Daily Independent (Lagos)
Emma Maduabuchi
28 March 2009
Lagos — Lassa fever and Meningitis are twin ailments devastating Nigerian homes currently thus throwing a challenge to the nation's health authorities. But, would something drastic be done to curtail the spread of the scourge?
The village of Ewu in Edo State got a terrible scare recently, as Lassa fever, the dreaded disease that has been wrecking havoc across the nation, claimed the lives of loved ones in quick succession within weeks.
Saturday Enquirer investigations has it that the alarming spread of the disease has challenged the health authorities in the country. Already, the Federal Ministry of Health has sent out alerts to 36 states health ministries of the nation, directing them to commence and step up public awareness campaigns in order to curtail the spread of the disease.
Kano State, one of the already affected states is complying: "We have embarked on a rigorous campaign on the radio to sensitise our people on the dangers of Lassa fever, how it is contracted and effective measures to avoid infection," the state Health Commissioner, Aisha Isyaku Kiru said.
A notorious disease restricted to West African countries such as Guinea and Sierra Leone, has also been identified in such towns as Irrua in Edo State, where laboratory findings show that more than 12 cases have been discovered in the town.
The Chief Medical Director (CMD) of Irrua Specialist Hospital, Professor Judge Akpede, is one of many medical professionals expressing concern on the spread and management of the disease. His major concern stemmed from the fact that out of 229 suspected cases of the terrible disease reported in the country between January and December 2008, only about 199 persons were saved; 30 patients lost their lives.
According to Akpede, without waiting for the usually long and belated Federal Government efforts, and as a way of providing serious control and combating the disease, Irrua Specialist Hospital had to go it alone. It had to enter into partnership with two world-renowned medical research institutes such as Behard-Notch Institute of Tropical Medicine, Hamburg, Germany, and Harvard University, United States of America (U.S.A.).
Akpede stated that the partnership was instituted as collaboration, which would enable the institutions donate facilities for the confirmation of the disease in the hospital, without taking samples abroad.
It was reported that only in few hospitals across the country, especially in the southern parts have the facilities for the confirmation of the disease.
Findings show that more than 300 patients are being treated in secluded wards in hospitals in states around the Federal Capital Territory (FCT), Abuja. About 10 of such patients are said to have already died at the National Hospital, Abuja.
"We have an epidemic on our hands," Ogugua Osi-Ogbu, head, Lassa fever prevention and care at the National Hospital lamented.
The outbreak has already caught the attention of Integrated Regional Information Network (IRIN) and the United Nations Children Fund (UNICEF). The two agencies of the United Nations Organisation (UNO), have reported the emerging epidemic in their March 2009 report.
Marguerite Lamunu, a Lassa fever expert with the World Health Organisation (WHO) said: "That is a major increase; besides these are just the cases we hear about in hospitals. In reality, there will probably be many more cases and deaths in the community; the disease is spreading from state to state."
Already, the disease has been reported in the South Eastern state of Ebonyi as well as in Kano, in the North Central part of the country. The nation's capital, Abuja has also been consistent in the news as National Hospital, and hospitals in neighbouring states have reported high-level outbreak within their communities.
The nation's health authorities had earlier been jolted out of bureaucratic complacency, when the news broke of the death of seven people at the National Hospital, Abuja on January 26. After months of hedging and denials, the Federal Government finally accepted the existence of the disease.
But that was not before Patrick Ikhariale, a House of Representatives member from Esan in Edo State expressed concern on the spread of the disease nationwide, and called for urgent control measures nationally.
Minister of State for the Health Ministry, Dr. Aliyu Idi-Hong, equally expressed similar sentiments when he lamented government's apathy in combating the disease. He berated government for its inability to take proactive measures against the disease and Cerebral Spinal Meningitis (CSM), another ravaging scourge, which is equally dangerous, and with similar symptoms as Lassa fever. He is of the view that a health crisis might be imminent in the country, unless necessary preventive measures were set in motion.
