Lassa Fever Final Edited Edited
Lassa Fever Final Edited Edited
Lassa Fever Final Edited Edited
INTRODUCTION
Lassa fever, also known as Lassa haemorrhagic fever (LHF), is an acute viral
haemorrhagic fever caused by the Lassa virus. It was first discovered in 1969
in a town called Lassa in Borno State, Nigeria (Frame et al., 2007). The
primary host of Lassa virus is the natal multimammate rat (many breasted
rat called Mastomys natalensis) found in and around homes in most sub-
(Werner, 2004). Lassa virus is transmitted by contact with the faeces or urine
the virus in urine, saliva, respiratory secretion and blood (Keenlyside et al.,
2003). Humans presumably become infected with the virus through contact
with infected rodents’ excreta, urine, tissues or blood (Monath et al., 2007).
through sexual intercourse (Ogbu et al., 2007). Lassa fever outbreak has
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been observed in the West African region like Nigeria, Liberia, Sierra Leone,
In Nigeria, the recent outbreak in Bauchi State which occurred in 2015 was
had already spread to other states like Nasarawa, Niger, Taraba, Kano,
Rivers, Edo, Plateau, Gombe and Oyo. A total of 81 cases and 35 deaths
A study conducted recently in and around Lafia, North Central Nigeria among
200 respondents revealed that 87% of the respondents have heard about
Lassa fever previously even though there was a misconception on the mode
major clinical manifestation (Reuben & Gyar, 2016). In another related study
was fair with (68.3%) out of the 300 respondents involved in the study have
not heard of Lassa fever before, while rural dwellers have the poorest
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outbreaks and subsequent responses to arrest the outbreak in Nigeria have
sore throat, muscle pain, cough, chest pain, nausea, vomiting, diarrhoea,
and abdominal pain with or without bleeding (Reuben & Gyar, 2016). It is
an emerging disease that causes high morbidity and mortality and has the
capacity to devastate and threaten lives if adequate measures are not put in
Lassa fever is prevalent in the West African region with about 300,000 to
500,000 cases reported annually and causing about 5,000 deaths each year
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(Ogbu et al., 2007). In Nigeria Lassa fever outbreaks occur almost every
year in different parts of the country, with yearly peaks observed between
the country have shown that knowledge of the disease is lacking among
Outbreaks of Lassa fever have however been reported in Edo, Ebonyi, Ondo,
Taraba, Plateau, Anambra, Nasarawa, Yobe and Rivers States (Ogbu et al.,
conducted in the country has shown that the seroprevalence of the disease
the prevalence of the disease is presently high in the country, thus the need
disease.
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1.3 Aim and Objectives of the Study
The main aim of the study is to assess the knowledge and perception of
lassa fever among dwellers in Ihiagwa, Owerri West Local Government Area
of Imo State.
respondents.
RQ1: What is the level of knowledge of lassa fever among the respondents?
RQ2: What is the level of awareness of lassa fever among the respondents
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1.5 RESEARCH HYPOTHESIS
ii. This study therefore will also provide basic information that would help
educate the community on the disease and its vector control measures.
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iii. This study will also help to institute preventive measures that would
iv. This study will also help future researchers in providing them with
developed countries and temperate regions but with fewer number of cases.
This study therefore will provide basic information that would help educate
the community on the disease and its vector control measures. This will go
a long way in helping to institute preventive measures that would reduce the
This study therefore will assess the level of awareness of the Lassa vector
and its control measures among dwellers who are likely to be infected. This
campaign.
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Information on rodent control provided by this study will also go a long way
in curbing transmission via Matomys natalensis. This would help prevent the
foetal death and deafness. This study would as well include suitable
time and the problem of self-reporting whereby the dwellers may not say
what they actually know and may say what they think the researcher would
this work.
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1.9 DEFINITION OF TERMS
interpreted
Lassa Fever: An acute and often fatal viral disease, with fever, occurring
illnesses caused by four families of viruses. These include the Ebola and
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Seroprevalence: The level of a pathogen in a population, as measured in
blood serum.
Faeces: Waste matter remaining after food has been digested, discharged
disease.
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CHAPTER TWO
LITERATURE REVIEW
several putative new arenaviruses from Africa and North America have been
discovered in recent years and are not yet included in the ICTV list, such as
Lujo virus, Catarina virus, Kodoko virus and Merino Walk virus (Briese et al.
