5 months ago
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Lagos, Nigeria’s commercial city is currently under the siege of a cholera outbreak that is sweeping through communities, leaving deaths in its trail. So far, about five deaths have been reported, while over 60 residents hospitalised. Though the state government claims to have the situation under control, SODIQ OJUROUNGBE visited the affected communities and observed an alarming disregard for basic sanitation, while open defecation, and poor hygiene practices are the norm
Lagos with its global ranking of being the 19th best city to visit in the World by a British Media and hospitality company, Time Out, ahead of Melbourne, Naples, Singapore, Miami, Dubai, Beijing, and Montreal, among others, appears to be in a strong romance with open defecation and indiscriminate waste disposal.
This silent menace, among other sanitation infractions, no doubt, triggered the recent cholera outbreak, which claimed the lives of five and left others fighting desperately for their lives.
Access to basic sanitation facilities remains a dream for some Lagos residents, especially those living in densely populated Ilaje, Bariga, and Oworonshoki, in the Kosofe Local Government Area of Lagos State.
Every dawn, as the first streak of light kisses the horizon, Bukola Olusoji, would embark on a quiet, sneaky journey, clutching a small plastic bucket tightly.
As she ventures through the narrow alleys of Olowolagba in Bariga, picking her steps towards a nearby canal choking with debris, each step taken is borne out of nature’s necessity.
The canal, a silent witness to countless mornings like this, awaits her arrival.
With steady hands familiar with the assignment, she empties her faecal waste into the murky depths of the major drainage channel.
This has been the norm, a usual morning ‘ritual’ Olusoji and some other residents within the area feverishly carry out due to lack of access to toilets.
For her and others in Olowolagba, eliminating faecal matter from the body was merely a matter of convenience and are unaware that it is a battle against the forces of nature itself.
Speaking with PUNCH Healthwise during a visit to the community, following the cholera outbreak, Olusoji said many of the residents within the area resorted to disposing of their faeces in the canal because some houses do not have toilets, while ravaging flood had destroyed the few they managed to build.
“We have no choice but to engage in this practice because we don’t have toilets and you know we can’t cheat nature. Flood disturbs us here and it has destroyed many of the makeshift toilets we have.
“The other option some left for us is to go and use toilets in better parts of Bariga, but we all know that when nature comes, you may not be able to meet up with that kind of journey. This is why we defecate in containers and empty them into the canal here,” she explained in Yoruba.
When our correspondent visited some parts of Bariga, Oworonshoki, and Ilaje, he observed that overflowing garbage bins, which are potential breeding grounds for disease-carrying pathogens, lined the streets.
Findings by our correspondent showed that residents of these communities lack access to proper toilets and sanitation facilities, and based on this, indulge in open defecation.
This, combined with the indiscriminate waste disposal, medical and environmental experts say, creates an enabling environment for a full-blown cholera outbreak.
Cholera on the rise
On June 11, 2024, Nigerians were alerted to a cholera outbreak with the potential to spread to other parts of the state, prompting an emergency heightened surveillance and response intervention.
The Lagos State Commissioner for Health, Professor Akin Abayomi, while confirming that no fewer than five persons were confirmed dead and 60 others hospitalised from the outbreak of severe gastroenteritis in communities around Eti Osa, Lagos Island, Ikorodu and Kosofe LG areas of the state, said everything was being done to prevent the spread of the deadly, communicable waterborne disease.
He called for heightened vigilance and the adoption of precautionary measures to prevent further spread.
Abayomi explained that severe gastroenteritis cases were reported in Lagos within 48 hours and that the five deaths recorded were mainly from patients presenting late with extreme dehydration.
Although the commissioner did not list the affected communities, a source at the Ministry of Health, who did not want his name mentioned because he was not authorised to speak to the media, confirmed to us that Oworonshoki was among the locations where the outbreak was reported.
During a fact-finding mission by PUNCH Health to this particular community and others, it was observed that cholera outbreaks will be a reoccurring decimal that can majorly be attributed to a lack of clean water, functional toilets, and dysfunctional waste management systems.
‘Stinking communities’
In Oworosonki, it was discovered that residents, with impunity, engage in open defecation due to the unavailability of toilet facilities in their homes.
