Health
Unregistered tiger nut drinks caused Lagos cholera outbreak – Govt
Special Adviser to the Lagos State Governor on Health, speaks on the cholera outbreak in the state.
What are the primary causes of the recent cholera outbreak in Lagos State?
There have always been cases of cholera in Nigeria. We typically have isolated cases that we treat. However, we observed a surge in cholera cases between the 10th and 11th of June 2024. This increase qualifies it as an outbreak. The top three affected local government areas are Lagos Island, Kosofe, and Eti-Osa. The Nigeria Centre for Disease Control and Prevention anticipates cholera outbreaks, particularly during the rainy season, as is the case now. Firstly, this doesn’t surprise us. Secondly, we know the necessary steps to take when such outbreaks occur. It largely relates to environmental conditions and what I refer to as the social determinants of health. There are areas lacking adequate clean water, relying instead on wells. Open defecation is also prevalent. When it rains, these factors result in faecal matter contaminating water sources like wells. Other contributing factors include flooding when canals overflow and poor sanitation practices. What we observed was a sudden increase followed by a decline due to our prevention campaigns and efforts to raise awareness, encouraging regular handwashing. So, that’s the crux of the matter.
What specific factors contributed to the increased prevalence of cholera in those particular areas and regions you mentioned?
When there’s an outbreak like this, we have Environmental Health Services officials from the Ministry of Health and the Ministry of Environment who go around ensuring that the environment is kept clean. So when we noticed an increase in cases in Eti-Osa Local Government Area of Lagos specifically, we went there to investigate. We carried out a survey and found that the common denominator, which was one of the deadly factors, was a tiger nut drink. People who came to the hospitals all identified that they had drunk tiger nut drink. We couldn’t just take their word for it, so we had to take that drink and test it to see what was in it. We immediately sent people out to look for those selling it so we could take a sample. We found empty bottles with a name on them, but we discovered that it wasn’t even registered with the National Agency for Food and Drug Administration and Control, the regulatory body that ensures the safety of consumables. There was a phone number and a name on the bottle, and we started tracing. We did contact tracing, similar to what we did with COVID-19. We combed the area to ask people where they got the drinks from. We couldn’t find any full bottles. We only found empty ones, which were of no use because we could not test them. The phone number on the bottle was not reachable. From our investigations, we realised that the beverages were not registered, so the producers hadn’t gone through the processes to ensure that what they were producing was safe for the public to consume. We traced it to that. Of course, cholera is also water-borne, so we took samples of the water to test it. The bottom line is that we took stool samples because different things cause diarrhoea. It could be anything else. We found out that it was confirmed cholera, specifically Vibrio cholera subtype 01, which is the most infectious and aggressive type. There are different types, but we identified this one. In Lagos Island, Eti-osa, and Kosofe, we recorded the highest number of cases that went to the hospital. I’m not talking about reported cases. These are the people who did the right thing by going to the hospital to complain of symptoms, and they were treated. That’s when we were alerted. When the hospitals report cases, we are notified, and we set up an emergency office in Yaba to swing into action. That’s what we’ve been doing since. We continue to test everyone’s stool specimens. Unfortunately, we can’t test everyone because most have already taken antibiotics, which doesn’t give us a good sample. We test those who just came and have not taken anything at home. Hence, part of our campaign is to advise people not to take antibiotics. Pharmacists should not sell them antibiotics. They should come straight to the hospital for testing. We provide oral rehydration therapy, which is crucial during cholera symptoms. It doesn’t mean the other local governments didn’t have cases, they did, but the numbers started decreasing. We were quite relieved because there was a day when we didn’t have any new cases. However, we anticipated an increase after the Ileyah celebrations, which indeed happened. Unfortunately, we also had an increase in deaths. That’s the unfortunate part. More people have died, and about three of them were already dead upon arrival from home. From our history, we realised they had diarrhoea and vomiting for the past two or three days, but they never came to the hospital. They were probably treating themselves locally, which we advise against. That’s how we know. We’re hoping for a decline as we continue our efforts in the community.
