By Stephen Enoch
As of March 2023, at least 61 persons were reported to have died, following confirmation of diphtheria outbreak in Kano.
In this report, Stephen Enoch visited Sumaila, Ungogo and Bichi Local Government Areas (LGAs) to find out why the deadly disease persist amidst government efforts to contain it.
Diphtheria is a highly contagious, infectious disease caused by a bacterium called Corynebacterium diphtheriae. People with diphtheria have serious breathing and swallowing problems, and they may develop sores on their skin.
The disease is caught by coming into contact with droplets from the respiratory tract of an infected person, particularly spread by coughing or sneezing.
Between August to September 2023, Yan Gargajiya, a Hausa word for Traditional Medicine Doctors have sent more than 11 children to their early graves in Gala village, Sumaila LGA.
Gala is approximately 8KM to Sumaila Town, and 85Km to Kano Metropolis.
Stallion Times Spoke to more than five community members in Gala Village, who confirmed this, although there is no definite number as residents say the number of casualties surpasses 10.
Gala Village, Sumaila LGA. Photo: Stephen Enoch.
28 Year-Old Zainab Musa, a resident of Gala revealed that when some residents are referred to Murtala Muhammad Specialist Hospital or Aminu Kano Teaching Hospital (AKTH), they opt-in for the services of the traditionalists, since it is cheaper.
“The Traditionalists use two fingers to forcefully remove the thick grey matter which is visible in the patient’s mouth.
“If they do not use their fingers, they make use of a Knife to cut off it off.
“When a Knife isn’t available, the traditionalist attach a razor blade to a metal and use it to cut off the thick substance,” Zainab revealed.
Describing how children are prepared before they get set for the ‘locally conducted operation’ by the traditional medicine doctors, she said;
“Their legs are tangled and then their hands are held by either the father of the child or any strong male around. Their hands are also held by the same person and then the local doctor conducts the operation.
“After removing the substance, the children will be told to cough it out. Some children who mistakenly swallow the substance after it is removed, end up dying.”
The regret of losing her first child Aisha Yahuza, to Yangangajiya is one which pains 31 Year-Old Azuma Adam till date.
She said the scenario that played out before the death of her 8-year-old daughter felt like a spear was pinned to her chest.
According to her, Aisha’s death was more painful than the labour pains she went through in the process of giving birth to the child.
She disclosed that Aisha was sick in August and she took her to Sumaila General Hospital where she paid N6,000 for treatment but the child did not get well, after one week.
The following week, Azuma took Aisha to Gala PHC, where it was discovered that she had contracted diphtheria.
She was referred to AKTH for the treatment of her child, but according to Azuma, herself and her husband had a cheaper and closer option, which was the Traditionalists.
This reporter observed that Azuma’s eyes had become red and filled with tears as she started narrating her daughter’s death under a Dogon Yaro tree, front of her house.
She paused for some seconds, and the clucking of Hens and bleats of Goats from her compound overshadowed the atmosphere.
She couldn’t withhold her tears when she attempted to continue, so she turned away and used her multi-colored Hijab to wipe her face.
After a while, she continued narrating the how she lost her daughter with a shaky voice and red eyes.
Back shot of Azuma. “I did not get permission for a photograph from my husband,” She said. Photo: Stephen Enoch
“When we visited the traditional doctor, he gave us some herbs which we used as recommended but Aisha was not getting better after six days, so we decided to take her back to him again.
“On noting that Aisha wasn’t getting any better, the traditional doctor then used two of his fingers to punch the thick substance in Aisha’s throat and it was removed.
“He also and carried out other traditional medical procedures which I wasn’t familiar with, after removing the substance that evening.”
Azuma and her husband went home happy that evening with 8-year-old Aisha since the substance had been removed finally. Unknowing to them, they just signed Aisha’s death warrant.
“It was at 1:30 am in the early hours of Thursday morning that Aisha woke up and said she was hungry so I prepared rice and stew for her.
“When I gave her the food, she said she could not eat but would prefer water which I gave her.
“As she drank the water, she could not swallow it as it flowed through her nose. At that moment, I was terrified that I called the attention of my husband.
