Cholera Outbreak in FCT: Appraisal of Efforts to Halt Spread

Following the outbreak of cholera in the nation’s capital in May, the Federal Capital Territory Administration, FCTA, has taken some steps to halt the spread of the disease. Adedayo Akinwale writes on the impact of measures taken to check the disease and also reduce fatalities

Since May, the Federal Capital Territory (FCT) has witnessed a frightening outbreak of Cholera which is currently ravaging the nation’s capital, Abuja.

Though the current outbreak is however not limited to the FCT as states like Plateau, Bauchi, Gombe, Kano, Zamfara, Bayelsa and Kaduna are also facing the scourge. A recent report by the Nigeria Centre for Disease Control (NCDC) revealed that 47,603 suspected cholera cases have been reported in 23 states.

The 23 states where there are suspected cholera cases in 2021 include; Benue, Delta, Zamfara, Gombe, Bayelsa, Kogi, Sokoto, Bauchi, Kano, Kaduna, Plateau, Kebbi, Cross River, Nasarawa, Niger, Jigawa, Yobe, Kwara, Adamawa, Enugu, Katsina, Borno, Taraba and FCT

Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Cholera is an extremely virulent disease that can cause severe acute watery diarrhoea. It takes between 12 hours and five days for a person to show symptoms after ingesting contaminated food or water. It affects both children and adults and can kill within hours if untreated.

In most cases, the outbreak is usually triggered by poor living conditions and lack of access to potable water supply, in over-crowded communities. Since the outbreak started in FCT in May, 1,170 suspected cases have been recorded out of which about six per cent have died, which is about 73 of suspected cases as at August 13.

However, all the six Area Councils in the FCT have recorded cases of Cholera in 26 Wards and 120 communities of the FCT, with Bwari and Abuja Municipal Area Council (AMAC) remaining the most affected area Councils. As of August 13, AMAC has recorded 575 cases, Gwagwalada (346), Bwari (190), Kwali (37), Abaji (12).

Interventions

The acting Director, FCT Public Health Department, Dr. Saddiq Abdulraheem told THISDAY that out of the 39 of the 62 wards of the FCT about 120 communities reported at least suspected cases of cholera, the FCT administration has activated its Emergency Operation Centres of cholera with nine pillars. This includes: Surveillance, risk communication, case management and logistics. He said all these pillars have been active since then and we also constitute about three teams.

The director explained that Cholera as a multi-sectoral disease requires a multi-sectoral approach. Hence, relevant agencies were brought on board such as FCT Water Board, Rural Water Supply Agency (RUWASA), Abuja Environmental Protection Board (AEPB), World Health Organisation (WHO), UNICEF, Area Council Chairmen and religious and traditional rulers.

He said advocacy has been intensified, while the Disease Surveillance Notification Officers at the Area Councils are working in synergy with the Disease Surveillance Notification Officers of FCT.

Abdulraheem said: “The cases of asiatic started in May till date. We have been witnessing it until June when the cases were going up. We did some rapid tests and we confirmed serotypes in the Cholera outbreak – serotype 01 and serotype 0139. So, the one we have so far is serotype 01 and the number has been steadily increasing. However, from that period till 13th of August, we have had up to 1,170 infections or suspected cases out of which about six per cent have died, that’s about 73 of this number.”

The director added that FCT administration has released funds to procure the necessary consumables, adding that all these are being distributed to all the public health facilities, selected comprehensive primary health centres across the six area councils and targeted communities.

Abdulraheem further explained that communities that have already reported cases had been mapped out and they have been categorized according to the disease burden which guides the distribution of these commodities to each respective facility in Area Councils and Wards.

Strategies

He revealed that the FCT administration had set up the risk communication desk, adding that the approach is slightly different from other outbreaks like COVID-19.

Abdulraheem added: “You need the factors to mitigate the outbreak. It is a factor of poor hygiene, poor environmental sanitation, lack of access to potable water and individual attitudinal change especially in communities where they are into open defecation. We also started Identifying the gap in the water side.”

The Director said it was against this background that the Public Health Department had a technical meeting with the Water Board, RUWASA and AEPB. He said the needs of the communities have been categorised.

He noted, “Those that don’t have water at all – meaning they get their water source from either Rivers, streams or Mai Ruwa (water vendor). Those that have a borehole but not functional, those that have a borehole that is functional but not adequate. We have taken water samples and done water analysis to also assess the quality of water in these respective areas. Both the microbiological aspect of the chemical analysis of this water is being analysed on a daily basis.