When PUNCH Healthwise got to the Mayaki area of Oworonshoki, it was observed that many old, rustic structures not fit for humans to live in have no functional toilets and residents empty their faeces into open water channels that link to sources of drinking water.
While moving around the community, it was discovered that gutters, bush paths, and a canal that empties directly into the Lagoon were taken over by fresh and congealed faeces, known to be harbingers of deadly bacteria and vectors capable of transmitting infectious diseases.
It was observed that many houses lack septic tanks and channelled pipes from their bathrooms and toilets directly into the canal to be emptied into the lagoon.
Aside from functioning as a faecal channel, the foul-smelling canal, built to act as a run-off for flood, had become a dumping ground and was clogged with garbage of all types.
The stench of urine and faeces was pungent and unbearable, yet, people moved about and carried on with their daily activities, unfazed.
A resident, Tajudeen Ademoye, told PUNCH Healthwise that areas close to the lagoon are the only places in the community without proper waste disposal.
He said, “There are toilets in many parts of Mayaki. It is only around the canal that you will see people engaging in open defecation.
“The unfortunate thing is that the state government recently came here and they promise to find lasting solutions to open defecation and indiscriminate waste disposal.
“Some people prefer to throw their waste inside the canal and that is why you will see that this place smells.”
Similar situation in Bariga, Ilaje
The situation was no different in Olowolagba, Ibrahim and Jide streets all in the Bariga area of the state.
During the visit, PUNCH Healthwise counted over 100 houses close to the lagoon that lacked toilets.
While some of the houses had makeshift bathrooms constructed with corrugated iron sheets, others did not have and tenants, it was learnt, improvise with wrappers hung on stilts to defecate or bath.
Aside from the offensive sights of faeces that greet a first-time visitor to these areas, large piles of refuse dominate significant parts of the environment.
The gutters, clogged with a combination of pep bottles and single-use plastics, also harboured mosquitoes.
Meanwhile, evidence that the area must have been seriously flooded following the recent rain, stood out like a sore thumb.
Despite these appalling conditions, some residents who conversed with PUNCH Healthwise claimed that there were no reported cases of cholera in the area.
One of them, who refused to mention his name, told our correspondent that the lack of sanitation facilities was not just an inconvenience but a matter of life and death for them.
“My children fall ill always. We live in constant fear of a disease outbreak, but there’s nowhere else to go,” he lamented.
When asked why his house did not have a toilet, he claimed the makeshift structure he constructed was destroyed by flood.
“Don’t you see that some houses have been destroyed by flood,” he said, with a tinge of anger evident in his voice.
“Many houses are flooded when it rains. Despite that, we can’t leave here because there is nowhere to go.
“To construct a modern toilet will cost a lot of money and it is not something affordable now because we are more concerned about how to survive.
Plagued by illnesses
“I haven’t heard of any cholera cases here, but what’s undeniable is the constant struggle with illnesses.
“Children here often suffer from diarrhoea, while adults battle malaria and typhoid. And when the rainy season comes, it gets worse.
“Whenever it rains, the canal overflows and filth floods our homes. Imagine having faeces and waste floating in your living space – it’s unbearable. With the rains returning, we’re all filled with worry. We plead with the government to intervene and help us.”
At Ifelodun in Ilaje, the situation was no anywhere different as gutters in the area were blocked with pep bottles and single-use plastics.
Houses in the area, it was noted, also do not have toilets, while many of them were flooded.
Some residents told our correspondent that no case of cholera had been reported in the area but expressed frustration at the state government’s disregard for their plight.
The residents admitted to always defecating inside polythene bags and throwing them into the lagoon.
One of them, Mrs Joy Bankole said, “We are left with no choice but to defecate into nylon bags and toss them into the nearby lagoon.
“The government needs to step in. We’re pleading for basic amenities, for a clean and safe environment for our families.”
Yet another, Joshua Adegoke lamented the perpetual state of neglect they have been subjected to.
“While we might not have had a cholera outbreak, the filthy conditions here make it a looming threat. We are living unclean environment that has no proper drainage system. It’s a disaster waiting to happen,” he lamented.
Implications of open defecation
A study titled; “Open Defecation and Cholera in the Global South: A systematic review and meta-analysis”, found that open defecation was associated with an increased risk of cholera, as well as other water-borne diseases.
