CHOLERA OUTBREAK IN LAGOS 2024; EVALUATING NURSES’ PERCEPTION OF THE RISK FACTORS AND INTERVENTION MEASURES REQUIRED TO MITIGATE CHOLERA AMONG CHILDREN

CHAPTER ONE

INTRODUCTION

Background of the study

Cholera is a rapid-onset infection of the intestines caused by consuming Vibrio cholera, a bacteria present in water and food contaminated with feces. Annually, the disease claims the lives of thousands of individuals globally, primarily as a result of acute watery diarrhoea leading to severe dehydration. Cholera is highly contagious and can rapidly spread among populations, leading to public health epidemics with significant mortality rates (Halima, 2018). 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 cholera control is the timely, precise, and efficient detection and handling of outbreaks when they arise. Nurses have a crucial role in many communities, serving as trusted sources of health education and being responsible for monitoring and reporting disease outbreaks (Deen, et al 2020).

Nevertheless, countries experiencing ongoing cholera epidemics have attributed the problem to underperforming health systems staffed by inadequately skilled health personnel, namely nurses (Debes, 2018). For instance, in Nigeria, there is a recurring incidence of cholera epidemics on an annual basis. Furthermore, it has been noted that these epidemics in the nation persistently lead to case-fatality rates (CFR) above 1%. In 2017, there were a total of 4,221 suspected cases of cholera and 107 deaths, with a case fatality rate of 2.5%. Out of these, 60 cases were confirmed through laboratory testing. These cases were reported from 87 Local Government Areas (LGAs) in 20 different states (Rahim, 2023) 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 reported deaths, resulting in a Case Fatality Rate (CFR) of 7.6%. These cases were spread among 28 Local Government Areas (LGAs) in nine different states. 

The Lagos State Government officially announced a cholera outbreak on 09 June 2024. According to the Emergency Operations Centre (EOC) report on June 12, 2024, there have been 324 suspected cases of cholera throughout the state. Out of these cases, 15 individuals have died and 40 have been discharged. Lagos State is located in the southern region of Nigeria. Among the 36 states, this particular state boasts the second greatest population and the most compact land area. Lagos demonstrates significant urban disparities and marginalization, characterized by a prevalent practice of open defecation and a lack of societal recognition for toilets (Akin, 2022). There is a widespread practice of disposing sewage without discrimination, and there is a lack of understanding about the danger posed by cholera. Researchers have established a connection between the ongoing occurrence of cholera outbreaks in Lagos and the prevalence of unsatisfactory hygiene practices. This situation is further worsened by insufficient or incorrect health information provided by nurses. Additionally, the high case fatality rates (CFRs) serve as evidence of a deficient surveillance and response system.

 Cholera can manifest as a rapid and escalating outbreak following a natural catastrophe like a hurricane, flood, or earthquake. Cholera outbreaks can occur after a natural catastrophe due to the disruption of the water distribution system and the presence of insufficient hygiene or sanitation systems. Cholera is mostly spread through contaminated water (Watson, Gayer, & Connolly, 2017). Diarrheal illnesses are a significant worldwide public health issue that impacts both native communities and individuals who are travelling. Nigeria experiences a daily loss of over 2,300 children under the age of five, which positions the country as the second highest contributor to the global under-five mortality rate (WHO, 2016) cited by Mbakara (2021). 

The occurrence of cholera infections exhibits significant variation in accordance with seasonal patterns and the age of a kid. Infants are the most susceptible, with the highest occurrence in the first two years of life, which decreases as the kid ages. In Nigeria, the illness is commonly found and the occurrence of epidemics is not uncommon. According to the 2018 report by Water Aid Nigeria, approximately 33% (60 million) of the population in the country lack sufficient access to clean water, while 67% (over 120 million) do not have proper toilets and 26% (about 47 million people) engage in open defecation. These conditions make the population highly susceptible to Cholera disease. Therefore, the significance of the rise in cholera cases in Nigeria cannot be overstated. Therefore, the necessity for this investigation arises. 

