We do it in the open here: 108 million Nigerians engage in open defecation, UN report claims

World Toilet Day is celebrated on November 19 every year. Two days from now, this year’s edition of the day will be observed. TADE MAKINDE reports on the Nigerian situation where a majority of the citizens don’t have access to good toilet facilities.

DESPITE scientific, technological and industrial advances made in the world, an estimated 108 million Nigerians still lack access to toilets, the United Nations stated last year on World Toilet Day. One year after, Dr Victor Adeyefa of All Souls Hospital, Elebu, Ibadan, does not see anything on ground to believe that there has been an appreciable increase in what has been done to improve sanitation and toilet provisions in Nigerian homes.

Currently, available UN data show that 67 per cent of global population do not have decent toilets. The report also has it that only 39 per cent of the world population use toilets that are connected with safe sewage system. It is also believed that 10 per cent of the world’s population consume food that has been smeared with waste water.

Open defecation leads to so many health issues, especially preventable deaths.

Open defecation

Open defecation, now very common, not only in Nigeria, but all over the world, has become a tradition of sort among Nigerians, especially among the underprivileged. This is mainly because many houses do not have adequate toilet facilities. Many of the houses do not even have toilets. This residents in such houses have to make do with whatever they can find to relieve themselves. Open space, canals and other waterways are the most preferred ‘people toilets’ for such people.

Eighty two per cent of the one billion people practising open defecation live in just 10 countries: India, Indonesia, Pakistan, Nigeria, Ethiopia, Sudan, Niger, Nepal, China, and Mozambique. The number of people practising open defecation is still rising in 26 countries in sub-Saharan Africa, though they have declined in Asia, Latin America and the Caribbean.

In Nigeria, numbers of open defecators increased from 33 million in 1990 to 49 million in 2015.

Ade Fasehun, who would not allow his picture to be taken, told Sunday Tribune that he had always found it difficult to use toilets when he has to defecate.

“I don’t have anything against it, but I don’t enjoy using it. I like to be free and to enjoy the breeze that blows across my face and groin when shitting. I also like watching the flies. I don’t know what it does to the ground, but the joy of knowing that I have fed some dogs, birds, ducks, is more than enough for me,” he admitted.

Speaking further, Fasehun said his wife and children use toilets though, “but most of the times when I travel, I always ask bus drivers to stop so I can use a bush to do my thing. There was a time I travelled for an event in the north. We were camped somewhere around the presidential lodge, but I used an open space behind the compound. That was the first thing I asked our guide for. He just pointed a dusty field to me. The first time I used it, I met nine others doing same thing.

“For me, maybe because growing up in Ilesha, where everyone did it on open fields, grew with me. It is going to take more than toilet days to stop me from defecating in open spaces. It is not because I don’t like using toilets, but it’s easier knowing that I won’t have to go fetch water or ask my wife to fetch water for me just to use it to flush toilet. Water is an issue where I lives.”

Dangers

Dr Ganiyu Aremu of Federal Medical Centre, Jabi, Abuja, does not believe that it is ‘just’ 108 million Nigerians that lack access to toilets or are involved in open defecation.

“It is an understatement. Far more Nigerians use open spaces to stool. A lot of Nigerians don’t have access to toilets. It is that bad. The prevalence of curable, but contaminable diseases in this country is so high simply because a huge number of Nigerians don’t have access to toilets or good sanitation. What we have is an environmental health emergency,” he said.

Another medical practitioner, Dr Olawumi Adekola of International Health Services, Dugbe, Ibadan, Oyo State, warned that open defecation is responsible for the deaths of Under 5 children, especially in Nigeria.

“Diseases spread infections by anal routes and unfortunately, it is children that are made to suffer, even at the cost of their lives. Some of the diseases that accompany open defecation or lack of toilets include diarrhea and cholera. Diarrhea alone has been named as the biggest killer of children under five years old. When it is not the highest, it is pneumonia. The two diseases are deadly and they interchange positions. If pneumonia is the highest killer in a particular year, diarrhea will be second and vice versa

“The Who Health Organisation (WHO) rates the state of a nation’s health position using mortality rates among U-5 as its indices. Any country where children under five years die a lot is considered a failure according to their health standard. Nigeria is likely going to be in that category because of what happens to our little ones. Our health infrastructure is in trouble,” he said.

“Two major diseases especially brought by poor environmental sanitation are measles and trachoma. They can result in blindness for those affected by any, or all of it. Without proper sanitation facilities, people often have no choice but to live in and drink water from an environment contaminated with feces.

“When people don’t take care of their environment, bad sanitation can be risky and life threatening. The neglect of health facilities, lack of hygiene education, non-existent or insufficient water supply, poor sanitation and inadequate hand washing facilities, dirty and unsafe water supply; toilets or latrines can lead to loss of lives. For children, water contamination causes diarrhea and leads to other diseases such as cholera and schistosomiasis. Diarrhea is the second fastest killing disease among children,” Dr Adu also said.

