 The Nigerian Centre for Disease Control, NCDC, has released a situational report of cholera cases in Nigeria. And we've invited Dr Iman al-Khafo to discuss this with us. Good morning, Dr Al-Khafo. Hello, good morning. Thank you for having me. Thanks for joining us. The NCDC is reporting over 70,000 cholera cases in Nigeria, and over 2,300 deaths in 25 states and the FCT. Do you think Nigerians understand the gravity of this situation? To the largest extent. I don't think the general populace has a full grasp of what is going on in the community in terms of the cholera outbreaks, because the number of suspected cases and, of course, the number of suspected deaths have been on the rise for quite a while now. Right from, like you said, right from January, the first up to now over 70,000 deaths, over 2,000, sorry, over 70,000 suspected cases and over 2,000 deaths. This is quite a significant amount when you look at the number that we actually detect. So I think important information is to be passed to the public, to the public concerning what is going on and at least that's what we're doing right here. And this will go a really large way. Alright, talk a little bit more about what cholera is and how it is spread, because we were talking about 25 states. Does it mean that the water in 25 states in Nigeria currently are, you know, infected? So what exactly is cholera and how is it spread? Okay, here's what cholera is. Cholera is primarily a water-borne disease, right? It is an intestinal infection caused by a certain bacteria. It's the passage of high amounts of watery diarrhea. Okay, here is some of the signs in which women suspect they have cholera is the watery diarrhea, like we said, large, large amounts. It may start off with, it may start off with having some too many, right? Some thicker matter in it. But, you know, as it progresses, because cholera can have a clinical manifestation within two to three, four, five days of, you know, it's getting started. So apart from the water diarrhea, you could have nausea. That's the feeling of wanting to vomit. You could actually vomit. And like I said earlier, it may start off as just watery stool and you're still seeing some materials that suggest stool. But as it progresses and as it gets worse, it just becomes like a white opaque fluid, right? Like we usually like to wash the water that you get after you wash rice or when you want to cook rice. When you notice your stool has become like that, right? And you're seeing that it is really, really, the amount you're getting is really, really large. There's a high chance that, you know, cholera is ongoing. But like I said, it's an infection with a certain kind of bacteria. Yeah, but how is it, you know, how does cholera spread? Is it through dirty water or through food? Yes. Yeah, okay. Cholera spreads through contaminated food and contaminated water. So it goes both ways, right? So once you have water because you have the organism that is causing it primarily, right? It has human reservoirs and water reservoirs. Those are the two primary reservoirs in which you have them. So once, you know, we have contact with someone, you know, that, you know, has, let's say someone that has cholera, right? It goes ahead to prepare your food because cholera is not always symptomatic. You don't always have symptoms from cholera, right? So you could have somebody. So just imagine a food seller who has cholera but is not showing any symptoms. Constantly preparing food for people. She's not washing her hands. She's not following good hygiene practices. You would just have, you know, cholera spread to a whole lot of people. Also places that have, you know, poor access to water, clean water. You could have, you know, a body of water that is, you know, widely contaminated with the organism and they just take it in, right? And we experienced this in certain parts of Nigeria where open defecation is common practice, right? So you can just go to large bodies of water and, you know, dump the excreta there. When someone goes ahead to drink that water, right? No boiling, no chlorination, nothing to take care of the water. Depressing, consuming such water, consuming such food as earlier described, yes, could get cholera. So that is how it spreads. Okay. I want you to tell us more about how it spreads because I've spoken to other medical practitioners and they also emphasized on seafood and how it should be prepared to avoid cholera. Please tell us more about that. Okay. When it comes to seafood, you could have it. We notice, you know, sometimes things like crabs. You could have, you could have the bacteria, the organism, stay in those kind of organisms in water bodies. So the primary thing there is to make sure if you're taking seafood that you boil it well, right? Emphasis on boiling, for example, in crabs, people eating crabs, it's been demonstrated that, you know, if you boil it for up to 10 minutes, if you boil the crab for up to 10 minutes, the likelihood of you getting cholera is super low. But even if you just deviate from that in the two bits, right, we have still seen cholera in significant quantities in crabs that are boiled over a shorter period of time than 10 minutes, right? 18 minutes, you still see some roots of the bacteria. For 10 minutes, generally, you're good to go in boiling your seafood. Nice addition to what I mentioned earlier, how people could get it. You mentioned crabs. How about fishes? Do we also need to take such percussion? Especially when you drive around Lagos, you know, these bridges, you see fishermen, you know, putting their hook and bait into the water and, you know, they catch these fishes, people buy them on the roadside. Do we also need to take such precautions? So generally, right, whatever is going into your mouth, whatever is going into your body, to your mouth, especially as it pertains to food, right? Once it's edible once you're thinking of consuming it, you want to make sure that it is appropriately cooked or appropriately boiled, right? This can't be over-exercised because, you know, doing less than is necessary, doing less than you should could lead to, you know, one getting cholera, of course. Okay, now let's talk about managing cholera. We heard about 70,000 cases, 2,300 dead. Talk about the process of