Lagos , Nigeria’s richest state, is also its cholera epicentre

In June, Caleb Ezechimere, a younger medical laboratory scientist, died barely one month into his internship on the Army Hospital, Lagos.

“He had bought some tiger nut drinks from a vendor, and everybody who purchased from the identical vendor ended up within the hospital, however he didn’t make it,” his sister-in-law, Jaachi Nwagbara, a medical physician, recalled how Mr Ezechimere died from cholera.

“Until now, it’s nonetheless an awesome loss. The whole lot reminds us of him. It was a preventable demise, and that’s essentially the most painful form of demise. Preventable deaths from infectious ailments like cholera are unacceptable within the twenty first century.”

As of 29 September, Lagos, Nigeria’s richest state, had recorded 134 deaths from 4,667 cholera instances. The state has the very best share of instances in Nigeria because the outbreak started in June. Being a water-borne illness, the latest outbreak has been linked to contaminated water sources, significantly unregistered tiger nut drinks, and insufficient water provide, particularly in Lagos Island, the illness’s epicentre.

Lagos changing into Nigeria’s cholera hotspot raises a important query: What drives the surge? This evaluation examines cholera information through the years and the persistent problems with insufficient water provide and contamination.

Lagos: Topping Nigeria’s cholera chart

States like Zamfara, Katsina, Bauchi, Cross River, and Bayelsa had been the cholera hotspots in Nigeria. Nevertheless, within the present outbreak, Lagos accounted for 43 per cent of the ten,837 suspected instances recorded in 35 states and the Federal Capital Territory (FCT) as of 29 September. Three native authorities areas (LGAs), Lagos Island, Eti Osa, and Lagos Mainland, recorded essentially the most instances within the state.

PREMIUM TIMES’ assessment of weekly epidemiological and scenario experiences of cholera from 2015 to 2024 by the Nigeria Centre for Illness Management and Prevention (NCDC) exhibits that Nigeria skilled the worst cholera epidemic in 2021, with 111,062 suspected instances and three,604 reported in 33 states and FCT.

The case fatality charge (CFR), which suggests the proportion of people that died from the illness amongst all people identified, was 3.2 per cent.

In that yr, Lagos ranked eleventh with 2,551 instances and 12 deaths, whereas northern states like Bauchi (19,558 instances, 320 deaths), Jigawa ( 15,141 instances, 517 deaths), Kano (12,116 instances, 368 deaths), Zamfara (11,931 instances, 244 deaths), and Katsina (9,20 9 instances and 238 deaths) topped the chart.

In 2018, when a complete of 51,675 instances and 1,136 deaths had been recorded nationwide, no instances had been reported in Lagos State. States like Adamawa, Zamfara, Katsina, Bauchi, and Borno topped the chart. 4,221 suspected instances and 107 deaths had been recorded in 20 states in 2017.

Out of the 23,763 instances and 592 deaths recorded in 2022 from 32 states and the FCT, Lagos State ranked 18th with 47 instances and one demise.

Nevertheless, NCDC information for 2023 doesn’t have Lagos on the checklist of 31 states affected, as Nigeria recorded 3,683 suspected instances and 128 deaths.

From January to December 2016, Nigeria recorded 782 and 32 deaths in 14 states, in contrast with 5,330 instances and 186 deaths throughout 18 states and FCT throughout the identical interval in 2015. Bauchi, Kano, Jigawa, and Zamfara had been states with the very best instances in each years.

Nigeria reported 4,108 cholera instances and 71 fatalities in 2019, adopted by 1,858 instances and 75 deaths in 2020.

Insufficient water provide

With an estimated inhabitants of over 24 million, Lagos faces important challenges in offering potable water for its residents. Regardless of the efforts of the Lagos Water Company and the allocation of N16 billion between 2019 and 2023, insufficient water provide stays a urgent concern.

Whereas some residents have resorted to costly options, reminiscent of drilling boreholes with out correct water therapy plans, others depend upon distributors, often called “mairuwa,” who promote water in jerrycans.

Other than the monetary burden, this exposes residents to the danger of cholera and different ailments, reminiscent of dysentery and typhoid.

In June, Nkoyo David, a 31-year-old who relocated from Gbagada to Bariga, suffered extreme diarrhoea and vomiting after ingesting borehole water as a result of she was sceptical about consuming sachet water.

“I believed I used to be detoxifying. I didn’t know there was a cholera outbreak,” Ms David recalled. “It took me seven days to get well, and I used to be fortunate. Some folks weren’t that lucky.”

Ms David’s expertise highlights the results of consuming water from unreliable sources. Residents of Adeniji Adele, Onola, and Tapa areas of Lagos Island who spoke with PREMIUM TIMES expressed frustration over the water provide.

“I’ve been working right here for over 10 years, but there isn’t any public water provide. I purchase water day by day from distributors, which isn’t clear,” mentioned Abiola Lawal, a dealer at Onola.

