…Experts trace burden to  sanitation crisis

By Chioma Obinna

In the heart of a rural Nigerian village, in the South West, the Ademola family’s life remains a constant struggle against disease and poverty.

Their home, a simple constructed hut, is surrounded by the pungent smell of human waste. Open defecation is a daily reality for the Ademolas, as they have no access to proper sanitation facilities.

The family’s health has suffered greatly from this practice.

Little Bukola, just five years old, is often sick with diarrhea and worms. Her older brother, Ola, has been diagnosed with river blindness, one of the Neglected Tropical Diseases, NTDs, caused by parasitic worms transmitted by blackflies.

Sadly, Ademolas’ parents, struggling to provide for their family, have no choice but to work long hours in the farms, leaving their children vulnerable to disease.

But the Ademola family’s story is not unique as millions of Nigerians face similar challenges, living in areas without adequate sanitation and healthcare. They are faced with NTDs including; onchocerciasis, schistosomiasis, trachoma, lymphatic filariasis, soil-transmitted helminthiasis (STH), leading to perpetuate cycle of poverty, malnutrition, and ill health.

Across communities in Nigeria, many have seen firsthand the devastating impact of these diseases. Blindness, caused by onchocerciasis (river blindness), has robbed countless individuals of their sight, hindering their ability to work and care for themselves. Lymphatic filariasis, often referred to as “elephantiasis,” has led to grotesque swelling of limbs, causing immense pain and social ostracism.

Aderayo, Ola’s mother, recalls the day he was diagnosed with river blindness. “He used to be so strong and hardworking,” she says, her voice filled with sadness. “But now, he can barely see. It’s been so difficult for us.”

The Baale of Alagba Village, Ona Ara Local government Ibadan, Oyo State, Baale Babalola Abidemi, said the practice of open defecation, a deeply ingrained cultural habit, poses significant health risks to the community.

He said his village has made progress in addressing the issue, with the construction of a few latrines. However, the challenge remains to convince the villagers to adopt a new way of life.

“Before we started a year ago, we have contaminated water sources, increased transmission of diseases like cholera and typhoid but they are now reduced with our new arrangement with some banks.”

Burden of open defecation and NTDs

Despite these devastating situations, not less than 48 million Nigerians still defecate in the open according to the WASH National Routine Mapping (WASHNORM) report of 2021 while over 200 million Nigerians are at risk of one of the 17 NTDs.  Worse still, Nigeria has the highest burden of NTDs in Africa.

In Nigeria, Ebonyi state leads in open defecation with 73 percent followed by Plateau and Kogi with 56 percent each.  In the South West, Oyo State leads with 54 percent followed by Ekiti with 41 percent. Others are Ondo 38 percent, Osun, 18 percent, Ogun 14 percent and Lagos 3 percent. However, 126 of 774 Local governments are certified open defecation free.

Medical experts say open defecation contaminates water sources, leading to outbreaks of cholera and other waterborne diseases. NTDs, such as river blindness and lymphatic filariasis, also pose  significant threat to the health of many Nigerians.

For concerned health stakeholders, the Ademolas’ situation is a stark reminder of the urgent need for improved sanitation and healthcare in Nigeria.

Unfortunately, only 37 million (18 percent) Nigerians out of the over 200 million population have access to safely managed sanitation services.

Deadly duo

Studies have shown that NTDs are usually find among poverty-stricken people in communities that nobody is paying attention to, and they are basically transmitted by behavioral issues that can be tackled if there are positive sanitation and hygiene behaviour.

Despite these realities, open defecation is common sight everywhere in Nigeria even in cities like Lagos. From the popular Kara bridge along Lagos- Ibadan expressway,  Apapa-Oshodi expressway, Mile 2 -Badagry expressway, and Ikeja along near the Ikeja Local government by the railway, open defecation is an eyesore.  Lagosians defecate indiscriminately.

Residents including children continue to pay for this age long practice.

How open defecation spread s NTDs

Monday Johnson,  WASH Specialist, UNICEF Lagos Field Office, explains the dangers of open defecation, saying, “It’s a vicious cycle. When people defecate in the open because there are no proper toilets, that in turn, leads to more diseases, which makes it even harder for people to build toilets.”

He said dealing with sanitation will cut off the life cycle of NTDs and from manifesting in people. Further, Johnson explained that if there is no feaces that is left in the environment, definitely there will not be any issue of these soil-transmitted diseases, because they are there, people pick them up, people ingest them, because faeces are around the environment. Once open defecation is tackled, then this particular disease will go.

For diseaaes like schistosomiasis which is found where you see children passing blood in their urine, and the disease is basically a water-based disease. It’s pierced through the skin, and the transmission is the infected person will urinate in the water, the Saccharia will pass through the snail, and then it sheds into the river. When you pass through that water unknowingly to you, the disease will enter your skin.

“So, if there is no urination into the water, then you wouldn’t have this disease. So, that is why we are saying that by the time we can cope with the open defecation issues, somw of these diseases will automatically go.”

He insisted that depending on the transmission route, definitely these diseases will be eliminated. Johnson said issues around NTDs  are all behavioral and eliminating them require stopping open defecation.

“Nigerians know that it is not dignifying for you to defecate in the open, knowing that defecating in the open can result in snake bites, which is also being classified as a neglected tropical disease, knowing that there can be issues of rape as a result of somebody going to the field to actually defecate.

If the toilets are available, because we are dealing with stopping open defecation in the field, nobody would be going into the bush to defecate. There would be reduced rape because women or girls that enter the bush to go and defecate will not go there. There is a safe toilet that they can use.

“Changing those behaviors, communities, households, constructing latrines, making them safe for people to use at home will increase dignity among men and women, especially young girls. This will decrease the rate at which we have diarrhea in children, because either the flies have taken the pathogen from wherever to the food that we are eating.

“It will also have a corresponding effect on elimination of NTDs. The NTDs currently are being tackled by different drugs.”

Efforts to eliminate open defecation

However, with the help of UNICEF, other partners and government agencies, efforts are being made to provide access to clean water, sanitation facilities, and medical treatment.

However, much remains to be done to address the deep-rooted problems of poverty and inequality that contribute to the spread of disease.

For UNICEF Chief of Water, Sanitation and Hygiene (WASH), Jane Bevan, many of the NTDs are transmitted through poor sanitation and unless Nigerians practice safe sanitation and hygiene, there is a risk that more people will get more NTDs.

Bevan said practicing hand washing is perhaps the most affordable immunisation that all Nigerians, including children, can receive that will assist to save lives, avoid some of these diseases and save lives.

On the need to end open defecation in Nigeria, Bevan added that UNICEF is working closely with the government and with the Clean Nigeria Campaign to make a difference on the issue of poor sanitation and open defecation in the country.

“We have been able to achieve 126  open defecation-free LGAs in the country and we are working hard to ensure more LGAs to achieve open defecation-free status.”

The National Coordinator, the Clean Nigeria Campaign, Mrs Chizoma Opara, who lamented that Nigeria was off track from being open defecation free (ODF)by 2030, said 20 million toilets need to be constructed in public and private places.

Opara who called for more investments to achieve their target, said a total of $10 billion annual investment is needed as current investment is estimated at $0.8 billion annually.

She said already, the campaign was committed to ensuring that every Nigerian will have access to safely managed sanitation and hygiene facilities in cities, small towns, and rural communities.

As Nigeria continues to develop, the health and well-being of its citizens must be prioritized. By addressing the challenges of NTDs and open defecation, the government cannot only improve the lives of millions of Nigerians but also contribute to the overall progress of the nation.