Health
People with O blood group more prone to cholera –Expert
Dr Samson Shonowo, a general practitioner, tells ALEXANDER OKERE about the complications and treatments of cholera, a common but deadly infection
What is cholera?
Cholera is an infectious disease which is transmitted through contaminated water and food; it is usually of sudden onset and characterised by passage of loose watery stools, fluids, electrolytes and subsequent dehydration. Despite being easy to treat, it is a disease that can lead to death, especially in children, if not quickly and properly attended to at a medical facility. It is an epidemic.
What are the causes?
Cholera is caused by a bacterium known as vibrio cholerae. It was discovered in 1883. It is common in Asia, Africa and some parts of Latin America. The bacteria thrive in damp, dirty linen, moist earth and in the stools of patients with the disease. Vibrio cholera bacteria live in shallow salty water. They can also exist as colonies that coat the surfaces of the water, plants, shells, stones and similar items and they can also live among the eggs of flies which can also serve as a good reservoir for cholera bacteria. Once inside the human intestine, the toxic strains of the cholera bacteria produce poison that immediately leads to violent passage of loose or watery stools in humans. Once the bacteria enter where humans live, they can quickly lead to a severe epidemic.
What are the risk factors for cholera?
Everyone is susceptible to cholera except infants who got their immunity from their nursing mothers who have previously had cholera. However, certain risk factors can make you more likely to contract the disease or more likely to have severe signs and symptoms. Some of those risk factors are poor sanitary conditions, reduced or non-existent stomach acid, household exposure, Type O blood group, and contaminated food.
Cholera is more likely to thrive in areas where a sanitary environment, including a safe water supply, is difficult to maintain. Such conditions are common in refugee camps, places with public wells, overcrowded areas, and impoverished countries – areas ravaged by war, famine, natural disasters and drought.
Cholera bacteria can’t survive in an acidic environment and ordinary stomach acid often acts as a defense against the infection. So, people with low stomach acid, such as children, older adults or the elderly, people who take antacids, H2 receptor blockers(cimetidine, ranitidine), proton pump inhibitors (omeprazole, rabeprazole) lack this protection, so they are at greater risk of having cholera.
You are at increased risk of coming down with cholera if you live with someone who already has the disease. For reasons that are unclear, people with type O blood group are twice as likely to have cholera as other blood groups. Eating raw or undercooked seafood, especially shellfish, from certain places can expose you to cholera bacteria.
Also consuming raw, unpeeled fruits and vegetables are a frequent source of cholera infection in areas where there is cholera. In developing countries, uncomposted manure fertilisers, irrigation water containing sewage can contaminate produce in the field. In regions where cholera is widespread, grains like rice and millet that are contaminated after cooking and kept at room temperature for several hours can grow cholera bacteria.
There have been reports of infection and deaths caused by cholera across the country, including the reported deaths of 24 persons in Bayelsa State. How prevalent is this infectious disease in Nigeria?
Between 2010 and 2019, the most severe cholera infections occurred in 2014 and 2018, with an annual infection rate of 58 and 22 cases per 100,000 inhabitants, respectively. The reported cases and deaths have increased a great deal since then.
The consumption of sachet water is common among Nigerians with concerns about hygiene. Can this type of packaged water put one at risk of being infected?
Yes, it can. We all know how people and businesses try to make more profit by cutting cost. This leads to a drop in the standard of safety and hygiene. Ideally, water should be properly treated, the workers should be screened for diseases, hygiene should be strictly enforced in water companies and bodies and agencies that are supposed to monitor these sachet water-producing companies should do their jobs thoroughly.
A lot of people eat fruits already peeled or sliced by roadside sellers. Should this be a concern?
Yes, it should. It is obvious that roadside sellers have little or no hygiene. And it is also difficult to ascertain if they have cholera or live with someone who has cholera since they don’t go through the food handlers screening that major restaurant operators go through. Fruits bought from the roadside should be washed with clean water before they are consumed.