2009; Cajimat et al. 2007; Cajimat et al. 2008; Charrel, de, X, and Emonet
2007; Milazzo et al. 2008; Palacios et al. 2008; Palacios et al. 2010).
epidemic (Armstrong and Lillie 2003), and thereafter became a popular tool
2007; Zinkernagel R.M. 2002). Arenaviruses are zoonotic, and in nature most
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cause chronic infection in rodents from Africa, the Americas and Europe, with
to this general rule since it has been isolated from bats. Most arenaviruses
do not cause human disease; however, some are known to infect humans,
and can even cause severe disease, such as a viral hemorrhagic fever (VHF)
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2.2 Discovery of Lassa fever
throat, had difficulty swallowing and her oral temperature was 1000F. Over
the next few days her condition deteriorated: she appeared dehydrated, her
neck and face began to swell and hemorrhagic signs were present on her
skin. On January 25, she was transferred to the Bingham Memorial Hospital
in Jos, Nigeria. At her arrival, L.W. was in shock with low blood pressure,
irregular pulse and signs of cardiac failure. She died the following day (Frame
et al. 2007). This new disease was termed Lassa fever after the town where
L.W., the first reported confirmed case, worked (Frame et al. 2007). The
causal agent, named Lassa virus, was then isolated and based on its
(Buckley and Casals 2007; Buckley, Casals, and Downs 2007; Murphy 2007;
(10 cases total) have revealed that the gross pathology cannot account for
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the death of the individuals. Based on histological data and organ viral titers,
the liver appears to be the main target organ as it is the major site of viral
replication and tissue damage, although LASV can be recovered from several
and heart (Walker et al. 1982b; Winn, Jr. and Walker 2007). In addition, the
it plays a major role in the fatal outcome but it does not correlate with the
severity or duration of the disease prior to death (Winn, Jr. and Walker
2007).
2.4 Epidemiology
2004). Lassa fever is endemic in Guinea, Sierra Leone, Liberia and Nigeria
Ghana and Benin (Akoua-Koffi et al. 2006; Emmerich, Gunther, and Schmitz
2008; Frame 2007), but only one clinical case of Lassa fever has been
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reported in these countries (Gunther et al. 2000). In addition, LASV-infected
identified in Mali (Atkin et al. 2009; Frame 2007; Richmond and Baglole
2003). There have also been 28 reported cases of travelers importing Lassa
fever to Europe and North America since 1969 (E-alert 24 July: Case of Lassa
fever imported into Germany from Sierra Leone 2006; Amorosa et al. 2010;
Atkin et al. 2009; Gunther et al. 2000; Kitching et al. 2009; Macher and Wolfe
2006), of which 36% died, with the last case imported in the USA in 2010
2.5 Transmission
The virus is primarily transmitted to humans by contact with the urine and
feces of the reservoir host Mastomys natalensis, also known as the multi-
al. 2006; McCormick et al. 2008b; Monath et al. 2007b; Wulff, Fabiyi, and
in the local health care system. In common with many other VHF outbreaks,
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nosocomial transmission is believed to occur through close contact with
blood and secretions from infected patients (Frame et al. 2007; Fraser et al.
2.6.1 Infection
virus probably then spreads in the human body via the reticuloendothelial
Walker et al. 1982b; Winn, Jr. and Walker 2007), resulting in a multi systemic
provides evidence that dendritic cells (DCs) are the primary target cells in
vivo, as in many other VHF infections, and that the virus is present initially
in lymphoid tissues. It later migrates to the liver and adrenal glands to finally
system and epithelial cells throughout the body, resulting in a multi systemic
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2.6.2 Host immune response
another one has not been investigated (Barber, Clegg, and Lloyd 2009;
Clegg, and Sidibe 1993; ter Meulen et al. 1998). Most evidence suggests so
far that the humoral immune response to LASV does not play a role in
only appear later, during the convalescence phase of the infection (Tomori
(Jahrling 2003; Jahrling and Peters 2008). Recent data from cynomolgus
monkeys also showed that antibodies appear earlier and to higher titers in
fever was undertaken in Kenema (Sierra Leone) among 813 men and 867
women in four camps for internally displaced people and eight primary health
units. The survey revealed a reasonable knowledge of Lassa fever, its mode
153 deaths (case fatality rate 19%), from January 2009 to April 1997, despite
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The need for greater understanding of the perceptions and beliefs of the
local population became apparent after a small pilot study (of 23 people)
was undertaken in 2002 in Sierra Leone (Merlin ;2012). In this study, Data
which were facilitated by trained local health workers. Two groups consisting
of chiefs, elders, female, male adults and male youths were conducted, one
interviews with relatives of patients on the Lassa fever ward and one with a
issues relating to risk factors, early diagnosis, medical treatment and the
sequelae of Lassa fever (Merlin ;2012). One of the risk factors for Lassa fever
suggested that rodent control and a clean environment would reduce the
risk of Lassa fever and other similar diseases. However, it was reported that
not everybody in the community shared this knowledge and that further
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relation to miscarriage, the blame appears to lie directly with the woman.