The earlier data before the festivities recorded 15 fatalities. What is the case now?
It has increased. As of Thursday morning, we had 21 cases. During an emergency meeting around 11 pm on Wednesday, we received information that someone had died within an hour or two of arriving at the hospital from home. This individual did not just develop diarrhoea on that day but had been at home. The incident could have occurred before Ileyah or around that time, but we are reporting the death now because it happened recently. It’s not a new case that occurred on Wednesday; it’s a new case that has been reported, unfortunately resulting in death.
Aside from diarrhoea and vomiting, what other cholera symptoms should residents know?
It begins with abdominal pain. That’s the initial symptom. Following that, there is diarrhoea. Some cases may also present with fever, though not all. Additional symptoms include vomiting, muscle pains, and cramps, primarily due to the loss of electrolytes. Others include a rapid heart rate and general malaise. Fatigue and tiredness are also common due to the significant loss of water, which carries essential electrolytes like potassium, vitamins, and magnesium. These losses lead to muscle pain and cramps. While watery diarrhoea is the most typical symptom, not all instances of diarrhoea indicate cholera. Some people experience diarrhoea that resolves, but true cholera manifests as profuse watery diarrhoea, almost like water itself, as the bacteria in the small intestine absorb water from the body, causing it to pass quickly through the intestines.
How quickly do these symptoms typically appear after infection, and how is cholera diagnosed?
It varies depending on the amount of bacteria in the body. Symptoms can start within a few hours if the bacteria are already present in your system after consuming contaminated food or water. The onset also varies among individuals, similar to COVID-19 where the virus multiplies differently in different people. Some may experience symptoms within two to five days, but with cholera, symptoms can manifest in as little as 24 hours. Once symptoms appear, it’s crucial to seek medical attention immediately. During outbreaks like the current one, we typically suspect cholera based on symptoms, but confirmation requires a stool specimen. The Nigeria Centre for Disease Control and Prevention has distributed rapid diagnostic tests to all hospitals, enabling immediate testing on-site. Samples are also sent to labs for confirmatory tests.
Upon arrival at the hospital, anyone presenting with diarrhoea or vomiting receives immediate intravenous infusion for rehydration, regardless of test results. Hydration is prioritised to replace lost fluids and electrolytes, crucial for kidney function and overall health. Some patients arriving late required dialysis to manage dehydration-related complications. For those unable to reach a hospital promptly, we recommend oral rehydration with boiled, clean water, a pinch of salt, and a teaspoon of sugar mixed thoroughly. This temporary measure helps maintain electrolyte balance until professional medical care is accessed, ensuring their well-being until they receive proper treatment at a hospital.
In the areas affected in Lagos, how significantly has this outbreak impacted their health and daily lives?
Due to the sensitisation and campaigns, we’re conducting in all those communities, people know they have to be careful because of the outbreak. We revisited the Eti-osa area and did not find a single person selling tiger nut drinks. So the communities are devoid of all those beverages right now. People are aware, and that’s our goal. We want that awareness so that people are careful. We hope people are boiling their water, ensuring they’re washing their hands, and also taking responsibility by informing others not to defecate outside in the streets. Sadly, people continue these practices in their daily lives. Lagosians are very resilient, and we believe this has spread to other states. We know of a case where someone travelled from Lagos to Oyo State and then started showing symptoms, resulting in cases in Oyo State. So the NCDC is monitoring the situation across Nigeria, not just in Lagos State. Lagos State is typically where things originate due to our overpopulation and clustering of people. Many people have travelled to Lagos for festivities and returned to their states, contributing to the spread. It has also been reported in other states, with Bayelsa being the first after Lagos. Therefore, the NCDC is working diligently, providing support for Lagos and all other states.
The NCDC has stated that it may declare an emergency on cholera. What are the implications of this?
