CHOLERA AS A NEW SOCIETAL ISSUES IN 2024: A CRITICAL INVESTIGATION OF ITS CAUSES AND HEALTH IMPLICATIONS OF LAGOS STATE, NIGERIA.

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Cholera is a highly contagious illness that is mostly spread by limited availability of clean drinking water, improper handling of food, and inadequate environmental hygiene. Vibrio cholerae, a bacterium, is the causative agent of the disease, which is transmitted by the contamination of food or water. Out of the several serogroups of V. cholerae that exist, only two (O1 and O139) are responsible for causing outbreaks. The infection is distinguished by intense episodes of acute diarrhoea (resembling rice-water stool) and vomiting, and impacts individuals of all age groups. The World Health Organisation (WHO 2015: Benneth et al., 2018) reported that there are around 1.3 to 4.0 million cases of cholera and 21,000 to 143,000 deaths worldwide each year. Cholera is a worldwide public health issue that serves as a marker for both inequality and insufficient social progress (Randy & Jones, 2019). 

Cholera has a significant impact on numerous countries worldwide, including Pakistan, Somalia, Sudan, Vietnam, Haiti, India, Bangladesh, and various countries in Asia and Africa (Usman et al., 2021). Cholera is quite prevalent in numerous African countries. Angola, Ethiopia, Zimbabwe, Ghana, and Nigeria, among other countries, have seen severe outbreaks of cholera (Emeka et al., 2019). According to Ali et al (2018), the majority of cholera infections go unnoticed, however, there are significant occurrences of cholera epidemics in underdeveloped nations. It was noted that industrialised nations have had virtually no instances of cholera in the past century due to their robust water and sewage treatment facilities. 

The actual number of cholera cases may be significantly greater than the figures reported to the World Health Organisation due to variations in how cases are defined, authorities' hesitancy to acknowledge and report cholera, inadequate surveillance systems in hospitals, the absence of reliable diagnostic tests, and the resemblance of cholera symptoms to those of other acute watery diarrhoea (AWD) illnesses (Dele, 2023). Between 1970 and 2023, only seven countries in Africa - Angola, Democratic Republic of Congo, Mozambique, Somalia, Tanzania, South Africa, and Nigeria - accounted for half of all reported cases (Bunta, 2024). Estimating the precise number of infections in developing nations is challenging since many cases are not officially reported due to socio-political considerations, as there is a fear that an outbreak could adversely affect the country's tourism industry (Emeka et al., 2019).

The persistence of cholera in Nigeria has been attributed to various factors, as identified by numerous studies. These factors include the disruption of public sanitation services, the occurrence of landslides and floods, which disturb the natural equilibrium, the uncontrolled flow of sewage water in the vicinity, and the contamination of food and water supplies by parasites and bacteria due to the destruction of essential water and sewage systems. Other contributing factors include the lack of resources, inadequate infrastructure, and a deficient disaster preparedness system, among others (Benneth et al., 2018). Cholera is commonly thought to occur in most nations during the dry season. However, in Nigeria, where it is prevalent, cholera occurs in both the rainy and dry seasons. Nevertheless, the incidence of cholera tends to rise at the onset of both seasons (Anderson, 2022). Nevertheless, numerous studies continue to indicate that the regions afflicted by cholera in the country suffer from inadequate water supply, substandard sanitation, overcrowding, insufficient public health education, and a dearth of quality medical facilities, among other factors (Hazel et al., 2021). 

The first recorded cases of cholera in Nigeria were reported in 1971 at a town located near the former capital city, Lagos. An extensive epidemic occurred, resulting in 22,931 reported cases and 2,945 deaths (WHO, 2013: Oguns, 2017). Oguns (2017) referenced a 2011 report by the World Health Organisation (WHO) which said that there were around 59,478 documented cases and 7,645 fatalities in 1991. Lagos State is situated in the southern part of Nigeria. Out of the 36 states, this state has the second highest population and 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. If these concerns are left unresolved, not only will cholera continue to exist, but also the bulk of infectious diseases that are widespread in slums. Therefore, the necessity for this investigation arises. 