Dr Adeyefa told Sunday Tribune that contaminated water can transmit diseases such as diarrhea, cholera, dysentery, typhoid, vomiting, intestinal worm infections, hepatitis, polio, trachoma and polio, while open defecation causes fever from mild to severe, lasting from a few days to several weeks. Infection of the intestines can cause watery diarrhea and frequent watery faeces, which can both lead to dehydration.

“Access to clean water is the most important thing if we are to achieve UN’s goal of open defecation eradication at all. We all know that water has become a major problem in the country. When residents have to travel miles to get water, especially women and girls, we should not expect that the water would be used to flush toilets, or clean hands. Water is vital to life, but we don’t see it that way,” Adeyefa told Sunday Tribune.

“Everywhere you go in this country, a majority of home owners have to drill boreholes by themselves. This act does damage to the earth crust, but we are not bothered just yet because we have not begun to experiences earthquakes or tremors. Only governments can ensure that water gets to homes in serious countries. Those who drill holes do it only for their households, not the general public. When government officials drill boreholes at homes, you should know that access to clean water is a long shot from happening,” Dr Richard Adu of Maranathan Clinic, Sogunle, Lagos, added.

WaterAid, an NGO set up in 1981 as a response to the UN International Drinking Water and Sanitation, buttressed both Dr Adeyefa and Adu’s views. According to the NGO, at the current rates of progress, Nigeria will never reach the point where everyone has the basic sanitation services by 2030.

“Nigeria is the worst country in Africa and the forth worst globally for urban sanitation with more than 58 million urban dwellers (67.2 per cent of the population) living without access to safe, private toilets. But then, 4.2 billion people all over the world also live without toilet nor have access to well-managed sanitation services. 33 per cent of world population also lack access to clean water, while 26 per cent practice open defecation,” he said.

“Nigerians are not used to washing their hands regularly. Washing hands can save lives. If only we learn to wash our hands regularly like we use toothpicks, even after taking water, a lot of diseases can be avoided. Poor waste management, linked to poverty, is one of the ways in which feces can enter the environment and cause disease. Contact with human feces is still the world’s most hazardous pollutant and constitutes a threat to human health.”

“Last year, UNICEF warned on World Toilet Day that slow progress on sanitation and the entrenched practice of open defecation among millions around the world continue to put children and their communities at risk. In 2013 more than 340,000 children under five died from diarrheal diseases due to a lack of safe water, sanitation and basic hygiene – an average of almost 1,000 deaths per day. Access to safe drinking water is vital. Another health official of the organization warned that it is the poor who overwhelmingly do not have toilets, but everyone suffers from the contaminating effects of open defecation, so everyone should have a sense of urgency about addressing this problem,” Adeyefa said.

Solutions

All over the world, major cities battle with dealing with ever-increasing volume of human fecal wastes and all health experts, Dr Aremu, Adeyefa, Adekola and Adu advise that containment, treatment and safe reuse or disposal are some of the ways of ensuring that smooth sanitation process can be achieved.

“WHO had adopted an approach called WASH (Water Solution and Health),” Adekola said.

According to him, this new approach by WHO is what the international organization has urged people and governments to begin to focus on.

“Without water, we can’t have good health. Water is life. We drink it, bath with it, wash in it, etc. Water is life, not data, not oil. I don’t know the conditions of our public toilets, but there should be a building code that all homes must have a toilet. The code should be followed to the letter. That is the only way to ensure a drastic reduction in health sanitation.”

Dr Adu also advocated for the return of Home Inspectors if there is to be a positive change in home health sector. “The old practice of using Inspectors should return. All tiers of government should be involved in this project otherwise the high prevalence of diseases transmitted via faeco-oral route in the country will not end. Governments and individuals should also make sure that houses come equipped with modern toilets, while water ‘must’ be made available at homes,” he said.

“Many people all over the world, even when they have the rights to clean water and accessible toilets, still don’t enjoy these services. Although various governments are trying their best to provide these, they are not targeted at those people who are really struggling to survive,” added Dr Adu, while suggesting that making these services available to the homes of the poor, who really need it, should now be the target of government.

Dr Adeyefa also suggested that safe drinking water, good sanitation facilities and easy disposal of infectious wastes will prevent diseases and improve health.

“By and large, good hygiene practice is vital to preventing disease transmission. Water should be provided in sufficient quantities to enable proper hygiene. Hand washing at critical times should also become a lifestyle. I know that town planners have made it compulsory that toilets and bathrooms should be in every house, a lot of supervision is needed because a majority of houses were built when this was not a standard. That is why we still have a lot of house in the rural areas without toilets still litter the landscape.”