How to Fight Cholera

Emmanuel sang sonorously in church the previous day but by 5 pm the next day, his mother made a frantic call for prayers on his behalf. He had lost consciousness after vomiting intermittently and visiting the toilet three to four times. The apprehensive mother, despite her belief in the efficacy of prayers, rushed him to a nearby hospital and he was saved from untimely death.

Emmanuel had suffered from cholera. Recently Nigerian health authorities warned of a possible cholera epidemic and confirmed the existence of the pandemic in 12 of the country’s 36 states, leading to reported deaths of over 800 people.

Health authorities are of the opinion that the disease could spread further because of heavy rains, poor sanitation and lack of access to clean water. But the country is not prepared to deal with a cholera epidemic, says Dr. Lateef Olepina, an infectious diseases consultant at the Lagos University Teaching Hospital (LUTH).

“There is scattered infrastructure in some teaching hospitals that can handle it. However, most of the infections seem to be happening in rural areas and it takes quite a long time to transport victims to hospitals. Besides, some of the victims do not have the resources to treat themselves in major hospitals, where they can get meaningful help,” said Olepina in an interview with reporters. He said some hospitals have reported an increase in the number of patients, but the national hospitals have not yet collected data on the number of people infected.

Surprisingly, on the average, some Nigerians know enough of the root cause of the disease. When asked about her knowledge of the disease, Miss Nike Bukola, a graduate in accountancy, said it is mainly a disease associated with poor hygiene. “If you want to avoid cholera, be hygiene-conscious”, she said. But since knowledge of the disease is appreciably sufficient, Raphel Ihedigbo, a staff of Score Card Ventures Limited, thinks government should provide people with clean water.

“This disease is caused by dirty water and contaminated food. Government should ensure that pure water is pure indeed and that money voted for provision of clean water is used for such and not embezzled. When you squander money meant for clean water provision and you make the people vulnerable to death as a result of cholera, you have become a murderer”, he said.

He condemned the inability of government to provide clean water, and advised Nigerians not to vote for politicians who have not included provision of potable water in the manifesto.

It is quite disturbing that at 50, Nigerian governments are still struggling to contain a cholera epidemic that has killed many Nigerians in two months as reported in the papers. About 13,000 people have been affected, according to the nation’s health ministry, and poorly funded clinics are jammed with patients.

The 2010 epidemic, reportedly the worst in nearly two decades, has also spread to neighbouring countries, killing nearly 400 people in Cameroon and more than 40 in Chad. Cases have also been reported in Niger.

However, Dr. Henry Akpan of the Federal Ministry of Health described the situation as “under control” in Nigeria. “We’re not having new deaths anymore,” he told Al Jazeera recently. “We’re still having cases but the cases have been contained and we have a lot of centres where people get treatment.”

Cholera recurs regularly in Nigeria – 13,000 cases were reported in 2009 – but in 2010 the disease has been spreading much more quickly, said Claire Lise Chaignat, coordinator of the World Health Organisation’s cholera response group. Despite its prevalence, only a few private clinics and six teaching hospitals in northern cities – Zaria, Jos, Kano, Maiduguri, Sokoto, and Ilorin – have the microscopes that can diagnose cholera. Laboratory technicians identify cholera by examining stool samples under a microscope. It is easily preventable with clean water and proper sanitation. But in Nigeria, almost half the country’s 150 million people lack access to just that, according to the World Health Organisation.

Isa Sadiq Abubakar, a consultant epidemiologist at Aminu Kano Teaching Hospital, Kano, noted that northern Nigeria had good cholera surveillance systems but they were not being used properly. Nigeria uses an Integrated Disease Surveillance and Response (IDSR) system, set up a decade ago to more effectively combat communicable diseases – such as yellow fever, meningitis and cholera – by training and equipping health staff to improve disease detection and response.

