Carbon Monoxide Poisoning: a Clear and Present Danger in Nigeria Today

                                                           L K Solomon

On a recent trip to Nigeria, I was astonished by the number of privately owned electricity generators and their associated noise levels. I was in Lagos, Port Harcourt and Yenagoa , and the story was all the same in the less affluent areas: small, smoky, oily generators placed in metallic cages close to doorways. It was even worse in the so called multifamily ‘yards’ , where on a good evening you could have up to 5 different generators running. In the more affluent areas, these generators were mostly bigger and smokier, and though housed in sheds slightly distant from the main houses, sometimes directly discharged their fumes into other nearby accommodation. It struck me at such that most Nigerians were inadvertently exposing themselves to unprecedented levels of carbon monoxide.

Carbon monoxide is a colourless, odourless, tasteless, poisonous gas that is released when any carbon-containing material is partially burnt (combusted). Most common of these materials are petrol, diesel, kerosene, cooking gas and wood.  These would normally combust to mainly produce the gas carbon dioxide which is by far less poisonous. (Carbon dioxide is also the gas produced as a waste in our bodies and breathed out.) However, impartial or rapid carbon combustion produces carbon monoxide in significant amounts. Such combustion could occur in faulty generators and engines, cooking stoves and gas cookers, faulty or improperly installed electrical appliances such as air conditioners and refrigerators, and during house fires. Carbon monoxide levels  rise fairly quickly in enclosed and/or poorly ventilated spaces: in Nigeria, most windows, especially those without mosquito-nets, are shut at night; it is not also unusual to see passengers crowded in the enclosed back of pick-up vans especially in villages.

Carbon monoxide is referred to as the ‘silent killer’ because it is colourless, odourless and tasteless, and so not detected by our sense organs. It is rapidly fatal when inhaled (breathed in) in high doses. In fact, those trapped in household or industrial fire accidents can be killed from carbon monoxide poisoning in the smoke fumes without even getting burnt. Other manifestations of carbon monoxide poisoning depend on the amount inhaled, and may range from headaches, nausea, vomiting, ‘stomach’ cramps, blurring of vision, confusion, agitation, memory disturbances, convulsions and drowsiness to loss of consciousness. Those particularly vulnerable are children, smokers (have a higher level of carbon monoxide in their blood), those with heart problems, those with low blood levels (anaemia) and the elderly. Carbon monoxide is able to cross the placenta and hence also affect the baby in pregnant women.

In the blood circulation, oxygen (the essential gas that keeps us alive) is attached to haemoglobin (the molecule that gives blood its distinctive colour). In this attached state our organs such as the brain, heart, liver and kidneys can extract the oxygen from blood. When carbon monoxide is breathed in however, it rapidly moves across the lungs into the blood circulation, where it displaces oxygen from haemoglobin molecule, making it unavailable to these vital organs: it effectively cuts off the oxygen supply to the body. The brain and the heart are the organs that need oxygen most and are thus most severely affected. Unfortunately, this haemoglobin molecule preferentially attaches to carbon monoxide and will only attach to oxygen when carbon monoxide is no longer available. In other words, it attaches (binds) to haemoglobin more strongly than oxygen does.

The first aid measure in any suspected case of carbon monoxide poisoning is to move the victim out of the source to a well ventilated area and administer high doses of oxygen if available. This high-dose oxygen treatment is also the main treatment given in hospitals.

Prevention of carbon monoxide needs to be tackled seriously in Nigeria. Individuals may take the steps outlined in the box. The government on the other hand needs to provide electricity to Nigerians: its lack is the root cause of this problem. In the mean time, publicity campaigns in news media should be carried out to increase public awareness of the dangers of carbon monoxide. All shops selling electricity generators should also be mandated to stock carbon monoxide detectors and sell them with every generator.  Measures to tackle fuel scarcity and adulteration may also help.

The setting in Nigeria of lack of electricity, proliferation of electricity generators most of which are poorly maintained and improperly positioned, and  overcrowded and poorly ventilated dwellings significantly increase the chance of carbon monoxide poisoning not only killing individuals but wiping out entire families. There have been previous sporadic reports of carbon monoxide related deaths from generators in Nigeria but I suspect the incidence is much higher.