Can you explain the basis of diarrhea in cholera disease?
When the cholera bacteria get into the intestine, they release a poison or toxin that causes the cells that line the inside of the intestines to release or secrete more fluids than they are supposed to. This then leads to severe diarrhoea that can cause death in an otherwise healthy adult, if not treated properly and quickly. This type of diarrhoea is known as secretory diarrhoea.
How long does it take someone who has been infected with cholera to start having diarrhoea?
The time between when the cholera bacteria get to the human body and when symptoms, including diarrhoea, develop is from two hours to five days. This period is also known as the incubation period. About one in 10 people who get infected with cholera bacteria will develop severe symptoms.
Apart from diarrhea, are there other symptoms?
The signs and symptoms of cholera-related diseases are watery or loose stools (diarrhoea) which contain patches or flecks of whitish materials. These whitish materials consist of mucus and the cells lining the inside of the intestines. The size of these patches is about that of rice grains, hence the name ‘rice water stools’ and the stool also smells fishy. Although many bacterial infections can cause diarrhoea, the volume of that caused by cholera can be enormous. About 10 to 18 litres of fluid can be passed in the stool of an adult in 24 hours. People go on to develop other symptoms and signs like rapid heart rate, which is as a result of volume depletion through diarrhoea and vomiting.
There is a loss of skin elasticity, which is usually obvious especially on the hands. It gives an appearance similar to that of the hands of a washer man, hence the term ‘washer man’s hands.’ Other symptoms are low blood pressure, dry mouth and mucous membranes, thirst, muscle cramps, restlessness and irritability, especially in children, unusual sleepiness or tiredness. Other signs that may occur, especially with more severe disease, include abdominal pain or cramps, fever, rectal pain, dehydration, severe vomiting, low urine output, weight loss, seizures, shock and death.
Is dehydration during severe diarrhoea and vomiting a serious problem for those infected with cholera?
Yes, it is. Those infected immediately require rehydration to prevent these symptoms from continuing because severe vomiting and diarrhoea indicate that the person is becoming or is already dehydrated and may go on to develop severe cholera. People with severe cholera can develop severe dehydration which can lead to sudden onset of kidney failure, severe electrolyte imbalance and coma.
People who are prone to severe cholera include five per cent to 10 per cent of healthy people who got infected, a population that has been compromised by poor nutrition and a population with a lot of children or elderly.
How long does it take for dehydration to result in the death of an infected person if left untreated?
If untreated, severe dehydration can rapidly lead to shock and death. Severe dehydration can often occur four to eight hours after the first liquid stool, ending with death in about 18 hours to a few days in poorly treated or untreated people. In epidemic outbreaks in developing countries where little or no treatment is available, death or mortality rate can be as high as 50 to 60 per cent.
What are the other complications of cholera?
Cholera can quickly become fatal. In the most severe cases, rapid loss of large amounts of fluids and electrolytes can lead to death within hours. In less extreme conditions, people who don’t receive treatment can die of shock and severe dehydration hours to days after first symptoms of cholera appear. Although shock and dehydration are the worst complications of cholera, other problems such as low blood sugar (hypoglycemia), low potassium levels (hypokalemia) can occur, kidney failure
Dangerously low level of blood sugar or glucose, which is the main energy source of the body, can occur when people become too ill to eat. Children are at the greatest risk of this complication which can lead to seizures, unconsciousness and even death. People with cholera lose large amounts of minerals, including potassium, in their stool. Low levels of potassium interfere with heart and nerve functions and are life-threatening. When the kidneys lose their ability to filter, excess amounts of fluids, electrolytes and waste accumulate in the body, which is also a life-threatening condition. In people with cholera, kidney failure often accompanies shock.
When then should an infected person seek help?
The risk of cholera is slight in developed nations. Even in areas where it exists, you are not likely to become infected if you follow food safety regulations. Still, cases of cholera occur throughout the world. If you develop a case of severe diarrhoea after visiting an area with active cholera, see your doctor. If you have diarrhoea, especially severe diarrhoea, and you think you might have been exposed to cholera, seek medical treatment right away. Severe dehydration is a medical emergency that requires treatment right away.
