CHAPTER ONE

INTRODUCTION

BACKGROUND TO THE STUDY

Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholera ( Riyan 2004
& WHO 2010). The main symptoms are profuse watery diarrhea and vomiting. Transmission is primarily
through consuming contaminated drinking water or food. The severity of the diarrhea and vomiting can
lead to rapid dehydration and electrolyte imbalance. Every year there is an estimated 3-5 million cholera
cases and 100,000-120,000 deaths due to cholera. The short incubation period of two to five days,
enhance the potentially explosive pattern of out breaks (Faruque 2008 and WHO 2010). Cholera
transmission is closely linked to inadequate environmental management. Typical at-risk areas include
peri-urban slums, where basic infrastructure is not available, as well as camps for internally displaced
people or refugees, where minimum requirements of clean water and sanitation are not met. The
consequences of a disaster – such as disruption of water and sanitation systems, or the displacement of
populations to inadequate and overcrowded camps – can increase the risk of cholera transmission
should the bacteria be present or introduced.

Epidemics have never arisen from dead bodies. Cholera remains a global threat to public health and a
key indicator of lack of social development. Recently, the reemergence of cholera has been noted in
parallel with the ever-increasing size of vulnerable populations living in unsanitary conditions (Emch
2008 and WHO, 2010).

Cholera can cause mild diarrhea but not generate epidemics. The bacteria are transmitted via
contaminated drinking water ,food pathogenic. Cholera can survive refrigeration and freezing in food
supplies. (Reildl et al 2002) The dosage of bacteria required to cause an infection in healthily volunteers
via oral administration of living vibrios is greater than 1000 organisms (Hartely 2006). After consuming
an antacid, however, cholera development in most volunteers after consumption of only 100 cholera
vibrios experiments also show that vibrios consumed with food are more likely to cause infection than
those from water alone (Finkelstein 1996). Cases tend to be clustered by location as well as season, with
most infections occurring in children ages 1-5 years (WHO 2010).

Cholera is severe water-born infectious disease caused by the bacterium vibrio cholera. In 2005, 131,943
cases including 2,272 deaths have notified from 52 countries. The year was marked by a particular
significant series of outbreaks in West Africa, which affected 14 countries and accounted for 58% of all
cholera cases world-wide (WHO 2006). In the same year Nigeria had 4,477 cases and 174 deaths. There
was reported case of cholera in 2008 in Nigeria in which 429 death out of 6,330 cases. More so, 2,304
cases in Niger State in which 114 were reported death in 2008 (NBS 2009). Recent years have seen a
strong trend of cholera outbreak in developing countries, including among others, those in India (2007),
Iraq (2008), Congo (2008), Zimbabwe (2008-2009), Haiti (2010), Kenya (2010). Koko in Edo State (1989).
In Nigeria, according to UN figure, 1,555 people have died since January and 38,173 cases have been
reported. The figure is more than four times the death toll the government reported in August
(Guardian. 2010)
Cholera is a disease characterized by profuse diarrhea accompanied with a severe dehydration and loss
of electrolyte (Colwell and Huq, 1994), caused by toxigenic Vibrio cholera, a serologically diverse,
environmental, and gram-negative rod bacterium (Li et al., 2002). In the absence of appropriate
treatment, there is a high mortality rate. Cholera is a major public health concern because of its high
transmissibility, death-to-case ratio and ability to occur in epidemic and pandemic forms (Kaper et al.,
1995). Cholera is responsible for an estimated death of 120,000 globally every year (WHO, 2001), and
still continues to be a scourge worldwide covering all continents. In developing countries with endemic
areas, cholera is still very significant with incidence of more than five million cases per year (Tauxe et al.,
1994; Lan and Reeves, 2002). The explosive epidemic nature and the severity of the disease and the
potential threat to food and water supplies have prompted the listing of V. cholera as an organism of
biological defense research (Zhang et al., 2003). In an epidemic, the great majority of cases can be
recognized by clinical diagnosis easily and a bacteriological diagnosis is often not required. Cholera is
endemic in Nigeria (Falade and Lawoyin, 1999) and epidemiological features (Utsalo et al., 1991, 1992;
Eko et al., 1994; Hutin et al., 2003) have been reported from various parts of the country with
investigations on possible sources of outbreaks. Outbreaks of cholera had been reported from various
States in Nigeria such as Ogun, Edo, Pleatue State etc, of Nigeria. Investigations on outbreak of cholera
in Nigeria have focused on the epidemiological features, the probable source of contamination and the
risk factors without spatial linkage of health data. However, advances in Geographical Information
Systems (GIS) technology provides this opportunity and have become an indispensible tool for
processing, analyzing and visualizing spatial data within the domains of environmental health, disease
ecology and public health (Kistemann et al., 2002).

The use of GIS is not new in waterborne disease outbreaks and cholera studies. It has been applied in
investigating waterborne disease outbreak (NWW, 1999), microbial risk assessment of drinking water
reservoirs (Kistemann et al., 2001a), drinking water supply structure (Kistemann et al., 2001b), and
spatial patterns of diarrhoea illness with regards to water supply structures (Dangendorf et al., 2002). In
cholera studies, GIS technology has been applied in studying the correlation between socio-economic
and demographic indices and cholera incidence (Ackers et al., 1998), environmental risk factors (Ali et
al., 2002a), spatial epidemiology (Ali et al., 2002b), health risk prediction (Fleming et al., 2007) and
spatial and demographic patterns of cholera (Osei and Duker, 2008). This study seeks to assess the
causes and effect of cholera outbreak in Benin City, Edo State.

1.2 STATEMENT OF PROBLEM

The threat of cholera rampaging through Nigeria has long been of concern to many. The crowded
settings coupled with minimal water, sanitation, hygiene and health services, present a fearsome
breeding ground for cholera to quickly escalate beyond control. In an attempt to avoid this worse-case
scenario, a massive response needs to be mounted by the Government to enlighten the general public
about the causes of this deadly disease and also ways to avoid the outbreak. Hygiene promoters should
be employed to work every day, sharing information on how to avoid contracting the illness and the
signs and symptoms of the disease.

1.3 PURPOSE OF THE STUDY

The purpose of this study is to determine the causes and effect of cholera during rainy season in Benin
City.

The specific objectives of the study are:

1. To identify the cause of cholera in Benin City.

2. To ascertain if cholera outbreak is usually rampant during the rainy season among children in Benin
City.

3. To identify the problems associated with the prevention of cholera in Benin City

4. To determine the ways of preventing cholera outbreak in Benin City.