An emergency has not yet been declared. The NCDC is monitoring the trends and conducting risk assessments. We are actively involved in this effort. Dr Jide Idriss is the DG of NCDC, and his team members are in Lagos. We are collaborating closely with them, as well as with the Ministry of Environment and the Ministry of Education, particularly concerning children. We are working diligently to ensure that the spread is contained. Risk assessments are ongoing, and further action will depend on whether the NCDC decides to declare an emergency. Hopefully, this will not be necessary as we aim to avoid causing panic. People are going about their daily lives; everyone is going to work, and schools remain open. If an emergency were declared, schools would have been closed. There are established protocols in place. Within the Ministry of Education, we have a quality assurance system that monitors developments and keeps us informed. There have been no reports of schoolchildren vomiting in schools. Teachers have been sensitised and instructed on what symptoms to look for and what actions to take. Hydration measures are also in place in schools. We are actively managing the situation. This is typical in outbreaks; cholera is not new in Nigeria. It’s during outbreaks that the NCDC is particularly vigilant, and we implement these measures.
Is there any collaboration with national or international health organisations in managing this crisis? If so, can you elaborate on these partnerships?
Many people have been mobilised, and we’re working with numerous partners. UNICEF has been fantastic. They excel in providing information. The Red Cross has also been extremely helpful. Additionally, WHO consistently monitors the situation to prevent it from escalating into a pandemic, although we are confident it won’t. We are currently in a monitoring phase. As I mentioned earlier, we anticipated a potential increase following the Ileyah Festival when everyone returns home and settles down, and that’s indeed what we’ve observed. Therefore, we are closely monitoring the situation day by day. We convene every night to discuss developments, where people provide their reports based on the pillars we are focusing on. We analyse electronic real-time data, conduct risk assessments, and oversee community surveillance, among other aspects. Currently, the situation is not deemed an emergency, and we are urging people not to panic. Treatment for suspected cholera cases at hospitals is entirely free of charge. We understand that some individuals may be concerned about medical expenses, but they need not worry as it is a public health concern. Treatment, including diagnosis, medications, and admission, is provided free of charge at all public government-owned hospitals and primary healthcare centres. No one will be asked for payment. While hospitalisation may not be necessary for everyone, we understand the economic challenges people face, which may deter them from seeking medical care.
No fewer than 20,966 Nigerian health workers relocated abroad within one year, according to official figures contained in the State of Health of the Nation Report 2025, obtained by Saturday PUNCH.
The mass exodus comprised 3,919 doctors, 7,487 nurses and midwives, 6,861 medical laboratory professionals, 702 pharmacists, 658 physiotherapists and hundreds of other healthcare specialists.
The growing migration came under the spotlight following the relocation of a Senior Consultant Neurosurgeon at the University of Ilorin Teaching Hospital, Dr Salamat Aliu-Ibrahim, to the United States.
Aliu-Ibrahim, a renowned neurosurgeon, now serves as Medical Director, Paediatrics, at Freeman Children’s Clinic, a facility under Freeman Health System in Joplin, Missouri.
Data obtained from the United Kingdom’s General Medical Council showed that 4,691 Nigerian-trained doctors joined the UK medical register between May 2023 and April 2026.
According to the GMC register, 15,896 Nigerian-trained doctors are currently licensed to practise in the UK, comprising 9,664 males and 6,232 females.
However, President Bola Tinubu, on Friday, appealed to Nigerian medical professionals in the diaspora to encourage more Nigerians abroad to return home and contribute to the country’s development, stressing that there is no place like home.
20,966 Nigerian Health Workers Migrated
An analysis of the State of Health of the Nation Report 2025 showed that only 60,551 of Nigeria’s 95,456 registered doctors currently hold active practising licences, representing 63 per cent. Only 51 per cent of licensed doctors are actively employed within Nigeria’s health system.
The nursing and midwifery workforce, Nigeria’s largest health profession, has also suffered substantial losses, recording the highest level of migration among health professionals.