“After a few minutes, Aisha cried that she wanted juice. I gave it to her and as she took a gulp, it flowed through her nose again and this time, she started choking and gasping for air.
“It was not up to 2 minutes, then Aisha died. As I am speaking with you, I am filled with regret.” Azuma narrated.
She told this reporter following the death of Aisha, her second child Abdullahi, was discovered to have contracted diphtheria and she hurriedly took him to AKTH for treatment.
Azuma said 8-year-old Aisha used to sell Awara and Waina (Hausa Street Food) which brought in some income for her, since her husband insisted that she remains a full housewife since her death, she has been financially unstable.
YanGargajiya Frustrating Efforts of Gala PHC
A health worker who spoke to Stallion Times anonymously confirmed Azuma’s ordeal with Yangargajiya.
According to him, their activities really caused the untimely death of about than 11 children in the village and the continuous spread of the disease.
He disclosed that the first case was recorded on 6 August and from then till now, the village has recorded more than 100 cases.
He said that the deaths were not recorded in the facility’s books because most of the victims were immediately buried in accordance with Islamic rites.
Dogo revealed that children as little as 1-year-old are subjected to barbaric operations conducted by traditional medicine doctors, all in the name of curing diphtheria the local way.
“Children who mistakenly swallow the substance that is removed from their throat end up dying.
“Illiteracy and lack of awareness are the major reasons why some community members take their children to the traditional medicine doctors even after we warn them to desist from doing so.
“Some of the parent blame the distance and cost of transportation as the reasons why they take their children to Yan Gargajiya, instead of AKTH or Murtala Muhammad Specialist Hospital for proper care.
“I believe that more awareness has to be carried out in this community so that parents will stop taking their children to Yan Gargajiya.
“Just yesterday, I heard that one child died of diphtheria in this village. They are too stubborn and some think that Yan Gargajiya can cure diphtheria but this is not so.
“This attitude has caused other children to contract the disease, because after referring them to Murtala Muhammad Specialist Hospital or AKTH, they simply take the children to Yan Gargajiya and these children still play around in the village and in the process, they spread this disease to other children.
“Despite our effort at the PHC level to spread awareness on the dangers of diphtheria disease, some community members are adamant,” He disclosed.
Dogo pointed out that when patients are referred to AKTH or Murtala, the process of scouting for a motorbike to Sumaila town and getting a Vehicle to convey such patients to the hospital takes more than 4 hours which is why some of the patients die in the road.
He said if the PHC’s ambulance was active, it would have aided in speedily rushing patients to the hospital and saved some lives.
Rickety Ambulance lay waste in Gala PHC. Photo: Stephen Enoch
Dogo added that if Gala PHC was well-equipped with PPEs and staff, the number of deaths would have significantly reduced.
“If the Kano ministry of health can equip us with adequate staff and create an isolation center in this PHC or at Sumaila General Hospital, it will be much more effective in saving lives because the distance from Sumaila to Kano Metropolis is too much.
“I want to use this opportunity to call on the Ministry of Health, Primary Health Care management Board and development partners to put in measures to drastically reduce the spread of diphtheria here because some people are still hiding their children at home and taking them to Yan Gargajiya,” he added.
Statistics from the Nigeria Center for Disease Control (NCDC) and the World Health Organization (WHO) says there has been 8576 confirmed cases across LGAs in 19 States and the Federal Capital Territory, as of 1 October 2023.
The Executive Director of the National Primary Health Care Development Agency (NPHCDA), Dr Faisal Shuaib also confirmed that Kano is the worst-hit state in a press briefing in Abuja.
Seeking Cure for the Unknown
Just like Azuma, who lost one of her children to Diphtheria, Rabiu Shuaibu, a 39-year-old resident of Lamba, in Bichi lost two of his children to the disease in September 2023.
He said, that despite spending N30,500 on treating different illnesses, Badiya (7) and Saifullahi (8) still died.
Rabiu spoke to this reporter shortly after dropping a passenger along Malikawa Garu, a nearby community to Lamba.