The study, which was published in 2016 in PLOS Neglected Tropical Diseases, analyzed data from 30 studies conducted in a range of countries, including Bangladesh, India, and Pakistan.
One of the most significant findings of the study was that the risk of cholera was approximately 4.5 times higher in areas where open defecation was common, compared to areas where it was not.
The researchers discovered that the risk of cholera was even higher in areas with high population density and poor water quality.
They also noted that open defecation causes quite several other health conditions including stunting, diarrhoea, and respiratory infections.
The World Health Organisation described cholera as an extremely virulent disease transmitted through the ingestion of contaminated food or water.
The global health body noted that cholera can cause severe acute watery diarrhoea and the severe forms of the disease can kill within hours if left untreated.
According to WHO, most people infected with V. cholerae do not develop any symptoms, although the bacteria are present in their faeces for 1–10 days after infection and are shed back into the environment, potentially infecting other people.
The Nigeria Centre for Disease Control and Prevention revealed on Thursday that the country had recorded 65 confirmed cases of Cholera with 30 deaths from 1 January to 11 June, across 96 local governments in 30 states.
NCDC in a public health advisory alerted the public to a possible rise in cholera cases across the country as the rainy season intensifies.
According to the NCDC, a total of 1,141 suspected cases were recorded in 2024, with ten states contributing 90 per cent to the total number.
The states listed were Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, Nasarawa and Lagos.
NCDC noted that cholera can be prevented by ensuring access to safe, potable drinking water; proper sanitation and waste disposal; and appropriate hygiene including handwashing.
It warned that raw fruits and vegetables, food from street vendors, and raw or undercooked seafood should be avoided.
To reduce the risk of cholera, the NCDC advised the public to “ensure that water is boiled and stored in a clean and covered container before drinking, practice good personal hand hygiene by washing your hands frequently with soap under clean running water.
“Use alcohol-based hand sanitiser if soap and clean water are not available. Ensure that food is well cooked before consumption. Only consume raw food such as fruits and vegetables, after washing thoroughly with safe water.”
It also advised against open defecation and indiscriminate refuse dumping, urging residents to ensure proper waste disposal and frequent clearing of sewage.
“If you or anyone you know experiences sudden watery diarrhoea, please do not self-medicate, visit a healthcare facility immediately,” the NCDC advised.
Fighting open defecation remains tough
Open defecation also known as OD is a human act of defecating openly in exposed areas such as in bushes, farms, waterways, or drains without appropriate disposal of such human waste.
OD is a serious environmental health hazard affecting third-world countries such as India and Sub-Saharan Africa.
In a joint report by the United Nations Children’s Fund and WHO, it was noted that lack of toilets remains one of the leading causes of illness and death among children.
According to WHO and UNICEF, Nigeria was ranked 5th among countries practising open defecation, while India topped the rank with 626 million people
Open defecation remains a challenge in the country with data from the Sanitation and Hygiene National Outcome Routine Mapping showing that as many as 48 million Nigerians still practice open defecation, representing 23 per cent of the population.
The report said poorest households were 48 times more likely to practice open defecation than the richest households.
To help the nation get started on its path to ending open defecation by 2025, former President, Major General Muhammadu Buhari (retd), announced a state of emergency in the water, sanitation, and hygiene sector in November 2018, and introduced the nationwide campaign tagged ‘Clean Nigeria: Use the Toilet to jump-start the country’s journey towards becoming open defecation-free by 2025.’
Five years later, statistics indicate that more Nigerians are reportedly using bushes, open fields, forests, and water bodies for their convenience.
Of all the 774 local councils in the country, only 100 were declared Open Defecation Free, as of December 2022.
A report by UNICEF published on November 19, 2021, declared that there has been limited progress in the fight against open defecation in Nigeria.
Indiscriminate dumping of refuse
Dumping of refuse on the road was another common practice PUNCH Healthwise observed was a pastime the residents of Ilaje, Bariga and Oworonsoki indulged in.
It was observed that they indiscriminately dump refuse stacked in sacks, nylons, and bags in any available space, especially drainage.
