What happened to disease control?

It is appalling that Nigeria frequently reports outbreaks, mortality and morbidity from diseases instead of sustainably promoting and implementing preventive measures. What is the purpose of report rhetoric without concrete actions?

Some prominent and recurring diseases reported are Lassa fever, yellow fever and pneumonia. The latest headlines – “Lassa fever hits nine states,’ claims two,” “Yellow fever outbreak claims 29 hires in Bauchi” and “Nigeria losses 162,000 children to Pneumonia”; attest to this assertion. While available data suggest Nigeria has over the years been struggling with these diseases, the confluence of these three diseases is threatening and the current outlook should be worrisome.

According to the World Health Organisation (WHO), Lassa fever is an acute viral haemorrhagic illness of 21 days duration that occurs in West Africa. It is an acute febrile illness, with bleeding and death in severe cases. Descriptions of the disease date from the 1950s, but the virus was first described in 1969 from a case in the town Lassa, in Borno State, Nigeria. The virus is zoonotic, or animal-borne. Again, WHO states that the reservoir or host of the Lassa virus is the “multimammate rat” called mastomys natalensis, which has many breasts and lives in the bush and around residential areas. So, it is mostly spread by rats!

Lassa fever has plagued Nigeria over the years and has become an annual decimal since 2016. In 2016, the country reported 273 suspected cases and 149 deaths (case fatality rate 55 per cent) from 23 states. According to Nigeria Centre for Disease Control (NCDC), during the 2017 outbreak, nineteen (19) States (Ogun, Bauchi, Plateau, Ebonyi, Ondo, Edo, Taraba, Nasarawa, Rivers, Kaduna, Gombe, Cross-River, Borno, Kano, Kogi, Enugu, Anambra, Lagos and Kwara) reported at least one confirmed case.

As at November 2017, the outbreak was active in five states – Ondo, Edo, Plateau Bauchi and Kaduna. Again, on January 14, 2018, four cases of Lassa fever among health care workers in Ebonyi State were reported at the NCDC. Three of the four cases – two medical doctors and a nurse subsequently passed away, despite efforts to save their lives. According to the University Graduates of Nursing Science Association (UGONSA), more than 40 health workers died as a result of Lassa fever in Ebonyi alone in the past 13 years. As at March, 2018, the NCDC said Lassa fever had claimed 43 lives in Nigeria with a total of 615 cases reported across 17 states.

In February this year, the NCDC Situation Report (SitRep) released on January 20, reveal that from January 1 to 20, 2019, a total of 377 suspected cases of Lassa fever had been reported from nine states. Of these, 136 were confirmed positive and 240 negative; and since the onset of the 2019 outbreak, there have been 31 deaths. As at the time of the SitRep, 81 patients were being managed – Irrua Specialist Teaching Hospital (ISTH) treatment Centre, 30; and Federal Medical Centres in Owo, Bauchi, Plateau, Taraba, and Ebonyi states are managing 25, 9, 8, 3 and 6, respectively.

Currently, the latest NCDC SitRep for November 3 to 10, ten new confirmed cases were reported from Ondo (5), Edo (2), Ebonyi (1), Bauchi (1) and Abia (1) states with two new deaths from Edo and Abia states. So, from January 1 to November 10, 2019, a total of 4500 suspected cases of Lassa fever had been reported from 23 states.  Of these, 764 were confirmed positive, 19 probable and 3717 negative; and since the onset of the 2019 outbreak, there have been 160 deaths.

From the above, it is needless to argue that Lassa fever has become a recurring decimal in the Nigerian health ‘scene,’ and in some cases, affected several persons in families across class. So, it is also a health deficit in Nigeria that cuts across class, which requires practical and strategic credits to nil the account! Attempts at containing Lassa fever have thrown up different issues just as viral diseases have different strains. Some of the issues range from poor access to preventive care and management, to prohibitive cost of treatment engendering high morbidity and mortality. According to experts, 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 morbidity and mortality rates recorded over the years.

On Yellow Fever (YF), the NCDC, from the onset of its outbreak in September 2017 to December 2018, 3,902 suspected cases were reported from all 36 states and the Federal Capital Territory (FCT) in Nigeria. Out of the 3,295 samples collected and tested, 185 were presumptive positive in-country and were sent for confirmation to the Institute Pasteur (IP) Dakar for further testing. From the results, 78 positive cases from 14 states (Kwara, Kogi, Kano, Zamfara, Kebbi, Nasarawa, Niger, Katsina, Edo, Ekiti, Rivers, Anambra, FCT and Benue states) were confirmed at IP Dakar.

For the 2019 outbreak, the latest figures on YF in the country as at Expanded Programme on Immunisation (EPI) Week 32 (August 11, 2019), show that a total of 62 samples were presumptive positive in-country based on immunoglobulin (IGM) diagnostic examination of blood serum; and sent to the regional reference laboratory, Dakar, Senegal for confirmation. These presumptive positive cases were reported from 42 local councils in 17 states viz Anambra, one; Benue, one; Borno, 10; Ebonyi, 12; Enugu, two; Abuja, one; Jigawa, three; Katsina, six; Kebbi, 14; Kogi, two; Kwara, one; Nasarawa, two; Ogun, one; Ondo, one; Osun, two; Plateau, one; and Taraba, one.

Specifically, the SitRep for weeks 35-38 (31st August – 18th September, 2019) NCDC, stated that Nigeria was responding to an outbreak of yellow fever, in people who are either resident in, or have visited Alkaleri Local Government Area (LGA) in Bauchi since August 1, 2019. Suspected and confirmed cases with an epidemiological link to Bauchi have been reported in Borno, Kano, Gombe and Katsina states. Out of these cases with an epidemiological link to Bauchi, were 243 suspected cases, 10 presumptive positives cases, 28 confirmed cases and 34 deaths (Bauchi, 10; Kano, one and Katsina, 23).

All we are saying with the huge data here is that the annual resurgence of Lassa fever among other diseases in the country should be a major source of worry and should be treated as an emergency, particularly as it is spreading, to avoid needless morbidity and mortality in Nigeria.

For Nigeria not to be seen as a country that takes pride in reporting rapid response to preventable disease outbreaks and quick to condole with families that lost loved ones to such disease outbreaks; there is the need to focus seriously on disease prevention to forestall the reoccurrence of Lass fever, YF and pneumonia. Reason: rapid response to diseases outbreaks without prevention and control is reactionary and a weak strategy. Thus, it is important to ensure that there is robust budget for the primary healthcare centres and the centres for disease control where reports can be dealt with. Lamentation on the report of the diseases outbreak cannot be a strategy. There must be commitment to measures to prevent them though public health campaign strategy and equipment of the health centres, as we have repeatedly noted here.