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.
ENUGU — The Presidential Candidate of the National Democratic Congress (NDC), Mr Peter Obi, and the party’s Enugu State Governorship Candidate, Sir Chinyeaka Ohaa, on Thursday, August 13, 2026, visited Parklane Specialist Hospital, Enugu, to show solidarity with patients battling kidney disease and other related illnesses.
They arrived at about 5:00 p.m. in the company of other party leaders, including the NDC Senatorial Candidate for Enugu East, Ada Ogbu; Hon. Kentus Eze; Hon. Ike Ezugwu; Architect Everastus Odo; Comrade Obi Mamah, H(JP); Hon. Odo Joel; and other party faithful who turned out to receive Peter Obi.
The visit followed a humanitarian gathering convened by Okwuluora to draw attention to the plight of more than 500 kidney patients and their families struggling to afford treatment.
Over 500 Kidney Patients Cry for Help as Families Battle for Survival
It was an emotional scene as men, women and children living with kidney-related illnesses converged at Parklane, hoping to receive urgent assistance.
Many of the patients showed visible signs of prolonged illness and hardship. Some were due for dialysis but could not afford the treatment, leaving them and their families trapped in a painful struggle for survival.
The severity of their condition was evident, with some displaying swollen hands, arms and legs, while others had bloated abdomens and anxiety-filled faces as they awaited assistance.
Among those present was a 13-year-old boy from Akure, Ondo State. His mother said she had sold virtually everything she owned to sustain his dialysis treatment for the past five years. Despite the sacrifices, the boy was at Parklane hoping to benefit from the intervention.
The large turnout has renewed concerns over the growing burden of kidney disease and the rising cost of dialysis and transplant care in the South-East and other parts of the country.
Speaking at the event, Okwuluora commended the stakeholders who supported the initiative and called for sustained assistance for kidney patients and their families.
The national and state leadership of the NDC also commended Okwuluora for his consistent commitment to Nigerians in need, particularly those battling critical health challenges.
In his remarks, Peter Obi expressed concern after listening to the testimonies of the patients. He called on well-meaning Nigerians, corporate organisations and governments at all levels to support kidney patients in dire need of assistance.
The organisers and families of the patients expressed gratitude to Obi for honouring the invitation and using his platform to draw attention to the plight of sick and vulnerable Nigerians.
They also thanked Sir Chinyeaka Ohaa for standing with the people of Enugu during the difficult moment and for demonstrating what they described as leadership that places human lives first.
Appreciation was equally extended to NDC supporters who attended the gathering, with attendees saying their presence offered hope and reassurance to the patients and their families.
The NDC leadership reaffirmed its commitment to advocating for improved healthcare funding, greater access to dialysis and policies aimed at reducing the burden of catastrophic healthcare expenses on families in Enugu State and across Nigeria.
Gov. Peter Mbah says Enugu State remains fully ready to support Nigeria Centre for Disease Control and Prevention (NCDC) on health security facilities and projects within the state.
Mbah said this on Wednesday in Enugu when the Director-General of Nigeria Centre for Disease Control and Prevention (NCDC), Dr Jide Idris, paid him a courtesy call during a working visit to the state.
Represented by the Deputy Governor, Chief Ifeanyi Ossai, the governor said that the government had prioritised all issues concerning security especially those dealing on health security and invested heavily on health and related concerns.
According to him, we are fully ready and committed to work with you by providing land, logistics and other necessary requirements to make all health security projects/initiatives a reality.
He said, “We are fully aware of the need to focus and give priority to health security projects and issues.
“As a state, the high volume of travellers coming in their thousands to the state each day have increased our socioeconomic activities, made more investment possible and increased all forms of tourism.
“However, we recognise that only two weeks of a confirmed outbreak of any dreaded disease will scare away these large inflow of people coming into the state.
“This alone will affect and wipe away the striving tourism industry, our people’s vibrant trade and commerce, striving transport ecosystem, investors influx and the huge investment we have put to make Enugu the most attractive city in Africa.”
Mbah said that every effort or investment in health security “is in the right direction to secure our selves, investments, hopes and future.”
