IRIN Background report on epidemics in northern Nigeria

[This IRIN report does not necessarily reflect the views of the United Nations.] Cholera, measles, guinea worm and cerebro-spinal meningitis have become endemic epidemics in parts of central and northern Nigeria, taking turns between the country's two main seasons to ravage large populations of people, health and aid workers say. With the rainy season now at the peak in the region, cholera is currently taking a big toll across several states in the north of this West African country of 108 million people, leaving hundreds dead and thousands hospitalised. The worst affected states include Kano, Borno and Katsina in Nigeria's northern fringe. Outbreaks have also been reported in the north-central states of Kaduna and Bauchi. "Most heavily hit is Kano State," an official of the French humanitarian group Medecins Sans Frontieres, which has been involved in combating the cholera outbreak, told IRIN. In Kano MSF has treated over 700 cases, with 60 people dead in its treatment centres, he said, "But it is hard to know how many people have actually died." In June, at least 60 people were reported dead out of over 200 admitted in hospitals for the epidemic in Kaduna State. Local officials in the north-eastern state of Borno, overwhelmed by the scale of the disease, reported another 40 dead. In the past two weeks cholera has claimed at least 50 lives in Katsina State, with 20 people dying in one day in the worst affected Fafana local government council. Cholera, which thrives in areas of poor hygiene, is an acute intestinal infection that can cause cramps and severe diarrhoea. The disease is caused by people consuming food or water contaminated with the bacterium vibrio comma. "In northern Nigeria the main cause of the disease is shortage of drinking water, which forces a lot of people to resort to unwholesome sources such as ponds and streams with faecal contamination," Isaiah Angulu, a health official in Kaduna State, told IRIN. Equally water-borne is guinea worm which, while not fatal like cholera, has a debilitating impact on its victims. Former Nigerian military ruler General Yakubu Gowon, a member of Global 2000 founded by former President Jimmy Carter of the United States which has been fighting to eradicate guinea worm in the country, said the incidence of the disease had fallen from 700,000 victims a decade ago to about 14,000 in 1998. Gowon said most of the remaining victims were to be found in a few states of Nigeria where special efforts will be required to eradicate the disease. Guinea worm incapacitates its victims who are often farmers, thereby undermining agricultural productivity and food security in many rural areas. "Gombe State is one of those endemic areas where it will take extra efforts to curb the menace," he told a local newspaper recently. At least 640 new cases of guinea worm have been reported from the area, he said. Health officials in Katsina State said over 5,000 people had been infected by the worm, mainly in Matazu, Dutsin Ma and Rimi local council areas, where the only source of domestic water were infected ponds and streams. "In one village alone, known as Karadua, more than three thousand people are infected," one official said. However, many health and aid workers worry that as soon as the rainy season is over in October they would have to contend with measles and meningitis, the spread of which is usually accelerated by the dry, north-southerly harmattan winds from the Sahara Desert. "The airborne diseases which seem to take a break during the rainy season usually come back strongly in the dry season," Charles Okoye, a Kaduna-based medical doctor, told IRIN. He said measles and meningitis are spread very quickly this way, accounting for their high rate of fatalities. Health workers said while meningitis killed relatively fewer people, mainly due to vaccination programmes implemented by local health authorities and international aid agencies, measles took a heavier toll. "Measles was very heavy this year before the rains came in June, claiming hundreds of lives, particularly among children under five," an MSF worker told IRIN. Reasons for the heavy toll of this infectious disease include low levels of immunisation among the mostly affected rural communities, health workers said. However, rural poverty is singled out as a circumstance aggravating what could have been a relatively easy disease to control. They advise that President Olusegun Obasanjo's government should direct considerable efforts towards alleviating rural poverty in order to make the job of health workers easier. "It is really frustrating to treat some of these diseases while aware that the circumstances which created them have not changed, and that more people are still going to be affected," Okoye said.