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.
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.
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.”
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.”