AN EXAMINATION OF THE SPECIFIC RISK FACTORS CONTRIBUTING THE INCESSANT CHOLERA PANDEMIC IN THE CONTEMPORARY SOCIETY OF LAGOS STATE

CHAPTER ONE

INTRODUCTION

Background of the study

Cholera poses a global public health risk, causing illness in more than one million individuals and resulting in approximately 90,000 fatalities annually (Grey, 2017). Sub-Saharan Africa (SSA) has the second highest burden of cholera cases and fatalities, following Asia. Between 2018 and 2023, SSA has been identified as the leading region for cholera cases and deaths. In 2018, Nigeria reported the highest number of cholera cases in SSA. Cholera is a widely recognised disease characterised by severe diarrhoea. It is caused by drinking food or water that has been contaminated with Vibrio cholera bacteria. The specific serotypes 01 and 0139 of this bacterium are very dangerous and are known to cause the diarrheal illness. The serotypes mentioned are recognised for their production of essential pathogenic components, namely Cholera toxin (CTXAB) and toxin co-regulated pilus (TCP) (Arman et al., 2020).

The initial documented instances of cholera in Nigeria occurred in 1971 in a town near the former capital city, Lagos. This led to a widespread outbreak, with 22,931 cases and 2,945 fatalities recorded (WHO, 2013: Oguns, 2017). Oguns (2017) cited a report from the World Health Organisation (WHO) in 2011, stating that there were around 59,478 recorded cases and 7,645 deaths in 1991. According to data from the United Nations in 2010, Nigeria saw its most severe cholera outbreak in almost twenty years, resulting in the deaths of more than 1,555 individuals and the infection of approximately 40,000 people. The statistics from the World Health Organisation (WHO) indicates that Nigeria recorded a total of 672,345 cases and 53,827 fatalities from 1995 to 2022, making it the country with the highest numbers in Africa. 

A total of 435 Local Government Areas across the country were affected, with the states in Northern Nigeria seeing the most severe consequences due to flooding and inadequate sanitation. The issues that need to be addressed include poor road infrastructure leading to affected communities, security concerns, open defecation in those regions, lack of access to clean water in rural areas and urban slums, inadequate vaccination coverage in all local government areas, wards, and settlements, insufficient healthcare facilities, lack of necessary supplies for managing cholera such as Ringer's Lactate, shortage of trained case managers in states, and inadequate reporting management from states (Bassey et al., 2023). Additional variables that contributed to the dissemination of cholera disease, as previously indicated, included unfavourable living conditions and a lack of sanitation and hygiene services.

Lagos State is situated in the southern part of Nigeria. Out of the 36 states, this specific state is ranked second in population and has the smallest land area. Lagos exhibits substantial urban inequality and social devaluation, with open defecation being widespread and toilets lacking social importance (Akin, 2022). Sewage is indiscriminately disposed of, and there is a lack of comprehension regarding the peril of cholera. Cholera has persistently afflicted the state of Lagos since its initial discovery, leading to recurring outbreaks. Hence, this study aims to examine the occurrence of cholera outbreak and the social risk factors linked to it in Lagos state. 

1.2 Statement of the Problem

Nigeria is afflicted by several contagious diseases, with cholera being a persistent menace to public health. The seventh cholera pandemic first emerged in Nigeria during the early 1970s, as documented by Barua and Cvjetanovic (1970), Cvjetanovic and Barua (1972), and Goodgame & Greenough (1975), as mentioned by James (2018). The annual recurrence of this phenomenon has been a matter of concern for both individuals and the entire nation. The continuous existence and reemergence of cholera in Lagos State is a notable public health issue. An inquiry into the prevalence of cholera in the State has uncovered that specific Local Government Areas (LGAs) are currently experiencing a substantial surge in cholera instances. Multiple causes have been identified as contributing to the ongoing reappearance of Cholera in Lagos state. 

