Lack of potable water and poor personal and environmental hygiene have been identified as two of the major causes of waterborne diseases, such as Cholera. While there have also been several reported cases of the disease, some communities still depend on rivers as a source of drinkable water yet practise open defecation.
Shishipe, a community in Katampe, the Federal Capital Territory community, has faced the harsh reality of obtaining drinking water from a small stream. This is alongside the community practising open defecation, as there are no proper WASH facilities available. This community, along with three suburbs -Eke Bassa, Dagiri and Patenka- in Nigeria’s capital city, risk an outbreak of cholera disease, The ICIR’s Mustapha Usman reports.
THIRTY-FIVE-YEAR-OLD Moses Joy takes the same route daily to access water from the nearby stream. It has been a daily ritual. All her life, she has been used to the same water source as the river, which remains the only available water for domestic use by residents of the Shishipe community.
Shishipe, a local neighbourhood in Katampe area of the Federal Capital Territory (FCT), struggles for potable water like several other smaller communities in the territory.
Multiple sources in the community told The ICIR that despite the impurity level of the river, over 500 residents rely on it. Due to the river’s location on the outskirts of the village, residents would usually do a long trek to get some scoops while also serving as a water source for herds.
The situation is much worse during high demands when the stream becomes muddy and dirty. Besides, not only are the residents of Shishipe community confronted with no access to clean water, but they are also vulnerable to water-borne diseases due to unhealthy practices of open defecation.
Cholera, an endemic disease, is still one of the major diseases that affect Nigerians, particularly in the rural region of the country. The disease, according to the World Health Organisation (WHO), is an acute diarrheal infection characterised, in its severe form, by extreme watery diarrhoea and potentially fatal dehydration.
In 2020, the Nigeria Centre for Disease Control (NCDC), a body leading the national response to outbreak of cholera and other epidemic diseases across states in Nigeria, attributed the surge in cholera cases in the country to poor access to clean water, open defecation, poor sanitation, and hygiene.
“This is the only water we rely on; we drink, wash and bathe with the same water. Although we would have preferred a working borehole, we are still happy that we can still feed on this.
“The government came to construct a motorised borehole for us many years back, but it didn’t last long before it got damaged. And ever since then, we are back to our usual hustle for water,” Joy narrated.
But there was more to Joy’s predicament. She almost lost her two children. On several occasions, she was advised by health workers to stop feeding her daughter with water from the stream.
Sometime in 2022, a medical centre in Katampe diagnosed her two children with Cholera. They were admitted for two weeks before being discharged. “I was told it’s the water they drank, and needed to stop them from further taking the water, but that was just a mere talk as we have no other way to get water in the village.”
This is the situation of some other communities visited by The ICIR. For instance, in Dagiri, a neighbourhood in Gwagwalada Area Council, a section of the river that runs through the area has been transformed into an open toilet and a dumpsite.
A resident who identified himself as Sheidu said many individuals who lack toilets in their homes resort to using the side of the erosion gully as a place to defecate.
Sheidu further explained to The ICIR that the riverside has been turned into a dumpsite by most residents living nearby.
The FCT, in June 2021, recorded 91 suspected cases of cholera and seven deaths in the Abuja Municipal Area Council (AMAC) due to the same problem.
Former Acting Secretary of FCT Health and Human Services Secretariat (HHSS), a medical doctor, Mohammed Kawu, while speaking to newsmen in Abuja, listed Bwari and Gwagwalada among the two other affected areas. About a month later, the Federal Capital Territory Administration revealed 514 suspected cases, of which eight laboratory investigations were confirmed to be cholera.
Outbreak since 2021
Nigeria is one of the 13 African Countries battling Cholera over time. The current outbreak has been ongoing since 2021, when the country reported 111,062 suspected cases, which include 3,604 deaths, according to data from NCDC.
The cases were reported largely among children of the 5-14 age group across 33 states and the FCT.
The data reveals that both genders affected share the same percentage. Four states among the 33 affected states plus FCT, which are Bauchi, Jigawa, Kano and Zamfara account for 53 per cent of all cumulative cases.
Bauchi, which topped the total number of cases reported, had 19,558 cases, translating to 18 per cent of the actual cases, while, Jigawa (15,141), Kano (12,116) and Zamfara (11,931) represented 14, 11 and 11 per cent.
Meanwhile, the NCDC recorded 1,286 suspected cases in the FCT, while 77 deaths were confirmed. There are projections that the figure might have been high if all residents had visited the public health centre or hospital to complain about the waterborne disease.
Comparing the cases recorded to 2022 data, the country, between January 1, 2022, to December 30, reported a cumulative number of 23,763 suspected cases of Cholera with 592 deaths across 32 states plus FCT. Although there were concerns over the number of cases reported, the data shows a significant decline to 2021.