Although Nigeria has 267,951 registered nurses and midwives, comprising 73,130 nurses, 21,031 midwives and 173,790 nurses with post-basic qualifications, only 113,123 currently hold active practising licences, representing an effective licensing ratio of 42 per cent.
Of those with active licences, 78 per cent remain employed in the country.
The report further showed that 658 physiotherapists have migrated, leaving only 852 of the country’s 8,642 registered physiotherapists with active practising licences.
Similarly, 21 occupational therapists have migrated, while only 11 of the 176 registered professionals currently hold active licences.
There are 257 registered occupational therapist assistants, but only 51 currently possess practising licences.
The report also showed that 431 optometrists have migrated abroad. Of the 6,975 registered optometrists, only 2,156 hold active practising licences, while 66 per cent remain employed locally.
Among opticians, only 307 of the 2,976 registered professionals currently hold practising licences, while 18 have migrated abroad.
UK, US, Canada, Saudi Arabia Top Destinations
The United Kingdom remains a leading destination for Nigerian health workers, particularly doctors and nurses, due to easier professional registration, better remuneration, structured specialist training and persistent workforce shortages within the National Health Service.
Although international recruitment has slowed since 2025, Nigeria remains one of the major source countries for overseas-trained nurses practising in the UK.
A breakdown of data obtained from the UK GMC register showed that 7,875 Nigerian-trained doctors were licensed to practise in the UK in 2020, rising to 9,976 in 2022.
In 2023, the number rose further to 12,198, making Nigeria the third-largest source of foreign-trained doctors in the UK, behind India, with 38,228 doctors, and Pakistan, with 27,739.
Figures from the UK Nursing and Midwifery Council also showed a sharp rise in the number of internationally educated nurses and midwives on its register, driven largely by recruitment from countries including Nigeria, India, Ghana and the Philippines.
According to the council, the number of Nigerian nurses and midwives in the UK has risen above 16,000.
Beyond the UK, the United States and Canada have also become increasingly attractive destinations for Nigerian healthcare professionals.
As of 2020, a total of 3,895 Nigerian-trained doctors were licensed to practise medicine in the US.
Australia has also intensified recruitment of overseas-trained doctors and nurses to address shortages in regional and rural health services, while Saudi Arabia and the United Arab Emirates continue to attract Nigerian healthcare professionals with tax-free salaries, subsidised accommodation and other employment benefits.
The Enugu State Government, through the Ministry of Health, has sealed four private health facilities in Enugu North Local Government Area for operating without valid licences and failing to meet regulatory requirements.
The ministry’s Public Relations Officer, Mrs. Chidiogo Ugodu, disclosed this in a statement issued on Thursday in Enugu, noting that the enforcement action was carried out on July 8.
According to the statement, the ministry has intensified the monitoring and supervision of private health facilities across the state to ensure quality healthcare delivery and strict compliance with regulatory standards.
The renewed enforcement exercise was initiated by the Commissioner for Health, Prof. George Ugwu.
As part of the exercise, the Director of Medical Services, Dr. Chinyere Ezeudu, led a team of senior ministry officials on an unscheduled inspection of private health facilities in Enugu North LGA.
The ministry explained that the exercise was aimed at ensuring that all private hospitals and healthcare providers operating in the state comply with statutory requirements, including the renewal of operating licences and the registration of facilities yet to be captured by regulatory authorities.
During the inspection, the team visited seven private health facilities, assessing their operational status, licensing documentation, and compliance with established healthcare standards. Four of the facilities were subsequently sealed for regulatory violations.
Speaking on the exercise, Commissioner for Health, Prof. George Ugwu, reaffirmed the commitment of the state government, under the leadership of Governor Peter Mbah, to protecting residents by ensuring the delivery of safe, effective, and quality healthcare services.
He stressed that the monitoring and enforcement exercise would continue across the state to ensure that only duly registered and licensed healthcare facilities operate.