Malikawa Garu Road, Bichi LGA. Photo: Stephen Enoch
Rabiu told Stallion Times that his children were always falling sick and got treated of Malaria and Typhoid more than five times in two weeks but never got better after visiting a Chemist and Tsanyawa General Hospital.
He said that he never knew of Diphtheria disease but only observed a thick substance behind their throat and strongly believed that it was not the cause of their constant illness.
Rabiu re-counted how he lost his children: “After I got home from work my wife told me that they developed fever and their temperature had risen beyond normal.
“I went to a local medicine doctor and got some herbs for them and after taking the concoction a few hours later, they got stabilized.
“After eating dinner that fateful night, they woke us about 12 am with cry of throat pains. I left my wife to handle them since I was so tired after working all day but when the cry was severe, I had to stand up.
“I quickly stood up, turned on my bike and headed to Malikawa Garu PHC with Saifullahi. After a few minutes, I discovered that Saifullahi stopped crying and was almost falling off the bike.
“I tapped him and called his name several times but he didn’t respond. I then stopped the bike, only to discover that I had lost my boy. At that point, I did not know how to tell my wife that we had just lost our boy because my wife is so emotional.
“I summoned courage and went home with his corpse,” He said.
Rabiu Shuaibu. Photo: Stephen Enoch
Double Tragedy for Rabiu
On reaching home at about 1 am, Rabiu said he was welcomed with ‘Inna Lillahi wa inna ilayhi raji’un’ meaning ‘To God we belong and to Him we return’.
“My neighbors told me that Badiya died a few minutes after I left with Saifullahi. It was at that point it dawned on me that the hard substance that I saw in their mouth could be connected to the death of my children.
“We buried them that day and after I made my findings from Lamba PHC, the health workers told me about Diphtheria.
“It is the dream of every parent that their children should be the one that will bury them after living their life on earth but in my case, I buried two of my children.
“This is so painful but what can I do? Allah is the one who gives and takes so I have taken my fate as it is,” Rabiu said.
Vaccine Hesitancy, Low Awareness, and Poor Hygiene in Communities
Ibrahim Shafiu, a health worker in Malikawa Garu PHC revealed the vaccine hesitancy among community members in Malikaw Garu has caused the continuous spread of diphtheria in the community.
He added that misconception about the vaccine being spread in Malikawa Garu, Lamba and neighboring communities has discouraged parents from bringing their children for vaccination to prevent the spread of diphtheria.
Ibrahim told Stallion Times that poor hygiene, and low awareness of the existence of diphtheria has also caused the continuous spread of the disease.
“Some community members in Malikawa Garu, Lamba, and neighboring communities believe this false narrative that when their children are given the vaccine it will cause high-fever.
“When the vaccine is administered, the child will actually feel some pain for a day or two but after that period, the child is safe from the disease but some community members still don’t believe.
“Just like when false narrative of Covid-19 was widely spread, the same is happening with diphtheria,” He said.
He added that although the PHC receives some women who bring their children for vaccination, there still exists a dearth of knowledge on diphtheria and vaccine hesitancy in the community.
Women who brought their children for vaccination in Malikawa Garu PHC. Photo: Stephen Enoch
To confirm what Ibrahim said, this reporter went into Malikawa Garu to sample opinion about diphtheria and the vaccine.
45 year-old Danjumai Alhassan, a resident of Malikawa Garu said he has no idea about vaccination against diphtheria in the community.
The father of five told this reporter that he does not believe in the vaccine, although he has heard about diphtheria-related death in Bichi.
“Since my children have not contracted the disease, I don’t think there is any need to take them to the hospital for vaccination. In fact, I am not aware that there is a vaccine for the disease.
“A friend of mine told me that when children receive this vaccine, they get feverish. So I don’t think there is any need to take my children for vaccination since they have not contracted the disease,” He said.
This reporter asked Danjumai: “What if your children contract the disease and probably die afterwards, are you not scared?”
He simply replied: “I believe that Allah will keep protecting them for all harm and if anything happens, who I to question him? It is Allah who gives and takes.”
Danjumai, community member in Malikawa Garu, Bichi LGA. Photo: Stephen Enoch.
