There is need for change in environmental status
By Azoma Chikwe
Lassa fever, a viral hemorrhagic disease, is
recently sending fear and threat of death to the people and health
workers in the country. The fever shares some symptoms with the Ebola
Virus Disease like vomiting, stooling, muscle fatigue and very high
fever at the primary stages. Facial swelling, flushing, photophobia and
swollen glands are also symptoms of Lassa fever.
Fatality rate is lower than that of Ebola’s, but Lassa fever is also
easily transmitted from person to person. Patients must be isolated
during treatment. Treatment with Ribavirin has helped in recovery of
patients. Early diagnosis and supportive treatment with rehydration
therapy like the treatment of Ebola increases the chances of survival of
patients. It has been noted that cases of severe infection might be
associated with defective immune responses as was the case with Ebola
virus treatment.
However, Lassa fever outbreaks is an annual ritual in Nigeria and some
West African countries. Virtually every year, pockets of outbreaks occur
in the country. Perhaps, the government took the disease for granted
until the nation had an encounter for the first time with Ebola that
opened the eyes of the people to how dangerous a viral haemorrhagic
disease can be. They spread like wildfire through contact, fluid, sex
etc., many have no vaccine or cure. It was a wake-up call.
Nigeria suffered her biggest Lassa fever outbreak early this year..
Unfortunately, it came when the present administration was settling
down, the case fatality rate was high, about 43 per cent, killing 40
people.
History
Lassa fever or Lassa haemorrhagic fever(LHF) is an acute viral
haemorrhagic fever caused by Lassa virus and first broke out in 1969 in
Lassa, in Borno State, Nigeria. Lassa virus is a member of the
Arenaviridae virus family.
The disease was named after the town in Borno State, Lassa, where it was
first recorded in 1969, when two missionary nurses contracted the
sickness, and died thereafter from it. The sickness is spread through
the consumption of infected rats, and exchange of bodily fluids with
infected persons. Natal multimammate mouse found commonly in sub-saharan
African countries are the main host of the Lassa virus.
Nigeria, and several other West African countries, experience yearly
outbreak of Lassa fever. This year, had the highest number of Lassa
fever cases in Nigeria with a mortality rate of 43.2 percent , there
were 83 cases and 40 deaths in 10 states.
Lassa fever is similar to Ebola. They are both acute viral haemorrhagic
fevers and are caused by RNA viruses. Both viral infections suppress the
immune system and present themselves as headache, nausea, vomiting and
muscle pain. Both, also, have an incubation period of 1-3 weeks. It is
difficult to clinically distinquish Lassa fever from Ebola and malaria.
Lassa fever virus is present in the urine and fluid of survivors for
three -12 weeks after.
Research shows that about 80 per cent of people who become infected with
Lassa virus have no symptoms. One in five infections result in severe
disease, where the virus affects several organs such as the liver,
spleen and kidneys.
Person-to-person infections and laboratory transmission can also occur,
particularly in hospital environment lacking adequate infection
prevention and control measures. Lassa fever is known to be endemic in
Benin, Guinea, Liberia, Sierra Leone and parts of Nigeria, but probably
exists in other West African countries as well.
Always around
Experts say that Lassa fever will always be with us until there is a
change in environmental status quo and the factors that had continously
lead to Lassa fever outbreaks in the country taken care of. They are
concerned that on each occasion there is disease outbreak in the nation,
we had to contend with public health emergencies.
President of the Pharmaceutical Society of Nigeria (PSN), Mr Ahmed
Ibrahim Yakasai said the fundamental problem with our health system
appears to be unfortunate emphasis on curative rather than preventive
healthcare. “We have conditioned our nation with a health system that
thrives on ad-hoc measures rather than build structures anchored on
invincible myth which are both enduring and sustainable.
“The norm in civilized or evolving clime is to nurture and build a
virile as well as viable primary health care model which embraces the
utilization of the skills, expertise and on-hand experiences of all
healthcare professionals and workers. To the detriment of consumers of
health in our nation, the culture and philosophy of primary health care
has been continually jeopardized, neglated, frustrated and almost
destroyed.
“In the active days of Ebola Virus Disease, the erstwhile leadership of
the Federal Ministry of Health promised more proactive measures to
actualise the primary care concept which the National Health Act has
legitimised . Typical of us, we have waited for another epidemic styled
Lassa fever, a recurrent annual epidemic, to emerge as a public health
emergency before coming up with the vintage reactionary slogans.
“The PSN wishes to call on the incumbent Minister of Health, Prof Isaac
Adewole whose body language and comportment epitomizes a radical
departure from this status-quo which is a gross waste of human resources
necessitating wretched outputs, to introduce institutional reforms. The
Federal Ministry of Health must drive the processes which will compel
the active participation of community pharmacists and physicians,
environmental health officers, nurses, laboratory scientists and other
public health experts at grass root levels. These services must be paid
for to incentivise these health care workers as it ultimately saves our
nation tones of money spent on curative drugs that we waste resources
importing.