The 2022 reported cases were on a high between July and November before a sign of decline in December.
In September 2022, the country recorded 7,322 suspected cases with 171 suspected deaths, making it the highest within that period. Likewise, in December, Nigeria recorded its lowest number of cases as it reported 219 suspected cases with nine suspected deaths.
Data further shows that 5-14 year-old children were mostly affected, while 49 per cent of the reported suspected cases were male, and 51 per cent were females. Borno, having 12,465 cases, led the way as the state with the highest number of cholera cases. Yobe (1,888 cases) and Katsina (1,639 cases) joined the state in the three top most plagued states.
These three states, together with Gombe (1,407 cases), Taraba (1,153 cases) and Kano (1,131 cases) account for 83 per cent of the total reported suspected cases.
Mapping out Cholera cases across the country so far in 2023
Already in 2023, the country has recorded several suspected cases of Cholera across 24 states. As of July 2, a total of 2,052 suspected cases, including 55 deaths, have been recorded. And the common story here is that children under age were mostly affected by the outbreak.
Out of the 22 states, Cross River, with 718 cases accounts for 25 per cent of all the suspected cases thus far. According to the data, Obubra Local Area of the state reported the highest number of suspected cases of 515 cases, translating to 25 per cent of all the suspected cases.
However, early this year, on January 21, The ICIR reported how a cholera outbreak in Obubra LGA was said to have claimed over 60 lives. Just like The ICIR investigations reveal that residents of some FCT communities depend on a river as the only source to get water, inhabitants of Obubra also live on a river as the only water source.
About three months after the crisis, the LGA led other affected LGAs as the most vulnerable areas. Katsina, Ebonyi and Zamfara had 288, 227 and 216 cases, respectively.
Other communities with similar woes
About a year after The ICIR first published a story detailing how Ikeh Bassa faced several hurdles in accessing potable water, this reporter visited the town and discovered that the community still shares water with the herd.
Issa Rose, a twenty-six-year-old resident of Bassa, has been touring the bush to fetch water from the river since she was four years old. When she eventually gets the water, she and her family use it for sustenance.
Even after getting married, Rose maintains this routine and supplies water from the muddy source to her two children. This persists despite doctors instructing her against the actions.
“I have been to the hospital on several occasions to treat my children anytime they complain of stomach ache or other symptoms. I have been told it’s cholera; sometimes, the Doctor will say it’s diarrhoea, fever or malaria.
“This happens almost every time, and I would have to spend my hard-earned money from farming to treat them. Some of us that are adults are used to it, and we hardly fall sick, but our kids fall sick almost every time.”
A UNICEF report stated that although about 70 per cent of Nigerians are reported to have access to basic water services, more than half of these water sources are contaminated, meaning that over 60 million Nigerians drink contaminated water, which has generally been linked to several deadly diseases, including cholera.
Ikeh Bassa Youth leader Musa Ibrahim described the community as a hunter’s dog who, despite all his efforts to make the hunter achieve his goal, doesn’t benefit from it.
He said, “Not that we are not casting votes, we are casting votes and participating in elections, but at the end of the day, they will leave us as the hunter’s dog that we go to the farm and catch, after catching even to eat the bone, they won’t allow it to eat it.”
He explained that the residents have tried their best to seek the government’s assistance to construct a borehole so as to stop drinking stream water but didn’t yield a positive result.
The community has also written to the Kwali Area Council, stating their plights, but the government has turned deaf ears.
In a letter addressed to the council and received on March 9, 2022, the community spelt out their needs, including water, hospital and road.
The ICIR reports that N50 million naira was budgeted in 2021 for the construction of motorised boreholes in Kwali and Kuje Areas Councils. However, Ikeh Bassi hasn’t benefited from the supposed allocation.
Lugbe and the challenge of waste management
Aside from poor access to potable water, waste management is a great challenge in the Patenka area of Lugbe, as humans find themselves in a constant struggle for space with waste and filth. This dire situation affects traders who sell at the entrance of the market and passersby who pass through the road to Lugbe Zone 9.
Sadly, the community has reached a point where the traders have reluctantly accepted their fate, as ‘Baban Bola’ – young men working as independent waste collectors – and local cleaners take charge of the location.
While reports have shown that Nigeria has recorded some improvement around the issues related to Water Sanitation and Hygiene (WASH), there are growing concerns with regard to Nigeria achieving the Social Developmental Goal (SDG) by 2030.