Rasheed Egbafolorun, a landlord in Onola, additionally mentioned: “We don’t have a public water provide; everybody has to drill their borehole. Individuals patronising distributors are additionally susceptible to cholera as a result of most distributors don’t wash their jerrycans.”

Poor waste administration and open defecation practices compound the scenario. On the Adeniji Adele Canal, folks might be seen urinating straight into the waterway, and enterprise homeowners close by confirmed that some people even eliminate their wastes within the canal throughout rainfall.

Contamination sources

The cholera outbreak in Lagos additional raises issues concerning the metropolis’s water high quality and sanitation infrastructure. Consultants level to varied contamination sources that contribute to the unfold of the illness.

The contamination sources embrace floodwater and poor drainage, septic tank leakage, poor waste administration, overflow from canals, insufficient wastewater therapy, open defecation, and lack of sanitation services.

In accordance with Mekwunye Kidochukwu, a WASH (Water, Sanitation, and Hygiene) knowledgeable, counting on particular person boreholes exposes residents to contaminated groundwater, particularly throughout floods.

Mr Kidochukwu, a hydrogeologist, environmental scientist and sustainable growth guide, mentioned contamination spreads quickly by means of soakaways, streams, gutters, and boreholes, making a poisonous combine.

“Main issues with the cholera outbreak and different water-borne ailments are linked to poor planning, waste administration, and the inadequacy of the federal government in offering potable water to the folks.

“Particular person boreholes will not be the perfect resolution to water provide. It contributes a lot to groundwater contamination. Flooding impacts the boreholes, goes into the soakaway, mixes with the stream, gutter, and borehole, and all the pieces goes collectively.

“Till the federal government addresses water provide and waste administration, we’re not going wherever; we may have extra instances of water-borne ailments, and the instances will improve,” he mentioned.

Lagos, Nigeria’s financial hub and richest state, faces extreme flooding, significantly in the course of the wet season (April-October). Throughout this era, Nigeria experiences a surge in cholera outbreaks yearly.

The Lagos State Chairman of the Nigerian Medical Affiliation (NMA), Babajide Saheed, mentioned the floods are exacerbated by poor drainage programs and landfilling of the lagoon, which impacts boreholes and results in contaminated water.

“Greater than 50 per cent of Lagosians depend upon boreholes. In some areas, they open the septic tank and permit it to stream into the drainage system, which might go wherever.

“What they name pure water is pricey in Lagos, so folks simply search for something to drink. The meals distributors additionally contribute to it with unhygienic practices,” he mentioned.

Inhabitants development

Mr Kidochukwu mentioned inhabitants development has considerably contributed to cholera outbreaks in Lagos. The big inhabitants places immense stress on the state’s small landmass, resulting in insufficient settlement patterns and elevated inhabitants density.

“Properties designed for one household now home three, tripling waste era, and poor septic tanks can’t deal with the load. Some residents join their soakaways to gutters, which discharge waste into close by water our bodies,” he mentioned.

Lagos leads in cholera instances, whereas Kano, formally essentially the most populous state, ranks nineteenth with 809 instances and 46 deaths (as of 29 September).

Suggestions

Mr Kidochukwu urged the federal government to prioritise water provide, enhance waste administration and implement efficient water therapy programs.

The NMA chairman, Mr Saheed, mentioned the federal government needs to be proactive with an infection prevention and management measures.

“Lagos needs to be proactive. The primary is training and enlightenment as they used to do; the second is drainage system cleansing. The third one is that they need to assessment buildings and the way they influence the drainage system’s free entry,” he mentioned.

In accordance with the Director Common of the Nationwide Institute for Coverage and Strategic Research (NIPSS), Ayo Omotayo, in a presentation on the 2024 Lagos Bodily Planning Summit, clear and protected water and complete sanitation companies needs to be a part of methods for contemporary infrastructure growth in Lagos State.

The Lagos State Authorities acknowledges the issue and says it’s working to resolve it. In June, the state authorities activated the Public Well being Emergency Operations Centre (PHEOC) in response to the cholera outbreak.

The Commissioner for Well being, Akin Abayomi, additionally introduced the One Well being Technique, which he mentioned recognises the interconnectedness of human, animal, and environmental well being.

In accordance with Mr Abayomi, PHEOC’s actions would come with implementing the One Well being method by means of related ministries, departments, and businesses of the federal government.

Nevertheless, the cholera outbreak additionally highlights the necessity for improved epidemic preparedness and an infection prevention and management (IPC) measures within the state.

NCDC recommends entry to protected ingesting water, correct sanitation, and hygiene practices to stop cholera. Strengthening illness surveillance and enhancing IPC measures, as instructed by consultants like Mr Saheed and Ms Nwagbara, can also be essential to stopping future outbreaks.