Khadijah Aliyu
For years, diphtheria has refused to disappear from Kano State.
While the disease has declined significantly from the devastating levels recorded at the height of the outbreak, health authorities say thousands of suspected cases have been investigated since 2022, with thousands of confirmed cases and more than 1,800 deaths recorded.
Behind the statistics are children who arrived at health facilities too late, families who did not recognise the seriousness of the disease, and communities where routine vaccination remains dangerously low.
There are also stories of traditional interventions, misinformation and rumours that sometimes spread faster than the disease itself.
For Professor Muhammad Adamu Abbas, Director-General of the Kano State Centre for Disease Control (KNCDC), the experience has reinforced one lesson: people cannot protect themselves from a disease they do not know exists.
“Why I am giving these numbers is to show you that we are not shying away from telling the numbers,” Abbas said. “Because if people don’t know, they won’t know how to protect themselves.”
Kano’s current disease surveillance system was partly shaped by the painful experience of the COVID-19 pandemic.
In 2020, while reports of unusual deaths were emerging across Kano, a dispute developed between state and federal authorities over whether coronavirus was responsible.
The controversy eventually led the Federal Government to send experts to the state to conduct what is known as a verbal autopsy, interviewing families who had lost relatives and documenting the symptoms they had experienced.
The exercise eventually established that some of the deaths were COVID-19-related.
For Abbas, the episode exposed the importance of having a coordinated system capable of detecting, investigating and communicating outbreaks.
It was against this background that the idea of establishing a dedicated disease control centre in Kano gained momentum.
According to him, the administration of Governor Abba Kabir Yusuf had, during the 2023 election campaign, promised to establish a centre that would coordinate responses to epidemics.
But Abbas said previous attempts in some states to establish similar institutions had failed because they lacked legal backing.
The State House of Assembly worked on a law establishing the centre, which was sent to the governor for assent. Corrections were later made, returned to the Assembly and incorporated before the law was re-enacted.
The legislation was eventually assented to by Governor Yusuf on February 18, 2025, giving the KNCDC its legal foundation.
Since then, Abbas said, the centre has been involved in responding to more than 200 outbreaks, while also strengthening disease surveillance, laboratory capacity, health-worker training and community engagement.
Kano recorded a diphtheria outbreak in December 2022, but according to the KNCDC chief, the state has continued to battle the disease.
He said that from December 2022 to August 2026, more than 39,000 suspected diphtheria cases were investigated, of which more than 32,000 were confirmed.
More than 1,800 people died.
The confirmation of cases, Abbas explained, does not depend solely on laboratory testing.
Some cases are confirmed through laboratory tests using nasal and throat swabs. Others are clinically confirmed where the characteristic signs and symptoms are obvious, while epidemiological confirmation may be made when a person has been exposed to a confirmed case within an outbreak setting.
The figures, he stressed, are not being hidden.
Rather, they are necessary for public health action.
“It’s our duty. The law says we must inform the people of Kano when these things happen,” he said.
But communicating disease information is not as simple as announcing every suspected case immediately.
The state considers laboratory or clinical evidence, the nature of the disease and the potential consequences of public communication.
In some communities, Abbas said, premature announcements can create fear and cause people to flee instead of seeking treatment.
This is why the state uses risk communication and community engagement mechanisms to balance the need for transparency with the need to prevent panic.
Perhaps the most disturbing finding from the diphtheria data is the vaccination status of affected children.
Abbas said more than 16,000 of the confirmed cases were children who had received no vaccination at all.
That means they were “zero-dose” children — children who had never received a routine vaccine.
More than 9,000 confirmed cases were fully vaccinated, while another group was partially vaccinated or had no reliable record of vaccination.
The vaccination gap, Abbas suggested, provides an important explanation for why diphtheria has been able to continue affecting communities.
The disease is vaccine-preventable, yet thousands of children remain vulnerable because they have never received the protection that routine immunisation is designed to provide.
Why late presentation is costing lives
Vaccination is only one part of the problem.
The other is delayed treatment.
Diphtheria is an acute illness that can deteriorate rapidly. Abbas explained that its incubation period can be as short as two days and is usually around five days, although symptoms can sometimes take longer to appear.
Yet many families do not seek medical attention early.
By the time some children arrive at health facilities, the disease may already have progressed significantly.
The situation becomes even more complicated when families seek alternative interventions before going to a hospital.
