More than 2,300 people have died from suspected cholera in Nigeria as Africa’s most populous country struggles with one of the worst outbreaks of the disease in years.
This year’s cholera outbreak, with higher mortality than the previous four years, is exacerbated by what many consider to be a major priority for state governments: the COVID-19 pandemic. Nigeria is facing an increase in cases driven by the delta variant, and less than 1% of the population has been fully vaccinated.
At least 69,925 suspected cholera cases were registered on September 5 in 25 of Nigeria’s 36 states and in the capital Abuja, according to the Nigeria Center for Disease Control. Children between the ages of 5 and 14 are the most affected age group and the overall mortality rate for cases is 3.3%, more than twice the death rate of COVID-19 in Nigeria.
At least 2,323 people have died from suspected cholera this year, but there are fears that could be underestimated as many affected communities are in hard-to-reach areas.
Northern Nigeria’s states where floods and poor sanitation increase the risk of transmission are hardest hit. The 19 states in the north account for 98% of the suspected cases.
Cholera is endemic and seasonal in Nigeria, where only 14% of the population of more than 200 million have access to safely managed drinking water supply services, according to government data from 2020, which also shows that at least 30% still use feces in 14 states.
Nigeria also continues to see regular outbreaks of yellow fever, Lassa fever, measles and other infectious diseases.
“We must remain aware that these multiple outbreaks may further affect our health system,” outgoing Nigeria CDC Director General Chikwe Ihekweazu told the Associated Press (AP).
But he and other officials say the experience of these health crises has helped Nigeria prepare for the worst. “Previous investments in diagnostic capabilities, case management, electronic monitoring systems, event-based monitoring, risk communication, logistics management systems and national / subnational workforce development have yielded significant results during the COVID-19 pandemic,” he said.
However, it has not contained cholera, and in some states, authorities have said that COVID-19 has taken center stage.
In the Kogi state, which has Nigeria’s second highest mortality rate in cholera cases, 24.5%, senior health official Saka Haruna told the AP that the frequency is high due to the difficulty of accessing care in hard-to-reach areas.
Even in the capital, it has been difficult to find care. Ese Umukoro said she had a “very difficult” experience when her brother, Samson, had cholera and was denied admission to three hospitals before being admitted to the fourth. She asked the government to “do its best to at least give us good water to avoid that kind of disease.”
Sokoto State has Nigeria’s fourth highest number of suspected cholera cases, and its health commissioner told the Associated Press that 22 of the 23 local government areas have been affected by the outbreak.
“What drives the infection is the lack of good sanitation in our villages and open faeces, exacerbated by heavy rainfall,” says Ali Inname.
This is a common problem. Government data from a study supported by UNICEF found access to safely managed sanitation services in only 21% across the country.
Engineer Michael Oludare, an Oyo-based water scientist, said it was “very important” for the authorities to provide basic water and sanitation. He said the poor, women, children and the internally displaced are among “those who will have problems when it comes to cholera.”
In addition, Nigeria is still struggling with the challenge of insufficient vaccines and skilled labor to cover all local authorities where the cholera outbreak has been recorded.