On May 1, the first case of acute watery diarrhea (AWD)—a telltale symptom of cholera—was reported in the local government area (LGA) of Maiduguri Metropolitan Council, in Borno State in northeastern Nigeria. Since then, cholera has spread into 18 LGAs and has caused nearly 15,000 cases and 115 deaths.
Cholera is a bacterial disease that’s most often contracted by drinking contaminated water, though it can also be spread from person to person through poor hygiene. Contact tracing at the beginning of this outbreak indicated that people were getting sick from the municipal water supply. The water system’s 40-year-old infrastructure has leaky and broken pipes, which pass through areas of open sewage, dump sites and other dirty environments—providing ample opportunity for contamination.
International Medical Corps, which has decades of experience handling disease outbreaks in a variety of settings, is in Borno State working to end the outbreak and mitigate its effects. Though our staff are not treating patients directly, we are supporting case management at the local hospital in Damboa. We have donated essential supplies, including medical commodities, 9,000 copies of educational materials and more than 450 cholera kits containing medications and testing supplies. We are also supporting the government’s surveillance efforts by sending volunteers into communities to actively search for cases while providing education to households on the prevention and symptoms of cholera.
At the same time, our Water, Sanitation and Hygiene (WASH) team is putting measures in place to keep people from getting cholera in the first place. We are going from house to house providing chlorine to treat water, and water cans to store it. We’re setting up clean water points at cholera hot spots. We also have teams doing hygiene promotion within communities, demonstrating how proper handwashing can prevent the person-to-person spread of cholera.
Preparing for the Next Outbreak
Cholera outbreaks occur regularly in Nigeria, taking place every two years on average. As we’ve responded to this most recent outbreak our teams have identified gaps in public health management that need to be closed to prevent future cholera outbreaks. One area of potential improvement includes the training of rapid response teams (RRTs). Late last year, we trained RRTs at national NGOs in Cameroon and Nigeria—three of which are now participating in this outbreak response. Encouraged by this success, the Nigeria country team is looking at ways to train more RRTs that can spring into action immediately once cholera cases begin to mount and an outbreak looks inevitable.
Prepositioning supplies well in advance of an outbreak can also go a long way toward saving lives.
“Considering that cholera outbreaks happen almost every two years, we should be prepositioning stock so that we have the ability to set up a cholera treatment center in multiple places,” says Nigeria Health Manager Dr. Emmanuel Anyanwu. “That way, once there’s an outbreak, we will be able to start using the stock right away for a more rapid response—we can just activate and proceed.”