Lagos, ranked 19th globally as a top city to visit by Time Out, a British Media and hospitality company, surpassing cities like Melbourne, Naples, Singapore, Miami, Dubai, Beijing, and Montreal, seems to have a significant issue with open defecation and uncontrolled waste disposal (Punch, 2024). Nwosu (2019) argues that two conditions must be fulfilled for a cholera outbreak to happen: there must be substantial failures in the water, sanitation, and hygiene infrastructure utilised by communities, allowing widespread exposure to food or water contaminated with Vibrio cholera bacteria; and cholera must be prevalent in the population. Some Lagos residents, particularly those residing in highly populated Ilaje, Bariga, and Oworonshoki in the Kosofe Local Government Area of Lagos State, still do not have access to basic sanitation amenities. The environment in the majority of Lagos is characterised by extensive degradation, poor sanitation, and almost complete desolation. The increasing amount of yearly rainfall is a major factor that is causing the recurrence of cholera. Abiola, in the year 2023

Moreover, due to the high population density of Lagos, there is a substantial demand for land, resulting in intense rivalry for space. Open spaces and drainage areas are consistently exploited for their designated functions. This often results in flooding and its associated consequences. Excessive and enduring precipitation causes floods, which in turn contaminate drinking water sources, leading to the resurgence of cholera (Yekini, 2023). The objective of this study is to examine the occurrence of a cholera epidemic and the factors that contribute to its spread in Lagos state.

 1.3 Objectives of the study 

The primary objective of this study is to critically examine the specific risk factors contributing the incessant cholera pandemic in the contemporary society of Lagos state. Specific objectives of this study are to:

Determine the extent of cholera outbreak in Lagos state.

Investigate the factors that causes cholera in Lagos state.

To assess the effects of cholera in Lagos state.

To identify the strategies adopted by Lagosians to tackle cholera outbreak in the state.

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

What is the prevalence of cholera outbreak in Lagos state?

What are the risk factors associated with cholera in Lagos state?

What are the effects of cholera in Lagos state?

What strategies should be adopted by Lagosians to tackle cholera outbreak in the state?

1.5 Research Hypothesis

Ho: There is no high prevalence of cholera outbreak in Lagos state.

Ha: There is a high prevalence of cholera outbreak in Lagos state.

1.5 Scope of the study

Broadly, this study focuses to critically examine the specific risk factors contributing the incessant cholera pandemic in the contemporary society of Lagos state. The study will explore the prevalence and the factors associated with cholera in Nigeria.

This study will be carried out in Lagos state, Nigeria.

1.6 Significance of the study

This study will serve as a baseline for researchers and students and also guide government, health practitioners to examine cholera outbreak and its associated risk factors in Lagos state. This study will also be of great importance to the youths, government and the nation as a whole as it will identify the strategies in tackling cholera outbreak.

Finally, this study will also serve as a reference material to students and researchers for further studies and future research.

1.7 Limitations of the study

As is common in all human pursuits, the researchers faced minor limitations during the execution of the study. The main limitation was the limited amount of literature available on the subject due to a lack of sufficient data on the topic of cholera outbreak and its related risk factors in Lagos state. Consequently, a significant amount of time and effort was necessary to locate the appropriate resources, books, or information, as well as to gather data. Additionally, this study is constrained by its small sample size and narrow geographic scope, focusing just on Lagos state. Consequently, the results of this study are not applicable for generalization, thereby leaving room for other research. 

Furthermore, the researcher faced a time constraint due to the necessity of conducting this research while still fulfilling obligations such as attending lectures and other educational activities. 

1.9 Definition of terms

Cholera: Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae.

Diarrhoea: This is a condition in which feces are discharged from the bowels frequently and in a liquid form. a range of symptoms including diarrhea and vomiting.

Communicable disease: Communicable diseases are illnesses caused by viruses or bacteria that people spread to one another through contact with contaminated surfaces, bodily fluids, blood products, insect bites, or through the air. There are many examples of communicable diseases.