THE ROLE OF HEALTH WORKERS IN MANAGING CHOLERA OUTBREAKS IN LAGOS STATE, NIGERIA

CHAPTER ONE

INTRODUCTION

Background of the Study

Cholera is a rapid-onset infection of the intestines caused by the consumption of Vibrio cholerae, a kind of bacteria that is present in water and food contaminated with faecal matter. Annually, the disease claims the lives of thousands of individuals worldwide, primarily as a result of acute watery diarrhoea leading to severe dehydration. Cholera is highly contagious and can rapidly spread among communities, leading to public health epidemics with significant mortality rates (WHO, 2020).

It is widely acknowledged that the most effective way to protect against cholera is through prevention, which involves maintaining hygienic conditions in living environments to avoid the spread of the bacteria that causes the disease. Another crucial element in controlling cholera is the timely, precise, and efficient detection and handling of outbreaks. Health workers are crucial in multiple communities due to their role as trusted providers of health education and their responsibility for monitoring and reporting illness outbreaks (Bhattacharya, 2019). On the other hand, countries experiencing ongoing cholera outbreaks have identified poor health systems staffed by inefficient health personnel as contributing factors (Adagbada et al.,2012).

 In Nigeria, cholera outbreaks persist annually.  According to ReliefWeb(2017) report, it has been noted that these epidemics in the nation persistently lead to case-fatality rates (CFR) above 1%. Likewise, in 2017, a total of 4,221 suspected cases of cholera were recorded, along with 107 deaths. Out of these cases, 60 were verified through laboratory testing. The cases were reported from 87 Local Government Areas (LGAs) in 20 different states. The case fatality rate (CFR) was calculated to be 2.5%. During the initial three weeks of 2018, there were a total of 210 suspected cases, out of which two were verified through laboratory testing. Additionally, there were 16 deaths, resulting in a Case Fatality Rate (CFR) of 7.6%. These cases were reported throughout 28 Local Government Areas (LGAs) in nine different states. Authors have shown a connection between the recurring cholera outbreaks and the presence of unsatisfactory hygiene practices. This situation is worsened by the insufficient and incorrect health information provided by healthcare workers (Hutin, Luby & Paquet, 2023). Additionally, the condition of Human Resources for Health (HRH) in Nigeria continues to be a significant obstacle that may be contributing to the high occurrence and Case Fatality Rate (CFR) of cholera in the country. As majority of Human Resources professionals lack access to ongoing education and the essential resources and infrastructure needed to effectively perform their duties. 

According to the National Policy on Health, Primary Health Care (PHC) workers have the responsibility of providing health education and raising awareness among community members. They are also involved in frontline cholera surveillance and, in some instances, cholera control and case management. Similarly, Ogunfowora & Daniel, (2018) asserts that primary health care workers serve as the most immediate and accessible health care providers for the community. Due to their placement in the outermost part of the healthcare delivery network, they play a crucial role in assessing and prioritizing patients at the initial point of contact. Beyond that, they receive specialized training to address minor health issues, provide immunizations, refer very ill patients to higher levels of care, and actively educate community members about health.

 In addition, they serve as primary disease monitoring and notification officers responsible for identifying and reporting outbreaks of epidemic-prone diseases like cholera (Aisien & Shobowale, 2019). Nevertheless, research has indicated that these healthcare professionals frequently possess insufficient expertise to fulfil their responsibilities. Aisen and Shobowale found that over 33% of the healthcare professionals in their research believed that HIV might be transmitted through tears, faeces, and urine. In a similar vein, Ebuehi et al. (2016) noted that primary healthcare (PHC) worker possessed a significant level of awareness regarding emergency contraceptives. However, they demonstrated a lack of particular understanding regarding the optimal time frame for successful usage, the mechanism of action, the legal status, and the accurate prescription of emergency contraceptive pills. Twelve Bawa et al. discovered that primary healthcare professionals had inadequate understanding of both notifiable diseases and the protocols for reporting them. Thirteen 

Additional research also demonstrated the presence of knowledge deficiencies among Nigeria's primary healthcare workers. The magnitude of these deficiencies is primarily determined by characteristics such as job rank, level of experience, and geographical region (Ogunfowora & Daniel, 2018). However, methods such as workshops, seminars, and other interventions have been proposed as ways to enhance the knowledge of health workers and thereby improve the health status of the population. These approaches involve ongoing education and retraining. Research has shown that these measures can effectively enhance the understanding of healthcare professionals and subsequently alleviate the cholera issue in the nation ( Fufore, Cook & Kirfi, 2018). Therefore, a survey will be conducted in order to investigate the role of health workers in managing cholera outbreaks in Lagos state, Nigeria.