The governor commended the NCDC on their recent fight against COVID-19 and all initiatives to ensure prevention of Ebola virus as well as containing other outbreaks in the country.
“I must commend NCDC team for inspecting the ongoing South-East High Definition Molecular Laboratory and other health projects meant to serve our people, South-East and every Nigerian,” he said.
He assured that the government would undertake any responsibility to ensure that NCDC facilities continue running as well as protecting such facilities notwithstanding the premises they are domiciled in within the state.
On the issue of Ebola Virus, the govenor said that the state was taking the designation of Enugu State as a state with high importation risk “very serious”.
“From assessment, the scare of the disease coming to Enugu is real through the Akanu Ibiam International Airport. We are tightening all preventative measures and protocols, while ensuring robust synergy with relevant stakeholders on it.
“The state ministry of health and its partners are on alert over the issue and we are providing necessary support and access to our office on it,” he said.
Mbah called on the NCDC to give the state needed support in terms capacity building and training, close coordination and guidance as well as awareness materials and support in its preventive efforts.
Earlier, Idris said that visit was meant to access uncompleted South-East High Definition Molecular Laboratory, the level of Ebola Prevention and Preparedness at the Akanu Ibiam International Airport and other related projects.
He commended the state government on huge investment in Primary Healthcare Centres, general hospitals, tertiary hospitals and recently the Enugu International Hospital meant to attract medical tourism.
The director-general said that the NCDC wanted the state government to get involved in protecting And maintaining the South-East High Definition Molecular Laboratory and other facilities of the agency coming up in Enugu.
“We are here to strengthen the existing cordial relationship with the state and see how both NCDC and Enugu State Government can collaborate to strengthen issues of health security,” he said.
The Enugu State Government and key health sector partners have pledged a commitment to sustain the gains of the IntegratE Project.
The IntegratE Project is a five-year family planning initiative that expanded access to reproductive health services through Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) within the state.
The Commissioner for Health, Prof. George Ugwu, gave the commitment on Wednesday during the dissemination of the Enugu State Private Sector Family Planning performance under the IntegratE Project, which ran from Oct. 2021 to July 2026.
Ugwu said that the project had significantly improved reproductive health services and positive outcomes for women in the state over the past five years.
He described family planning as a sensitive but essential service, assuring that the government would continue expanding access while ensuring responsible use.
Ugwu said that Gov. Peter Mbah’s administration remained committed to strengthening primary healthcare outcomes in all ramifications
He revealed that more than 100 new primary healthcare centres would become operational before the end of the year.
The commissioner said that the state government’s commitment to innovation would continue to position the state as a leader in modern healthcare delivery.
Speaking, the representative of the Pharmacy Council of Nigeria (PCN), Mrs Ifeyinwa Ohiaeri, described the project as a major intervention that strengthened family planning services through pharmacy practice.
Ohiaeri stressed that “family planning remains critical” to reproductive, maternal and adolescent health.
She said that the dissemination provided an opportunity to review achievements, challenges and strategies for sustaining the project’s impact, while reaffirming its commitment to professional ethics and quality service delivery.
The representative of the Enugu State Primary Health Care Development Agency, Mrs Maureen Nwankwo, said the agency would sustain the gains achieved.
Nwankwo noted that the programme had helped reduce unintended pregnancies, maternal and child deaths through improved access to family planning services.
Group Director of Donor-Funded Programmes at the Society for Family Health, Mr Emeka Okafor, said the national project tested the pharmacy-led delivery model for family planning in Enugu State.
Okafor noted that while about 70 per cent of residents patronise private health providers, much of the state’s routine health data comes only from the public sector, leaving a significant gap.
He said that according to the project’s implementation report, 29,262 women accessed family planning services through trained PPMVs in Enugu State, while 14,541 referrals were made to public health facilities.
He said that the project also exceeded training targets, introduced digital supportive supervision and contributed to the institutionalisation of the Tiered Accreditation System for PPMVs.
The Pharmaceutical Society of Nigeria (PSN) and the National Association of Patent and Proprietary Medicine Dealers (NAPPMED) also pledged continued support for the initiative/project at the grassroots.
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.
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