As the schools resume from the mid-term break and the Sallah holiday on Wednesday, there are fears the pupils may be at risk of contracting cholera, a food and water-borne disease caused by the ingestion of the vibrio cholera bacteria.
Public health experts noted that the disease, which broke across the country last week, could spread fast in schools if preventive measures were not in place to prevent it.
Against this background, the Chief of UNICEF, Lagos Field Office, Celine Lafoucrier, has called for extensive measures to protect school children, noting that concerted efforts must be made to prevent disruption in the academic calendar over the spread of the disease.
The Nigeria Centre for Disease Control and Prevention had recently warned the public of the increasing trend of cholera cases as the rainy season intensifies.
The NCDC stated that from January 1 to June 11, 2024, over 1,141 suspected and over 65 confirmed cases of cholera, resulting in over 30 deaths, had been reported from 96 LGAs in 30 states.
The centre noted that the 10 states contributing 90 per cent to the burden of the current cholera outbreak include Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, Nasarawa, and Lagos states.
Explaining the need to prevent the disease outbreak in schools, Lafoucrier noted that children faced substantial health risks, particularly those under five, who are prone to severe dehydration and higher mortality rates.
Lafoucrier, according to the News Agency of Nigeria, in a statement on Monday, stated, “Similarly, post-recovery issues in children can include malnutrition, stunted growth, and weakened immune systems, increasing susceptibility to other diseases. These outbreaks underscore the urgent need for improved access to clean water and sanitation in many areas.
“Despite the state government’s efforts to provide water to its population, the current outbreak demonstrates the need for an urgent government focus on ensuring the water provided to the population is clean and risk-free.’’
The UNICEF official said educational disruption is another critical consequence of cholera outbreaks, as an illness and the need to care for sick family members lead to school closures and reduced attendance, hindering children’s learning and development.
UNICEF advises govt
“Addressing the challenges of cholera outbreaks requires a deliberate focus of state policies to provide high-standard water and sanitation facilities, as well as strengthened healthcare systems capable of responding to the demand in times of outbreaks, and state-led educational campaigns on cholera prevention to protect children and the population at large,” she emphasised.
A professor of public health at the University of Ilorin and Consultant Public Health Physician at the University of Ilorin Teaching Hospital, Kwara State, Prof Kayode Osagbemi, said the infection could spread in schools if measures were not taken to prevent it.
Osagbemi said, “There will be gatherings of people in schools, and the moment they (schoolchildren) are sharing items, it can spread. If any of them is infected, it can spread to others, rather than if they are in their homes.
“Generally, the spread in schools is not a major concern, except maybe in boarding houses. In boarding houses, one person infected may infect others through contamination of the water and their food.”
The public health expert noted that the best way to prevent the spread is with the provision of clean food, water, and hand washing among the students.
“So, for now, the students should go with their water bottles, rather than sharing water. Then, there should be hand-washing facilities in the schools, and even in their toilets.
“When they get home, they should wash their hands and take their baths before eating; and within schools, there should be no sharing of things for now, since there is an outbreak,” he explained.
Cholera spreads fast
A Consultant Paediatrician at the Federal Teaching Hospital, Katsina State, Dr Abdurrazzaq Alege, also stated that cholera could spread fast among students due to the rainy season, holidays, and poor hygiene.
“For the fact that children are coming back to school, they will be more exposed to this, especially those of them that are not taking potable water.
“Most of us use municipal water, and even the so-called sachet water that we take, we cannot guarantee the hygiene around it, even the fruits and other food items that we consume. So, coming back to school is a great risk this season,’’ he warned.
The Team Leader/Chief Executive at Q-Impact Medicare, Dr Lekan Adelakun, said the infection could spread fast in schools, calling for preventive measures to curb it.
He said, “Cholera is a very infectious disease, and there has to be a lot of campaigns among the parents, and school owners. The schools too have to create awareness because of the food served in schools, and the vendors who prepare the food.
“Food hygiene is very important. There should be adequate supervision in the preparation and conservation of their food, and make sure they don’t drink contaminated water. If you are taking fruits, you want to be sure they are washed well.’’
An Osogbo-based medical practitioner, Dr Olurotimi Fagbule, said the reopening of schools after the Sallah holiday was a risk factor that must be addressed.
He called for stringent measures to be adopted to prevent the outbreak of the disease in schools as pupils resume.
Fagbule, who said prevention of cholera outbreak was cheaper than any measures to contain it, told parents to monitor closely whatever their wards would eat at home.
“Pupils returning to school after the holidays can be a risk factor. Osun State doesn’t have any suspected case yet but the situation must not be taken for granted,’’ he counselled.
Also, a former Chairman of the Association of Private Medical Practitioners of Nigeria, Dr Tunji Akintade, noted that there is a need to put up preventive measures in schools.
Akintade said, “School resumption is an event. In resumption, there are crowds and they will need water and they are going to be using the water and these are the indicators that encourage the spread of this.
“We need to be proactive. We don’t know the houses the children are coming from, but we do know that a lot of houses are represented in schools and if a child brings in vibrio cholera into the school, it can spread to other children.’’
The Lagos State Health Commissioner, Prof Akin Abayomi, said laboratory tests carried out on samples had confirmed that the identified cholera strain was highly aggressive and contagious, with potential for widespread dissemination.
According to him, through community-based case finding and contact tracing, the number of cases has peaked and is now declining.
