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Housing Factors and Transmission of Lassa Fever in a Rural Area of South-south Nigeria

  • December 2014
Authors:
Oboratare Ochei at Delta State University, Abraka
Oboratare Ochei
Abejegah Chukwuyem at University of Sunderland
Abejegah Chukwuyem
Emmanuel Okoh at Irrua Specialist Teaching Hospital
Emmanuel Okoh
Stephen Abah at Ambrose Alli University
Stephen Abah
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Keywords Abstract Housing Factors Transmission Lassa fever Background: Lassa fever is a severe hemorrhagic fever with devastating consequences that is transmitted via a virus from the Mastomys rat which breed around human residences, to man. An alternate hypothesis is that household characteristics—like housing quality and hygiene—are associated with the occurrence of Lassa fever. Aims: Assessment and comparison of housing quality and hygiene in two peri-urban settlements differentiated by the annual incidence of Lassa fever. The study also assessed awareness and family history of Lassa fever in the preceding year of the study. Methodology: This was a descriptive cross sectional study carried out in two peri-urban settlements (Eguare and Ikekogbe) in Irrua town of Edo State in 2012. Both communities are similar in terms of ethnicity and socioeconomic developments but differ in the incidence of Lassa fever: Eguare had 6-10 cases of Lassa fever per year while Ikekogbe had 0-1 case of Lassa fever per year. Eguare has an estimated population of 911 and Ikekogbe 517. The sample size was obtained using the formula for comparing two proportions. The minimum sample size for this study using this formula is 155 although a total population survey was conducted. Information was obtained by Interviewer administered questionnaire with the head of each household and in their absence; any household member above the age of 18years was interviewed. A checklist was used to elicit information on quality and hygienic state of houses and its surrounding. One questionnaire and checklist per household was administered. Results: 7.7% of the households in Eguare reported a case of Lassa fever in the preceding year as against 1% in Ikekogbe (x 2 =5.01, df=1, p=0.03). There was no difference in the housing quality between the two settlements (X 2 =6.469, df=2, P=0.091), however there was a difference in hygienic state in the two settlements. 20.5% and 54.5% of households in Eguare had good and poor hygiene respectively while 56% and 15.4% of households in Ikekogbe has good and poor hygiene respectively(X 2 =43.796, df=2, P<0.000). This may account for the higher incidence of Lassa fever in Eguare. Houses that had brick walls and ill-fitted roofs had higher risk of reporting cases of lassa fever with odds 2.212 (CI 10.766-6.383), P=0.142 when compared to houses with brick walls and well-fitted roofs. Surrounding with foliage over growth had higher risk of reporting cases of lassa fever with odds 1.455 (CI 0.532-3.980), p=0.465 well compared to houses with clean surroundings. Houses that had household equipments, appliances, tools heaped up in the premises had higher risk of reporting cases of lassa fever with odds 4.969 (CI 1.663-14.848), P=0.004 when compared to houses that had their tools neatly arranged within the premises. The use of buildings for both residential and commercial purposes had higher risk of reporting cases of lassa fever odds 11.425 (CI 3.080-42.371), p=0.000 compared to buildings that are purely residential. Houses that had poor grade on the hygiene scores had higher risk of reporting cases of lassa fever 50.645 (13.718-186.973), p=0.000 compared to houses that had good grade on the hygiene scores. Conclusion: Poor hygiene and use of buildings for both residential and commercial purposes are likely risk factors for transmission of Lassa virus in households. Cleaning up houses and surroundings should be seen as a way of controlling the disease.
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Housing Factors and Transmission of Lassa Fever in a
Rural Area of South-south Nigeria
Ochei Oboratare *
Department of Community Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.
Abejegah Chukwuyem
Department of Community Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.
Okoh Emmanuel
Department of Community Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.
Abah Steve Obekpa
Department of Community Health, Ambrose Alli University, Ekpoma, Edo State, Nigeria.
*Corresponding author: dratare@yahoo.com
Keywords Abstract
Housing
Factors
Transmission
Lassa fever
Background: Lassa fever is a severe hemorrhagic fever with devastating consequences that is transmitted via a virus from the
Mastomys rat which breed around human residences, to man. An alternate hypothesis is that household characteristics—like
housing quality and hygiene—are associated with the occurrence of Lassa fever.
