An Assessment on the Awareness of Lassa fever and its Health Implication

AN ASSESSMENT ON THE AWARENESS OF LASSA FEVER AND ITS HEALTH IMPLICATION AMONG RESIDENTS OF BEKWARA GOVERNMENT AREA

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CHAPTER ONE

INTRODUCTION

Background of the Study

Lassa fever is an acute viral haemorrhagic illness caused by Lassa virus, a bisegmented ambisense single-stranded RNA virus that belongs to the family old world Arenaviridisae spp. It is an endemic disease in the West African sub-region (Nigeria, Sierra Leone, Guinea, and Liberia) where about 3-5 million individuals are infected yearly. There have been reports of outbreaks in Ghana and Ivory Coast, however, several imported cases with hazardous outcomes have been reported in countries where it is not endemic. The first case was reported in 1969 where two missionary nurses along with some other hospital workers were infected and lost their lives in the process at Lassa Village, Nigeria (Ogbumgbiri, 2016).

According to Centre for Disease Control and prevention (CDC) (2012), multimammate rats (Mastomys natalensis) are the natural hosts for the virus, commonly found in rural environment where over 70% of the population resides, they breed frequently and are widely distributed throughout central, west and east Africa . These rats shed the virus in their excreta and humans are infected by contact with the excreta of the rats or by eating them (they are considered as a delicacy in some areas of the endemic region) or food stuff that has been contaminated with the urine of the rodent. The virus has the capacity of person to person spread or Secondary human spread through contact with body fluids especially if the body fluid contains blood. This occurs during care of sick relatives or among health care personnel in health care setting. The morbidity and mortality associated with the disease can be reduced by careful management of infected persons, proper and timely control measures and in some cases, administration of prophylactic therapy to relatives and health care workers after exposure (Bond, Schieffelin, Moses, Bennet and Bausch, 2013).

Lassa fever presents initially with symptoms and signs that are common with other viral and bacterial infections and indistinguishable from those of febrile illnesses such as typhoid, malaria and other viral haemorrhagic diseases such as Ebola. All age groups are susceptible and it has an incubation period of 6-21days, it is difficult to diagnose clinically but should be suspected in patients who present with fever (>38ºC) that does not respond to antimalarial and antibiotic drugs, sore throat, retrosternal pain, conjunctivitis, bleeding from orifices, petechial haemorrhages, abdominal pains, vomiting and diarrhoea. Multiple organ damage and sensorineural hearing loss are part of the complications associated with Lassa fever (Bausch, Hadi, Khan, Lertora, 2010).

Lassa fever is a highly contagious disease which can result in death. Therefore it is important to report and diagnose any suspected case of Lassa fever through establishment of diagnostic facilities in the disease-endemic zones/regions of the world that can provide rapid molecular testing. This will facilitate early detection of the disease and management of cases as well as contacts that have been exposed to the disease.

The situation of Lassa fever in Nigeria is captured by Asogun, Okokhere, Okogbenin, Akpede, Gunther and Happi (2010) while presenting the report of Pest Control Association of Nigeria, (PECAN) lamented that no fewer than 3,000 Nigerians died annually from Lassa fever. This statistics is quite alarming when compared with the report of WHO (2012) that between 300,000 to 500,000 cases of Lassa fever and 5,000 deaths occur yearly across the West African sub- region. According to WHO, in fatal cases, death usually takes place within 14 days of onset. It further argued that the disease is especially severe late in pregnancy which would invariably lead to foetal or maternal death in over 80 percent of cases in the third trimester.

Medical experts according to Adebiyi (2012) & Ogunyedeka (2012) indicate that contracting the fever usually occurs through coming in contact with the multimammate rat’s excreta or urine. The virus is usually contained in the urine and droppings of the mastomys rodents. Humans can easily get infested when these rats make droppings or urinate on foods that are meant to be consumed. Coming in direct contact with these droppings can also lead to infection. Touching open sores or cuts could lead to its transmission. Since these rodents can be found around homes, they usually scavenge on human food wastes or poorly stored food. The infection could be airborne when sweeping the droppings of these rodents; the particles of such droppings could be inhaled thereby leading to infection (Adebiyi, 2012).

Lassa fever is not gender or sex specific as it occurs both in men and women. Individuals who stand at greater risk are those who live in overcrowded environments, slums, and rural areas where sanitation is not only poor but are lacking. The rodents which carry the Lassa virus largely thrive in such places. It is the common practice of many farmers in rural areas in Nigeria to spread their farm products especially pepper, melon, maize, and tubers meant to be processed into flour along road sideways to dry. This practice easily encourages the contamination of the foodstuff by the virus-carrying rodents which come out of a nearby bush to feed on them thereby aiding transmission. The Federal Government and the various State Governments have embarked on sensitization of residents of the states on the preventive and proactive measures to be taken against the outbreak of the fever. Knowing the awareness among rural people that rat/rodent is a vector of Lassa fever should be the first step in the fight against Lassa fever (Ibeabuchi, 2012).

