In this interview with MOTUNRAYO JOEL, the National Chairman, Association of Public Health Physicians of Nigeria, Dr. Tanimola Akande, talks about cholera and the current outbreak affecting some parts of the country

What are the symptoms of cholera?

Cholera is a form of gastroenteritis caused by Vibrio Cholera bacteria. The patients with cholera present with profuse passing of watery faeces and vomiting which may be accompanied with fever. Such patients lose body fluids rapidly and become dehydrated and therefore have body weakness. The first case may not be recognised as cholera since some other gastroenteritis can present that way but as soon as many more cases are recorded within a short time, a high suspicion of cholera should be made.

What leads to cholera transmission?

Cholera is transmitted through the faeco-oral route. That means the bacteria are shed in the patient’s faeces and it gets into another person by mouth from water or food that is contaminated with the bacteria.

Is Nigeria susceptible to a cholera epidemic and why?

Nigeria is highly susceptible to cholera epidemics and there have been several ones in the past in the country. Currently there are epidemics of cholera in various parts of the country. This is because of poor basic hygiene and sanitation. Only about three-quarter of households living in urban areas have access to improved source of drinking water. The situation is worse in rural areas where less than half of the households have access to improved source of drinking water. In some of these communities people have their drinking water from polluted streams or rivers. In the same vein only about 40 per cent of the urban population have non-shared improved toilet or latrines and it is as low as about 30 per cent in rural areas. Surveys show that about three in 10 households in Nigeria use an improved toilet facility.

A situation where people still pass stool in the open makes the population vulnerable to epidemics of cholera. Such faeces are often washed by rain into streams and rivers that serve as drinking water for some people. In addition a high proportion visit toilets and will not wash their hands, this practice unfortunately is not uncommon among food handlers.

More states in Nigeria have recorded cholera outbreak, why is this happening?

The reason for the spread of cases of cholera in more states is not farfetched in view of the sanitary and water supply situation described earlier. Government and households are not doing enough to improve water supply and provide improved sanitary facilities. Whilst some people may have improved sanitary facilities in their homes, this may not be the case in their places of work particularly those in the informal sector. In most cities and towns public toilet facilities are not either not available or grossly inadequate. Some brands of packaged water (often called pure water) are also sources of cholera spread because of the poor sanitary condition of the factories where they were produced.

Why hasn’t Nigeria been able to curb cholera outbreak?

Nigeria has not been able to curb this epidemic because we have not been able provide all citizens with safe drinking water and improved sanitary facilities both in the homes and public places. People are probably also not well informed about cholera and the preventive measures they can put in place to curb it. Imagine that some people managed to build houses with about four – six rooms (the face-me-I-face-you type) but they find it difficult to go the extra mile to provide a toilet or latrine. It is a shame to find houses in cities and towns without toilets. You want to therefore ask what those in charge of approving plans or inspecting houses are doing if this simple measure cannot be enforced. It was not until recently when my area of residence got crowded with houses, that the dwellers stopped passing faeces all around the open spaces. Now we are luckier they have to move a little further. The houseflies that hover around such faeces are not discriminatory; they fly anywhere and land on anyone’s exposed food.

Does boiling of water prevent cholera?

The way cholera spreads is through contaminated food and water but particularly water. Boiling water, of course, is quite helpful in preventing cholera. Some other measures of disinfecting water through urban water supply chlorination and domestic water chlorination are also helpful.

What is the recommended treatment in patients who have developed cholera?

Patients who have developed cholera need to be quickly rehydrated since they would have lost some fluid. The rehydration (replacement of the lost fluid) could be though oral salt and sugar solution or the packaged oral rehydration salt (ORS). In severe cases the rehydration will be though intravenous fluid (drips). In addition the patients are given antibiotics to take care of the cholera bacteria.

Could a cholera outbreak occur in developed countries?

Cholera outbreak is not impossible in developed countries, but will be quite unlikely. Some people can have cholera and may not show symptoms. If such people travel to such developed countries and practised poor sanitary hygiene, they may infect a few people. This situation, even though it affects a few people, will still be considered an outbreak. It is unlikely to affect many people because of the good water supply, sanitary facilities and personal hygiene of citizens of developed countries.


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Not much surprise there since most of us drink our own sh'it from boreholes in the same compound as our septic tank/soakaway pits as our STATE governors have ABANDONED their constitutional RESPONSIBILITY to provide all of us something as basic as TAP water.

The LGAs can also not be bothered about ensuring hygiene in individual homes (just a few decades ago, we had Sanitary Inspectors aka Wole Woles in the South west) and businesses in their areas talk less of undertaking activities for public sanitation.

We are really in deep shi't

The sanitary inspectors we ar having in lagos are only after their own pocket they collect has little as N500 naira bribe to turn their eyes away from filth and poo.

2cato: The sanitary inspectors we ar having in lagos are only after their own pocket they collect has little as N500 naira bribe to turn their eyes away from filth and poo.

That is probably because they are VERY LOWLY paid based on the N18,000 minimum wage while an ordinary LGA Councillor collects almost N300,000 guaranteed as salary monthly.
What do you think our LGA Councillors do to be collecting so much money from our taxes
Do you think such DISPARITY exists in those oyinbo places our people are rushing to do under-employment vis-a-vis their qualifications compared to their oyinbo colleagues in the same organisation?

Cholera have always been an epidemic in Nigeria because of too much carelessness on our part. People refuse to keep their environment clean, so why won't cholera strike?
We should endeavour to tale desperate measures.

PREVENTING CHOLERA WITH THE BEST WAYS