Aims: Assessment and comparison of housing quality and hygiene in two peri-urban settlements differentiated by the annual
incidence of Lassa fever. The study also assessed awareness and family history of Lassa fever in the preceding year of the
study.
Methodology: This was a descriptive cross sectional study carried out in two peri-urban settlements (Eguare and Ikekogbe) in
Irrua town of Edo State in 2012. Both communities are similar in terms of ethnicity and socio-economic developments but
differ in the incidence of Lassa fever: Eguare had 6-10 cases of Lassa fever per year while Ikekogbe had 0-1 case of Lassa
fever per year. Eguare has an estimated population of 911 and Ikekogbe 517. The sample size was obtained using the formula
for comparing two proportions. The minimum sample size for this study using this formula is 155 although a total population
survey was conducted. Information was obtained by Interviewer administered questionnaire with the head of each household
and in their absence; any household member above the age of 18years was interviewed. A checklist was used to elicit
information on quality and hygienic state of houses and its surrounding. One questionnaire and checklist per household was
administered.
Results: 7.7% of the households in Eguare reported a case of Lassa fever in the preceding year as against 1% in Ikekogbe (x2
=5.01, df=1, p=0.03). There was no difference in the housing quality between the two settlements (X2=6.469, df=2, P=0.091),
however there was a difference in hygienic state in the two settlements. 20.5% and 54.5% of households in Eguare had good
and poor hygiene respectively while 56% and 15.4% of households in Ikekogbe has good and poor hygiene
respectively(X2=43.796, df=2, P<0.000). This may account for the higher incidence of Lassa fever in Eguare.
Houses that had brick walls and ill-fitted roofs had higher risk of reporting cases of lassa fever with odds 2.212 (CI 10.766-
6.383), P=0.142 when compared to houses with brick walls and well-fitted roofs. Surrounding with foliage over growth had
higher risk of reporting cases of lassa fever with odds 1.455 (CI 0.532-3.980), p=0.465 well compared to houses with clean
surroundings. Houses that had household equipments, appliances, tools heaped up in the premises had higher risk of reporting
cases of lassa fever with odds 4.969 (CI 1.663-14.848), P=0.004 when compared to houses that had their tools neatly arranged
within the premises. The use of buildings for both residential and commercial purposes had higher risk of reporting cases of
lassa fever odds 11.425 (CI 3.080-42.371), p=0.000 compared to buildings that are purely residential. Houses that had poor
grade on the hygiene scores had higher risk of reporting cases of lassa fever 50.645 (13.718-186.973), p=0.000 compared to
houses that had good grade on the hygiene scores.
Conclusion: Poor hygiene and use of buildings for both residential and commercial purposes are likely risk factors for
transmission of Lassa virus in households. Cleaning up houses and surroundings should be seen as a way of controlling the disease.
Introduction
Lassa fever is a severe hemorrhagic fever that presents with fever, general weakness, headache, sore throat, muscle pain, cough, chest pain,
nausea, vomiting, diarrheoa, abdominal pain with or without bleeding. It can cause deafness which has psychosocial impact on the victim as well
as other multisystem complications [1]. The clinical features are similar to other febrile illnesses such as malaria and typhoid fever. In about 80%
of people infected the disease has mild or no symptoms [2].
The disease is caused by the Lassa virus which is transmitted by Mastomys genus (a multi-mammate rat) to man. Transmission by infected rats
occurs when man comes into contact with contaminated materials e.g. food, bedding and ingestion of contaminated rats [3]. The incubation
period is 6-21days [4].
It is an emerging disease with devastating and life threatening potentials. According to WHO statistics, an estimated 300 000-500 000 case and
5000 death occurs each year worldwide. The case-fatality rate as estimated by WHO is 1%-15% among hospitalized patients [5] within 14 days
of onset in fatal cases [5]. The prevalence of antibodies to the virus in the population is 8-52% in Sierra Leone, 6.4-55% in Guinea, and 7-21% in
Nigeria [2]. It affects all age groups; both gender and cut across all social class especially communities with poor housing and poor
environmental sanitation. It possibly can be used as an agent of Bioterrorism or Biological Warfare [5].