Statement of the Problems

Despite the epidemic and highly contagious nature of Lassa Fever (LF) in Nigeria and other African countries, the details of outbreaks and subsequent responses to contain it have not been well documented in these places, and it is difficult to learn from these experiences to improve the management of future outbreaks. Available Nigerian reports have focused mainly on a nosocomial outbreaks that occurred almost two decades ago Asogun, Okokhere and Okogbenin (2010), or more recently on laboratory diagnosis of blood samples of suspected cases sent to a national reference laboratory.

The high virulence and fatality rate of this disease is a major concern which is further complicated by the non-specific modes of presentation (mimicking some other fevers). From the foregoing, early presentation and subsequent diagnosis is usually not feasible especially in our hinterlands and villages. The contagious nature of the illness poses a big threat to the Medical attendants, other hospital workers and the care-givers who often are exposed to this disease unprotected, prior to diagnoses and establishment of barrier nursing. The fomite and aerosol mode of contraction posses a huge challenge to all who have close contact with the patients.

The control of the carrier vectors is herculean. The natural habitat of these rats within and around homes and farm settlements makes it cumbersome. Biological control by introduction of safe predators to rats like cats within the endemic areas tentatively carries some prospect; however the future consequences may be worse than the present. The ecosystem will totally be distorted because there is no way the cats will be able to selectively eliminate the Lassa rats alone. This line of reasoning could also be applied to why chemical control (rat pesticides) may also not suffice as an effective mode of control. Worse still, it may be possible that with time, following genetic transformations, such predators might transmute into Lassa Virus carriers. This will spell doom since these are household pets.

The inherent danger of complications that survivors and sub-clinically exposed individuals might suffer from is a concern. Studies had shown that survivors who developed severe sensorineural hearing losses had characteristic poor speech discrimination and were not amenable to hearing aids. The role of antioxidants and hyperbaric oxygen in ameliorating hearing losses and other neurological complications remains hypothetical.

Purpose of the Study

The purpose of the study is to find out the Awareness of Lassa Fever and Its Health Implication among Residents of Bekwara Government Area. The objectives are: The specific objectives of this study were:

To determine the awareness of Lassa fever in Bekwarra Local Government Area of Cross River state, Nigeria,
To examine the awareness of signs and symptoms of Lassa fever in Bekwarra Local Government Area of Cross River state, Nigeria.
To find out the risk factors of Lassa fever in Bekwarra Local Government Area of Cross River state, Nigeria.
To identify the methods of prevention of Lassa fever in Bekwarra Local Government Area of Cross River state, Nigeria.

Research Questions

The following questions will be answered:

What is the awareness of Lassa fever in Bekwarra Local Government area of Cross River state, Nigeria?
What is the awareness of the signs and symptoms of Lassa fever in Bekwarra Local Government Area of Cross River State, Nigeria?
What is the awareness of the risk factors of Lassa fever in Bekwarra Local Government Area of Cross River State, Nigeria?
What are the methods of preventing Lassa fever in Bekwarra Local Government Area of Cross River State, Nigeria?

Scope and Delimitation of the study

This study attempts to study the awareness of Lassa Fever and its Health Implication Among Residents of Bekwara Government Area. The study will be delimited to the following: The inhabitants of Bekwara Area of Cross River State. Three research assistants, structured questionnaire. Descriptive and inferential statistics of Chi Square (X²). Testing of hypotheses at 0.05 alpha level.

Limitation of the Study

There is paucity of research on the subject matter and by implication there is paucity of material, concerning the study area, so the researcher would have to work hard to get enough information on the study. Some households did not have an eligible respondent present, or refuse to give consent in the absence of the head of the household, the researcher arranged for a meeting with the eligible respondent whenever they felt convenient otherwise the next household was considered.

Significance of the Study

This study may enable government to know the adverse of Lassa Fever on the inhabitants of Bekwara Area of Cross River State and its effect in the society so as to provide professional help through which the problems could be resolved or curbed.

It will also be of great importance to the students by broadening their knowledge about the adverse effect of Lassa Fever within the society and the precautionary measure that should be adopted.

The study may influence government decision on policies against Lassa Fever generated through several means within and outside Cross River. It may serve as baseline data for those who may which to carry out research on Lassa Fever.

Operational Definition of Terms

Lassa Fever: LASSA Fever is an acute and often fatal viral disease, with fever, occurring chiefly in West Africa. It is usually acquired from infected rats.

Health: Health can be defined as level of functional or metabolic efficiency of a living organism.

Blood Pressure (BP): Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels. When used without further specification, “blood pressure” usually refers to the arterial pressure in the systemic circulation.

Fever: Fever (also known as pyrexia or controlled hyperthermia) is when a human’s body temperature goes above the normal range of 36-37C (98-100F).

Rat-bite fever: Rat-bite fever is an acute, febrile human illness caused by bacteria transmitted by rodents, rats, or mice, in most cases, which is passed from rodent to human by the rodent’s urine or mucous secretions.

Project Overview

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An Assessment on the Awareness of Lassa fever and its Health Implication among Residents of Bekwara Government Area

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