By January 28, 2020, Lassa fever resurgence has
spread to 11 states of the federation with the Federal Government confirming 29
deaths and 195 cases. The fear that this instrument of finality would spread to
more states and record more deaths have put both the federal and state
governments on their toes in search of a solution.
A recent report from Nigeria Centre for Disease
Control (NCDC) released January 25 indicates that the states affected so far
are Edo, Ondo, Ebonyi, Delta, Taraba, Plateau, Bauchi, Ogun, Abia, Kano and
Enugu. The report also said 89 per cent of the confirmed causalities are from
Ondo, Edo and Ebonyi.
The Lassa fever virus is commonly transmitted by
rodents such as rats, rabbits, mice, squirrel and marmot prevalent in the
environment including homes, offices, motor parks, churches, mosques and other
places of human habitation.
Symptoms
It takes Lassa fever a period of 6–21 days to
incubate. Thereafter, it starts gradually with fever, general weakness, and
malaise.
Then after a few days, it graduates to headache, sore throat, muscle
pain, chest pain, nausea, vomiting, diarrhoea, cough and bleeding from body
openings in extreme cases.
Medical experts advise that if a patient does not
respond to treatment for malaria or other febrile illnesses after 48 hours, he
or she needs to be tested immediately for Lassa fever. The disease was first
identified in 1969 in a Lassa village in Borno State; hence it was named Lassa
fever.
Resurgence
Dr Solomon Avidime, Chairman, Nigerian Medical
Association (NMA) Committee on Inter-Professional Relations and professor of
Obstetrics and Gynecology in Ahmadu Bello University, Zaria, speaking on why
the Lassa fever is recurring in the country said the causative virus which has
rodents as a vector are ever prevalent in our environments.
He said that Nigeria has a high burden of the disease
which occurs majorly during the dry season.
Poor
Hygiene, Ignorance, Poverty
Collaborating, Prof Mojisola Adeyeye, Director
General, National Agency for Food Drug Administration Control (NAFDAC), has
blamed the resurgence of Lassa fever in the country on poor hygiene, ignorance
and poverty.
Adeyeye said, “This is all about hygiene when I was
growing up as the daughter of a farmer, we want to dry our food on a stone
surface in the farm, we don’t leave them overnight and we wash often washed
them well.
“Now I see people putting cassava and Garri by the
roadside for one or even two days, you know how many rats that would be running
around the place overnight. So, Lassa fever can be traced to the interaction of
rodents with our foods.”
Other reasons Lassa fever recurs, he said, are some
socio-cultural practices that promote the transmission of the disease such as
bush burning, eating of the rat as a delicacy, poor personal and environmental
hygiene. These coupled with the fact that Lassa fever has no cure at the moment,
but can only be prevented.
Education
And Sensitisation
Dr Avidime also believes that other things that
account for the recurrence is poor community sensitisation, stressing,
“Community education and sensitisation is poor, Nigeria’s response to the outbreak
again leaves much to be desired.”
Contributing, Lawal Bakare, Founder, EpidAlert and
Risk Communication Expert regretted that Lassa fever would continue to recur
so long as the State, Federal and local governments do not live up to their
responsibilities.
Bakare said, “Sanitation in Nigeria needs to
improve. Where I live here in Germany, I drink my water from my tap, I don’t
even buy water. It was the same story when I was growing up in Lagos, Surulere,
we used to drink water from the tap, but all of that has now changed.
Bakare also berated the sanitation situation in Nigeria.
“We talk about routine environmental sanitation, we talk about sewage and there
is a lot that needs to happen in the safety space, which has to do with the
Ministry of Agriculture and controlling of the food chain/product that goes
into the market.
“Some of our food items are not able to go into the
international market. It is because we are not able to produce those crops and
products (foods) which are good for basic human consumption.
We are not yet hygienic enough, we don’t even take
care of our crops, and we just grow crops. Some people, if you see the way they
process some of the crops they produce, you will ask yourself if this is for
human beings.
“But, the truth is somebody is being paid in every
Local Government and at the Federal level for this product inspection. Where
are these people? Who is monitoring them and are they getting the jobs done?
When they don’t get the job done, is anybody getting punished? Or is it when
they hear of Lassa fever outbreak?”
He warned, “We cannot just be pushing doctors to the
line and say doctors should be taking care of people that have Lassa fever.
Lassa fever cannot survive in modern American or Europe, because they have good
sanitation.”
Commenting, Dr Mohammad Mahmood Abubakar, Minister
of Environment, noted that in 2019 his ministry created Sanitation Desks in 36
states of the federation to coordinate the programme and activities, liaise
with the Local Government Area environment departments and to report back to the
ministry.
“We are responding to the increasing number of Lassa
fever cases across the country by sensitising the public on preventive and
control measures to avert further outbreak and spread,” the minister said.
He added that in 2019, they worked with World Health
Organisation(WHO) and NCDC to carry out environmental sanitation response
activities in Edo and Ondo states by distributing equipment and chemicals.
Contributing, Adeyeye said, “Part of what we are
trying to do in NAFDAC is to continue to enlighten our people about other
means of drying foods than putting them on the ground by the roadside.
