When 50-year-old Lawan Umar left home with his daughter, six-year-old Zulaihat, he believed she had a fever that would be treated at the hospital. He never imagined he would return to bury her.
Also, he could not have imagined that, within five days, he would also bury her siblings – Khadija, nine, and 12-year-old Umar. All three children died from diphtheria in October 2023, a year after Nigeria’s ongoing diphtheria outbreak began in 2022.
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“They waved at me when Zulaihat and I were leaving for the hospital,” Mr Umar recalled with his eyes filled with tears. “They were smiling. They looked fine.”
What started with a fever turned out to be the start of a heartbreaking chain of events. Zulaihat was first taken to a local clinic, then referred to the Infectious Diseases Hospital in Kano, and finally to the Murtala Muhammad Hospital, where she died the same day.
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After her burial, Mr Umar noticed Khadija and Umar were unusually quiet. Though they seemed well, he took them to the hospital as a precaution.
“They were cheerful,” he said. But both were immediately quarantined. Khadija died two days after Zulaihat, and Umar died two days later.
The family lives in Gaidar Fulani in the Kumbotso Local Government Area (LGA) of Kano State. At the time of the tragedy, Mr Umar and his wife had five children. Since losing three, they have welcomed another child.
Sadly, Mr Umar’s tragedy is just one of many similar stories in Kano, where diphtheria has claimed hundreds of lives.
The story is not different in Lagos, Nigeria’s commercial capital. In June 2024, at the peak of the cholera outbreak in Lagos, Caleb Ezechimere, a young medical laboratory scientist, died just one month into his internship at the Military Hospital in Lagos. He had bought a tiger nut drink from a local vendor.
“Everyone who bought from the same vendor ended up in the hospital, but he didn’t make it,” his sister-in-law, Jaachi Nwagbara, a medical doctor, told PREMIUM TIMES.
“It was a preventable death, and that’s the most painful kind. Deaths like this shouldn’t still be happening.”
Across Nigeria’s two biggest cities, Kano and Lagos, preventable diseases like diphtheria and cholera continue to spread, exposing cracks in disease surveillance, vaccination coverage, and outbreak preparedness.
A visit to some of the worst-hit communities in Kano and overcrowded slums in Lagos reveals how these systemic failures are putting countless lives at risk.
A crisis long in the making
Since 2022, Nigeria has battled its worst diphtheria outbreak in decades. According to the Nigeria Centre for Disease Control and Prevention (NCDC), over 43,000 suspected diphtheria cases have been reported in 360 LGAs across the 36 states and the Federal Capital Territory (FCT).
What happened in Mr Umar’s home highlights a much larger public health crisis in Kano. The state alone accounted for more than half of Nigeria’s diphtheria cases, reporting 24,415 suspected cases, with 18,284 confirmed infections, and 860 deaths, making it the epicentre of the country’s ongoing diphtheria outbreak.
On the chart for confirmed cases, Kano is followed by Bauchi (2,334), Yobe (2,411), Katsina (1,610), Borno (1,166), Plateau (119), and Jigawa (53).
Nationwide, 26,499 cases were confirmed, and approximately 64 per cent of those infected were children aged one to 14. Only 4,999 (19.1 per cent) of the confirmed cases were fully vaccinated with the diphtheria toxoid-containing vaccine. This means that over eight in 10 confirmed cases had either incomplete vaccination or none at all.
Kumbotso, Mr Lawan’s local government area, was among the eight most affected LGAs in Kano during the 2023 phase of the outbreak. Others included Ungogo, Dala, Fagge, Gwale, Nassarawa, Kano Municipal, and Tarauni.
In these communities, families shared stories of loss and survival that reflect their vulnerability to future outbreaks if nothing changes.
Health gaps, low vaccination rate
In communities like Rimin Kebe, Gama B, and Rangaza, residents lamented the long distances to health facilities, irregular access to immunisation, and poor sanitation. These factors make it harder to prevent and control outbreaks, especially among children.
Rimin Kebe, located in Ungogo LGA, recorded some of the highest diphtheria cases in the state. Ibrahim Haruna, a 75-year-old resident who has lived there for over three decades, said awareness about such diseases often comes too late.
“It is not just the disease but the delay in getting help,” Mr Haruna said, sharing how his wife recently went into labour at night, and they had to travel on a motorcycle due to the absence of any nearby facility. By the time they reached the hospital, the baby had died and was removed through surgery.
Poor vaccination access is a recurring concern among residents. A Community Health Extension Worker (CHEW), in Rangaza, another community under Ungogo LGA, who requested anonymity, noted that health officials often hesitate to enter the area, even during outbreaks.
“We have to go to the general hospital, which is far. I sometimes have to personally beg officials to come vaccinate the children,” she said.