Giving an update on the outbreak via his Instagram page @profakinabayomi on Monday, the Lagos State health commissioner noted that through community-based case finding and contact tracing, the number of cases had peaked and was declining.
The geographical distribution of suspected cases by local government areas shows that Lagos Island is the epicentre of the outbreak with 106 cases; followed by Kosofe 49; Eti-Osa 38; Lagos mainland 30; Ojo 17; Ikorodu 16; Kosofe 16; Shomolu 11.
Others are Surulere -nine; Apapa -eight; Mushin -eight; Ifako Ijaiye -eight; Mushin -five; Alimosho -four; Ajeromi Ifelodun -four; Oshodi-Isolo -three; Ikeja three; Ibeju Lekki -two; Badagry -two; Amuwo-Odofin -one.
Abayomi, however, disclosed that there were 17 confirmed cases out of 350 suspected cases and 15 deaths so far.
He said, “Three hundred and fifty suspected cases of cholera were reported in 29 wards across multiple LGAs in Lagos State with 17 confirmed cases and 15 fatalities attributed to severe dehydration caused by delayed presentation.
“We are receiving support from the Nigeria Centre for Disease Control and international partners, including the WHO and United Nations Children’s Fund.
“Local non-governmental organisations are actively raising awareness and conducting community-based surveillance efforts.”
He also said the state was intensifying its public health campaigns in light of the Sallah celebrations and the associated transmission risks from gatherings and catering services, to prevent a resurgence.
“Suspected cases are receiving free treatment at our public health facilities, in line with public health response protocols,” he added.
Meanwhile, the Lagos state government has said it will activate the guidelines used during the COVID-19 era in a bid to curb the spread of the disease.
As schools are expected to resume on Wednesday after the two-day Sallah break, the Lagos State Commissioner for Information and Strategy, Gbenga Omotoso, said an emergency response committee that included representatives from the education sector, met on Monday.
Emergency committee meets
In a telephone interview with our correspondent on Monday, Omotoso said, “The Emergency Response Committee is going to meet this (Monday) evening and the education (team) will be joining the meeting.
‘’The focus is that, since students are going to be resuming from Wednesday, all of the general warnings that we have given to people will also be given to students and all the precautionary measures that we took during the COVID (period), we are going to be activating them.”
Emphasising personal responsibilities, the commissioner said, “People need to wash their hands as many times as possible, wash fruits before eating, drink clean water, avoid open defecation, and so on.”
“We don’t have any suspected case not to talk of casualties. And as a matter of fact, we are prepared for any outbreak even though we don’t envisage any because we made a release a couple of days ago to sensitize our people, through print and electronic media.
“We have also activated our rapid response centre for public health, as well as emergency management committee. We have replicated that in all the local government areas too.
“After educating and sanitising our people, so we don’t envisage any, and if for any reason, somebody imports it from Lagos or anywhere, we are prepared for it, even though we don’t pray we would have any case here,” Akintola said.
In Ekiti State, the State Health Commissioner, Dr Oyebanji Filani, said on Monday that personnel of the Ministry of Education were being carried along in the efforts to prevent the spread of cholera in schools.
Filani said, “We are taking all steps, we are not leaving any step behind. We have sent out an advisory which has gone out across to different stakeholder groups.
“We are engaging our colleagues in the Ministry of Education so that we can also capture the different schools and inform them appropriately.’’
“We have been to more than 70 community border wards in different places across the state just to ensure that we can sensitize our residents about the issue and that if should there be any concern, they should let us know as quickly as possible,” he said.
The commissioner also said the state has set up an incident management system.
‘’So, far so good, we are ready and prepared and we hope that we do not have it, but should it come, we should be able to manage it,” Filani assured.
To curtail the cholera outbreak and other deadly diseases, the Sokoto State Government disclosed that it had set up a monitoring team in all the schools and public places, including hospitals.
The state Commissioner for information, Sambo Danchadi, while speaking with our correspondent, said the state government was doing everything humanly possible to avert any outbreak of diseases in the state.
He said the Ahmad Aliyu administration, apart from clearing refuse dumping sites within the town, had also cleared drainages, especially within the metropolis.
The Benue State Commissioner for Health and Human Resources, Dr Yarman Ortese, revealed that the state had an emergency operation that dealt with any eventuality.
He said the emergency operation had been activated to tackle any contaminant anywhere in the state, adding that the state has not recorded an outbreak of cholera.
The Gombe State Epidemiologist, Dr Bile Nuhu, disclosed that the state had constituted a prevention committee.
Nuhu noted that the state had identified 55 hotspots with poor sources of water, making them susceptible to cholera outbreaks.
He said, “The Commissioner for Health Dr Habu Dahiru, has already activated a cholera prevention committee under the chairmanship of Rural Water and Sanitation Agency. As the focal person, the sector lead of Water Sanitation and Hygiene is working to prevent cholera.
“In Gombe, we have 55 hotspots and their sources of water are in four types of well- shallow boreholes, some ponds, and others dig small pits in gullies to get water. These areas are where we used to have cholera in five to six years.”
Nuhu disclosed that by Wednesday, the committee would embark on decontamination of their sources of water, stressing that the exercise would be carried out every two weeks.
On its part, the Delta State government said it had put under control the recent cholera outbreak in the state.
The state Commissioner for Health, Dr Joseph Onojaeme, said currently there was no cholera in the state, adding that the two cases recorded two weeks ago had been put in check.
