Nigeria faces one of its worst cholera outbreaks in years

LAGOS, Nigeria — Nigeria is seeing one of its worst cholera outbreaks in years, with more than 2,300 people dead from suspected cases as Africa’s most populous country struggles to deal with multiple disease outbreaks.

This year’s cholera outbreak, with a higher case fatality rate than the previous four years, has been worsened by what many consider to be a bigger priority for state governments: the COVID-19 pandemic. Nigeria faces a resurgence of cases driven by the Delta variant, and under 1% of its population has been fully vaccinated.

As of Sept. 5, 69,925 suspected cholera cases were recorded in 25 of Nigeria’s 36 states and in the capital city of Abuja, according to the Nigeria Center for Disease Control.

Children 5 to 14 years old have been the age group that’s most affected.

The overall fatality rate is 3.3% — more than double that of COVID′s 1.3% fatality rate in Nigeria.

At least 2,323 people have died from suspected cholera this year. But there are concerns that might be an undercount given that many affected communities are in hard-to-reach areas.

States in Nigeria’s north, where flooding and poor sanitation increase the risk of transmission, have been 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 has access to safely managed drinking water supplies, according to government data. According to the government’s estimates, open defecation is still practiced by at least 30% of residents in 14 states

Nigeria also continues to see regular outbreaks of yellow fever, Lassa fever, measles and other infectious diseases.

“We must remain conscious that these multiple outbreaks can further strain our health system,” outgoing Nigeria CDC director-general Chikwe Ihekweazu said.

But he says the experience from those health crises has helped Nigeria prepare for the worst and has “paid off significantly during COVID-19 pandemic.”

That hasn’t contained cholera, though. In some Nigerian states, authorities have said the coronavirus has taken center stage as the most pressing health concern.

In Kogi State, which has Nigeria’s second-highest cholera case fatality rate at 24.5%, top health official Saka Haruna said the rate is high because of the difficulty in accessing care in hard-to-reach places.

Even in the capital, finding care has been challenging.

Ese Umukoro said she had a “very difficult” experience when her brother Samson had cholera and was rejected at three hospitals before being admitted at the fourth. She asked the government to “try their best to at least give us good water to avoid that kind of sickness.”

Sokoto State has Nigeria’s fourth-highest count of suspected cholera cases. Ali Inname, its health commissioner, said 22 of its 23 “Local Government Areas” have been hit by the outbreak.

“What is driving the infections is lack of good sanitary conditions in our villages and open defecation, aggravated by heavy rainfall,” Inname said.

It’s a common problem. Government data from a study supported by UNICEF found that just 21% of the nation has access to safely managed sanitation services.

Michael Oludare, an Oyo-based water scientist, said it is “very important” for authorities to provide basic water and sanitation. He said the poor, women, children and displaced people are among “those that will have problems when it comes to cholera.”

Nigeria still is grappling with the challenge of inadequate vaccines and trained health workers to cover areas where the cholera outbreak has hit.