“There was a recent outbreak of diphtheria among children here. I believe overcrowding, poor hygiene and blocked drainage worsened it.”
Anas Ibrahim, a pharmacist who runs a small shop in Ungogo, said that poor access to slum areas discourages even health workers from coming into the communities for health campaigns, especially vaccination.
“People mostly fall ill and rely on self-medication, and we’ve lost some people in transit trying to reach a hospital,” Mr Ibrahim said.
Strengthening disease surveillance in Kano
Despite being the epicentre of Nigeria’s diphtheria outbreak, with over 18,000 confirmed cases and hundreds of deaths since 2022, officials in Kano insist the government is not inactive.
In response to PREMIUM TIMES’ enquiries, the Kano State Ministry of Health acknowledged that the state remains the epicentre of Nigeria’s ongoing diphtheria outbreak. However, the ministry, through its spokesperson, Ahmad Abubakar, noted that “it would be incorrect to suggest that the government is doing nothing.”
According to Mr Abubakar, the state is making “continuous efforts through targeted vaccination campaigns, community sensitisation, and collaboration with partners” to reduce the spread of diphtheria, especially in high-risk communities.
On the issue of low vaccination coverage, Mr Abubakar said the government had “intensified outreach services, engaged community leaders, and scaled up routine immunisation programmes” to ensure that residents in densely populated areas have access to vaccines and healthcare services.
He also stated that the state was strengthening its surveillance system by working closely with stakeholders to enhance early detection and response.
“Surveillance officers have been trained, and community informants are being used to report suspected cases,” he added.
Diphtheria is preventable
Diphtheria is a serious bacterial infection caused by the bacterium Corynebacterium diphtheriae. It affects the nose and throat, and in severe cases, can block airways or spread to other organs, leading to death.
Despite its severity, diphtheria is entirely preventable, with its vaccine typically administered as part of the pentavalent vaccine in early childhood immunisation schedules.
As of September 2023, the NCDC confirmed that more than 80 per cent of diphtheria cases involved children who were not fully vaccinated in the ongoing outbreak.
A 2024 study titled, “Vaccine Hesitancy under the lens: Nigeria’s struggle against the worst diphtheria outbreak in decades” highlights how deeply rooted vaccine hesitancy worsened Nigeria’s ongoing diphtheria crisis.
In Kano, where the outbreak has been most severe, the study found that only 14 per cent of the target population of children under five received the diphtheria-containing pentavalent vaccine during key immunisation campaigns.
The study noted that cultural beliefs, misinformation, and distrust in health systems continue to fuel hesitancy, leaving millions of children vulnerable.
The study recommended that tackling vaccine hesitancy is about stopping the current outbreak and building long-term trust in vaccines to prevent future disease outbreaks.
Experts say that tackling outbreaks like diphtheria goes beyond routine immunisation days or mass campaigns.
Christiana Fashola, a global digital health and vaccine expert with experience across Africa, Central Asia, and Latin America, told PREMIUM TIMES that while these traditional methods remain important, Nigeria must now adopt more community-based strategies to reach the people who need vaccines the most.
“One of the most impactful approaches is integrating community pharmacies and pharmacists into immunisation service delivery,” Ms Fashola said.
“They are often the first point of contact in underserved areas and can help reach not just children but also adolescents and adults.”
She added that culturally sensitive communication and working with local influencers are key to building trust and driving vaccine acceptance.
Disease risk lingers in Lagos
Lagos is Nigeria’s most developed state, yet many of its communities face daily risks of disease. In slum areas like Ajegunle, Makoko, Badia East, and Bariga, poor sanitation, flooding, and inadequate healthcare increase their susceptibility to outbreaks.
During the rainy season, these conditions worsen as contaminated water enters homes, drainage overflows, and the risk of cholera and other preventable diseases grows.
A community leader at Ifelodun Local Council Development Area (LCDA) of Ajegunle, Liadi Eniola, pointed to houses directly by a wooden pedestrian bridge surrounded by dirty water and waste, while people still live and eat there.
Mr Eniola suggested that people there may have built resistance to sickness. “If not, many of us would be dead by now,” he said. But many people still come down when there is an outbreak.
Other residents shared similar stories of lives lost to preventable causes. Hunkarin Felix, 39, a resident of the Araromi area of Bariga, lamented that despite their susceptibility to disease risk due to the environmental conditions, they still scramble to access health care.
“We run from place to place when someone is ill,” Mr Felix said. “Before we get to a clinic, it is sometimes too late.”
In Makoko, one of Lagos’ most underserved waterfront communities, the risk is even higher. Emmanuel Enasumahousiele, a former works supervisor in Yaba LCDA, shared how he lost his wife on 17 June to a suspected malaria outbreak.
“She died because we couldn’t get care in time,” Mr Enasumahousiele said. “If Makoko had a standard health facility, it wouldn’t have happened.”