It affects all age groups; both gender and cut across all social class especially communities with poor housing and poor environmental sanitation.
It possibly can be used as an agent of Bioterrorism or Biological Warfare [5].
It is endemic and has epidemic potential in Sierra Leone, Nigeria, Guinea, Cote d’ Ivoire and Central African Republic. It is endemic in thirteen
states in Nigeria and endemic/epidemic in Esan area of Edo state where this study was conducted4. Edo state accounts for the highest number of
cases in Nigeria.
General Health and Medical Sciences, Vol(1), No (2), December, 2014. pp. 15-20
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The Institution of Lassa fever Research and Control (ILFRC) Irrua Specialist Teaching Hospital (ISTH) Edo state was established in 2007,
primarily in response to the Lassa fever epidemic in Esan land, other parts of Edo State and neighboring states of Nigeria. It accounts for 1.6% of
all admissions in the hospital (ISTH) and 6% of febrile patients [4]. A total of 335 cases of Lassa fever have been confirmed and 100 deaths
reported (case fatality rate of 29.8%) in the institution between 2008 –December 2011 though many remained undetected [4]. The case fatality
rate ranges from 18.3%-32.2% annually in ISTH [4] It is not constrained by age, sex, gender, social class, religion, race or ethnicity.
In the hospital setting, Lassa fever can be transmitted through the nosocomial route to patient and hospital staff which could lead to mortality
among the health care workers
One cost effective intervention known to prevent and control this disease is to terminate the route of transmission; the mastomys rats. Numerous
studies have shown that the rat breeds around houses, field crop and store food [2, 6, 7, 8, 11-13].
Earlier article published on Lassa fever epidemiology in Kenema, Sierra Leone found that rats in houses of infected people are seropositive for
the virus 10 times more often than those in control houses [2]. In another study in the eastern province of Sierra Leone, Mastomys spp.
comprised 50–60% of rodents captured in houses and 10–20% captured in surrounding agricultural and bush areas, suggesting that houses could
be an essential location for transmission of the virus [6]. In the same studies it was found that Mastomys natalensis does not move far from
houses where they have established residence [6]. Rodent populations in cultivated and fallow fields in Tanzania were sampled by trapping.
Mastomys natalensis was by far the most abundant rodent in these habitats (62% or more of samples) [11].
The odds of observing a rat burrow was higher in case than control houses (OR 24, 95% CI 6-93). In a study conducted to determine risk of
Lassa fever in households in Sierra Leonean refugee camps, case houses scored significantly worse in the quality of housing and external
hygiene [7]. In another study in north-west Liberia showed higher prevalence of indirect fluorescent antibodies (IFA) in Gbanwei, a roadside
village which did not maintain traditional sanitary measures, than in Zuwulo, similarly located but with maintenance of clean-swept areas
without shrubbery or rubble between the houses [12].
Fichet-Calvet, et al. conducted a study in Guinea to determine the prevalence of Lassa virus in Mastomys natalensis; the mean trapping of M.
natalensis was always higher inside houses than in proximal cultivations. Mean trapping of M. natalensis also increased 2-fold inside houses and
decreased up to 10-fold outside (p < 0.0001) in the dry season, suggesting aggregation of rodents inside houses due to restricted food supply.
53.5% (601/1123) of the animals were identified as M. natalensis using morphometric and molecular criteria while 14.5% (80/553) of M.
natalensis were tested positive for Lassa virus by reverse transcription-polymerase chain reaction [9].
McCormick, et al. (1987) found that houses with stores of food afford a perfect environment for rodents, where they can deposit virus-laden
urine on surfaces, such as eating utensils, beds, floors, and tables [8].
To effectively control Lassa fever, there is urgent need for exhaustive information on risk factors for the disease particularly those related to the
housing conditions and the application of the findings for the control of Lassa fever. We therefore compared the quality and hygienic states of
houses in a settlement with more cases of Lassa fever and another with few cases to determine if there is a difference in the quality of houses and
the hygienic states of houses located in these settlements. The study assessed knowledge of Lassa fever and family history of Lassa fever in the
preceding year. The null hypothesis is that there is no difference in the quality and hygienic factors of houses located in settlements where there
are more cases of Lassa fever and in settlements where there are fewer cases of Lassa fever.
