Dr. Samuel Momoh is a public health expert with the University Teaching Hospital, Ibadan. He speaks with OLUCHI OGBONNAYA on the awareness of gastroenteritis and how to tackle the infection following its outbreak in some local government areas in Lagos state. Excepts!
What is gastroenteritis?
Gastroenteritis is a bacterial infection. In some cases, gastroenteritis infection may be very mild. Infected persons experience nausea, vomiting, diarrhoea and abdominal pain. It also includes feeling feverish, a lack of energy and dehydration. In contrast, people who develop the severe type may continue vomiting and stooling continuously until they become so dehydrated that they lapse into an unconscious state. Gastroenteritis also lowers the blood sugar and this may lead to convulsion in children. Unfortunately, persons with very mild symptom can unknowingly contaminate and infect other people around them.
Can the epidemic be managed?
One does not have to look too far to find the answer to this problem since gastroenteritis is a waterborne disease. In addition, contaminated rivers, coastal seas and fecal-laden streams are natural reservoirs for the bacteria. Gastroenteritis epidemic may start in a number of ways. Sick people who pass faeces into rivers and streams might contaminate other persons who wash or fetch water from these contaminated sources. It is also not uncommon for septic tank removal trucks to empty their fecal contents straight into the lagoon without any chemical treatment. Contamination can also occur in urban areas, where families with no toilets in their homes, contaminate shallow wells and surrounding drains with infected faece.
How does flooding cause gastroenteritis?
Where there is flooding, contaminated water from drains may overflow into nearby homes and streets. Furthermore, poor hand hygiene can promote the transmission of this bacteria since persons with no running water in their homes are also the least likely to wash their hands after using the toilet. The roadside food vendors also pose a serious risk. In India, the government recently decided to ban street food in high-risk cholera areas.
What policies should be implemented to ensure proper sanitation in Nigeria?
Public health departments in Nigeria have noted the risk of roadside food shops. Several years ago, local government public health officials would visit waterless neighborhoods and shut down illegal roadside cafeteria. However, this form of control is not so common today. I have also visited popular fast food outlets that did not have running water. Such eateries are at risk of spreading many waterborne diseases such as gastroenteritis through contaminated food. Environmentalists from the local government also found that roadside food vendors often use contaminated water to wash dishes and rinse raw food. Lastly, according to the World Health Statistics of 2010 and 2011,
at least 42 per cent of Nigerians or the around 75.6million people living in Nigeria do not presently have access to safe drinking water sources. Hence, we will need to address several such factors which may be contributing to persistent gastroenteritis outbreaks.
Can people die before they are diagnosed?
Sadly, many people who contact the severe form of gastroenteritis hardly survive the illness. This is because the bacteria produce an enterotoxin in the small intestine which permits loss of body water and electrolytes such as potassium. The victim then experiences copious diarrhea, profuse vomiting and severe dehydration. Therefore, gastroenteritis may lead to fatalities if left untreated. For instance, affected persons may lose up to a liter of fluid every 10 minutes.
Hence, between 12 midnight and 6am, an adult may lose almost his entire body-water volume of 40 liters.
Can you give a hint of what other countries have done that Nigeria is not doing?
Good hand hygiene is the most effective way of preventing the spread of infection. Organisations must ensure that hand washing facilities and alcohol hand sanitizers are available for staff, residents, children and visitors. Everyone should be told of outbreaks when they occur and the need for thorough and frequent hand washing, and display hand washing signs in toilet and care areas. Everyone in the facilities must be made to wash their hands thoroughly with soap and running water for at least 30 seconds and dry their hands with towels; even if they have been wearing gloves, if hands are visibly dirty, after using the toilet, after changing nappies, before eating/ preparing food, if there are body fluids (e.g. blood, urine, faeces) on your hands. Alcohol hand sanitizers can be used to clean the hands for other situations. To control and prevent gastroenteritis outbreaks, a number of measures will need to be put in place at a national level. For instance, the World Health Organisation has suggested that three major interventions are required. The first measure is the provision of safe, clean water for all Nigerians. Many urban slums and rural areas in Nigeria are forced to use shallow wells as sources of drinking water.
These shallow wells can easily be contaminated by infected underground water or through flooding. Therefore, such communities would benefit enormously from government sponsored boreholes. The second measure is really related to environmental sanitation. In Nigeria, it would be difficult to stop open defecation without installing a public toilet system. There must be a maintenance system, otherwise, such toilets rapidly become health hazards and homeless shelters. Thirdly, the World Health Organisation believes that health education can help to change attitudes and bad habits such as poor hand hygiene and open defecation. I do not think we are doing enough in this area. It was only during the Ebola crisis that hand hygiene was actively promoted on radio and on TV. We need to integrate this form of health promotion all year round. It will also help if such health promotions take place regularly in public schools.
Frequent cholera and gastroenteritis outbreaks have been linked to a huge shortfall in human development index and failure of good leadership in the country’s health sector.
How can Nigeria surmount this?
I think that ‘good leadership’ in this context means everyone. We all require a commitment to health improvement measures. For as long as
the average Nigerian is unconcerned about environmental hygiene, and personal health values, the problems will continue. If we all decide to stop patronizing roadside food vendors, for example, things will change. We need to be role models. In India, a doctoral student recently spearheaded a public toilet project. He wasn’t blaming the government or waiting for government intervention. Leaders in all spheres of life can make an impact. For instance, we could brainstorm on solutions and come up with effective public health improvement projects.
What kind of drugs can be used to treat it?
Gastroenteritis usually responds to antibiotics. Hence, intravenous antibiotics will always be used to treat severe gastroenteritis. However, without providing intravenous fluids, gastroenteritis patients could still die of dehydration. This is why self-medication should be avoided.