What will a doctor look out for in an infected person?
Not all cases of cholera infection exhibit symptoms. Although signs and symptoms of severe cholera are unmistakable in places where it is common, the diagnosis can only be confirmed by testing for the bacteria in stool. Rapid cholera district tests enable doctors in remote areas to confirm the diagnosis.
What are the common ways of treating cholera?
Cholera is easy and straightforward to treat. The treatment, however, depends on the level of dehydration, whether it is no dehydration, some dehydration or severe dehydration. Medical agencies worldwide use the same or similar protocols – rehydration with either oral rehydration solutions or intravenous solutions (drips). Antibiotics are reserved for those people with much more severe cholera infection. Examples of antibiotics include tetracycline and ciprofloxacin. Antibiotic sensitivity should be done because different strains of the bacteria respond to different antibiotics.
In what ways can cholera be prevented?
Cholera can be prevented using several methods. Developed countries have an almost zero incidence of cholera because they have widespread water treatment plants, food preparation facilities that usually practise sanitary protocols and most people have access to clean toilets and hand-washing facilities. Although these countries have occasional lapses and gaps in these protocols, they have prevented many disease outbreaks, including cholera.
Individuals can prevent or reduce their risk of getting cholera by thorough hand washing, avoiding areas and people with cholera, drinking clean water or similar safe fluids, and eating clean, well-cooked food. In addition, there are vaccines that help prevent cholera that are 50 to 90 per cent effective. The vaccines are oral because the injectable have been shown not to be effective. The oral vaccine only works for two years. Oral cholera vaccine is available in Nigeria.
In 2024, the Minister of Health and Social Welfare, Prof. Muhammad Pate, revealed that Nigeria had about 55,000 licensed doctors.
Speaking during an interview on Channels TV’s Politics Today, Pate disclosed that no fewer than 16,000 doctors had left the country in the past five years, while about 17,000 others had been transferred out of active service.
Worrisomely, a new revelation by the Lagos State Commissioner for Health, Prof. Akin Abayomi, indicates that the number of practising doctors in Nigeria has declined from 55,000 to 40,000 within just one year.
In his presentation at a one-day leadership dialogue in Lagos themed “Strengthening PHC Systems: A Joint Leadership Dialogue,” Abayomi identified manpower shortage as one of the most critical challenges facing the health sector.
The dialogue, organised by the Lagos State Primary Health Care Board with support from development partners, addressed barriers hindering PHCs from meeting expectations and proposed practical solutions for building sustainable PHCs with lasting impact.
Abayomi stated that Lagos currently has only 7,000 doctors serving an estimated 30 million residents, far below the number needed for optimal care delivery.
The commissioner raised concerns over the acute shortage of health workers in the state, disclosing that the state requires an additional 33,000 doctors to meet the healthcare demands of its growing population.
“Nigeria currently has about 40,000 doctors against an estimated need of 300,000, while Lagos alone requires about 33,000 doctors but has only about 7,000,” he said.
According to him, Lagos’ doctor-to-population ratio remains far below what is required for optimal healthcare delivery, noting that the state’s doctors are serving an estimated population of nearly 30 million people.
To address the shortfall, Abayomi said the state government is investing in its newly established University of Medicine and Health.
“Within five years, UMH will produce about 2,500 healthcare workers annually, including laboratory scientists and other essential cadres,” he stated.
The mass exodus of healthcare professionals popularly known as japa syndrome, especially doctors, nurses, and pharmacists has remained a major concern in Nigeria.
A 2017 survey conducted by a Nigerian polling organisation in partnership with Nigeria Health Watch revealed that about 88 per cent of Nigerian doctors were seeking job opportunities abroad at the time.
The President of the Nigerian Medical Association, Prof. Bala Audu, recently warned that Nigeria has moved beyond passive brain drain and has become a direct recruitment hub for foreign governments seeking skilled medical professionals.
