Cholera has killed more than 200 Nigerians in the last month as poor sanitation facilities are overwhelmed by rains.

Nigeria's cholera outbreak spreads as far south as Cross Rivers and Ogun States and is even effecting the capital, Abuja. But most of the cases so far are concentrated in the northeast states of Borno, Bauchi, and Adamawa.

Nigerian Health Minister Onyebuchi Chuku says more than 230 people have died and more than 4,600 people are affected by a disease that has spread since the start of rains in late June.

"Many people in those areas still do not use standard toilet facilities. It is open defecation. So as long as there is nothing carrying that waste into the source of water supplies, there is no problem," said Chuku. "But during the rains, of course, flood water will carry all that into our streams. And streams are the common source of water supply in those area. And when people now take their water supplies from those streams, they then get the infection." 

Chuku says that is made worse by inadequate health surveillance at the local level that is slow to report problems before they grow.

"So we discover it late. And cholera kills rapidly. Why? Because you lose a lot of water and electrolytes through vomiting and diarrhea, severe vomiting, severe diarrhea. And in hours, someone can die if he doesn't get help," said Chuku.

In the next four months, Chuku says the Health Ministry wants to strengthen local surveillance so federal officials are on the scene within 24 hours of any health emergency. He says preventing future cholera outbreaks requires greater cooperation between federal, state, and local officials to provide toilet facilities that dispose of human waste properly while expanding the number of safe water supplies so Nigerians are not drinking from open streams.