“As we speak, if you compare to COVID-19 deaths to what we are getting from cholera, it tends to be higher in number. However, it is a disease that could be mitigated within a shortest possible time.”

Abdulraheem stated that as part of the strategies adopted by the Public Health Department to contain the outbreak, a number of tests which vary from Rapid Diagnosis Testing to cottura susceptibility have been carried out.

He pointed out that the Rapid Diagnosis Testing (RDT) was conducted to ascertain the disease itself and to know the serotype, while the Cottura Susceptibility was done at the national reference laboratory under Nigeria Centre for Disease Control (NCDC) to understand the real situation or the type of the germs involved.

“Are we only dealing with cholera? If we are dealing with cholera, what is the sensitivity pattern of the drug? So, these are some of the things we are looking at. And these numbers are increasing on a daily basis because all our Diseases and Surveillance Officers from Area Councils will go and take these samples to the reference laboratory for us to have a clearer picture on issues around the choice of drug and to understand if we are dealing with Vibrio cholerae or other additional bacteria, that is one. The result will also guide us for a long time to take a decision; to also bring on board intervention using vaccination, because you cannot base your vaccination of the public on the RDT test, that is currently where we are,” Abdulraheem explained.

Interventions Outcome

The director said the interventions made by the FCT administration have started yielding results. He said people have started cultivating awareness and reporting cases of Cholera. He noted that at the beginning of the outbreak, people were not sure where to go due to lack of understanding and awareness of the disease. He revealed further that the number of cases have stagnated over the last three weeks.

According to him, “Awareness has increased both in the media. Also we have been going with Outside Broadcast Vans to the targeted communities, announcing and sensitising and having meetings with the key stakeholders. That has yielded positive results. Individuals now move promptly to the nearest facility and get assistance. Once the intervention is prompt, the mortality goes down and the cases are mitigated.”

Abdulraheem listed some of the communities where the sensitisation and advocacy had been carried out to include; Gwagwa, Jiwa, Kabusa, Karu, Bwari, Dutse, Kubwa, Gwagwalada, Dobi. In Kuje, Jigiri, Robochi, Kwali, Kinlankwa, Kudunwa, Yangoji, Abaji, Kurudi, Gawo, among others.

A nurse at the Primary Healthcare Centre in Dutse who preferred anonymity said the number of cholera cases have reduced. Dutse was one of the communities in FCT where cases of Cholera have been recorded. Though the nurse only restricted her answer to when she was on duty.

According to her, “I can only talk about when am on shift but from last week till now we have not recorded any case. From last week Sunday (August 15) till Saturday (August 21) for children. For adults, there was a case of a woman we recorded on Saturday (August 14) who has stooped for five times. She was treated and was okay the following day. Unlike before, the number of cases have really reduced.”

Also, the immediate past President of FCT National Association of Resident Doctors (NARD), Asokoro District Hospital, Dr. Roland Aigbovo, said since the outbreak started in May, high prevalence of death and infection rates were recorded in both AMAC and Bwari Area Councils. He added that though, there were deaths from other Area Councils but the percentage was not as high as in those two. He further said that it was based on this that the FCT administration increased awareness on personal hygiene, adding that people are now cautious of their environment. Aigbovo noted that people now go to the nearest hospitals whenever a cholera case occurs. Aigbovo however said it is appalling that the seat of power still has open dedication over the places.

He said there was need to tackle the root cause of the cholera .

He added: “Go to Mabushi roundabout, the place is a mess. If you are driving by you just have to wind up your glass because of the scent. Drive along that Kubwa express, you see people in the gutters and tunnels defecating and urinating there with such disregard to the extant laws. I strongly believe that laws should be implemented about this issue of open dedication.”

In tackling the root causes of cholera, the physician said there should be provision of portable water so that people do not have to make use of contaminated water.

“There should be provision of toilet facilities. Yes! Abuja is a busy place, but even at that you can see a lot of human activities, there should be proper planning. Where you have increased human activities, there should be one or two public facilities like a toilet which people can make use of.”

This story has been supported by Nigeria Health Watch through the Solutions Journalism Network, a nonprofit organization dedicated to rigorous and compelling reporting about responses to socialproblems, solutionsjournalism.org”