Lassa fever: Prohibitive cost of treatment engendering high mortality
The high cost of managing Lassa fever, as well as, late presentation, slow identification and poor management of cases, range top among reasons for the high mortality rate being recorded this year, according to experts.
This year’s outbreak, which is said to be unprecedented due to the high number of confirmed cases and deaths, further stirs the compelling need for critical efforts in managing the deadly ailment.
While experts are also blaming the poor treatment outcome on late presentation, the fact that patients bear some of the treatment cost, except for Ondo and Edo states, (where the Alliance for International Medical Action (ALIMA) is helping out), also adds to the grim scenario.
A typical example of late presentation resulting in poor treatment outcome, recently played out at the Accident and Emergency Section (A&E) of the Federal Medical Centre (FMC) Owo, Ondo State, where a bleeding and barely conscious woman was wheeled into the ward. Few hours later, she was pronounced dead, and days later, the autopsy revealed that she died of Lassa fever.
This year, the outbreak of Lassa fever in the country (a disease graded as Neglected Tropical Disease (NTD) became a Grade Two Emergency on the World Health Organisation (WHO) Emergency Response Framework due to the high infection and death rate.
The unprecedented number of states affected within a short time, the high number of confirmed cases, the continuous health workers infection and the number of deaths recorded also became major concerns to world health bodies, especially since there is risk of the disease spreading to other countries if nothing is done to curtail it.
According to Head, Lassa Fever Unit at the medical centre, Dr. Chuks Abejegah: “Late presentation is a major problem not only at FMC Owo, but at other treatment centres. Many of the patients come to the hospital when they are already at the late stage of the disease, and the chances of survival depend largely on the time of presentation. Many patients still present when it is late, with symptoms such as loss of consciousness, peripheral bleeding (bleeding under the skin), vomiting of blood, disorientation, emaciation, and acute renal injury.”
He said reasons why this continues to happen “include ignorance, cultural beliefs, a late referral from private and general hospitals. There is need, therefore, for doctors to have a high rate of suspicion for cases that look like malaria so that referral can be faster.”
Aside from late presentation, experts also explained that there are instances, where early identifications were made, but the cases are being managed at treatment centres that are bereft of diagnostic facilities, meaning that specimens have to be transported to Irrua, in Edo State for confirmation.
“For instance, from Ondo State, samples are taken to Irrua in Edo State by road, every day and the journey takes about two hours, and the turnaround time is between 18 to more than 72 hours (three days), with personnel risk on the road. There is also the absence of dedicated dialysis centres, limited number of staff dedicated to Lassa fever management, lack of equipment, drugs and consumables. All these factors contribute to affecting the treatment outcome,” Dr. Abejegah said.
At the newly constructed treatment centre, at FMC Owo, 35-year-old female, Bukola, who resides at No 8 Wuniola Street, Owo, was recently treated for the disease and discharged after receiving a chlorine bath.Rasheed is lucky because she didn’t have to pay for bed space, blood, or drugs, just as she was also privileged to be managed by many trained health personnel at the newly constructed Infectious Disease Control (IDC) building dedicated for Lassa fever patients.
According to an investigation, this is a new development, brought to bear since the Alliance for International Medical Action (ALIMA) stepped in mid-January to assist in the cost of treatment of the disease, and reconstruction of the treatment centre. Before ALIMA came on board, patients took care of themselves. For instance, patients that have renal failure had to take care of the cost of dialysis by themselves. There is no renal dialysis centre in Ondo State, so patients are referred to the Irrua Diagnostic Centre, where they pay about N40, 000 per dialysis session. They also have to pay for bed space, blood and drugs.
“Treatment of Lassa is expensive. A patient without complications spends about N180, 000. If the patient is unable to buy antibiotics, he/she would be denied treatment, and this has an effect on the outcome. Blood is also a major problem, but thanks to ALIMA that has been taken care of, with the support of the management of FMC, Owo. We don’t collect bed fee and no service charges.
The number of health workers dedicated to the management of Lassa fever has also improved. At the moment, we have 17 nurses, four doctors and 24 cleaners that have been trained, and are dedicated to Lassa fever management,” Dr. Abejegah explained.Investigation reveals that ALIMA, WHO and MSF’s interventions at Ondo and Edo states, have resulted in improved treatment outcomes, unlike in other states, where lack of health personnel, payment of fees, constitute a major problem.
About 18 states have recorded Lassa fever cases and there is a risk of more infections in many state. Those already hit by the outbreak include Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Anambra, Benue, Kogi, Imo, Plateau, Lagos, Taraba, Delta, Osun, Rivers, FCT, Gombe and Ekiti states.At other centres, it was gathered that the cost of treatment is borne by patients.
Epidemiological report indicates that since January at the FMC Owo alone, (not the entire Ondo State), there have been 95 suspected cases, 36 confirmed and two dead. In February, there were 119 suspected cases, 48 were positive, 41 managed at the ward, one died and two referred to Irrua. This month, only one case has so far been confirmed, and more results are still being expected from Irrua.
Last month, it was gathered that about 22 patients had been treated and discharged at Owo, while 15 are currently on admission. Four of the patients had renal failure and were referred to Irrua for dialysis.From the analysis, the number of cases are more than that of last year. In 2017, there were 249 suspected cases, 90 confirmed and 49 treated at the centre.
Speaking on the free treatment, in an interview with The Guardian, Emergency Coordinator of ALIMA, Mr. Lorenzo said, “So far, we have been able to implement the free treatment only in FMC Owo. We pay for drugs, bed space, lab tests and food. But this is a collective effort, as the hospital has agreed to waive some fees for bed space.“Our main focus is to support NCDC in its response, and the federal hospital in the management of case. So, we help the health workers protect themselves with protective devices and implement certain guidelines. Our second focus is to treat those infected by improving the structures available,” the emergency coordinator said.
He continued: “The number of patients this year has been very high compared to last year. Because of this, there has been lack of bed spaces and equipment. So, we have tried to increase bed spaces, and help to facilitate the building of a new 35-bed space treatment centre. At Irrua Teaching Hospital, we built a temporary isolation unit aimed at increasing the number of bed spaces.“We have also been donating protective equipment, and training dedicated health workers on procedures. This is done in Owo, Ondo State and in Edo State. Right now, we have funding challenges, so we have limited the free treatment to FMC Owo.”
According to a recommendation by the CEO of EpidAlert, Dr. Lawal Bakare; “There is need for community mobilisation at the rural level, where this outbreak normally begins. Also, state governments need to take responsibility just like Edo State government is doing.”
The high incidence of the disease recorded this year calls for a rapid scale-up by national authorities and international partners in order to prevent further spread. According to the March report from NCDC the country has lost 110 patients or (23.8% of those infected), a figure that is more than the estimated fatality rate.According to Dr. Abejegah, this year’s index cases were not managed very well and this led to more spread. “The seasonal changes also affected the spread. It appears the dry season extended longer than expected.
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