INADEQUATE ACCESS TO WATER, SANITATION AND HYGIENE (WASH) AS A RISK FACTOR TO THE RECENT OUTBREAK OF CHOLERA IN 2024, LAGOS STATE

CHAPTER ONE

INTRODUCTION

Background of the study

In the 19th century, cholera disseminated globally from its initial birthplace in the Ganges delta in India. There have been six consecutive pandemics that resulted in the deaths of millions of people worldwide. The seventh pandemic originated in South Asia in 1961, subsequently spreading to Africa in 1971, and ultimately reaching the Americas in 1991 (Chakas, 2018). Cholera has become endemic in multiple nations. Cholera is a gastrointestinal illness that occurs when the bacteria Vibrio cholerae is present in the body, leading to the development of diarrhoea. This is a contagious disease that can be transmitted by contaminated water and food. Furthermore, it can be spread through direct contact between individuals due to poor hygiene standards, insufficient sanitation facilities, and restricted access to safe drinking water. These attributes promote the swift spread of the disease during an epidemic (Taiwo et al., 2017)

Cholera outbreaks may arise in times of crisis, such as earthquakes and floods, or in refugee camps when there is a disturbance in the water supply, sanitation, and hygiene infrastructure. The World Health Organisation (WHO) states that there are between 3 to 5 million cases of cholera reported each year, resulting in 100,000 to 120,000 deaths. However, only a small portion of these occurrences are officially recorded (WHO, 2014: Ola, 2020). According to the data from 2013, there were a total of 129,064 recorded cases and 2,102 deaths worldwide due to this disease. Out of these events, 44% were recorded in Africa, and an additional 45% were reported in Haiti. Haiti has documented a total of 696,794 cases and 8,531 deaths since the outbreak began in December 2013 (WHO, 2014: Ola, 2020).

Upon detecting an outbreak, the World Health Organization (WHO) advises implementing a response strategy that prioritizes reducing fatalities through prompt case management and decreasing the occurrence of illnesses by providing the affected community with safe water, proper sanitation, and health education to improve hygiene practices and safe food handling (Prosperity et al., 2018). Therefore, the procedures put in place to prevent and manage diarrheal infections are equally crucial in dealing with cholera epidemics. During an outbreak, the initial responders often utilise techniques like as providing chlorinated water using trucks, chlorinating individual water containers, or distributing cleaning materials for home water. This is expected to be improved by the promotion of personal and nutritional hygiene, along with the distribution of household disinfection and hygiene kits. In order to effectively control the spread of the outbreak, it may be necessary to simultaneously conduct numerous interventions, which might include educating the people (Jimoh, 2021). However, the ability of the responders to do so may be restricted by the resources and capabilities they have available.

Water, sanitation, and hygiene (WASH) interventions are frequently used to prevent and manage cholera by targeting potential sources of disease transmission (Raja et al., 2018). Water interventions enhance the volume of water (e.g., water transportation by trucks), the purity of water (e.g., treating water with chlorine), or the administration of water (e.g., ensuring safe storage). Sanitation interventions involve the implementation of infrastructure and waste disposal methods to effectively segregate feces from the surrounding environment, such as constructing latrines. Hygiene interventions, on the other hand, focus on preventing the transmission of diseases by practicing personal cleanliness, such as washing hands with soap. The elements that are expected to prevent cholera transmission, such as safe drinking water, are referred to as "protective factors." On the other hand, factors that are expected to promote transmission, such as open defecation, are called "risk factors" (Sterling et al., 2021).

The presence of polluted water, inadequate sanitation, and poor hygiene practices greatly contribute to the spread of diseases like cholera. Furthermore, these conditions can also give rise to the emergence of more dangerous strains of illnesses, such as widely drug-resistant typhoid fever. In order to address these challenges, it is imperative to exert targeted endeavours to improve water, sanitation, and hygiene (WASH) practices (Sterling et al., 2021). These improvements are crucial for reducing the spread of infections and tackling emerging issues like antibiotic-resistant illnesses. This study aims to assess the inadequate access to water, sanitation, and hygiene (WASH) as a causal factor in the recent cholera epidemic in Lagos state in 2024. Lagos State is located in the southern region of Nigeria. Among the 36 states, this particular state holds the second position in terms of population and possesses the smallest land area. In Lagos, there is a significant disparity in urban living conditions and a lack of social value placed on toilets, resulting in widespread open defecation. The disposal of sewage is done without discrimination, and there is a lack of information about the risks of cholera. In the absence of addressing these challenges, not only would cholera persist, but also the bulk of prevalent infectious diseases in slums. Therefore, the necessity for this investigation arises.