1.2 Statement of the Problem

Communicable diseases have been devastating African countries for many years, and they have been identified as a significant contributor to mortality. From 2010 onwards, there has been a gradual decrease of 1% per year in the mortality rate caused by communicable diseases (Stefan, 2023). Nevertheless, the World Health Organisation (WHO) anticipates that the data are prone to fluctuation, and the figure will experience intermittent growth before to 2050. Communicable diseases such as smallpox, dengue fever, rabies, Hantavirus infection, hepatitis A and B, measles, HIV/AIDS, cholera, Zika, and Ebola are some examples. Although first-world countries have successfully eliminated certain diseases, second- and third-world countries continue to struggle with them. This study specifically examined the most recent occurrence of a cholera outbreak in Lagos state. 

The environmental factors considered included precipitation and temperature. The environmental elements that contribute to the transmission of cholera include sanitation, waste disposal sites, geography, flooding, availability of safe drinking water, and sewage management systems. The environment in most parts of Lagos is often degraded, polluted, and almost desolate. The increasing amount of yearly rainfall is a crucial factor that is causing the resurgence of cholera (Abiola, 2023). The varying magnitude of rainfall throughout the year results in notable occurrences of flooding in multiple sections of the State, especially in highly populated areas that have seen extensive land development. 

Furthermore, temperature has a crucial role in the reemergence of cholera, making it an important environmental factor. Over time, the Earth's temperature is increasing significantly as a result of the intensifying impacts of climate change and global warming (Chioma, 2023). Cholera is more common in higher temperatures than to lower temperatures. The region experiences an average low temperature of 24.1o C and an average high temperature of 31.6o C. The combination of elevated temperatures, together with factors such as overcrowding and unsanitary conditions, heightens the susceptibility of communities to cholera outbreaks. 

Moreover, a recent study postulated an association between the weekly precipitation levels and the likelihood of cholera cases (Camacho et al. 2018). In a study conducted by Dureab et al. in 2019, it was discovered that the main variables that increase the risk of cholera are using water from a common source, not washing fruits, vegetables, and khat, and not using chlorine or soap at home. This study seeks to examine the causes and health consequences in Lagos state.

1.3 Objectives of the study 

The primary objective of this study is to critically investigate the causes and health implications of cholera in Lagos state. Specific objectives of this study are to:

Ascertain the extent of cholera outbreak in Lagos state

Identify the causes of cholera in Lagos state

Analyze the health implications of cholera in Lagos state.

Explore the strategies adopted by Lagos state government 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 extent of cholera outbreak in Lagos state?

What are the causes of cholera in Lagos state?

What are the health implications of cholera in Lagos state?

What are the strategies adopted by Lagos state government to tackle cholera outbreak in the state?

1.5 Research Hypotheses

The following research hypothesis will be validated in this study:

Ho: The extent of cholera outbreak in Lagos state is low.

Ha: The extent of cholera outbreak in Lagos state is high.

1.6 Scope of the study

Broadly, this study focuses to critically investigate the causes and health implications of cholera in Lagos state. Specifically, this study focuses on ascertaining the extent of cholera outbreak in Lagos state, the causes and health implications of cholera in Lagos state, the effects of cholera in Lagos state, and the strategies adopted by Lagosians to tackle cholera outbreak in the state.

This study will be carried out in Lagos state.

1.7 Significance of the study

This study will serve as a baseline for researchers and students and also guide government, health practitioners to evaluate elements contributing to the outbreak of cholera. 

This study's findings will provide invaluable insights into the factors contributing to the increased incidence of cholera, including environmental, social, and economic determinants.

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

1.8 Limitations of the study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraint was the scanty literature on the subject owing that there are no much data on critical investigation on the causes and health implications of cholera outbreak in Lagos state. Thus, much time and organization was required in sourcing for the relevant materials, literature, or information and in the process of data collection. Also the study is limited in sample size and geography covering only Lagos state. Therefore, findings of this study cannot be used for generalization thus creating a gap for further studies. 

Also encountered was time constraint as the researcher had to carry out this research in addition to attending lectures and other educational activities required of him.

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.