC), the National Primary Healthcare Development Agency (NPHCDA), and the Nigerian Institute for Medical Research (NIMR) to lead the fight against cholera instead of relying on ad-hoc committees.

It noted that by implementing these comprehensive recommendations, Nigeria can effectively contain the current cholera outbreak and prevent future occurrences, ensuring the health and well-being of its citizens.

The Academy’s statement serves as a clarion call for immediate and comprehensive action to control the current cholera outbreak and prevent future occurrences in Nigeria. By implementing these essential measures, the nation can safeguard the health and well-being of its citizens.

 “We need a robust focus on research and data collection. This will provide the necessary evidence base to inform future interventions and ensure they are targeted appropriately. Continuous improvement should be a cornerstone of the response strategy. By continually evaluating the effectiveness of existing programmes, we can identify areas for improvement and refine our approach based on real-world data.

“Funds allocated for ambulance services (5 percent) and public health emergencies (1.75 percent) within the Basic Health Care Provision Fund, BHCPF, should be immediately released and directed towards the response effort. This will provide much-needed resources for evidence-based interventions.

“By prioritizing research and development and securing adequate funding, we can ensure a data-driven response that tackles the public health issue effectively and lays the groundwork for future success.

Among others, the Academy called for effective risk communication strategies, based on the epidemiology of cholera should be activated in all LGAs with active involvement of the private sector, CSOs, and communities.

It seeks immediate personal hygiene measures including limiting handshakes and promoting the use of handwashing stations.

The statement said that the Academy was available to partner and will be intermittently providing evidence-based advisories for effective prevention and control of cholera and eliminating it as a public health problem in Nigeria, while scientifically highlighting the state of the outbreak along with its health and economic implications. 

The Academy notes that the current cholera epidemic is a national emergency that has been reported since January 2024 to date nationwide.

“It is anticipated that the epidemic will increase, if not curtailed because of the rainy season which could be accompanied by flooding; leading to contamination of drinking water sources in several communities across the country.

“Cholera is a bacterial infection usually spread through contaminated water and/or food. It is generally caused by the ingestion of the organism Vibrio cholerae in contaminated water and food. Water is usually contaminated by the faeces or unwashed hands of contacts of infected individuals. Contamination of drinking water can occur at the source, during transportation, or during storage at home. Food may be contaminated by soiled hands, either during preparation or while eating.

Cholera is a disease of poverty affecting people with inadequate access to safe water and basic sanitation. The risk of a cholera epidemic is very high when people live in crowded conditions without adequate sanitation. Most people exposed to the cholera bacterium (Vibrio cholerae) don’t become ill and don’t know they’ve been infected or have mild diarrhoea. But because they shed cholera bacteria in their stool for seven to 14 days, they can still infect others through contaminated water, other drinks or food.

Cholera when serious, causes severe diarrhoea and dehydration that can be fatal within hours, if left untreated even in previously healthy people. However, cholera is easily treated if tackled early. Death from severe dehydration can be prevented with a simple and inexpensive oral rehydration solution. Most cases of cholera that cause symptoms cause mild or moderate diarrhoea that’s often hard to tell apart from diarrhoea caused by other problems.  When severe, intravenous fluids are extremely effective in stemming the tide of severe dehydration and hypotension resulting from severe diarrhoea.