Disease control has ever been a tug of war in Nigeria. The Country is known to be a popular sufferer of several diseases across her nooks and crannies — a trend which has led to the avoidable demise of many. The poor state of disease control fastened on the foundation of a rotten health system fraught with archaic facilities suffering from wear and tear, have inflicted blows in the Country’s human capital with the demise of many who avoidably could have found rescue. Recent outbreak of Lassa fever in some parts of the Country has been another bane rearing its ugly head which the Federal and other levels of Government may still be feeling unconcerned about. Nigerian Government is known to be an addicted reactive organ who will only act when things have gone out of hand.
The Ogun State Government on Sunday confirmed a case of a pregnant 29 year-old person infected with Lassa fever who took ill and was referred to the Federal Medical Center (FMC), Abeokuta, though the State Government has said that all is being done to contain it. In a press release by the State’s Commissioner for Health, Dr. Tomi Coker, stating that the suspected Lassa fever case was confirmed by the Ogun State Virology Laboratory on January 24, 2020. Lassa fever is known to be an occasional visitor in Nigeria particularly during the dry seasons with the Government finding it difficult to proffer a lasting solution to the dreaded virus despite its reoccurrence over decades across the Country.
Lassa virus is mostly contracted when humans get exposed to the urine and faeces of the carrier rodents. Person-to-person transmission also occurs under poor sanitary conditions. The virus cannot be contracted through casual contact (including skin-to-skin contact without exchange of body fluids) but through contact with the virus in tissue, blood, body fluids, secretions or excretions. This includes
coughing, sneezing, kissing, sexual intercourse and breastfeeding. In health care settings transmission may be through pharyngeal secretions, urine, faeces, and vomitus or from Mastomys contaminated needles. On the average, it takes three to nine weeks before the virus can be detected in the urine. Lassa fever can also be sexually transmitted because the virus survives in semen for up to three months after recovery from the disease. Infants can be infected with Lassa virus through the breast milk, although this is not common as there is high foetal wastage with Lassa fever disease.
It will be recalled in August 2017 that looming tension gripped many in the South-West over Lassa fever outbreak in Lagos and neighbouring Ogun states. Between the two States, there was a total of six confirmed cases and two deaths were recorded, while 256 were placed on surveillance at the Lagos University Teaching Hospital, LUTH; Mainland Hospital, Yaba, Lagos, and Federal Medical Centre, Abeokuta. In 2017, the outbreak in LUTH led did not spare some Doctors who were also infected and placed on surveillance.
Available data reveals that Lassa Fever was only reported in 6 or 7 states between 1969 and 2008. With continued negligence, between 2009 and 2015, reports of Lassa fever outbreaks have come from between 10 and 14 states. In 2016 no less than 26 states reported cases of Lassa fever, and up to July 2017, at least 18 states have reported outbreaks of the disease. In 2018, the death of two medical doctors and one nurse from Lassa fever in Ebonyi State sent fear down the spine of many in the State. The avoidable loss of the health workers reflects nothing but the necessity on the Government to revive the wobble health system of the Country and develop its capacity for effective response to manage disease control.
In the 2012 outbreak in Ebonyi State, 20 cases (10 confirmed and 10 suspected) were recorded during the
outbreak. Nosocomial transmission to six health workers occurred through the index case. In the same year in Taraba State, of 35 cases reported, eight (22 per cent) occurred in health workers- 2 doctors, 5 nurses, and 1 other hospital staff.
According to Renowned Virologist and former President, Nigerian Academy of Science, Prof Oyewale Tomori in an interview with a national daily in 2017 “the continuing spread in, and invasion of Nigeria by Lassa fever may not be unconnected with the increase and spread of rodents through the country. With increasing movement of people into unplanned cities, coupled with our inability to keep clean environments, sanitation has gone to the dogs and we are getting filthier and filthier by the day as our cities are turned to refuse dumps and garbage heaps.
“Rodents love such environment, and now bold to even invade the office of our President. Some of these rodents
will include members of the Mastomys species, which are well known for their prodigious fecundity. These rodents with hairless tails, large ears, small eyes, pointed snout and 7 to 12 pairs of teats, mature sexually early in life.
“I can say with confidence that Nigerian governments between 1969 and 2015 have cared little or not at all about controlling Lassa fever. As earlier mentioned, Lassa fever cases and deaths were restricted to a few states reporting no more than 50 cases and smaller number of deaths. We all know that until hundreds of people get sick and scores die, no Nigerian government worth its name and salt will bother itself with such small numbers of cases and deaths. So it is not that we do not know what to do with Lassa Fever, it is just that we are unprepared and unwilling to do what is right and proper.
To further tackle the virus it is essential for the Government to be ready to invest massively in the man-power of the health sector to guide against the dangers inherent in entrusting health care services to careless professionals and poorly trained auxiliary nurses, amongst others.
The Government should make effort into revisiting the various recommendations of Lassa Fever workshops held in 1989, 1999, 2005, 2007 and 2009 among others, with a view to consider plausible recommendations that may be adopted for this time. The onus lies on the Government to embark on broad sensitization of citizens on how to control rodents, even if it is apparently difficult to totally eliminate them.
On the part of citizens, it is high time Nigerians developed the proper hygienic culture of living. It has been recommended by health professionals that food must be properly stored in well covered rodent-proof containers to avoid undue exposure of rodents to food source. Also Nigerians should, at this time, ensure their foods are properly cooked where there are traces of rodent contamination on food items. Eating fruits, vegetables and other perishable food items raw should be avoided. Other hygienic practices such as hand washing and care in handling, among others must be strictly adhered to.
Also, Nigerians should ensure proper environmental sanitation to keep both their houses and surroundings clean. Garbage should be offset far away from residential areas. It is also important for health workers that as they look after sick/infected patients, they are very cautious of adhering strictly to standard infection control practices to avoid spreading the disease among healthcare workers and patients. Healthcare practitioners are not immune from the virus if they fail to employ proper barrier and infection control practices. It is therefore important that all hands be on deck to fight a comprehensive war against virus.