Lassa fever. The need for further education, specifically in relation to the
safe disposal of rat carcasses and the mode of human transmission was
deemed necessary in order that people are absolutely clear about specific
may be carried out in the community. Both groups discussed the need to
educate the population about the signs and symptoms of Lassa fever. In
addition, the group from the affected area discussed the necessity for a local
treatment to the disease caused by the vector was highlighted in this small
pilot study, participants suggested for a variety of reasons that many people
were unlikely to seek medical care for the Lassa fever. In the first instance,
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medical treatment is expensive and may be accessed at the direct expense
of other necessities such as food for the family and school fees. Participants
repeatedly explained that when one member of the family required medical
mistrust of the medical treatment offered at the hospital were also described
apparently common belief that people are killed after being admitted to the
discussed the practical problems that arises when parents are hospitalized,
few persons. A cross sectional study might therefore be needed for a better
In 2002 a local study was done in Ihiagwa, Owerri West Local Government
Area, Imo State in Nigeria to compare the case fatality rates of Lassa fever
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and other medical diseases commonly seen in adult medical wards, as well
Ihiagwa in Owerri west local Government, Imo State, with the aim of
attitudes and practices pertaining to Lassa fever were used. The case-fatality
rate of Lassa fever in this centre was 28%. Cultural factors and habits were
The large sample size of this study is an advantage since it must have
increased the validity of the result. However, this study was done 10 years
ago and might therefore not reflect the current level of awareness of the
disease and its vector control in the populace since subsequent Lassa
Prevention of the Lassa virus from its host to humans can be achieved by
source is not recommended. Trapping in and around homes can also help
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reduce rodent populations. Putting food away in rodent-proof containers and
keeping the home clean help to discourage rodents from entering homes
(Barnes;2007). Various kinds of metal food storage bins have been devised
reduce the Mastomys population and also reduce the attractiveness of such
well as evaded15. Means of reducing pest numbers fall into two categories:
achieved some degree of success in the field trials, primarily against rats, in
toxicants and, in addition, are extremely slow to act and to show effect. For
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said to reduce or prevent success in field trial and practice (Richard and
poisoning, not only because of their relative safety for man and other non-
target species, but also because their slow action makes bait shyness far less
likely to develop among target rodents than it would if acute poisons were
suffers from lack of knowledge and has often resulted in large amount of
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ii. Average age at sexual maturity-approximately 90 days.
From this data it was estimated that a hypothetical population would return
control was achieved with acute toxicants and rodenticides and migration
toxicants would need to be carried out at least twice per yearperhaps three
Although this review was done 37 years ago, it is however still very useful
and can be said to be up-to-date since it was done using the biological
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populations down to a level at which rodentto-rodent virus transmission
would no longer occur and the cycle would be broken. Allan Barnes in 2007
noted two circumstances that would militate against this postulate. One is
the occurrence of Lassa fever in at least three countries, which indicates that
be re-infected. Another factor was that, at least in laboratory mice, virus can
quite likely to bring about resistance problem and that resistance to toxicants
Most often in the tropics, when the need for rodent control becomes
are used that are often inadequate and started too late to help solve the
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problem. It is unfortunately true that such operations are often attempted
for political and social reasons as well as for disease control (Richard and
Deborah;2003).
published by the Natural resource institute noted that in Africa, the politics
of rodent pests implies that providing government with new data which
shows the true extent of rodent disease problems is not actively encouraged
by most governments (Steven and Belmain; 2006). The worry was that the
figures will be alarming, cause panic, and add to the list of actions which
must be taken. It was also noted that rodent pest populations are worsening
slums are growing in and around many African cities. Rural practices such
bringing people (or peridomestic rodents and livestock) into contact with wild
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statements like “We do not know if rodent disease problems are worsening.
increasing human populations”, and “What people are doing in rural and
rodents controls in rural tropical areas revealed that, although various kinds
of metal food storage bins have been devised and are unquestionably
the initial cost, distribution, and convincing people of the need to use
government.