1.2 Statement of the Problem

An optimal setting in Europe, Asia, and other advanced and emerging countries worldwide, including Nigeria and Lagos State specifically, should consistently be devoid of cholera epidemics. The resident must possess significant and comprehensive knowledge of cholera, including its symptoms and preventive actions. 

Cholera remains prevalent in Lagos state, and the pandemic is spreading to nearby areas. As of June 12, 2024, there have been 15 documented deaths (Emergency operation centre, 2024). According to EOC's assessment in 2024, the majority of villages in Lagos state lack access to reliable water sources. Instead, they rely on streams or hand dug wells, which increases their vulnerability to the disease. Moreover, these settlements are susceptible to cholera outbreaks, leading to inadequate upkeep and deterioration of existing infrastructure, such as drainage systems and water pipes. The Lagos State Ministry of Health has identified the intake of polluted water and inadequate sanitation as the main factors contributing to the cholera outbreak. Jubril (2024) argues that the cholera outbreak in Lagos state is mostly caused by the consumption of water provided by street water vendors and the neglect of handwashing with soap before meals.  

According to a recent study by The Guardian in 2024, it was discovered that residents of Lagos have a habit of consuming raw food and vegetables. Additionally, they are not aware of the source of water used by the vendors. Aguwa (2024) recommended that Nigerians refrain from consuming raw foods and vegetables during this time due to uncertainty over their origin and concerns about the vendors' cleanliness practices.   

Aguwa (2024) recommends that residents of Lagos consistently practise hand hygiene, maintain proper sanitation, ensure the quality of their drinking water, and exercise caution while consuming food prepared outside their homes, ensuring that it is thoroughly cooked. In this context, the study will thoroughly evaluate the insufficient availability of water, sanitation, and hygiene (WASH) as a contributing factor to the recent cholera outbreak in Lagos state in 2024.

1.3 Objectives of the study

The primary objective of this study is to critically assess inadequate access to water, sanitation and hygiene (wash) as a risk factor to the recent outbreak of cholera in 2024, Lagos state. Specific objectives of this study are to:

To find out whether there is a relationship between unavailability of water, sanitation and hygiene(WASH) and cholera outbreak in Lagos state

To determine the factors contributing to unavailability of water, sanitation and hygiene in Lagos state.

identify the effect of water, sanitation and hygiene to cholera prevention in Lagos state

identify strategies of providing access to water, sanitation and hygiene so as to prevent cholera reoccurrence in Lagos 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 relationship between unavailability of water, sanitation and hygiene(WASH) and cholera outbreak in Lagos state?

What are the factors contributing to unavailability of water, sanitation and hygiene in Lagos state?

What are the effect of water, sanitation and hygiene on cholera prevention in Lagos state?

What are the strategies required to improve access to water, sanitation and hygiene so as to prevent cholera reoccurrence in Lagos state?

1.4 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: There is no relationship between unavailability of water, sanitation and hygiene(WASH) and cholera outbreak in Lagos state

Ha: There is a relationship between unavailability of water, sanitation and hygiene(WASH) and cholera outbreak in Lagos state.

1.5 Significance of the study

The study "Inadequate Access to Water, Sanitation, and Hygiene (WASH) as a Risk Factor to the Recent Outbreak of Cholera in 2024, Lagos State" is of critical importance. It addresses a fundamental public health issue that affects the well-being of the population, particularly in vulnerable communities. By providing valuable insights into the relationship between WASH deficiencies and cholera. The study will serve as a baseline for researchers and students and also guide government, health practitioners to evaluate measures to prevent the outbreak of cholera. 

This study will enlighten government and policy makers by providing insights that can inform the development and implementation of effective WASH policies and programs. It will also enlighten the government on the need for investments and improvements in water supply, sanitation, and hygiene facilities. Preventing cholera outbreaks through improved WASH can reduce the economic burden on healthcare systems and households, resulting in significant cost savings. Healthier populations are more productive, and by reducing the incidence of cholera, the study can contribute to improved economic productivity and development; this is a plus to Nigeria economy and the government of Nigeria

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

1.6 Scope of the study

Broadly, this study focuses to critically assess inadequate access to water, sanitation and hygiene (wash) as a risk factor to the recent outbreak of cholera in 2024, Lagos state. Specifically, this study seeks to find out whether there is a relationship between unavailability of water, sanitation and hygiene(WASH) and cholera outbreak in Nigeria and determine the factors contributing to unavailability of water, sanitation and hygiene in Nigeria. 

Further, this study will focus on identifying the effect of water, sanitation and hygiene to cholera prevention in Nigeria and it also seeks to identify strategies of providing access to water, sanitation and hygiene so as to prevent cholera reoccurrence in the state.

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

1.7 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 the topic inadequate access to water, sanitation and hygiene (wash) as a risk factor to the recent outbreak of cholera in 2024, 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.