20-30% Of Katsina Diphtheria Patients May Die, State’s NMA Chair Warns

BY GODWIN ENNA and LONGTONG YAKUBU

Two to three out of every 10 diphtheria patients admitted to the Federal Teaching Hospital Katsina (FTH Katsina) may die from the disease, the Nigerian Medical Association (NMA) has warned.

The chairman of the NMA, Katsina State branch, and Consultant in Infectious Diseases and Tropical Medicine at FTH Katsina, Dr Mohammed Abubakar, gave the warning while speaking on the ongoing outbreak, saying the hospital was under sustained pressure from rising cases, particularly among children.

He said 70 to 80 per cent of the hospital’s isolation centre was occupied by diphtheria patients, with about 20 of its estimated 20 to 25 beds occupied at the time of the interview.

According to him, between 80 and 90 per cent of the patients  are children, while the hospital  is  receiving an average of 20 to 25 admissions, sometimes rising to about 50 cases a week.

“Out of 10 patients admitted, you may see two or three patients dying from diphtheria,” Abubakar said.

He attributed the high mortality partly to shortages of diphtheria antitoxin, a critical medicine used to neutralise toxins produced by the bacteria.

He said the antitoxin had been unavailable for months before a limited supply recently arrived through the government and donor interventions.

“It’s not only about giving antibiotics. The diphtheria antitoxin works faster to stop the toxin from causing more damage,” he explained.

Abubakar said FTH Katsina had been operating at full capacity for about a month, with the isolation centre becoming completely occupied about a week earlier, forcing health workers to make contingency arrangements in the emergency and paediatric units.

During a visit to the Murja Isolation Centre, several children were seen with their parents occupying available beds and seats, many with swollen throats and crying.

A staff member, who declined to be named, said the facility was overwhelmed, adding that more than 40 patients were on admission at the main ward serving as the isolation centre, while the Murja building was being used temporarily to receive new cases.

There was no official figure for the total number of confirmed cases recorded in Katsina at the time of reporting.

Abubakar said most patients arriving at FTH Katsina were referrals from primary and secondary healthcare facilities and often presented with advanced disease or complications.

“Most of the cases you see, most of them are referrals. By the time they are coming, they are either very sick or they are complicated,” he said.

He identified gaps in routine immunisation as a major factor behind the resurgence and urged the government to intensify vaccination, community sensitisation and the supply of essential medicines.

He also called for three to five additional functional isolation centres across the state to reduce pressure on FTH Katsina.

“We need at least three to four or five functional isolation centres around that can reduce the burden of patient admission and lack of bed space on FTH,” he said.

He appealed for sustained supplies of diphtheria antitoxin, antibiotics, intravenous fluids, personal protective equipment and other essential materials, and urged parents to seek immediate medical attention for children with persistent sore throat, fever, difficulty swallowing, excessive salivation or other symptoms suggestive of diphtheria.

Katsina Records Over 1,000 Suspected Cases

Meanwhile, the Katsina State Government has secured an additional 650,000 doses of diphtheria vaccines as part of efforts to contain the outbreak.

The Acting Executive Secretary of the Katsina State Primary Health Care Development Agency, Shima’u Kabir, disclosed this at a press briefing, saying more than 1,000 suspected cases had been recorded in 29 local government areas, with about five per cent of the suspected cases resulting in deaths.

Funtua recorded the highest burden, followed by Bakori, Kankia, Katsina, Mani and Daura.

Shima’u said the response was being coordinated by the State Emergency Preparedness and Rapid Response Team and the Katsina State Primary Health Care Development Agency, in collaboration with the Ministry of Health, NPHCDA, NCDC, UNICEF, WHO and other development partners.

Reactive vaccination commenced on August 25 in five high-risk LGAs — Bakori, Charanchi, Funtua, Mani and Kankia — with support from the NPHCDA and logistics provided by UNICEF.

“By day three of the exercise, 67,670 eligible persons had received the Td vaccine, while 24,103 children had received the pentavalent vaccine across the five implementing LGAs,” she said.

She attributed the turnout to house-to-house mobilisation and the involvement of traditional rulers, community leaders and health workers.

The state has also established three additional isolation centres at MCHC Kanti in Daura, General Hospital Funtua and General Amadi Rimi Orthopaedic Hospital.

Shima’u said the government was supplying essential drugs, medical consumables and infection-prevention materials to the NCDC isolation centre at FTH Katsina, while case-management drugs were being pre-positioned in affected communities.

Health workers are also receiving additional training in diphtheria surveillance and case management.

She identified inadequate vaccination uptake and late presentation at health facilities as major challenges, as well as the state’s porous international border with Niger Republic, which requires sustained surveillance.

She urged residents to cooperate with vaccination teams and seek immediate medical attention for symptoms including sore throat, fever, difficulty swallowing or breathing, neck swelling and a thick greyish or whitish membrane in the throat, tonsils or nose.

“Please do not wait until the condition becomes severe and do not attempt to manage a suspected case at home,” she warned.

Kano Decentralises Treatment

In neighbouring Kano State, the government has decentralised diphtheria treatment to 26 health facilities to reduce delays in accessing care.

The Director-General of the Kano State Centre for Disease Control, Prof Muhammad Abbas, said the move was necessary because patients from communities far from Kano metropolis often travelled long distances to access specialised treatment at the Infectious Diseases Hospital.

The centres are located across the state, including Rano, Bichi, Danbatta, Wudil and Tudun Wada. The 26 facilities comprise 13 secondary and 13 primary healthcare centres, although treatment is now concentrated mainly in secondary facilities because of their capacity to provide specialised care.

“Most of them do not report to the hospitals early. Diphtheria is an acute illness. It can devastate within a short time,” Abbas said.

He disclosed that Kano recorded more than 39,000 suspected diphtheria cases between December 2022 and the previous Sunday, of which more than 32,000 were confirmed. More than 1,800 people had died during the period.

Abbas said the state had nevertheless significantly reduced its disease burden from its peak, when Kano accounted for more than 85 per cent of national cases.

He identified low vaccination coverage as a major factor driving transmission, noting that more than 16,000 confirmed cases involved children who had never received any vaccination.

The KNCDC has strengthened surveillance and active case searches to ensure early identification and referral of suspected cases.

Abbas also dismissed reports that more than 50 children had died from diphtheria in Rano Local Government Area, saying the state’s surveillance system had not recorded such a figure.

He said surveillance officers submit daily reports from all 44 local government areas and that an active case search conducted in Rano after the report emerged found no evidence supporting the reported death toll.

With Katsina battling a fresh surge and Kano maintaining surveillance after a prolonged outbreak, health authorities have stressed the importance of vaccination, early presentation and timely treatment in preventing avoidable deaths.