“Also, our plan this year is to engage National
Youth Service Corps (NYSC) members in the 774 local governments in the
enlightenment programme, where the youth corper will interact more with the
locals by educating them on this type of issue we are talking about.
“We are represented in 36 states, but we cannot be
in each local government so we will have our state coordinator working with the
local government to educate them so that the illiteracy rate in Nigeria will
decrease tremendously.
“We will have to educate them not to dry by the road
side, rather dry on the hill, stone base and whatever, but make sure you are
there to ensure that there is no interaction with rodents.”
She insisted that ignorance, poverty are causes of
recurring Lassa fever outbreak, apart from hygiene, adding, absence of
government health inspectors who enforce and promote good sanitation at local the level has also contributed to compromising hygiene across the country.
She said, “When we were growing up, we had local
hygiene inspectors, they would often go from house to house and inspect them
even water coolers, if they see dirty water cooler in any household, they would
fine them.
“The State, Federal and Local agencies are
responsible, we need to join hands, we don’t have health inspectors if we do,
they can`t be offered money for them to pretend like they didn’t see the
uncleanliness.”
Collaborating, Prof. Babatunde Salako, Director
-General, Nigerian Institute of Medical Research (NIMR), there is a need for a massive education of the people in the rural area, often in the States where
the outbreak has become very frequent. Salako said.
“Beyond that, we can talk about the general process of
hygiene like hand washing, ensuring that your environment is not bushy, and
clearing them to hinder rodents from getting into the house and ensure that we
cover some of the things we eat.
The NIMR boss also condemned the practice of drying
food on the roads and bush paths, saying it is another mode of transmission.
He said, “I know many of these practices of
spreading Garri, cassava and all sorts of food items on the roads and along the
bush paths which in the processed urine of rodents could be sprinkled on them and
can transfer the virus on those things and it is later consumed. Of course,
these items are what they sell in the market and I believe this need to be
eradicated.
It is going to take time since there are no technologies for them
to dry food items and even the ones available are too expensive for them to
afford.
“I’m not very sure it’s the rats that stay in the
house; I think it more of the ones from outside that carry Lassa fever. Another
one is the practice of bush burning, these are all theories. Bush burning may
send some of the rodents from the bush to come to people’s house.
This is dry season and people have started bush
burning and these rodents will leave the bush and run into the human habitat
making them mix with human activities, so these are all possibilities that
maybe responsible for the recurrent outbreaks we are having.
Research
And Funding
“But I think
more importantly, we need to go into this area research, the government need to put
money for research so that we can study the population where we have the diseases
and study the population where we don’t have it so as to see the differences
and peculiarity between where we have and where we don’t.”
Similarly, Dr Avidime, said, “Nigeria’s response to
outbreak again leaves much to be desired. More importantly, Nigeria is not
investing in research. We should by now have evolved a home-grown solution via
strategic research, which ultimately would produce vaccination.
“Facilities for laboratory diagnosis are few;
treatment centres are similarly few. It is important to stress that health
workers, particularly doctors need to have a high index of suspicion. So that
early diagnosis is made and treatment commenced, with isolation and contact
tracing,” he said.
Prevention
Part of the measures being taken to checkmate the spread of the menace, according to Dr Abubakar is to embark on proactive
measures to improve the overall general and hygiene in these environments.
Dr Avidime believes that as an infectious disease,
the only way to prevent Lassa fever is to stop the transmission chain from
vector to human, and from human to human.
He said efforts at breaking the chain are avoiding
contact with the rat -their body fluids such as urine and faeces.
Other measures, he said, are to block the holes
through which rats can penetrate our homes; avoid bush burning; improving
personal and environmental hygiene; emphasising early diagnosis, and case
management which involves isolation of infected persons; avoiding contact with
patient’s bodily fluids and hand-washing practices.
However, according to Dr Chikwe Ihekweazu, Director
-General, Nigeria Centre for Disease Control (NCDC), there had been a decline
in the case fatality rate of reported Lassa fever cases from 23.4 per cent in
2019 to 14.8 per cent this year.
Ihekweazu said NCDC continues to support
treatment centres across states in the country to effectively manage Lassa
fever cases.
“In addition, five laboratories in Nigeria have the
capacity to diagnose Lassa fever in Nigeria. These laboratories are critical to
reducing turnaround time between identifying a suspected case and confirmation.
This ensures prompt case management and other response activities, thereby
reducing the number of deaths,” he said.
Ihekweazu also noted that Nigeria is contributing to
research and other activities for the development of a Lassa fever vaccine.
He added that NCDC and the three main treatment
centres in the country, Irrua Specialist Teaching Hospital, Federal Medical Centre
(FMC) Owo and Alex Ekwueme Federal Teaching Hospital Abakalilki, are set to
commence Lassa fever epidemiological studies that would provide data to guide
research and response activities.
He assured that the NCDC was committed to protecting
the health of Nigerians, but stressed the need for members of the public to
practice good hygiene and take measures to protect themselves and their
families.
Dr Avidime also stressed the need for availability
of the drugs rivabain used in the management of the disease.