“But staff training has been slow to deliver, and most health centres still lack the necessary equipment to accurately diagnose cholera,” Abubakar noted. Despite the high prevalence of cholera, many health workers still do not think of cholera when patients come with diarrhoea and dehydration, as they “don’t have a high index of cholera suspicion”, he said.

Medical experts agree that if people in the Nigeria’s rural areas have access to clean water, proper sanitation and primary healthcare, water borne diseases like cholera would be curtailed. Cholera is an infection of the small intestine that causes a large amount of watery diarrhoea. V. cholerae; Vibrio Cholera is caused by the bacterium, Vibrio cholerae and the disease is spread by flies and water contaminated by the germs.

Speaking on the pandemic, the Director of the Nigeria Institute for Medical Research (NIMR), Prof. Innocent Ujah, said that preliminary studies carried out by the institute in two of the affected states in Nigeria, Borno and Bauchi, found that the strains were virulent in nature and were resistant to some antibiotics, especially tetracycline.

“Unfortunately, we discovered that 10 per cent of the people in Borno State were resistant to the drug and this is a big problem for a drug like tetracycline. 10 per cent is a large number and this means that these people must change to another drug. But in an emergency situation, you may not have the luxury of going to look for another drug,” he said.

Just as they have information, many Nigerians also know one thing or the other about how to fight the disease. According to many of them who spoke with reporters, the best way to deal with cholera naturally would be to have lots of water. “It is very important to keep the body hydrated, so make sure that the intake of water is high”, they suggest.

Onions are also beneficial in curing cholera. Victims are often advised to take about 30 grams of onions and 7-10 black peppers. Cholera can also be treated by having a mix of water, sugar and salt. Take about one litre of boiled water and add four tea spoon full of sugar and ½ tea spoon full of salt. In-take this as many times as possible.

“Lemon juice and orange juice also act favourably in treating cholera. Consume at least one glass of fresh juice on a daily basis”, one suggested.

“Prepare a glass of fresh juice from cucumber leaves and mix it with a glass of coconut water. Consumption of this juice, in 30 to 60 ml doses, will relieve you off the disease. Another effective treatment would be to consume buttermilk. Add roasted cumin seeds powder and rock salt to it, for better results”, said another.

“Boil a few basil leaves in a glass of water. Strain the decoction, cool it down and have it once in a day.”

Yet another said, “Water purification is very important. All drinking water from wells or boreholes should be boiled to kill the bacteria and other germs. This should become a routine in every home. Boiling of water should be done until millions of bubbles, ferociously come to the surface of the water. Antibiotics shorten the course of the disease and reduce the severity of the symptoms; however, oral re-hydration therapy remains the principal treatment.”

Tetracycline is typically used as the primary antibiotic, although some strains of V. cholerae have shown resistance. Other antibiotics that have been proven effective against V. cholerae include cotrimoxazole, erythromycin, doxycycline, chloramphenicol, and furazolidone. Fluoroquinolones such as norfloxacin also may be used, but resistance has been reported.

Historically, the first cholera occurred between 1816 and 1826. Previously restricted, the pandemic began in Bengal, and then spread across India by 1820. 10,000 British troops and countless Indians died during this pandemic.

A vaccine for cholera is available in some countries, but prophylactic usage is not currently recommended for routine use by the Centres for Disease Control and Prevention (CDC). [16] During recent years, substantial progress has been made in developing new oral vaccines against cholera.

Two oral cholera vaccines, which have been evaluated with volunteers from industrialized countries and in regions with endemic cholera, are commercially available in several countries.

The appearance of V. cholerae O139 has influenced efforts in order to develop an effective and practical cholera vaccine since none of the currently available vaccines is effective against this strain. [13] The newer vaccine (brand name: Dukoral), an orally administered inactivated whole cell vaccine, appears to provide somewhat better immunity and have fewer adverse effects than the previously available vaccine.

This safe and effective vaccine is available for use by individuals and health personnel. Work is under way to investigate the role of mass vaccination. All said and done, local wisdom counts in the fight against the deadly disease. Just as information is critical, knowing how to fight the disease is also vital.