managing a patient that has been found to have cholera. Okay, well, I'll start off by talking about its prevention, right? Because, you know, I believe most of the doctors already know what to do in the cases of cholera. The most important thing to tell people, you know, that they're going to be viewing this right now, that watching this right now is to prevent it in the first place, right? We want to make sure that they are taking whatever water they are taking, they properly boil it and destroy it safely, right? And nothing is to make sure that whatever food that they are eating is properly cooked. They want to cook it thoroughly. They want to make sure they are also preparing it in a safe and in a clean environment. The other thing is to make sure that, you know, people wash their fruits, their vegetable, whatever raw foods they are taking. They want to make sure you don't just, you know, pick it and stuff. You want to make sure you wash it thoroughly. People should also practice good hand hygiene, right? Wash your hands regularly, sanitize your hands when you need to. And for people to also avoid open defecation, okay? People, you know, the habits of, you know, just dumping, you know, excreta, maybe close to whatever this or whatever this should be eating of the past, to be honest. And then patronizing just, you know, just any food you see on the road, you want to be careful with that because you don't even know, you know, the process that goes into preparing it. That's being said when it comes to doctors and managing patients that, you know, had cholera ongoing. Our primary thing that we're looking at is to replace the fruits the person is losing, right? Because the person is losing fluids and electrolytes. In this instance, let's just call them body chemicals. So the person is losing all these fruits, either the stooling, which is frequent, which is profuse. Like I said, it can get so bad that the person can actually pass on within some hours of developing, you know, active symptoms of cholera, right? So you want to replace those fluids and remember the person might be committing as well. So I want to replace those fluids as soon as possible. I want to replace those electrolytes as soon as possible. That is the main thing that is going on in our mind because that is the primary thing that even kills people, right? Not just the infection in itself. It's the dehydration that comes with the infection. So I want to make sure we manage that. Then, of course, we have our antimicrobial therapies and other therapies that we use to support such patients that we discover have in case of cholera ongoing. Okay. Dr. Okafor, when we look at the statistics that the NCDC has put out their report, it says that Bouchie State has the highest number of cases, 566, while Bournemouth State recorded the most deaths that 13 in the past week. But I want us to talk about the myth that cholera is a disease you can only get in the rural areas because we know about the prevalence of open defecation, people pouring into bodies of water, and then people go into the streams to use that water to drink and cook without properly washing and boiling. So we know about that. But there's also that misconception that, oh, I'm in an urban city like Lagos, I can't get cholera. I want you to address that, especially with how our buildings are being constructed, when your borehole is sited up and your borehole is sited down and then your shockwave kit is sited up and the possibility of that sipping into the water that you consume. Please tell us more about that. Okay. There's no question. There's no doubt that cholera is more common in rural communities, right? And that is simply because access to clean water is precisely more common at this time in the urban cities, right? Access to facilities that process in the water that contaminates the water is more common in urban cities. But that means the possibility of having cholera is not excise involved, right? As long as food that people are consuming is involved, there is always that possibility. So it's just the responsibility of having a heightened sense of awareness of this disease, right? Especially now that it's an outbreak ongoing. People want to make sure that they do their possible best to prevent it in their own communities, to prevent it in their own families by taking care. Yet cases happen in urban centres. That is a fact, right? So it is not even something that should be in anyone's mind that the shared facts, that they are staying maybe in Lagos, shared facts that they are staying in an urban community that they are exempt from it. And just like you said, baubles need to be cited at the appropriate places. Even the process of going to the toilets, right? Of passing feces has to be done appropriately. The sewage that we produce has to be disposed properly even in these urban centres. The urban centres have more sewage disposer rates than the others. So everything has to be in place, right? What is preventing the cholera is the appropriate practice that will take not just the fact that we are in an urban centre. Alright. Is there also home remedies? Is there ways to manage a cholera patient at home? Or, you know, the case must be taken, or the person must be taken to the hospital? Yeah, the person wants to present with a case of profuse diarrhea that, you know, once you suspect you have cholera, there is no room for you to stay at home and manage it. No, you present to the hospital, the doctor will be the one to tell you, okay, you can take this, this, this at home, right? The doctor will be the one to assess you. Because someone could actually be on the brink of, you know, kidney shot down as a result of dehydration as you think that they can manage it at home, right? Cholera is something that once it gets started, right, once you start having clinical symptoms, it can get really, really bad, really, really quick. So you want the assessment and everything to be done in a hospital. The doctor will know whether he's admitting you. He will know whether, you know, he's comfortable with saying, oh, okay, it's not gotten super bad so far that you can, you know, take so, so, so, and the doctor has to tell you what to take as well, right? Because it goes beyond you just buying some medications