In an interview, Audu revealed that international recruiters now visit Nigeria to directly hire doctors—particularly specialists such as obstetricians, gynaecologists, and paediatricians—offering them superior working conditions, remuneration, and infrastructure.
He lamented that while Nigeria’s population continues to grow and mortality rates remain high, the country is losing specialists at an alarming rate.
“Many of our doctors are not even going abroad to look for jobs. Foreign governments now come into Nigeria to pick doctors and take them away,” Audu said.
“We are still having more births, yet maternal deaths remain high because the skilled birth attendants who should care for these women are reducing every day.”
Audu added that in some specialties, the number of Nigerian doctors practising abroad may already exceed those still working within the country, a situation worsened by the government’s failure to significantly improve doctors’ welfare despite existing policy frameworks.
Experts have warned that with the current pace of emigration, it would be impossible for Nigeria to produce enough health workers to meet its growing healthcare demands. They estimate that it would take at least 20 years to train the over 400,000 health workers required to close the gap.
A former President of the NMA, Prof. Mike Ogirima, described Nigeria’s doctor-to-patient ratio as “horrible,” noting that the country currently has about one doctor to 8,000 patients—far below the World Health Organisation’s recommendation of one doctor to 600 patients.
Nigerian health communication researcher, Ifesinachi Ayogu, has attributed the rising number of cancer-related deaths in the country to the neglect of routine self-breast examination among women and routine Prostate-Specific Antigen (PSA) testing among men.
Ayogu told journalists on Monday that the failure to prioritise regular screening had contributed significantly to late detection of breast and prostate cancers, which are among the leading causes of cancer-related deaths in Nigeria.
He said many cancer cases were only discovered when the disease had reached advanced stages, making treatment more complex and survival chances lower.
According to him, the increasing burden of cancer deaths calls for a more intentional and sustained approach to cancer awareness, early detection, and preventive health behaviour.
“Early detection saves lives, but many people are not practising simple, routine screening that could help detect cancer early,” Ayogu said.
He noted that breast cancer and prostate cancer were often manageable when detected early, but ignorance, fear, stigma, and limited awareness continued to discourage people from carrying out regular checks.
The researcher explained that self-breast examination allows women to notice unusual lumps or changes early, while routine PSA testing helps detect prostate abnormalities before symptoms become severe.
Ayogu said deaths resulting from breast and prostate cancers were often preventable, stressing that delayed diagnosis was a major factor contributing to high mortality rates.
He added that many Nigerians still lacked basic information on how to conduct self-breast examinations, when to go for PSA tests, and where to seek appropriate medical care.
The health communication researcher emphasised the need for community-based education, especially in rural areas, using trusted platforms such as churches, markets, women’s groups, and radio programmes to promote routine screening practices.
He also urged healthcare providers and public health institutions to intensify public education on cancer prevention and ensure that screening information was simple, accurate, and accessible.
Ayogu advised individuals with a family history of breast or prostate cancer to be particularly vigilant about routine screening and healthy lifestyle practices.
He stressed that promoting routine self-breast examination and PSA testing would play a critical role in reducing late presentation and improving cancer survival outcomes in Nigeria.
Ifeshinachi Ayogu is a PhD graduate student, at the University of Oklahoma United States of America, his core interest is cancer communication, according to him, he believes that the next breakthroughs in cancer care for Nigerian women and men will not come from medicine alone.
The Federal Government said it had intensified monitoring and screening procedures at all points of entry in response to the ongoing outbreak of the Ebola Virus Disease in the Democratic Republic of Congo.
The Director of Port Health Services at the Federal Ministry of Health and Social Welfare, Dr Akpan Nse, disclosed this in an exclusive interview with Saturday PUNCH on Friday.
Nse also noted that additional staff had been employed to strengthen border surveillance in the country.