Rabi escaped death by a hair’s breadth
Rabi Shehu, 3 year-old, was lucky to survive diphtheria when her mother Hassana Shehu discovered that she has contracted the virus at a stage when it could be managed.
Rabi’s mother who lives Barebari section of Ungogo LGA said she knew about the diphtheria and had taken three of her children for vaccination at Mangorori PHC twice, but was turned back due to stock-out of the vaccines.
“It was in the first week of August that Rabi contracted diphtheria, although I didn’t want to believe it was Diphtheria so I took her to the chemist where she was treated of malaria.
“After completing her malaria medication, she was able to eat well but that night, she woke up at about 3:30 am and was crying, I was patted her till 5:00 am before she was able to have a deep sleep.
“After I finished preparing her breakfast and ready to take her to the hospital I asked one of my daughter to wake Rabi but I suddenly heard a loud cry from the bedroom.
“Umma (My Mother) Rabi’s neck has swollen up.
“I took her to Mangorori PHC in the morning around 9am but no doctors were around, we sat after some minutes the doctors arrived, I bought prescription card for N50, my daughter was examined and confirmed to have contracted Diptheria.
“She was admitted for three days and while she was in isolation, I was crying and praying/, because I heard death cases of the disease.
“After the third day, she was discharged and I was so filled with joy. After she was discharged, they doctors cautioned me not to allow Rabi mingle with others for some weeks and I complied.
“When we got home he used to complain whenever she eats swallow food but after some days she started eating all types of food.
“When I realized I have completed the regulations, I allowed her to start going outside and mingle with her friends and siblings.
“After Rabi’s incident, I ensured that all my children got vaccinated against diphtheria.”
“But several attempts to get my child vaccinated, I will be told the vaccine has finished but that officials randomly vaccinated children at different households in community; no official came my way.
Mangorori PHC Reacts Hassan’s Claims of vaccine stock-out
Dr Saifullahi Isa the Office-in-Charge of Mangorori PHC confirms Hassana’s allegation on stock-out of vaccines in the PHC.
He said patients from neighbouring communities in Ungogo and people from Katsina and Jigawa states visit the facility on a daily basis to get vaccinated, therefore causing shortage of the vaccine sometimes.
He stated that in May 2023 the PHC recorded more than 3,000 cases of Diptheria, which were referred to Murtalla Specialist Hospital or AKTH, in August, the facility vaccinated 40 to 50 children daily.
Vaccine in the PHC. Photo: Stephen Enoch
“Whenever we have vaccine stock-out, we simply refer them to Murtala Specialist Hospital.
“What contributed to new cases despite the vaccination is that after discharging, some patients neglect the instruction of the doctors and non-adherence to these instructions.
“Another challenge is that some communities do not have health facilities and the cost of transportation get vaccinated is an issue for rural dwellers.
“Although the cases are decreasing because toward the end of September, I used to refer about 15 patients per day to Murtala Specialist Hospital, but now we barely refer 6 patients in a day and other days, no single case is reported.”
Dr Shehu Mohammed, the Kano State immunization officer in an earlier interview with the ICIR, the state constituted a technical working group with rapid response teams to respond to the epidemic.
“Part of our challenges has been awareness at the community level and to this end, we are calling on the government and development partners to assist in our effort on awareness creation at the community level.
“In administering the vaccine, people can get vaccinated at the PHC or during our outreach when health officials go the nook and cranny of different communities to administer the drugs to those in need.”
He also said routine immunization intensification has been carried out in the LGAs that have the highest burden of diphtheria in Kano which are Dala, Gwale, Nassarawa,Ungogo, and Tarauni.
Azuma Adam of Gala Village in Sumaila, Rabiu Shuaibu of Lamba in Bichi, and other residents across the state will continue to mourn the loss of their children to Diphtheria.
Intensification of vaccination efforts and raising awareness of people by the state government will avert deaths, consequently, knocking the causes of new cases headlong will avert possible diphtheria related mortality.
This publication was supported by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) through Stallion Times under the Collaborative Media Engagement for Development Inclusivity and Accountability Project (CMEDIA) funded by the MacArthur Foundation.