Meanwhile, a 2014 study published in the journal ‘Environmental Health Perspectives’, examined the impact of solid waste disposal on the incidence of cholera.
The researchers found that areas with improper solid waste disposal had a significantly higher risk of cholera outbreaks, even after having control over other risk factors.
They also noted that the risk was higher during the rainy season when heavy rains can cause flooding and spread contaminated water.
Overall, the researchers concluded that improving solid waste disposal would be an important step in reducing the risk of cholera.
Communities without proper toilets, waste disposal risk cholera
Public health experts warned that communities that lack proper toilets and waste disposal systems are at a higher risk of cholera outbreaks.
As Lagos State grapples with the ongoing cholera pandemic, the physicians highlighted the critical role of proper sanitation and hygiene in preventing the spread of the disease.
According to them, communities without access to proper toilets and waste disposal systems are sitting ducks for cholera outbreaks.
A senior Registrar in the Department of Community Medicine and Primary Care at the Federal Medical Centre, Abeokuta, Ogun State, Dr Solomon Olorunfemi described cholera as a highly infectious disease that can be transmitted through contaminated food, water, or direct contact with an infected person’s faeces.
“In areas without proper toilets or waste disposal, the risk of transmission is much higher because people are more likely to come into contact with contaminated faeces, water, or food.
He said, “Cholera is a disease of poverty and poor sanitation. When people are forced to defecate in the open or use inadequate toilets, the risk of cholera transmission increases exponentially,” he noted.
The physician, however, urged the governments and communities to prioritise sanitation and hygiene infrastructure to prevent further outbreaks.
Olorunfemi noted that proper toilets and waste disposal systems are essential for preventing the spread of cholera.
He added, “When waste is properly disposed of and toilets are available, the risk of transmission is significantly reduced. This is why it is crucial for communities to prioritize sanitation and hygiene infrastructure to prevent cholera outbreaks.
“Cholera is a preventable disease. We have the knowledge and tools to prevent it. What we need is the political will and investment in sanitation and hygiene infrastructure.”
Another public health expert, Dr David Ogunsanya, warned that the pollution of the river could lead to outbreaks of water-borne diseases.
He emphasised the importance of good hygiene practices in preventing the spread of cholera.
“Handwashing with soap, proper food handling and storage, and avoiding close contact with individuals who are sick are all crucial in preventing the spread of cholera. Communities must prioritize good hygiene practices to keep their members safe,” Ogunsanya stated.
According to him, the lack of proper toilets and waste disposal systems is a common problem in many parts of the world, particularly in developing countries.
He added, “This is a major public health concern, as it puts millions of people at risk of cholera and other waterborne diseases. We must work together to address this issue and ensure that all communities have access to proper sanitation and hygiene infrastructure.”
The physician recommended that communities establish early warning systems to detect cholera outbreaks quickly to ensure prompt response.
He emphasised, “Early detection and response are critical in preventing the spread of cholera. Communities must establish systems to monitor cases of cholera and respond quickly to prevent outbreaks from spreading.
“When waste is disposed of properly, it reduces the risk of contamination and transmission. This is especially important in areas with high population density, where the risk of transmission is higher.
“Such practice of emptying public toilet waste into river bodies leads to some serious negative effects on both the health of the people who have access to such water bodies and their environment in general.
“This results in faecal contamination of water bodies and generally the local environment, leading to various water-borne diseases, which are diseases transmitted via faecal pathogens in water; the most common being diarrhoea and intestinal worm infections, and also typhoid, cholera, hepatitis, polio, trachoma, and others.”
Environment ministry keeps mum
Efforts made to reach the state commissioner for environment, Tokunbo Wahab, were unsuccessful.
He did not pick up calls or respond to SMS and Whatsapp messages sent to his mobile number.
The Public Affairs Director of the Ministry, Kunle Adeshina, also did not pick up calls or respond to messages sent to him.
Ministry of Health reacts
When contacted, the Director of Public Affairs, State Ministry of Health, Tubosun Ogunbanwo said he cannot comment on issues bordering on open defecation and poor waste management.
“It is the Ministry of Environment that can speak on this issue. You will need to reach out to them,” he said.
When asked to speak on the cholera outbreak in the state, he promised to send a report on it soon.
However, he was yet to do so at the time this report was filed.
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