Methodology
Study area
This study was carried out in Irrua a rural area endemic for Lassa fever. Irrua is the head quarter of Esan central local government area of Edo
state, Nigeria. Esan central is made up of four kingdoms namely: - Irrua, Opoji, Ewu, and Ugbegun. It occupies an area of 266.31sq.km and has
a population of 105311 people in 2006 [13]. The residents of this local government area are mainly; farmers [13]. The settlements are mainly
rural and the settlement pattern being mostly linear. Irrua has a teaching hospital, ISTH and a school of midwifery. Basic amenities, such as
piped water, electricity and good roads, are inadequate. The native language is Ishan [13].
Study population
The study was carried out in two settlements (Eguare and Ikekogbe) of Esan central of Edo state. Eguare has an estimated population of 911 and
6-10 cases of Lassa fever per year; Ikekogbe 517 and Ikekogbe 0-1 case per year [4]. The number of confirmed cases from these communities
was obtained from the Institute of Lassa fever Research and Control Irrua Specialist Teaching Hospital (ISTH). ISTH is an institute for
diagnosis, treatment, surveillance and research of Lassa fever in Nigeria [14]. The population size was obtained during the study and the number
of persons per household was counted.
Study design
A cross-sectional descriptive study in two populations.
Sample size
The sample size was obtained using the formula for comparing two proportions [15]. The minimal sample size for this study using this formula is
155 after adjusting for cluster or design effect although a total population study was carried out. Information was obtained from all households in
the study population since the difference between the calculated sample size and the total number of households in the settlement was minimal.
There are a total of 247 households; 156 households in Eguare and 91 households in Ikekogbe.
Sampling technique
In this study, a household is the sampling unit which was defined as a group of people living together and had common culinary arrangement
[16]. A total population study was done giving the minimal difference in total population and calculated sample size.
Inclusion criteria and exclusion criteria
All residential buildings were included in the study and purely industrial and commercial buildings were excluded from the study.
Data collection tools
A questionnaire and a checklist were designed to obtain information on the housing factors associated with lassa fever disease. One
questionnaire/checklist was administered per household. The questionnaire was to elicit information on personal data of the respondents,
awareness of Lassa fever, family history of Lassa fever and what type of health facility was the diagnosis made. The household members
interviewed were also asked for presences of rat in their houses. This information was obtained by the use of interviewer administered
16 Oboratare Ochei *, Chukwuyem Abejegah, Emmanuel Chuks Okoh, Steve Obekpa Abah
General Health and Medical Sciences Vol(1), No (2), December, 2014.
questionnaire to the head of each household and in their absence; any household member above the age of 18years was interviewed. The
checklist was adapted from Bonner et al. It was used to elicit information on quality/hygienic state of houses and its surrounding by either one of
the researchers or one of the research assistants (see Box 1). The sanitary state of the interior and external surroundings of each house was
determined using the criteria as showed in box 1. The roof of a house is said to be ill-fitted or porous if there is a gap between the wall and the
roof and well-fitted if there is no gaps between the roof and the wall. The assessment of a toilet as clean was based on the inspection of the
following: presences of protection round the toilet, a toilet cover over the toilet pot, absence of littered faecal matter on the floor of the toilet and
proper disposal of used toilet paper. The study took approximately four months September 2012- December 2012. A team of fifteen persons
were recruited base on familiarity with the community and language spoken and trained.
Box 1. Criteria Used to Score Housing Quality and House Hygiene in the two Studied Districts
Housing Quality
Good housing---lives in a solid brick house or solid mud, a flat, roof tight fitted and roof protective, no holes or cracks on the outside
walls, windows/doors present and protective and floor in good condition. No holes or cracks on the floor
Poor condition--- brick or mud had many cracks or holes greater than 10, a passage or corridor house, roof ill-fitted or porous, no
windows/doors. Floor was covered with mud earth.
Fair condition--- had some of good and poor housing qualities, 1-9 holes or cracks on the outside walls, holes and cracks on floor
House Hygiene
Good hygiene---clean environs, items neatly arranged, waste bin with cover, presences of protection round the toilet, a toilet cover
over the toilet pot, absence of littered faecal matter on the floor of the toilet and proper disposal of used toilet paper. Plumbing system
closed, all food items covered and no rat present.