or maybe trying to drink water or something. No, there's much more to be done than that. So every case of suspected cholera, we advise that the person gets medical attention as soon as possible. Okay, my first question to you earlier was, if Nigerians understand how serious this cholera situation is, and you just mentioned, you know, the possibility of a kidney shutdown because of cholera, can you tell us more about that? And, you know, the challenges that we might have with, you know, internal organs, you know, when someone is diagnosed with cholera and they don't treat it fast? Oh, okay, it's pretty simple, right? Once the, there is, once there is dehydration ongoing in someone's body, once someone is not having as much fluid as they should come into their body and, you know, the kidney is primarily responsible for filtering, you know, some of the things that are not to be in the body, right? And it needs fluid to go through it regularly. Once that it's not been done, once there is that, you know, lack of supply of fluids to the necrosis, right? It's just, you know, partial debt or some parts of the kidney and you would see the kidney start to malfunction. It could go into an acute, it could have something called acute kidney injury which could progressively lead to, you know, a chronic kidney disease and other, you know, kidney pathogenic manifestations. So, we just want to make sure the most important thing that the populace needs to know right now is that that's the hydration and have more consequences that they know, especially when it's not feeling weak, right? That's a big thing for us, right? When someone that has missed doing a lot, you know, starts having, starting to feel so weak that, you know, they don't even want to take water or they don't want to be fed early at all. They just, they're just denying the tragic, you know. So, to everybody listening, it's a pretty serious thing, right? It's not just that you're playing more than usual. It is, it is something that you need to get help immediately, get help as soon as possible. Don't try to wait it out at home. Don't try to enjoy it and see. Don't try to chest it and put, right? Just present and get care. It is something that once we start treating early, right, fatality rates, people that die is much, much less than 1%, right? Play with those, play with those. But it is also something that without treatment, that's where we see high number of cases of deaths from this cholera go up. So, it's pretty, cholera has been there for a long, long time, right? Even as early, there have been cases that were described that are similar to cholera as far back as, I think, 360 BC. So, it's super, super important there. So, it's not something that we're on our way of, it's not something that we're not beginning with. So, it's super important that people get care for this, they stay that persistent for this long. Dr. Okafor, finally, quickly also share if there is any age group that is more at risk to fatality with regards to cholera. And also, once again, warning to Nigerians who are watching about the severity of this disease and what must be done. Yeah, okay, so when it comes to age predisposition, we see that most of the cases, especially in the country, according to the reports that we have from the NCDC that has been really active with activities. You know, they sent out different rapid response teams to the most affected community, started cholera emergency operations centers to help with surveillance, detection and immediate treatment. Sorry, one second. The ages that we see that are disposed is from five to 14 years, right? We see the most cases or the most affected who did that age range, five to 14 years, right? I remember these are children. They need care as soon as possible. It's not something that their parents should just be watching and hoping for the best. It is something super serious. In children, it can go bad pretty, pretty quick, right? And outcomes also in terms of mobility, in terms of real fatalities are worse in children than it is in adults. So cholera is something to be taken seriously, especially because of how it spreads, right? It's not, like I said, an adult can be asymptomatic. He may not show any symptoms. So we may not even show any symptoms from having cholera, right? So you might have, let's say, an asymptomatic parent preparing food regularly for the children, right? And the children just, everybody's just doing it and they're wondering what's going on. So having that in mind, it is important to pay attention to all the prevention methods that I mentioned earlier in the show and that we should also work towards eliminating this totally the best way that we can by following the processes I mentioned. Everyone should be highly alert. There's an outbreak going on. Be highly alert about the cholera outbreak that is ongoing. Take adequate, now is not the time for you to be drinking any kind of water. Now is not the time for you to be taking any kind of food, right? It doesn't, it may not show the person's face. The person will be walking, cooking, in fact, in history, there's a popular case of that, you know, that I will be able to go into details. With one person, just give so many people without even, you know, on heart, she have most symptoms whatsoever, right? For several people, we are dying as a result of this. So, let's wash our hands properly and take clean water. So, that's it, thank you. Dr Amano, thank you very much for your time and for speaking with us. Of course, I hope that the message has been properly spread. Thank you. I wish you a great day ahead. Thank you again. Thank you very much for having me. Absolutely. Yes, and that's it. This edition of the Breakfast on Plus TV Africa we've really had an interesting run beginning with that police officer who was denied asylum in Canada because of his association with the Nigerian police force all through to the Kogi-Krisenbrick story and now having the medical doctor share with us the importance of good hygiene because of the increasing cases of cholera in Nigeria. If you missed out on any part of the conversation, do follow us on all our social media platforms where we're at Plus TV Africa. I am Annette Phoenix, asking you to have a great day. And I am Osau Ghe, Ogbawang.