Statement of the Problem

Health workers have a crucial role in the management and control of cholera outbreaks. When cases are identified, doctors and nurses take immediate action by delivering vital treatment such as rehydration therapy, administering antibiotics, and ensuring patients receive the essential supportive care (Centres for Disease Control and Prevention, 2022). Despite the crucial role they play, health workers in Lagos State encounter several obstacles that hinder their ability to effectively handle cholera epidemics. Resource limitations, such as insufficient medical supplies, inadequate training, and restricted availability of clean water and sanitation facilities in healthcare settings, pose substantial obstacles (Oladele et al., 2010)

Contextually, Lagos State, the primary economic center of Nigeria, with a population over 20 million, is extremely vulnerable to cholera outbreaks as a result of its high population density, fast urbanization, and inadequate water, sanitation, and hygiene (WASH) infrastructure. Also, the state's extensive informal settlements frequently suffer from inadequate access to potable water and suitable sanitation infrastructure, which creates optimal circumstances for the transmission of cholera. While Lagos State Government, in partnership with international organizations and non-governmental organizations (NGOs), has made determined efforts to tackle these challenges. However, the presence of ongoing infrastructural deficiencies and periodic outbreaks suggests that there is still a significant amount of work that needs to be accomplished (Lagos State Ministry of Health, 2022). Hence, it is in the light of these that the study seeks to investigate the  role of health workers in managing cholera outbreaks in Lagos state, Nigeria.

 1.3 Objectives of the Study

The main purpose of this study is to investigate the role of health workers in managing cholera outbreaks in Lagos state, Nigeria. Specifically, the study will;

To evaluate the effectiveness of health workers in early detection and reporting of cholera cases in Lagos State.

To analyze the level of training of health workers in managing cholera outbreaks.

To assess the challenges faced by health workers in managing cholera outbreaks.

To investigate the impact of health worker interventions on reducing cholera morbidity and mortality rates in Lagos state.

1.4 Research Questions

The following questions have been prepared for the study:

How effective are health workers in early detection and reporting of cholera cases in Lagos State?

What is the level of training of health workers in managing cholera outbreaks?

What challenges do health workers face in managing cholera outbreaks?

What is the impact of health worker interventions on reducing cholera morbidity and mortality rates in Lagos State?

1.5 Research Hypotheses

H0: Health workers do not play a significant role in managing cholera outbreaks in Lagos state, Nigeria.

Ha: Health workers play a significant role in managing cholera outbreaks in Lagos state, Nigeria.

1.6 Significance of the Study

The study findings will assist public health authorities in Nigeria in enhancing strategies for the prevention of cholera. Furthermore, this research will help community leaders and organizations collaborate with health workers to improve local responses to cholera outbreaks. 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  role of health workers in managing cholera outbreaks in Lagos state, Nigeria.

1.7 Scope of the study   

The scope of this study is boarded on the  role of health workers in managing cholera outbreaks in Lagos state, Nigeria. Empirically, this study will evaluate the effectiveness of health workers in early detection and reporting of cholera cases, analyze the level of training of health workers in managing cholera outbreaks, assess the challenges faced by health workers in managing cholera outbreaks and  investigate the impact of health worker interventions on reducing cholera morbidity and mortality rates.

Geographically, the study will be delimited to some employees of Lagos State Ministry of Health.

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. 

Health Workers: Professionals employed in the healthcare system, including doctors, nurses, epidemiologists, public health officials, and sanitation workers, who are responsible for the prevention, treatment, and management of health issues, including infectious diseases like cholera.