Abbas recalled investigations in Rano where health officials discovered that some affected children had been taken to traditional barbers who attempted to remove the characteristic membrane associated with diphtheria.
In some instances, he said, traditional practitioners even attempted to cut the neck of affected children.
Health officials subsequently engaged traditional healers and barbers to explain the dangers associated with such practices.
The message was not that traditional practitioners had no role to play, but that they needed to recognise the limits of their practice and refer patients when faced with conditions requiring specialised medical care.
“We are not against your services,” Abbas said of the message delivered to the traditional practitioners. “But know your own limits.”
The experience also forced the state to rethink how diphtheria treatment was organised.
Initially, many patients from distant communities had to travel to Kano metropolis to access treatment.
For poor families, the journey could involve commercial transportation and long hours on the road.
Apart from delaying treatment, Abbas said, such movement could expose other passengers and communities to infection.
The state therefore decentralised diphtheria treatment services.
Treatment centres were established in locations including Rano, Bichi, Wudil, Tudun Wada and other parts of the state.
According to Abbas, Kano eventually developed a network of about 26 facilities involved in diphtheria response, including secondary and primary healthcare facilities.
The strategy was aimed at bringing treatment closer to communities and reducing the time between the onset of symptoms and access to appropriate care.
The issue of diphtheria deaths in Rano recently returned to the public space following claims that more than 50 people had died from the disease in the local government.
The claim, made on the floor of the Kano State House of Assembly, generated public concern.
But KNCDC investigated the allegation and rejected the figure.
Abbas said surveillance records showed that, as of August 26, 2026, Rano had recorded 32 diphtheria cases from January to August, rather than more than 50 deaths.
Of those 32 cases, seven were referred to an isolation centre because of complications, while 25 were treated at a diphtheria treatment centre.
Two of the 32 patients died.
Further analysis showed that approximately 94 per cent of the affected children had never received any vaccination, while about 91 per cent presented late for treatment.
For the KNCDC, the findings demonstrate the importance of investigating rumours rather than dismissing them outright.
Abbas said disease surveillance teams conducted active case searches in communities and health facilities, engaging community leaders and examining available records.
The investigation found no evidence supporting the claim of more than 50 diphtheria deaths.
The state’s disease surveillance system does not depend only on reports coming from hospitals.
There are two broad approaches: passive surveillance, where health authorities receive reports from health facilities or members of the public, and active case search, where health officials deliberately go into communities and health facilities looking for cases.
The KNCDC also uses event-based surveillance to monitor rumours and unusual health events circulating within communities and on social media.
One of the tools used for this purpose is TATAFO, a surveillance mechanism that can identify health-related rumours and alerts from multiple sources.
Abbas said such systems allow authorities to investigate claims before they develop into larger public-health threats.
A rumour, therefore, is not necessarily dismissed simply because it is unverified.
It can become the starting point for an investigation.
The Rano allegation was treated in that manner.
Health officials wanted the lawmaker who raised the alarm to help them identify the families allegedly affected, not merely to prove that his claim was wrong, but to ensure that any unreported cases were not left untreated.
“If you’ve lost 50, you can also go tomorrow,” Abbas said, explaining the rationale for wanting to trace the alleged cases.
Despite the sharp decline from the peak of the outbreak, the persistence of diphtheria in Kano remains a warning.
The disease continues to find vulnerable children in communities where vaccination coverage is incomplete, where families delay seeking care and where traditional practices or misinformation can interfere with treatment.
The statistics tell one part of the story.
More than 39,000 suspected cases investigated.
More than 32,000 confirmed.
More than 1,800 deaths.
More than 16,000 confirmed cases involving children who had received no vaccination.
In Rano alone, 32 cases were recorded between January and August 26, with 94 per cent of affected children reportedly unvaccinated and 91 per cent presenting late.
But behind every number is a family.
For Kano’s disease-control authorities, the response therefore goes beyond hospitals and laboratories.
It involves surveillance officers in local government areas, community leaders, traditional practitioners, journalists, health workers, vaccinators and families.
The ultimate objective is simple: detect disease early, communicate accurately, vaccinate children, get patients to treatment quickly and prevent avoidable deaths.
The battle against diphtheria may have entered a different phase in Kano, but the experience has shown that a disease can remain dangerous long after the headlines have faded.
And as Abbas puts it, telling people the truth about outbreaks — including the uncomfortable numbers — is itself part of the response.
Because the first step to protection is knowing what the community is facing.