Poor hygiene---foliage overgrown, refuse dump less than 30meters from the house, heap of wood/metals/equipment/grains/old house
items/spare parts neglected around dwellings and inside house, no garbage bin, no protection round the toilet, no toilet cover over the
toilet pot, presence of littered faecal matter on the floor of the toilet and no proper disposal of used toilet paper. Plumbing system open,
food items not covered and had rats
Fair hygiene--- had some of good and poor hygiene variables.
Data analysis
The SPSS version 16.0 was used for data validation and analysis. The x2 test was used in the test for association between awareness of Lassa
fever, confirmed cases of Lassa fever, type of houses, types of apartment, state of houses, state of windows, numbers of holes in houses,
arrangement of tools in the premises, surrounding of houses, bush burning per year, use of buildings interior organizations of houses, presences
of refuse bin, amounts of food item protected from rodents, location of kitchen, number of houses with rat, quality of houses and house hygiene
in the two settlements.
In assessing the quality of a house a total of twenty-one questions were employed. The maximum possible score for quality of a house was 73.
Those who scored 51-73 had good housing, those who score 44-50.9 had fair housing and those who score 0-43.9 had poor housing.
In assessing the hygienic state of a house a total of eight questions were employed. The total score for each house was calculated. The maximum
possible score for hygienic state of a house was 20. Those whose scores were greater than 14 had good hygiene. Those whose scores were 13.9-
10 had fair hygiene and less than 10 had poor hygiene.
Ethical clearance
Ethical clearance was obtained from Ambrose Ali University Department of Community Health. Permission to carry out the study was also
obtained from the head of Irrua community. Verbal consent was obtained from all participants before interview process began.
Results
Table 1. Socio-demographic data of study participants
Eguare Households(n=156) Ikekogbe Households (n=91) p value (X
2
)
No of households in the settlements, n 156 91
Total population
911
517
Sex
Male, n (%)
Female, n (%)
64(41)
92(59)
43 (47.3)
0.341 (0.908)
Age in years
18-24, n (%)
25-34, n (%)
35-44, n (%)
45-54, n (%)
55-64, n (%)
65 and above n (%)
31 (19.9)
48 (32.9)
31 (19.9)
18 (11.5)
17 (10.9)
11 (4.9)
17 (18.7)
25 (27.5)
15 (16.5)
15 (16.5)
15 (16.5)
4 (4.3)
0.301 (57)
Education
None, n (%)
Primary, n (%)
Secondary, n (%)
Tertiary, n (%)
19(12.2)
29(18.6)
70(44.6)
38(24.4)
10 (10.9)
21 (23.1)
30 (33)
30 (33)
0.241 (4.2)
Occupation
Professional
Trading
Student
Artisan
Unskilled
Unemployed
Others (clergy, housewives etc)
15(9.6)
68(43.7)
29(18.7)
13(8.3)
11(7.2)
10(6.4)
10(6.4)
15(16.4)
29(32.1)
21( 23.2)
2(2.1)
13(14.2)
7(7.7)
4(4.3)
0.277 (23.24)
17 Housing Factors and Transmission of Lassa Fever in a Rural Area of South-south Nigeria
General Health and Medical Sciences Vol(1), No (2), December, 2014.