1.2 Statement of the Problem

Research has indicated that nurses frequently possess insufficient information to effectively perform their responsibilities. Aisen and Shobowale (2021) found that over 33% of the healthcare professionals in their research felt that HIV might be transmitted through tears, faeces, and urine. In a similar vein, Ebuehi et al (2023) found that while Nurses demonstrated a strong level of awareness regarding emergency contraceptives, they lacked particular knowledge regarding the optimal time frame for successful usage, the mechanism of action, the legal status, and the accurate prescription of emergency contraceptive pills. Bawa et al (2023) discovered that primary healthcare (PHC) staff had inadequate understanding of both notifiable diseases and the protocols for reporting them. Additional research has demonstrated the presence of knowledge deficiencies among Nigeria's primary healthcare (PHC) personnel. The magnitude of these deficiencies is primarily determined by characteristics such as professional rank, level of experience, and geographic region. 

Methods such as ongoing education, nurse retraining through workshops and seminars, and other interventions have been proposed to enhance nurses' knowledge and subsequently improve the health status of the community. Research has shown that implementing these interventions can greatly enhance the understanding of nurses, leading to a subsequent decrease in the prevalence of cholera among children in Lagos state and the entire country. This study aims to assess nurses' view of the risk factors and management strategies needed to minimise cholera in children. 

1.3 Objectives of the study

The primary objective of this study is to critically evaluate nurses’ perception of the risk factors and intervention measures required to mitigate cholera among children. Specific objectives of this study are to:

Evaluate the level of knowledge among nurses towards the risk factors that contribute to cholera among children.

Determine the risk factors for cholera in children as perceived by nurses

Identify the intervention measures that nurses use in mitigating the risk of cholera among children

Identify challenges nurses face in implementing effective cholera prevention and control measures.

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 level of knowledge among nurses regarding the risk factors that contribute to cholera among children?

What are the risk factors for cholera in children as perceived by nurses?

What are the intervention measures that nurses use in mitigating the risk of cholera among children?

What are the challenges nurses face in implementing effective cholera prevention and control measure?

1.5 Research Hypothesis

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: The level of knowledge among nurses regarding the risk factors that contribute to cholera among children is low

Ha: The level of knowledge among nurses regarding the risk factors that contribute to cholera among children is high.

1.6 Significance of the study

The aims of this project are to improve comprehension and efficacy of cholera prevention methods, specifically targeting at-risk groups such as children. This study holds great importance and will serve as a fundamental reference for researchers, students, the community, nurses, and parents alike. 

Nurses have direct experience and expertise in patient care and disease prevention. Their observations offer valuable perspectives on the tangible obstacles and successful approaches to reducing the impact of cholera. By assessing the perspectives of nurses, the study can accurately represent the actual conditions of healthcare provision, resulting in recommendations that are more feasible and can be put into practice. The study enhances nurses' empowerment by respecting their perceptions, so fostering a sense of ownership and responsibility in efforts to avoid cholera. In addition, the perspectives provided by nurses can help identify specific areas that require further training or resources, resulting in improved capacity development within the nursing field.

The study aims to inform parents and community members by identifying crucial risk factors for cholera in children, based on the observations and experiences of nurses. This information is essential for implementing specific interventions. The study will additionally enhance knowledge and inform communities about efficient cholera prevention techniques, promoting more community engagement and compliance with health protocols.

Additionally, this study will function as a source of information for students and academics who wish to pursue further studies and conduct future research.

1.7 Scope of the study

Broadly, this study focuses to critically evaluate nurses’ perception of the risk factors and intervention measures required to mitigate cholera among children. Specifically, this study seeks to evaluate the level of knowledge among nurses regarding the risk factors that contribute to cholera among children and determine the risk factors for cholera in children as perceived by nurses. Further, this study will focus on identifying the intervention measures that nurses use in mitigating the risk of cholera among children, and it also seeks to identify challenges nurses face in implementing effective cholera prevention and control measures

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

1.8 Limitations of the study

As is typical in all human endeavours, the researchers faced minor limitations during the study. One significant drawback of the study is the researcher's financial constraint, as they are a full-time student with no source of money to support themselves.

Another constraint was the scarcity of comprehensive literature on the topic, since there is a limited amount of data accessible on cholera outbreak in Lagos 2024; evaluating nurses’ perception of the risk factors and intervention measures required to mitigate cholera among children. As a result, a substantial investment of time and effort was required to find the suitable resources, books, or material, and to collect data. Furthermore, this study is limited by its diminutive sample size and restricted geographical range, as it solely concentrates on Lagos state. Hence, the findings of this study cannot be extrapolated, thereby allowing for more investigation.

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.