Featured Infectious Diseases and One Health

Lassa Fever In Nigeria: Beyond One Health Strategic Plan

The Nigeria government has launched a One Health Strategic Plan, first in Africa, to combat diseases that happen at human, animal and environment interface. It was jointly developed by the Federal Ministries of Agriculture and Rural Development, Environment and Health. The strategy aims to strengthen multi-sectoral collaboration for health security in Nigeria. Lassa fever is one of the diseases that the Nigeria One Health Strategic Plan aims to address.

Lassa Fever is a highly infectious acute viral hemorrhagic fever that afflicts humans. The natural host is multi-mammate rat (Mastomys natalensis). Other rodents too have been implicated as the carrier of the Lassa Fever virus.

According to the Nigeria Centre for Disease Control (NCDC), “Lassa fever remains a major public health challenge in West Africa with Nigeria bearing the highest burden.”

The disease occurs throughout the year but more commonly in the dry season, especially from November through May.

The disease has been ravaging communities across Nigeria and has become ‘endemic‘ in some states of the country, notably Ebonyi, Edo, and Ondo.

As of December 15, 2019, there were about 800 cases of Lassa Fever in Nigeria with just two States – Ondo and Ebonyi – accounting for about 70% of cases and deaths from the disease (see graph below).

Number of confirmed cases and case fatality rate by State as of December 15, 2019 | Source: Nigeria Centre for Disease Control

The Case Fatality Rate (CFR) of Lassa Fever is 1% though can be as high as 15% in hospitalized cases. But in Nigeria, CFR ranges between 3-42%. The good thing is that early diagnosis and treatment increase the chance of survival.

Lassa Fever is transmitted in a dirty environment that encourages rodents to breed near human dwellings. Also, activities that increase the chances of rats coming in contact with humans. For example, practices like sun drying foodstuffs outside and bush-burning among others.

Transmission to humans occurs through foods or household items contaminated with faeces or urine of Mastomys rodents. Person-to-person transmission can also occur in settings (like hospitals or laboratories) with poor infection prevention and control.

Lassa Fever Situation in Nigeria

Distribution of confirmed cases of Lassa Fever in Nigeria | Source: Nigeria Centre for Disease Control Situation Report, Week 50, December 2019.

A case of Lassa Fever is an epidemic. In Nigeria as of December 2019, only 14 out of 36 states are free from Lassa Fever (See Map above). The situation recently forced the Ebonyi State government to declare an emergency on Lassa Fever.

But other States are yet to follow suit. It is important to note that efforts at the National level do not necessarily translate to similar commitment and efforts at the sub-regional levels. There are various challenges peculiar to each State.

Despite the epidemic nature, efforts have mostly been stop-gap approach without a concrete plan to tackle the root causes of the spread of Lassa Fever infection. Notable among these is environmental hygiene and control of associated social practices like burial rites and preservation of foodstuffs, even in the absence of epidemics. This exists in strategic documents and plans but rarely adhered to in reality.

While ongoing efforts at bringing Lassa Fever outbreaks under control are commendable, more efforts should be put on risk communication and waste management. It is safer and cheaper to prevent the disease than spend millions in naira caring for patients, a very expensive alternative indeed.

The Nigeria Centre for Disease Control itself in a Statement acknowledged what it described as the “high cost” of treating Lassa Fever, even though the statement also noted that the cost of treatment had not impeded the government’s ability to provide quality treatment to patients. But needless to say, at a huge cost!

Prevention is always better than cure. The huge fund government and partners expend on treatment could be better channeled, if appropriate efforts and investments are put into Lassa Fever prevention through focused environmental hygiene and adequate advocacy, communication and social mobilization activities.

An article that appeared in Nigeria Health Watch described Nigeria waste situation as a crisis requiring urgent action and gave reason for it: “Despite years of support for sanitation efforts in Nigeria by international partners, a lack of ownership through substantial funding by the Nigerian government has kept most parts of Nigeria in a perpetual state of uncleanliness.”

Developing a One Health Strategic Plan, although a very bold step to call the government to action, “if successfully implemented” (as captured by the document itself), is not enough to tackle the Lassa Fever epidemics in Nigeria.

Government policies must be backed up with active implementation at all levels. Communities must not be left behind in the planning and implementation of control strategies.

Local health workers must not only be part of the planning process but must also have the satisfaction that they have been adequately carried along. The master-servant attitude by officers sent from national to subregional levels, who feel that those at subregional levels are their subordinates and want to lord it over them, must be jettisoned.

Political interference must be removed from waste management and the environmental health officers should be allowed to perform their functions and appropriate sanctions meted out to offenders.

The subregional governments must take ownership of the control of the disease and health workers and government agencies and parastatals must avoid needless rivalries bickerings and superiority battles that impede government efforts to improve the overall health of the populace.

These and sundry other measures that hit at the root of the epidemics are the actual actions that are needed – beyond a One Health Strategic Plan.

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