Some parts of the country have started panicking as a result of reports emanating from across the country concerning Lassa fever. Cases have been reported of the dangerous disease in Borno, Imo, Enugu, Benue, Taraba, Adamawa, Ogun, Ondo, Kogi and Anambra states. Saturday Enquirer gathered that deaths from the ailment have occurred in 22 states of the country.
Residents in Lagos, like in most other parts of the country, have started waging what is akin to a "war against rats" as a reaction to the news of the Lassa fever outbreak becoming an epidemic. Reports indicate much frenzy and determination by Lagosians over what they call 'operation exterminate,' in the metropolis.
Dr. Olayinka Ogunleye, a consultant with the Lagos State University Teaching Hospital (LASUTH), believes the situation could not have been alarming if not that the disease manifests symptoms of less dangerous diseases like malaria, which may deceive medical experts into complacency.
According to Ogunleye, the disease is deadly because of "the fact that it can mimic several other common diseases, and as a result of that, you might not be successful enough if you don't have a high index of suspicion, as a caregiver. That is what we advocate; people should think about Lassa fever when they see certain symptoms that may mimic other diseases like malaria, like typhoid and sicknesses like that, especially areas where Lassa fever is endemic; where it occurs commonly."
The disease came to limelight in 1969 upon the death of Laura Wine, a missionary nurse who contracted the virus from her patient while working in a health facility in Borno State. From then on, epidemics of the disease have repeatedly occurred within and outside Nigeria, leaving behind a tale of woes and deaths.
Dr. Danny Asogun, director, Institute of Lassa Fever Research and Control (ILFRC), said that the turning point in the study and management of the disease in Nigeria came through in Ekpoma, Edo State in 1980. This followed the death of two medical doctors alongside their family members, which occurred in 1989. This signaled the beginning of a battle with the virus of which little was known about its mode of transmission among humans or how long it has been around. It also led to the establishment of Irrua Specialist Hospital in 1993, which was attached to Ambrose Ali Medical School, Ekpoma.
With the rampant but unexplained fever that comes with bleeding manifestations (many of which had resulted in death), and the fact that some survived, though with deafness, the authorities in the state, according to Asogun, decided to do something about it. In 1994/95 for instance, serological tests carried out on some blood samples from patients and staff members were positive for the Lassa fever virus. Survivors of the disease were few with high mortality and case fatality rates.
In the late 1990s to year 2001, fatality rate, according to statistics, ranged from 60-80 per cent due mainly to late presentation of patients to the hospital, low index of clinical suspicion and non-availability of ribavirin (the only drug of choice for the treatment of Lassa fever). It was not long before the doctors and nurses at ISTH mastered the signs and symptoms of the disease. With the yearly dry season epidemic, the health workers in hospitals became more vigilant and maintained a progressively higher index of clinical suspicion.
Despite the absence of laboratory facilities to confirm clinical suspicion, serological tests carried out on suspected samples sent outside the Irrua Specialist Hospital in 2003 showed correlation of 76 per cent with clinical diagnosis. It is a generally held belief among medical experts that the disease is difficult just as symptoms manifest negligently like any other fever.
Lassa fever and CSM are usually considered together because of their resemblance in causes and effect. Apart from rats' urine and excreta being the major causative factor in the case of Lassa fever, the other causes are overcrowding of people in poorly ventilated residential conditions, as well as poor sanitation.
Late January this year, Bill Gates, co-founder of Microsoft Corporation and world's richest man donated $50 million for the fight to eradicate polio in the country. The Bill & Melinda Gates Foundation, formed by Bill Gates and his wife, Melinda, concluded a $25 million agreement with the World Bank for the purchase of more than 100 million doses of oral polio vaccines in Nigeria.
The Nigerian elite is now wondering whether Nigerian governments are waiting for Gates or any other foreign national's gesture for the eradication of Lassa fever before they begin to combat it.
The Senate, through a motion moved by Abubakar Sodangi, on Wednesday, March 4, urged the three tiers of government to quickly find ways of combating and curtailing the spread of the disease. Sodangi stated that the serious attention given to Human Immuno Virus and Acquired Immune Deficiency Syndrome (HIV/ AIDS) have resulted in the total neglect of other killer diseases such as Lassa fever and Meningitis.
