 Now, talking health, Niger's 2021 cholera outbreak peaked up steam in July with 451 fatalities in 13 states recorded by the NCDC. The list of states with fatalities shows a strong correlation with the SBM Health Preparedness Index published in May 2021. Only two of the 13 states with cholera outbreaks, that's Bayousa and Kogi, were in the top half of SBM's HPI, while 11 of the bottom 18 states have seen fatalities during the outbreak. Only one of the affected state is in the southern part of the country. Zamfara is the only state in the northwest not affected by the outbreak. Cholera is primarily a disease of hygiene, so this chart shows the amount of work that the state health authorities still need to do in this state to ensure their citizens do not die of preventable causes. Joining us live is Dr. Akeem Masibong, a senior analyst at the SBM Intelligence. Many thanks for joining us on Tlossny's update. Hi, good afternoon. Thank you for having me. You're welcome. Sometime in May this year, your organization released a publication on this case of cholera in Nigeria. So far, it detailed that the states who were susceptible to all of this, how come after the reports have not much was done and we have an outbreak in our hands in Nigeria? So typically what you have with our health preparedness index is that it is a look at the recent past. We take into consideration a number of factors, including things like doctor to population ratio, expenditure on health care, maternal and child mortality in the 36 states of the federation, along with the federal capital territory. What the index shows us, along with other variables, of course, is the states who are more prepared than other states which regard to primary health care especially and primary health care typically entails things like immunization and basic hygiene. And as you rightly said, the issue of the cholera outbreak is something that directly goes to issues of hygiene. And as such, it is no surprise to us because we prepared the index. It's no surprise to us that these states are found most likely. All right. It is sad to note that about 451 fatalities where we call that in 13th state, you know, July with 40, as in July rather with 451 cases, but the question right now is that cholera is not a new case in Nigeria. What does these tell about our public health care delivery in the country? It doesn't tell a good story at all, especially at local government level and state level. Typically what you have is you have local health authorities ensuring that certain standards of hygiene are kept across and the entire state. Now when you have a cholera outbreak, it means that these basic health standards are not being met and are not being enforced. And as such, you know, the states in the states that have these fatalities, especially states like Kano and even states like the FCT, you know, interestingly enough, really have to look very closely at how the local health authorities in those states ensure that basic health standards are kept, not just in homes, but also in businesses and the way they handle food and the sources of water from which they draw to do their various tasks. All of these things are issues that need to be looked at closely. And the fact that we are still having cholera outbreaks in Nigeria that are typically associated with war zones, I might add, because of the issue of sanitation, really tells you all you need to know about just how far we have to go, particularly at local level, local government and state level. That's water and sanitation health. Most times countries who have issues with war or war-torn countries are usually the ones that are basically affected by that of cholera. So what would you say is the reason for the rise in cases in Nigeria? Is it that the average Nigerian lacks some portable or access to portable water, or just the very fact that the insurgency and banditry have actually increased in this northern part of the country? Yeah, so I think that typically you will find that the answer is a combination of those factors. Of course, the issue of portable water has always been something that has dominated this course regarding healthcare delivery. And also, like you rightly note, there have been growing issues of insecurity across the north, especially in the northwest, particularly in the last 18 months. But minus that, you also have under investments in the healthcare sector that we have also been catching as well. So we bring all these things together. It is tailor-made for the kind of periodic outbreaks that you see in our states, and this one in particular seems pretty severe. All right, another final note as we wrap up now. Nigeria is having new cases of the Delta variant that is COVID-19. And of course, we also have the prevalence of cholera. So what would the advice to the government be at this critical time? I think I would direct my advice really to the federal and state governments. And state governments. The federal government, particularly with regard to issues of cholera, don't, are not the first people to speak to when you have these kinds of outbreaks. It is the state governments that you need to speak to. And the local health authorities as well, the local government. So what I would tell them together is that, particularly with regard to COVID-19, for example, is all of those mass gatherings that they typically have should be downplayed for now. Nigeria has just taken delivery of additional vaccines. So ideally, these vaccines should go into the arms of people who are here to receive them. And then also, with regard to issues of cholera as well, really, really look closely at where people get water from and basic hygiene and the basic hygiene facilities that they use. All right, thank you so much for your time. Indeed, we have been speaking on the issue of a rise in cases of cholera outbreak in Nigeria. And of course, that of COVID-19 and the strike of them by the National Association of Resident Doctors. Thank you so much, Joakim, for your time. I do appreciate it. Thank you for having me. Hello. Hope you enjoyed the news. Please do subscribe to our YouTube channel. And don't forget to hit the notification button so you get notified about fresh news updates.