Ugwu also urged operators of private health facilities to regularise their operations by renewing expired licences and registering facilities that are yet to be approved.
“The ongoing monitoring exercise is not only a regulatory measure but also a critical step towards strengthening the health system and safeguarding the lives of citizens,” he said.
The latest enforcement follows a similar operation carried out a few weeks ago, during which the Ministry of Health sealed three illegal health facilities in Enugu South Local Government Area for operating without valid licences.
Elder statesman and former Governor of old Anambra State, Senator Jim Nwobodo, has commissioned the newly renovated and re-equipped Neonatal and Special Babies Ward at the Enugu State University of Science and Technology Teaching Hospital (ESUTH), Parklane, Enugu.
The commissioning formed part of the activities marking the 2026 Children’s Day celebration which was attended by top government officials, healthcare professionals and stakeholders in the health sector.
Governor of Enugu State, Dr. Peter Mbah, who was represented at the event by the Secretary to the State Government, Prof. Chidiebere Onyia, commended the intervention and described it as a major boost to healthcare delivery and neonatal care in the state.
He also praised the former governor for coming out to honour the unveiling of the project despite his busy schedules, saying his love for the people of the state would continue to resonate with the administration.
The project, which was facilitated through the Cecilia Oyebola Foundation founded by the Governor’s Special Adviser on Health, Dr. Yomi Jaye, was equipped with modern incubators, infusion and syringe pumps, phototherapy equipment, autoclave machines, baby monitoring devices and upgraded nursing facilities aimed at improving neonatal care and reducing infant mortality.
Speaking on behalf of Governor Mbah during the ceremony, Prof. Onyia lauded Dr. Jaye for his dedication and personal sacrifice towards advancing healthcare delivery in Enugu State.
According to him, the intervention reflected the culture of service and collective responsibility encouraged by the Mbah administration, where public officials contribute beyond their official responsibilities towards the development of the state.
He described Dr. Jaye, who also marked his 51st birthday, as a committed and exemplary public servant whose dedication continued to strengthen confidence in the administration’s healthcare transformation agenda.
Prof. Onyia further stated that the Mbah administration had transformed ESUT Teaching Hospital from the condition it met in 2023 into a modern and rapidly improving medical institution capable of competing with leading healthcare facilities across the country.
He reiterated the commitment of Governor Mbah’s administration to building a world-class healthcare system through sustained investments in infrastructure, equipment and manpower development.
Performing the commissioning and ribbon-cutting ceremony alongside his wife, Dr. Patricia Nwobodo, Senator Nwobodo expressed admiration over the quality of facilities installed at the neonatal ward.
He praised the governor for what he described as unprecedented transformation in the health sector and insisted that the governor deserved overwhelming support for re-election in 2027.
According to the former governor, the facilities and standards at the ward compared favourably with what is obtainable in advanced countries, stressing that the development further demonstrated that the current administration was delivering tangible results across critical sectors.
In his remarks, Dr. Yomi Jaye explained that the project was inspired by his lifelong commitment to children’s welfare and dedicated to the memory of his late mother, who was a teacher.
He disclosed that the renovated ward was designed in line with modern infection prevention protocols critical to newborn survival, recalling the painful loss of his almost twin brother due to infection-related complications.
Dr. Jaye noted that the intervention aligned with Governor Mbah’s vision of transforming healthcare delivery through preventive and patient-centred care, adding that ongoing investments in hospitals, primary healthcare and medical training had continued to reposition Enugu as a leading healthcare destination.
Earlier, the Chief Medical Director of ESUTH Parklane, Prof. Bethrand Ngwu, expressed gratitude to Governor Mbah and Dr. Jaye for their interventions and support towards improving healthcare services in the hospital.
He stated that the administration’s investments had significantly improved healthcare delivery and staff morale, assuring that the newly installed facilities would be properly maintained and maximally utilised for the benefit of newborns and other vulnerable patients requiring specialised care.
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.
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