According to a report published in 2022 by the Ministry of Water Resources, with data from the WASHNORM 2021 survey sampling over 24,600 households across the country, only 10 per cent of Nigeria’s population had access to integrated basic WASH services, which has serious negative health and security implications on the populace as well as in the attainment of the Sustainable Development Goals (SDGs 6) by the federal government.
Approximately 179 million Nigerians, which accounts for up to 87 per cent of the population, lack access to safely managed drinking water services. The situation is particularly dire in the North, where access remains insufficient, with the Northeast having the lowest access rate at just 2 per cent. In contrast, the Southwest region has the highest access rate at 29 per cent.
However, access to basic water supply services stood at 67 per cent of the population. The predominant sources of drinking water were boreholes/tubewells, utilised by approximately 37 per cent of the households while 11 per cent of the population use pipe-borne water and just 4 p use water from a source that is piped into their premise. Likewise, about a quarter of the population (25 per cent) still depend on unimproved and surface water supply for their daily water needs.
Comparing this data with WASHNORM 2019 report, there is a 3 per cent decline as 70 per cent of people had access to basic water supply services in 2019. In 2018, 68 per cent of the population had access to basic water.
Similarly, open defecation remains a challenge in the country, showing that as many as 48 million Nigerians across the country still practise open defecation. This data represents 23 per cent of the population.
WASHNORM survey showed that 46 per cent of the population was found to have access to basic sanitation services in 2021 compared to 44 per cent in 2019, representing a 2 per cent (6.9 million people) increase in the number of persons accessing basic sanitation services.
Despite the increase in the number of people with access to basic sanitation services, the proportion of people practising open defecation in the country has barely changed since 2019, with the number increasing from 46 million in 2019 to 48 million in 2021.
In FCT, 30 per cent of people sampled practice open defecation, while 52 per cent of the population have access to basic sanitation services. Ebonyi tops the list of states with the highest practice of open defecation, as 73 per cent defecate openly and only 14 per cent of the population have access to basic sanitation services in the state.
Meanwhile, Zamfara state, only recorded 1 per cent of the sampled people practising open defecation. This was despite the fact that the percentage of people having access to basic sanitation in the state stood at 43 per cent.
Just like Shishipe’s neighbourhood, where water facilities constructed by the government didn’t last a year, 38 per cent of all water supply facilities across the country were not functional at the time of the survey.
WASHNORM estimated the number of water points across the country to be 2.3 million water, with about 60 % located in rural areas and 40% in urban areas. 31 per cent of these facilities were motorised boreholes and about 1 in 10 (11 per cent) of the motorised boreholes were solar-powered. Handpump boreholes, including force-lift hand pump boreholes, make up only 13 per cent of water points in Nigeria.
The rapidly growing population and impact of Covid-19 were factors mentioned to be dwarfing the efforts made by the government so far.
The report warned that without addressing the WASH needs, cholera and other WASH-related infections and the associated childhood morbidity and mortality rates will remain high above the regional and global average.
Looming outbreak; expert warns
Cholera can be dangerous in children, particularly in areas where access to clean water, sanitation, and healthcare services is limited, according to a Public Health Physician, Dr Adewumi Babatunde.
Children are more vulnerable to severe complications and have a higher risk of mortality due to several factors, as highlighted by the Physician.
“Nigeria faces significant challenges in the implementation of WASH initiatives, particularly in underserved regions and among marginalized populations. Access to clean water remains limited, especially in rural areas, due to inadequate infrastructure and poor water treatment facilities.
Sanitation coverage is low, with open defecation practices persisting and insufficient proper toilet facilities. Hygiene practices, including handwashing, need improvement. Insufficient funding and investment hinder progress in WASH infrastructure and programs.
According to him, strengthening institutional capacity for policy development, coordination, regulation, and monitoring are a few of the crucial steps to be taken to improve health.
Speaking on possible solutions, Babatunde advised that Government at all levels should conduct public awareness campaigns to educate the population about cholera prevention and control measures is essential.
He added that strengthening of healthcare systems and improving vaccination coverage would help in putting a stop to the outbreak.
“Consideration can be given to vaccination campaigns targeting high-risk areas or vulnerable populations. Oral cholera vaccines are effective in preventing cholera outbreaks and can be administered to individuals or used as part of a mass vaccination strategy.
Babatunde further explained that Citizens can ensure they have access to safe drinking water by treating water through boiling, filtration, or adding chlorine.
“Proper sanitation practices, such as using toilets or latrines, help prevent the contamination of water sources and the spread of cholera. People should support efforts to improve sanitation infrastructure and discourage open defecation.
He also noted that by reporting early to hospitals, cases and spread of Cholera can be mitigated, adding that citizens who lack access to safe water should get vaccinated against Cholera as a way of preventing themselves from possible outbreaks.