Residents like Jejelola Shittu and Jacqueline Afan, both 30, also shared similar stories of watching families and friends die as a result of their vulnerability to diseases.
Beyond health concerns, residents of Araromi, Bariga, and Makoko fear that their entire neighbourhoods could be wiped away. Mr Felix and Mr Enasumahousiele told PREMIUM TIMES they were under pressure to vacate for demolition.
“We don’t want to leave,” said Mr Enasumahousiele. “We just want hospitals, clean water, and support. If they demolish everything, we have nowhere else to go.”
Overcrowded settlements in Lagos remain highly vulnerable to cholera and other infectious diseases. With recurring floods, poor sanitation, and limited access to health services, experts warn that a single case in these conditions could escalate quickly.
Adedayo Aderibigbe, a Consultant Community Health Physician at the Lagos State University Teaching Hospital (LASUTH), said slum communities in Lagos are extremely vulnerable to disease outbreaks due to the combination of unsafe environments and limited healthcare access.
“Slum communities are exposed to poverty, poor feeding, low standards of living, lack of potable water,” Mr Aderibigbe told PREMIUM TIMES. “These conditions make them vulnerable to both communicable and non-communicable diseases.”
He explained that the situation worsens during the rainy season, as many residents are exposed to contaminated food and water caused by indiscriminate dumping of waste and faecal matter, poor waste disposal, and harsh weather.
“This can further exacerbate the incidence of waterborne diseases amongst them, especially among children,” he said.
Data gaps, Cholera burden
According to the NCDC, in 2024, Lagos recorded the highest number of suspected cholera cases in Nigeria, contributing 43 per cent of the national total. Lagos Island alone accounted for five per cent of all suspected cases nationwide.
As of 29 September 2024, the agency’s last published situation report showed that Nigeria had reported 10,837 suspected cases and 359 deaths. However, just two weeks later, during a 13 October press briefing, NCDC Director-General Jide Idris confirmed that the figures had risen sharply to 14,237 cases and 378 deaths across 35 states and the FCT.
As of 2 March 2025, a total of 1,149 suspected cholera cases and 28 deaths, with a case fatality rate of 2.4 per cent, had been reported in the new year from 25 states. While Lagos recorded only three suspected cases, Bayelsa and Rivers now lead the national chart
This sharp reversal raises questions about the accuracy and consistency of disease reporting and surveillance, especially as conditions in vulnerable Lagos communities remain unchanged.
Meanwhile, the World Health Organisation (WHO) in June raised concerns over data gaps in cholera surveillance and reporting across Nigeria.
WHO reported that between 1 January and 25 May, Nigeria recorded 1,562 cholera cases, contributing to the 117,346 cases across 17 countries in the WHO African Region.
It warned that the figures may not reflect the full extent of the outbreak, citing underreporting, delayed submissions, and limited diagnostic capacity as barriers.
“The data should be interpreted cautiously due to potential underreporting and reporting delays,” the global health agency said, adding that “the figures might not accurately represent the true burden of cholera.”
This concern aligns with what residents in communities like Makoko, Ajegunle, and Badia East told PREMIUM TIMES that many cholera cases and even deaths are not officially recorded.
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Cholera response in Lagos
In response to PREMIUM TIMES’ questions, the Lagos State Government said it has intensified surveillance and improved its response systems.
The Special Adviser to the Governor on Health, Kemi Ogunyemi, explained that surveillance officers across all local government areas have received updated training, including on the use of SORMAS, an electronic platform for real-time case reporting.
She said 100 health workers were recently trained by WHO, NCDC, and the state government on the use of rapid diagnostic tests for cholera. The group includes 57 laboratory focal persons from primary healthcare centres, 25 from general hospitals, 23 disease surveillance officers, and five from the Lagos State biobank.
She also noted that quarterly evaluations are being held to build capacity among surveillance officers and improve data management.
In addition, she said the health ministry was working closely with environmental health officials, and community sensitisation efforts were ongoing in vulnerable areas.
While these actions are commendable, the effectiveness of the response will depend on how quickly and accurately data is captured from the most affected communities, like the ones featured in this report.
On the state’s disease surveillance system, Mr Aderibigbe, the consultant community health physician, noted that while Lagos has made progress compared to many other states, some challenges persist.
These include unsustainable funding, heavy reliance on external partners, and logistical difficulties. In some areas, he said, disease tracking is still done manually, slowing down response time.
“Digitalisation and the use of technology in surveillance are important,” he said. “It is cheaper to identify breakdowns in public health systems early and institute measures to manage them than to manage the consequences.”
He recommended that Lagos improve awareness about the importance of surveillance among healthcare workers and invest more consistently in early detection systems, electronic reporting, and coordinated public health response.
