2 April 2009
editorial
Lagos — With the recent outbreak of Lassa fever, with its attendant casualties, Nigeria has again been reminded of its poor healthcare infrastructure and the dangers it poses to human lives existence.
This recent outbreak, which has left in its trail a long list of mortality has brought to the fore the inadequacies in the health system and lack of emergency facilities and preparedness to contain communicable diseases.
Last year, pockets of lassa fever outbreak in Edo and Delta States were reported. Precisely, between January and December, 2008, the Chief Medical Director of Irrua Specialist Hospital in Edo state, Prof. George Akpede, disclosed that out of the 229 suspected cases of the disease reported, 30 people died from complications resulting from the ailment. The first quarter of this year too, has reportedly recorded several cases of the disease.
Although there were a few initial denials by health officials about the fresh outbreak of the disease, events in the last few months have confirmed its resurgence, which started in Abuja with a high mortality rate involving victims and health workers. The Minister of Health, Prof. Babatunde Osotimehin, who toured the affected states in the North said much more worrisome is the danger that the outbreak poses to health workers. According to Prof Osotimehin, four health staff working in the National Hospital, Abuja, who were taking care of one of the Lassa fever cases have fallen ill and the laboratory investigations have confirmed they were infected with Lassa fever. Confirming the death toll, the Minister said within the last few weeks, 13 cases with six deaths have been reported.
The disease, which is highly contagious, poses a major health risk not only to victims, but also to health workers because it could cause potentially fatal illness. So far, several people including health workers have been confirmed dead in the country in the last three months since its outbreak. Many cases may not have been reported especially those in the rural areas. The most common complication of Lassa fever is deafness and it occurs in approximately one-third of cases, and in many cases hearing loss is permanent, according to experts.
Lassa fever is an acute viral hemorrhagic fever identified in the town of Lassa in Borno state in 1969. It is said to be endemic in West Africa, and causes between 300, 000 and 500,000 cases annually with 5,000 deaths in the region, according to World Health Organization (WHO). Outbreaks of the infection have been observed in Nigeria, Liberia, Sierra Leone, Guinea, and the Central African Republic. Its primary animal host is rodent, specie of rat, and an animal indigenous to most sub-Saharan Africa.
Several modes of transmission have been identified. It can be transmitted directly from human to another or contracted by an air-borne route or with direct contact with infected human blood, faeces and urine of rats accessing food items in homes, or semen and eating of that specie of rat. Transmission through breast milk has also been observed. Its outbreak is attributed to the activities of hunters who burn bushes.
WHO said the incubation period for Lassa fever ranges from six to 21 days. The onset of the disease is usually gradual, starting with fever, general weakness and malaise. After a few days, headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhea, cough and abdominal pains.
It is estimated that about 15- 20 per cent of hospitalized Lassa fever patients will die from the illness. It is also estimated that the overall mortality rate is one per cent, however, during epidemics mortality can climb as high as 50 per cent.
So far, 55 persons are said to have died from Lassa fever between January and February 2009 out of over 390 patients admitted. Besides, more than 51 million Nigerians are at risk, with the annual rate of illness estimated at three million and with the number of death estimated at about 58, 330.
The sad news about the disease is that no vaccine against it is currently available. Reportedly, work on a vaccine is continuing, with multiple approaches showing positive results in animal trials. Another major challenge is the absence of diagnostic facilities in Nigeria, which makes it even more difficult to deal with the problem. Medical experts believe the disease has no specific symptoms and consequently, its attacks could be misdiagnosed since it presents similar symptoms like malaria and typhoid. For a disease that health experts say early diagnosis and treatment is the best approach, this is a sad commentary. The onus, therefore, is on the various governments to be proactive and desist from being lethargic about issues that concern human lives.
Ribavirin, the specific anti-viral drug for Lassa fever is said to be effective for the treatment, but its non-availability at health centers have made prompt responses to Lassa fever cases useless. They are only made available when there is an outbreak of the disease. This attitude must change. The Federal Ministry of Health and relevant authorities should demonstrate greater responsibility and alertness by making the drugs available to stem the tide of the disease. In addition, measures should be put in place to curb the spread across the country. Such measures should include creation of awareness and information campaigns to educate people particularly those in the rural areas to keep their houses and environments clean to discourage habitation by rats.
It is unfathomable that a disease that was discovered in Nigeria about 40 years ago still routinely claims several lives annually. Government should provide facilities for proper diagnosis of Lassa fever as a precautionary measure to checking the spread.
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