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Cholera: Improve nationwide access to WASH, gastroenterologist appeals to govts

A Consultant Gastroenterologist, Dr Mbang Kooffreh-Ada, says adequate access to water, sanitation, and hygiene (WASH) remains the sustainable solution to reducing the transmission of cholera cases and deaths in the country.

Kalaba community
Fetching drinking water from a tap

Kooffreh-Ada, who works at the University of Calabar Teaching Hospital, said this in an interview on Sunday, June 16, 2024, in Lagos.

A gastroenterologist is a medical practitioner who specialises in the diagnosis and treatment of disorders of the gastrointestinal tract and related organs.

According to the World Health Organisation (WHO), cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae.

Cholera can cause severe acute watery diarrhea and the severe forms of the disease can kill within hours if left untreated.

Kooffreh-Ada, however, warned that, “medical interventions alone won’t solve the underlying issues leading to cholera outbreaks”, stressing that cholera is an indicator of inequity and lack of social development.

She stressed the need for the government at all levels to prioritise access to potable water for citizens through the establishment of water boards to supply clean and hygiene pipe borne water to homes.

“We’re in the middle of the rainy season and you have a lot of runoff water from the heavy downpour, which can contaminate water sources, especially in communities where they practice is defecation.

“Many households do not have access to clean pipe borne public water supply from water boards in each of the states where water engineers chlorinate and purify the water.

“Creating a functioning water board in all states would be an avenue to nip this particular problem in the bud,” she said.

The gastroenterologist stressed that open defecation and indiscriminate sewage disposal should be discouraged and laws to punish defaulters put in place to serve as a deterrent to would-be offenders.

She noted that seepage could percolate down and contaminate underground water, thus appealing to borehole engineers to dig deep to prevent contamination of underground water sources.

Kooffreh-Ada noted that fecal-oral transmission was the main driving force behind cholera in most communities, advising the public to boil water to boiling points to kill the pathogens before drinking or cooking with it.

“Some people actually use human waste as manure; so, I always tell my patients that if you are going to prepare meals, especially with vegetables or fruits, make sure you wash them very well under running water.

“If you’re cooking them, you cook to the point where the organism can possibly be killed,” she advised.

The gastroenterologist emphasised that cholera could be easily treated through prompt administration of oral rehydration solution (ORS) or preparing the salt and sugar solution to help the person.

She said that the WHO/UNICEF’s ORS standard sachet should be dissolved in one litre of clean water for children, while adult patients might require up to six litres of ORS to treat moderate dehydration on the first day.

Kooffreh-Ada noted that severely dehydrated patients were required to take the rapid administration of intravenous fluids and appropriate antibiotics under the supervision of healthcare professionals to reduce diarrhea duration and dehydration.

She advised the public to promptly report all cholera cases at nearby health facilities for proper supervision and management to improve patient’s survival.

The gastroenterologist stressed that primary healthcare centres should be adequately equipped, especially with IV infusions, antibiotics and medical personnel to cater for patients with cholera.

She stressed the need for citizens to embrace frequent handwashing, improve hygiene in their homes, and environment to prevent infection with cholera.

The Nigeria Centre for Disease Control (NCDC), on June 12, hinted of increasing cholera cases nationwide, with recorded 30 deaths and 65 confirmed cases of cholera.

NCDC said the cases were reported from 96 local government areas (LGAs) in 30 states between January and June 11, 2024.

The agency disclosed that 10 states contributed 90 per cent to the burden of cholera listing the states to include Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, Nasarawa and Lagos.

The Lagos State Commissioner for Health, Prof. Akin Abayomi, on June 11, alerted residents of the state of cholera outbreak resulting in five fatalities and 60 hospitalisation in four LGAs of the state.

Abayomi disclosed that fatalities recorded were from patients with severe gastroenteritis presented late at health facilities with extreme dehydration.

He called for heightened vigilance and adoption of precautionary measures, disclosing that the state had activated a statewide heightened surveillance and response to check the transmission of the disease.

By Oluwafunke Ishola

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