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.
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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