In another study done between 2005 and 2006 on the ecological based and
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and rural communities to resort to the illegal use of highly toxic pesticide
(rodenticide) with acute toxicity or other poisons which induce fast and
painful death (Steven and Belmain; 2006). The consequence of this was
value of collecting dead rodent bodies (which does not occur when using the
The study employed the Media system dependency theory (MSD), proposed
relationship exists between the audiences, media and the larger social
to meet some needs and achieve certain goals. The theory identified two
basic reasons individuals will depend on the media for information. First, an
their needs than media that provide just a few and secondly, dependence
on the media may be imperative for social stability especially when social
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change and conflict are high and established institutions, beliefs and
that individuals will depend largely on the media for information on Lassa
The theory has been criticized for not considering other means of information
It has also been criticized for not taking into consideration problems that
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CHAPTER THREE
A descriptive cross sectional study design was utilized for this study.
(a) Location
(b) Climate
There are two distinct seasons which are rainy or wet season and
harmattan or dry season. The rainy season begins in the month of April and
lasts until October while the dry season begins in the month of November
and lasts until March. The vegetation is typical rainforest. It has an annual
mean temperature of about 2,250-2500mm and a mean temperature of 25
– 270C. It also has a relative humidity is 80%.
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(c) Vegetation
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(f) Economic Activities
n = Z2pq
d2
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Where n =minimum sample size
Z = 1.96
The total number of respondents which was 282 was allocated to the
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select the respondents from each category. The respondents were divided
into 4 strata based on their knowledge on the prevalence of lassa fever. The
strata were;
1. students
2. civil servants
3. Farmers
4. Artisans
instrument. First, the instrument was given to reputed scholars in the field
check the testability of the research hypotheses and to ensure that the
instrument could actually be used to generate data for the testing the
hypotheses.
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3.6 Reliability of the Research Instrument
interval, a re-test of the same copies of the questionnaire was carried out
Coefficient of
reliable.
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Data was collected using a structured, interviewer administered
questionnaire which consisted of both open and closed ended questions. The
section had questions on the levels of awareness of Lassa fever and its
vector, and the third section had questions on the vector control measures
Data collected was analyzed using the Statistical Package for Scientific
fever.
by rats were assumed to have good understanding, while those who either
did not think of Lassa fever as a disease or did not know it’s mode of
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The results were presented in tables and charts. Statistical test where
Respondents were informed about the nature and benefits of the study and
their informed consent was obtained verbally before the questionnaires were
administered.
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REFFERENCES
10(3): 144-155.
ISTH, Irrua.
bulletin.
39
National population commission (NPopC) 2006 population and housing
2009.
Nigeria: Tackling the Lassa Fever Epidemic. This day. The day newspapers.
40
Steven R Belmain, (2006). Rats and human health in Africa: proceedings of
41
QUESTIONNAIRE
SECTION A: (SOCIO-DEMOGRAPHIC DATA).
2. Marital status (a) single [ ] (b) married [ ] (c) widowed [ ] (d) divorced [ ]
(e) separated [ ].
3. Tribe………………………
4. Religion (a) Christianity [ ] (b) Islam [ ] (c) ATR (d) others, please
specify……………………
…
SECTION B: LEVEL OF AWARENESS.
5. Have you heard of the word Lassa fever (a) Yes [ ] (b) No [ ] If yes, from where
(a) Hospital [ ] (b) Media (television, radio, newspaper e.t.c ) [ ] Church (d) from the
8. If yes, then what? (a) Dirty environment [ ] (b) rat [ ] (c) drinking unclean water [ ]
others, please specify………………………………………………………………….
10. Do you know anyone that was sick of Lassa fever (a) yes [ ] (b) no []
11. If yes, who is this person to you? (a) a relative [ ] (b) a friend [ ] (c) a neighbour [ ]
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SECTION C: VECTOR CONTROL MEASURES
13. If yes, have you ever tried to eradicate the rats in your home? (a) yes [ ] (b) no [ ]
14. If yes, what did you use (a) Indocid [ ] (b) Rodenticide [ ] (c) kill and dry [ ] (d) traps [ ]
15. How often do you eradicate the rats in your home (a) anytime a rat is in the house [ ] (b)
everyday (c) once a week [ ] (d) once a month [ ] (e) once a year [ ]
17. If yes, is it (a) all at once (b) only a few are killed (c) most of them are killed.
18. What do you do to the dead rat (a) eat it [ ] (b) dispose it [] (c) ignore it [ ]
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