Health authorities in the Democratic Republic of Congo declared an outbreak of Ebola virus disease in Kasai Province, where 28 suspected cases and 16 deaths, including four health workers, had been reported as of September 5, 2025.
The outbreak comes at a time when much of Central and West Africa is grappling with overlapping health and humanitarian crises, including cholera, malnutrition, and population displacement.
The DRC’s last outbreak of Ebola virus disease occurred in the north-western Equateur Province in April 2022.
It was brought under control within three months.
In Kasai Province, previous Ebola outbreaks were reported in 2007 and 2008. Overall, the country has experienced 15 outbreaks since the disease was first identified in 1976.
Ebola virus disease is a rare but severe, often fatal illness in humans.
It is transmitted to people through close contact with the blood, secretions, organs, or other bodily fluids of infected animals such as fruit bats (believed to be the natural hosts). Human-to-human transmission occurs through direct contact with the blood or bodily fluids of an infected person, contaminated objects, or the body of someone who died from the disease.
In the ongoing outbreak, samples tested on September 3 at the National Institute of Biomedical Research in the capital, Kinshasa, confirmed that the cause was Ebola Zaire, a strain of the Ebola virus.
Dr Nse noted that although Nigeria was at risk of importing the virus due to high levels of international travel with the DRC, Port Health Services was on alert and had strengthened surveillance to prevent this.
He said, “We have intensified surveillance at all points of entry across the country—airports, land borders, and seaports. Every inbound traveller coming from Congo to Nigeria is thoroughly screened, and we collect their medical history through mandatory forms.
“We have also reactivated our portals. Every passenger on every flight coming to Nigeria from Congo is screened upon arrival. This applies to airports, seaports, and land borders. Even if passengers transit through Congo on their way to Nigeria, they must undergo screening.
“In addition, with support from WHO, we have recruited more staff to enhance surveillance. Increasing the workforce allows us to effectively prevent the importation of the virus and ensure thorough screening at all borders.”
He added that some private organisations had partnered the Federal Government to ensure that thermal scanners at airports remained fully functional.
Meanwhile, the WHO has released $500,000 from its Contingency Fund for Emergencies to support the response to the Ebola Virus Disease outbreak in the DR Congo.
Announcing this at a media briefing on global health issues on Friday, the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, disclosed that 28 suspected cases and 16 deaths had been reported so far, including four health workers.
He highlighted that the UN body already had staff on the ground in Kasai, with more on the way.
“We’re joining rapid response teams to trace contacts and find cases; we’re collecting and testing samples, and we’re providing technical expertise in surveillance, infection prevention and control, treatment, risk communication, and more. WHO has also delivered personal protective equipment, laboratory equipment, medical supplies, and a mobile laboratory.
“We had previously prepositioned 2000 doses of Ebola vaccine in Kinshasa, which we are releasing to vaccinate contacts and health workers. This is the 16th outbreak of Ebola in the DRC, and the government has rich experience from those previous outbreaks,” the WHO boss stated.
The Nigeria Centre for Disease Control and Prevention says the country has recorded a total of 807 suspected cases of cerebrospinal meningitis, and 74 deaths from 22 states as of March 26, 2025
The NCDC stated that the Case Fatality Rate is at 9.2 per cent as of March 26, 2025.3.27
The centre disclosed this in a statement titled: “CSM outbreak: NCDC rapid response teams in Kebbi, Sokoto, and Katsina states,” signed by its Head of Corporate Communication, Sani Datti, on Thursday.
It said its Rapid Response Teams are already in Kebbi, Sokoto, and Katsina states in response to the ongoing outbreak of CSM.
It noted that the deployment follows a significant increase in suspected cases reported from these states.
“As of 26th March 2025, a total of 807 suspected cases and 74 deaths have been reported across 22 states, with a CFR of 9.2 per cent.
“Affected states include Kebbi, Katsina, Jigawa, Yobe, Gombe, Adamawa, Borno, Ebonyi, Oyo, Bauchi, Ondo, Kaduna, Osun, Akwa Ibom, Anambra, Bayelsa, Benue, Ekiti, Niger, Plateau, FCT, and Sokoto.
