IMPACT OF CHOLERA OUTBREAKS ON PUBLIC HEALTH INFRASTRUCTURE IN NIGERIA

CHAPTER ONE

INTRODUCTION

Background of the Study

Cholera is a common waterborne illness that causes severe diarrhoea, leading to dehydration and death. Vibrio cholera is commonly present in brackish water that has a moderate level of salt. The microorganism can be found in various water sources such as wells, ponds, rivers, coastal waterways, and beaches (Codeço, 2018). Nevertheless, the spread of cholera is greatly influenced by environmental factors such as temperature, water salinity, sea surface temperature, and rainfall (De Magny, Cazelles, & Guégan, 2017). Humans can acquire the illness through an environmental source, known as primary transmission, which is particularly common in coastal regions where the vibrio bacterium naturally exists in reservoirs (Colwell & Spira, 2017).  According to Lipp et al. (2021), first infections commonly occur in brackish waterways that are used for occupational or recreational purposes. The main method by which cholera is transmitted to people is by the ingestion of water or food that has been contaminated with the faecal matter of an infected individual. Moreover, this form of transmission is known as secondary transmission (Colwell & Spira, 2017; Mandal, Mandal, & Pal, 2019). 

Annually, there are around 2.9 million reported cases of cholera and 95,000 deaths worldwide (Ali et al., 2015). According to  Clemens et al.(2016), these numbers have a greater impact on sub-Saharan African countries, particularly since the start of the seventh cholera pandemic in 1961.  In 2017, there were over 150,000 recorded cases of cholera in 17 African nations due to various outbreaks. However, in the past, Nigeria has had multiple cholera outbreaks with high Case Fatality Rates (CFRs). One significant outbreak occurred in 1991, which resulted in 59,478 cases and 7,654 deaths. The CFR for that outbreak was 12.9%, which remains the highest recorded in the country to this day. In addition, there was a significant cholera epidemic in Kano state in March 1999, which subsequently extended to Adamawa and Edo states by May of the same year. This outbreak led to a total of 26,358 reported cases and 2085 fatalities (Opajobi et al., 2004). Likewise, between the period of January to December 2010, Nigeria documented a total of 41,787 cases and 1716 fatalities (with a Case Fatality Rate of 4.1%) in 18 different states (Dalhat et al., 2010). The most recent significant cholera outbreak occurred in 2014, during which the number of recorded cases exceeded half of the combined number of cases registered between 2012 and 2013, as well as between 2015 and 2017. 

Concisely, the repeated occurrence of cholera epidemics in Nigeria highlights deficiencies in the country's public health infrastructure, namely in the domains of water, sanitation, and hygiene (WASH). Also, llimited availability of potable water and insufficient sanitation infrastructure are significant factors in the transmission of cholera. On the other hand, aaccess to clean drinking water is scarce in several regions of Nigeria, particularly in highly populated urban slums and rural areas. Additionally, the sanitation facilities in these areas are usually basic or completely absent (UNICEF, 2020). These circumstances create a favorable setting for the rapid spread of cholera, emphasizing the necessity of significant investment in water, sanitation, and hygiene (WASH) infrastructure to avoid recurrent outbreaks.

1.2 Statement of the Problem

Nigeria's public health infrastructure faces multiple obstacles, which are worsened by periodic cholera outbreaks. These epidemics put further pressure on healthcare institutions that are already overwhelmed, especially in rural and underserved urban regions. During a cholera outbreak, hospitals and clinics frequently see a sudden increase in patients in need of immediate medical attention, which strain scarce resources such as hospital beds, medical supplies, and healthcare staff (WHO, 2019). Nevertheless, a study carried out in 2010 to determine the risk factors associated with the outbreak of cholera in a rural community in the northern region of Nigeria showed that infected persons, improper washing of hands after visiting the toilet and before meals were highly significant risk factors associated with the cholera infection (Sheed et al., 2018).

On the other hand, the unexpected surge of patients  disrupt regular healthcare services, causing delays in treatment for other disorders and potentially resulting in higher fatality rates from diseases unrelated to cholera. Furthermore, cholera epidemics have a domino effect on public health infrastructure by redirecting resources from other crucial health programmes. The allocation of financial and human resources necessary to handle an outbreak, including the deployment of swift response teams, establishment of cholera treatment centres, and implementation of large-scale vaccination efforts, all result in the redistribution of funds from other critical healthcare services (CDC, 2021). This diversion impede the progress in other health activities, such as programmes focused on maternity and child health, campaigns to administer vaccines, and endeavours to manage other contagious diseases.

Cholera outbreaks not only put pressure on healthcare institutions, but also highlight the deficiencies in Nigeria's disease surveillance and response systems. Efficient cholera management depends on prompt identification, precise documentation, and rapid reaction to epidemics. These obstacles impede the swift execution of control measures, enabling the disease to propagate more extensively and intensifying the strain on public health infrastructure. Hence, it is in the light of these that the study seeks to assess the impact of cholera outbreaks on public health infrastructure in Nigeria.

 1.3 Objectives of the Study

The main purpose of this study is to assess the impact of cholera outbreaks on public health infrastructure in Nigeria. Specifically, the study will;

Assess the level of cholera outbreak in Nigeria

Examine the impact of cholera outbreaks on healthcare facilities in Nigeria.

Investigate the eeffectiveness of health infrastructure in preventing cholera outbreaks in Nigeria.

1.4 Research Questions

The following questions have been prepared for the study:

What is the level of cholera outbreak in Nigeria?

What is the impact of cholera outbreaks on healthcare facilities in Nigeria?

What are the eeffectiveness of health infrastructure in preventing cholera outbreaks in Nigeria?

1.5 Research Hypotheses

H0: Cholera outbreaks have no significant impact on public health infrastructure in Nigeria.

Ha: Cholera outbreaks have a significant impact on public health infrastructure in Nigeria.

1.6 Significance of the Study

The study results will help public health authorities in Nigeria to refine strategies for cholera prevention. Additionally, healthcare workers will benefit from insights into the epidemiology and clinical management of cholera outbreaks, enhancing their ability to provide timely and effective treatment. Nevertheless, subsequent researchers will use it as a literature review. This means that other students who may decide to conduct studies in this area will have the opportunity to use this study as available literature that can be subjected to critical review. Invariably, the result of the study contributes immensely to the body of academic knowledge with regard to the impact of cholera outbreaks on public health infrastructure in Nigeria.

1.7 Scope of the study   

The scope of this study is boarded on the impact of cholera outbreaks on public health infrastructure in Nigeria. Empirically, this study will 

Geographically, the study will be delimited to healthcare workers.

1.8 Limitation of the study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. In addition, there was the element of researcher bias. Here, the researcher possessed some biases that may have been reflected in the way the data was collected, the type of people interviewed or sampled, and how the data gathered was interpreted thereafter. The potential for all this to influence the findings and conclusions could not be downplayed. More so, the findings of this study are limited to the sample population in the study area, hence they may not be suitable for use in comparison to other schools, local governments, states, and other countries in the world.

 1.9 Definition of Terms

Cholera: an acute diarrheal disease caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae.

Health: refers to the state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. It encompasses various factors that contribute to overall well-being.

Infrastructure: refers to the fundamental physical and organizational structures and facilities needed for the operation of a society, such as transportation, communication, and utilities (like water supply and sanitation systems).

Diarrhoea: is a condition characterized by loose or watery stools, usually occurring more frequently than usual.