Cholera has killed more than 1,500 people in Nigeria this year, more than four times the death toll reported by the government in August, the United Nations said on Monday.

According to U.N. figures, 1,555 people have died from the disease in Africa’s most populous nation since January while 38,173 cases have been reported, Martin Dawes, regional spokesman for the U.N. Children’s Fund (UNICEF) told Reuters.

Heavy rains and flooding in rural areas where safe drinking water and sanitary facilities are scarce have fueled the outbreak of the disease, which is generally spread through food and water contaminated with bacteria.

Nigeria’s health ministry said in August the death toll from an outbreak concentrated largely in the north had risen to 352, but warned of a nationwide risk.

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LAGOS (Reuters)