“If a gospel of good hygiene and other public health ideals are spread
by health professionals in their practice facilities at community levels
and we empower Environmental Health Officers to enforce health statutes
, we may begin to reduce our disease burden by over 50% in Nigeria,” he
said.
Former President, PSN, Mr Olumide Akintayo, noted that there has always
been a fundamental distortion in health care management. According to
him, the health system is unduly distorted in favour of an unfortunate
status quo. “This is not about the new Health Minister or the new
government. Let’s take Lassa fever for instance , since 1969 it has
been recurring annual epidemic or endemic disease burden. During a
recent outbreak, they said confirmed fatality rate was 46.5 percent and
we had some other years when it was a thousand plus percent. But we’ve
never done anything about it . So, wholistically, the major problem is
our approach to health care.
“In other responsible and progressive climes, the emphasis is always on
preventive health care, primary health care, but what we have done is
place our own premium to do curative health care. And so we continue to
spend volumes of dollars of scarce foreign exchange to import drugs
each time there is a public health crises. So, moving forward, we have
to go back to the drawing board. In going back to the drawing board, we
need to stop this reckless politics of deceit whereby you make people
feel that if it is not done by a medical doctor it is not allowable in
our health sector. We must run a primary health care concept that is
all embracing, all involving.
“What am I saying? What are the major ingredients of a well run primary
health care concept? Good antenatal programme which takes care of
mortality problems to contend with, under five, under one, infant
mortality and all of that. Immunisation, at a time we were the major
exporters of wild polio virus. Why was it like that? Family planning,
all over the world from the point of conception starts. These are areas
that any average health professional is competent to handle , you don’t
need a post-graduate specialty to do them. We must look at what is
practicable in our country. Because a bloated population of 170 million
people like ours creates problem in the macro-economic environment.
“What happens In other places is that under the guise of their health
insurance scheme, health professionals are remunerated for carrying out
those services. Take immunisation, for instance, why is it taking us
such a long time to kick polio out of our shores? Because we are not
involving the right caliber of personnel in the management of such
issues. You don’t need to fix immunisation days and all that. It is a
must that right from the point of conception, immunisation starts. If
there should be anybody who should be actively involved in immunisation,
it should be a pharmacist. They are the ones who are involved in the
marketing and storage of these vaccines.
“And that is why I said if we need to get it right, we need to involve
the community pharmacist, the laboratory scientists, public health
nurses and so on. And not just involve them, you remunerate them. What
we spend in importing those drugs with scarce resources, will be saved
if we dedicate more funds to primary health care because it will reduce
the disease burden by over 50 per cent because we won’t even have it.
“Recall, in the 60s and early 70s, when we used to have health officers,
who will come into your house and look at your drinking water and all
of that. If your environment is clean, you won’t even find rats there.
It is because nobody regulates what food processors do, the woman in the
market will process her garri in an environment that rodents have
access to. So, let’s go back to the drawing board and evolve a primary
health care chain. We need to bring them together and come up with a
new national health plan that will accommodate everybody and remunerates
them properly. So that whether it is Lassa fever, because for all you
care, by this time next year, we will be contending with another
disease, it might be cholera the next time, or one gastroenteritis
disease. But the basic problem is getting a more ideal health plan and
until we address it through appropriate primary health care, it will
continue.”
Aggressive campaign
The need for aggressive campaign against this disease should not be
undermined. The public has been advised by the Special Committee on
Lassa Fever to avoid spreading or drying food items on the roadside or
outdoors as it is the practice in processing amala (unripe plantain
powder), garri etc. Food items should be properly covered and kept in
sealed containers. People should avoid eating food suspected to have
been contaminated with rodent’s faeces or urine.
According to Dr Charles Anyanwu, Lassa fever virus is zoonotic and
infection in humans typically occurs by exposure to animal excrement
through the respiratory or gastrointestinal tracts. Dr Anyanwu advised
all apple lovers to wash them with salt water before eating or
refrigerating. Wives and women should stop the practice of tasting garri
in the market done to determine the starch level of it. All garri
drinkers should stop for now.
According to him, the problem here is that most of our garri sellers in
the market buy it from bush markets. This garri, which is often fried
half dry and subsequently dried on polythene sheets on the tarred roads
or compounds in the villages become free food for hungry rodents. They
eat,defaecate and urinate on it. The wastes dries up with the garri and
when hot water is not used the virus gains enters into the body.
“Any food that has been partly eaten by rodents should be immediately
discarded. People have also been advised to get rid of all rats at home
while maintaining the basic hygiene practices of washing hands regularly
and keeping living environments clean. The major carrier of the virus
is the Natal Multimammate mouse ,so called because it has many nipples
like local street dogs after delivery. It is mostly found in sub-Saharan
Africa. Rat and mouse breeding should be avoided this period.”