Idris emphasised the importance of personal safety and instructed all team members to strictly observe infection prevention and control protocols throughout the response effort.
“The deployed teams, comprising multisectoral and interdisciplinary experts—including specialists in case management and lumbar puncture techniques—are already in the affected states and working closely with the state health authorities to contain the outbreak and prevent further transmission.
“Key objectives of the response include rapid containment of the outbreak; strengthening case management and IPC measures; enhancing surveillance and sample collection; conducting risk communication and community engagement activities; and identifying the outbreak’s source and recommending appropriate public health actions.
“The NCDC remains committed to supporting state governments and partners to safeguard the health of Nigerians through timely and effective response to public health threats,” he stated.
Health
WHO Lauds Enugu’s Healthcare Innovations, Declares Engr. Beloved-Dan Anike Most Pro-Health Chair
The World Health Organization (WHO) has commended Enugu State for its outstanding leadership in advancing Universal Health Coverage (UHC), recognizing the Executive Chairman of Enugu East Local Government Area, Engr. Pst. Beloved-Dan Obi Anike, as the most Pro-Health Mayor in Enugu State.
This recognition came during the official flag-off of the Enugu East Health Insurance Scheme at the Enugu Type Two Primary Health Care Center in Emene. The WHO South-East Zonal Coordinator, Dr. Chukwumuanya Igboekwu, highlighted the initiative as a groundbreaking model, marking the first time a Local Government Chairman in Nigeria has committed substantial resources toward community-wide healthcare access.
Dr. Igboekwu emphasized that Enugu East’s proactive approach aligns with global best practices, strengthening health security and enhancing economic growth through a healthier workforce. He applauded Enugu State’s strategic healthcare reforms, positioning it as a front-runner in the drive for Universal Health Coverage.
In his remarks, Engr. Pst. Beloved-Dan Obi Anike revealed that the newly launched scheme will enroll 5,000 elderly residents—both indigenes and non-indigenes aged 60 and above—into the State Universal Health Coverage program. The initiative, set to run from April 1, 2025, to April 1, 2026, guarantees free healthcare services for these beneficiaries.
The Mayor expressed gratitude to the Executive Governor of Enugu State for spearheading a wave of disruptive innovations across multiple sectors, particularly in healthcare. He reaffirmed his administration’s commitment to aligning with the state government’s vision, stating, “When you have a Governor delivering over a thousand projects concurrently, you must take steps to keep up with his momentum.”
As part of this commitment, Engr. Anike disclosed that his administration has also commenced the construction of Type One Primary Healthcare Centers in Neke-Uno and Obinagu Nike communities, with approval secured for three additional centers across Enugu East LGA.
Dr. Ifeyinwa Ani-Osheku, Executive Secretary of the Enugu State Primary Health Care Development Agency, described the initiative as a monumental achievement, emphasizing its life-changing impact on the elderly population. Similarly, Dr. Edith Okolo, Executive Secretary of the Enugu State Health Insurance Scheme, hailed the project as a historic milestone, ensuring that 5,000 people in Enugu East LGA will receive free healthcare for an entire year.
The event also had in attendance notable dignitaries, including the Member Representing Enugu East Rural Constituency, Hon. Raymond Ugwu; the Honourable Commissioner for Water Resources, Dr. Felix Nnamani; Member 4 of the Enugu State Local Government Service Commission, Amb. Mrs. Amaka Nweke; the Chairman of the Nigerian Medical Association, Rotarian Dr. Sunday; the PDP Chairman in Enugu East LGA, Hon. Okey Igbokwe, among others.
These stakeholders echoed WHO’s commendation, applauding the Enugu State Government’s unwavering commitment to strengthening healthcare systems and improving access to quality medical services.
Enugu State’s healthcare innovations continue to set a precedent, reinforcing its reputation as a leader in Universal Health Coverage and community-centered healthcare policies.
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