💧 Men's Health

Cholera Prevention & Treatment in Nigeria

Q: Should I stop eating during cholera?

No — continue feeding as soon as tolerated. Children especially should continue breastfeeding. Restricting food worsens nutritional status and slows recovery. Oral rehydration should be given alongside, not instead of, normal nutrition.

Q: How do I protect my family during a cholera outbreak?

1. Drink only water that has been boiled for 1 minute or treated with water purification tablets (sodium hypochlorite — 2 drops per litre, wait 30 minutes). 2. Wash hands with soap and water (or hand sanitiser) after toilet and before handling food. 3. Eat only freshly cooked food. 4. Avoid buying food from street vendors during outbreaks. 5. Dispose of faeces safely — use a latrine, not open ground. 6. Report any suspected cholera case to the nearest health facility immediately.

Understanding Nigeria's recurrent cholera outbreaks and how to protect your family

Cholera is an acute diarrhoeal infection caused by Vibrio cholerae — transmitted through contaminated water and food. Nigeria experiences regular cholera outbreaks, particularly in northern states, during and after flooding, and in areas with inadequate water sanitation and hygiene (WASH). The 2021 Nigerian cholera outbreak was one of the worst in recent years — over 100,000 cases and nearly 3,500 deaths. Cholera is characterised by sudden, profuse, painless watery diarrhoea (known as 'rice water' stools) and vomiting — causing severe dehydration that can be fatal within hours. Yet cholera is both preventable and treatable — with death nearly always avoidable with prompt oral rehydration therapy.

Signs and Symptoms

✓ Sudden onset of profuse watery diarrhoea — 'rice water' stools (grey-white, odourless)

✓ Rapid volume loss: up to 20 litres per day in severe cases

✓ Vomiting (usually without nausea)

✓ Rapid progression to severe dehydration: sunken eyes, dry mouth, skin tenting, rapid weak pulse, low blood pressure, reduced urine output

✓ Muscle cramps (from electrolyte loss)

✓ In severe cases: hypovolemic shock, kidney failure, metabolic acidosis, coma within hours

✓ 70–80% of infections are mild or asymptomatic — but infected people still shed bacteria in stool and contaminate water

Risk Factors

Contaminated drinking water: the most important risk. Surface water (rivers, streams, wells) contaminated with human faeces during flooding
Eating food prepared with contaminated water: rice, pap, soups reheated inadequately
Street food and raw vegetables washed in contaminated water
Open defaecation near water sources
Flooding: disrupts sanitation systems, contaminates water supplies — major amplifier of outbreaks
Displacement camps and overcrowded settings with inadequate sanitation
Areas with no access to pipe-borne water (most of rural Nigeria)
Blood group O: higher risk of severe cholera for unknown reasons

When to Seek Help

Sudden profuse watery diarrhoea + vomitingPresume cholera in an outbreak context — start ORS immediately and go to a cholera treatment centre

Signs of severe dehydrationSunken eyes, extreme thirst, inability to speak, no urine output, cold hands — requires immediate IV rehydration

Any dehydration in children under 5Children dehydrate much faster than adults — seek help within 2–3 hours of onset of severe diarrhoea

During a declared cholera outbreakAny acute diarrhoeal illness in the community should be reported to the LGA health department and assessed at a cholera treatment centre

Household contact of a confirmed cholera caseProphylactic doxycycline may be offered during outbreaks. Intensify water and hand hygiene

Tests & Diagnosis

🧪 Stool culture for Vibrio cholerae

Gold standard — but takes 24–48 hours. Diagnosis is usually clinical during outbreaks, confirmed by culture retrospectively

🧪 Rapid diagnostic tests (cholera RDT)

Crystal VC or similar dipstick tests — result in 15 minutes. Used in outbreak settings. High sensitivity but limited specificity

🧪 Electrolytes and creatinine

In severe dehydration — guides IV fluid replacement and monitors for kidney failure

🧪 Full blood count

Haemoconcentration (raised haematocrit) indicates dehydration severity

🧪 Blood pressure and pulse

Most important bedside assessment — monitors severity and response to rehydration

Treatment Options

Oral rehydration solution (ORS) — life-saving and the cornerstone of treatment

WHO ORS: 1 sachet dissolved in 1 litre of safe water. For mild-moderate dehydration: 50–100mL/kg over 4–6 hours. ORS available free at all PHCs during outbreaks. Homemade: 6 level teaspoons of sugar + 1 level teaspoon of salt in 1 litre of safe water — effective if ORS unavailable

IV fluids — for severe dehydration and shock

Ringer's lactate preferred (corrects acidosis). Rapid infusion: 30mL/kg in 30 minutes for adults in shock. Then continue at 10mL/kg/hour. Transition to ORS as patient improves

Antibiotics

Doxycycline 300mg single dose (adults) — reduces duration of diarrhoea and cholera excretion. Azithromycin for children and pregnant women. Only for moderate-severe cases — does not replace rehydration

Zinc supplementation

Zinc 20mg/day for 10–14 days for children — reduces stool volume and duration

Cholera vaccine (Shanchol/Euvichol)

Oral vaccine — 2 doses 2 weeks apart for adults and children > 1 year. Used in outbreak control and for high-risk communities. Reactive mass vaccination campaigns conducted by NCDC/WHO during outbreaks

PREVENTION — more important than treatment

Boil or chlorinate all drinking water. Wash hands with soap after toilet and before food. Eat freshly cooked food. Avoid street food during outbreaks. Build and use latrines. Improve drainage around homes before rainy season. Report suspected cases immediately

Frequently Asked Questions

Can I make ORS at home if I can't get to a pharmacy?

Yes. Home ORS: add 6 level teaspoons of sugar (not heaped) and 1 level teaspoon of salt to 1 litre of safe water (boiled and cooled, or bottled water). Stir well. This is very close to WHO ORS composition and is life-saving when commercial sachets are unavailable. Coconut water is a reasonable natural alternative. Never give plain water alone — it worsens the electrolyte imbalance.

Is cholera always fatal?

No — with prompt rehydration, cholera is almost never fatal. The case fatality rate with proper treatment is < 1%. Without treatment, it can reach 25–50%. The challenge in Nigeria is that many people die before reaching a health facility, or delay seeking care. Recognising the symptoms early and starting ORS immediately at home saves lives.

Should I stop eating during cholera?