The Senate said: "Lassa Fever is a dangerous communicable disease and official figures of those who died from it is likely to be less than the reality, as many Nigerians don't go to hospitals due to the economic crunch."
The stand of the nation's legislature appears to have roused the government from its slumber. The Minister of Health, Professor Babatunde Osotimehin reacted sharply by explaining steps to be taking by his ministry to step up treatment of the disease.
The ministry, Ostimehin said, "has been so moved that it has announced some phone numbers with which Nigerians could make enquiries for updates on Lassa fever. We have distributed ribavirin in adequate quantities to the FCT Health Department and all places where the incidences have been recorded to treat the disease effectively. We have distributed personal protective equipment to ensure protection and minimise contact," the minister said.
Saturday Enquirer gathered that emphasis has only been on treatment for Lassa fever, and not on immunisation because, according to sources, it does not have a vaccine yet like CSM. Just as Lassa fever is proving a hard nut to crack for health officials, CSM is also taking its toll on the nation's population.
While Lassa fever comes from virus infection, CSM comes through bacterial infection, which inflames the protective membranes of the brain and spinal cord. It is said to be spread through droplets of respiratory or throat secretions. The symptom of this dangerous disease includes severe headaches, vomiting, and stiff-neck and high fever.
Lassa is said to manifest same symptoms in addition to hemorrhaging, heart and kidney failures.
Apart from symptoms, the two diseases are said to be highly contagious. Ogunleye advises Nigerians to be careful and seek proper diagnosis because of the similarity in the symptoms the two diseases manifest.
Lassa and CSM have constituted a twin evil that the health authorities must find solution to. Osotimehin stated that 5, 323 cases have been reported across the nation, and that 333 deaths have occurred out of the number, across 22 states and 217 local government areas. He said that Bauchi State alone experienced 51 deaths; 40 in Kano, and 20 in Kaduna.
Just as the two diseases are considered to be highly dangerous in the absence of ready facilities and centres of confirmation across the country, there are worries across to many medical professionals. CSM is disease similar in many ways, but though it has already got a vaccine, and concerted efforts are being made by nations' agencies, together with international ones, are being made to combat it, none is seriously being done in the case of Lassa fever.
For instance, the Federal Government recently spent a whopping amount of about N237 million for CSM vaccine in the country, being purchased through the United Nations Children Emergency Fund (UNICEF). Besides this, an additional unit of 150, 000 vaccines are expected to be purchased for the nation through donation from the world children emergency fund.
It was Mohammed Ali Pate, executive director of the National Primary Health Care Development Agency (NPHDA) who revealed the FG moves.
The Federal Ministry of Health is also mounting campaigns, and advising Nigerians to desist from certain practices in order to prevent the disease.
They include:
Avoiding contacts between rats and human beings, keeping house and environment clean; covering all foods and water properly; discarding any partly eaten food by rats; cooking all food thoroughly; blocking all rats' hide-outs; stopping bush burning (It is explained that when bushes are burned, there hiding places are exposed and they take refuge in homes).
The measures also include not spreading food where rats can have access to it and reporting to nearby health centres if one realises that he has a persistent fever that is not responding to treatment.
According to findings, the scourge, which was first discovered in Nigeria in 1969 in the Northern town of Lassa, is not localised in Nigeria alone, but has been reported in some West African countries. Such countries where it had been known to be endemic in the West African countries include Guinea (Conakry), Liberia and Sierra Leone, but probably exists in other West African countries as well. However, since the rodent species that carry the virus are found throughout West Africa, the actual geographic range of the disease may extend to other countries in the region.
According to WHO, the disease, which has an incubation period of one to three weeks, has become endemic in parts of the sub region, and claimed that at least 5,000 people out of 300,000 to 500,000 die each year.
The illness is usually severe late in pregnancies, often killing the foetus and/or the mother in more than 80 per cent of cases.
*Additional report by Francis Onoiribholo, Benin.
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