Table 2. Association between District Location and Housing Factors
Variables Eguare Households ( n=156) n(%) Ikekogbe Households (n=91) n(%) p value (X
2
)
Awareness of Lassa fever
Yes, n (%)
No, n (%)
146(93.6)
10(6.4)
84(92.3)
7 (7.7)
0.707 (0.147)
Households that reported a case of Lassa fever
Yes, n (%)
No, n (%)
12(7.7)
144 (92.3)
1(1)
90(99)
0.03 (5.01)
Type of houses
Brick with well-fitted roof, n (%)
Brick with ill-fitted roof, n (%)
Mud with well-fitted roof, n (%)
Mud with ill-fitted roof, n (%)
82(52.6)
40(25.6)
9(5.8)
25(16)
42(46.2)
38(41.8)
5(5.5)
6(6.5)
0.026 (9.28)
Type of apartment
Flat, n (%)
Passage house, n (%)
Corridor house, n (%)
69(44.2)
54(34.6)
33(21.2)
48(52.7)
21(23.1)
22(24.2)
0.135 (5.565)
State of the house
In good state, n (%)
In fair state, n (%)
In poor state, n (%)
83(53.2)
57(36.5)
16(10.3)
35(38.3)
47(51.6)
9(10.1)
0.057 (5.739)
State of windows
Present and adequate, n (%)
Present and inadequate, n (%)
No windows, n (%)
88(56.4)
61(39.1)
7(4.5)
42(46.1)
41(45.1)
8(8.8)
0.183 (3.395)
No of holes on houses
No hole, n (%)
1-4 holes, n (%)
5-9 holes, n (%)
>10 holes, n (%)
97(62.2)
43(27.6)
11(7.1)
5(3.2)
43(47.3)
25(27.5)
12(13.2)
11(12)
0.009 (11.584)
Surrounding of houses
Foliage overgrown, n (%)
Heaps of refuse, n (%)
Littered with refuse, n (%)
Clean, n (%)
43(27.6)
32(20.5)
18(11.5)
63(40.4)
34(37.4)
8(8.8)
21(23)
28(30.8)
0.005 (12.935)
Interior arrangement of household item
Heap of items seen, n (%)
Items scattered around, n (%)
Items neatly arrange, n (%)
30(19.2)
45(28.8)
81(52)
10(11)
34(37.4)
47(51.6)
0.156 (3.715)
Presences/states of refuse bin
No refuse bin (littered), n (%)
Bin full and overflowing, n (%)
Bin opened but clean, n (%)
Covered and clean, n (%)
98(62.8)
15(9.6)
22(14.1)
21(13.5)
46(50.5)
14(15.4)
22(24.2)
9(9.9)
0.072 (6.991)
Arrangement of tools in the premises
Heaps of tools seen, n (%)
Tools scattered around, n (%)
Tools neatly arranged, n (%)
50(32.1)
49(31.4)
57(36.5)
35(38.5)
40(44)
16(17.5)
0.006 (10.185)
Proportion of food items covered
All food covered, n (%)
Some food covered, n (%)
None covered, n (%)
121(77.6)
33(21.2)
2(1.2)
72(79.1)
17(18.7)
2(2.2)
0.783 (0.487)
Number of times surrounding bush is burnt in a year
None, n (%)
1-2, n (%)
3-4, n (%)
>5, n (%)
88(56.3)
36(23.1)
16(10.3)
16(10.3)
31(34.1)
33(36.3)
8(8.8)
19(20.9)
0.003 (14.237)
Use of building
Residential plus industry, n (%)
Residential plus trading, n (%)
Purely residential, n (%)
9(5.8)
53(34)
94(60.2)
24(26.4)
17(8.7)
50(54.9)
<0.0001 (23.28)
Location of cooking area
Main house, n (%)
Outside main house, n (%)
Sleeping room, n (%)
71(45.5)
81(51.9)
4(2.6)
33(36.3)
58(63.7)
0(0)
0.085 (4.9)
Number of houses with rats
Yes, n (%)
No, n (%)
122(78.2)
34(21.8)
72(79.1)
19(20.9)
0.866 (0.029)
Quality of houses score
Poor, n (%)
Fair, n (%)
Good, n (%)
21(13.5)
54(34.6)
81(51.9)
21(23.1)
23(25.3)
47(51.6)
0.091 (6.469)
Hygiene scores
Poor, n (%)
Fair, n (%)
Good, n (%)
85(54.5)
39(25)
32(20.5)
14(15.4)
26(28.6)
51(56)
<0.000 (43.796)
18 Oboratare Ochei *, Chukwuyem Abejegah, Emmanuel Chuks Okoh, Steve Obekpa Abah
General Health and Medical Sciences Vol(1), No (2), December, 2014.
Table 3. Multivariate Regression Analysis of Housing Factors with an impact on District that had higher Risk of Lassa fever
Housing Factors Odds (confidence interval) p-value
Type of houses
Brick with well-fitted roof
Brick with ill-fitted roof
Mud with well-fitted roof
Mud with ill-fitted roof
Reference group
2.212(0.766-6.383)
0.936(0.165-5.309)
0.324(0.067-1.569)
0.142
0.940
0.161
No of holes on houses
No hole
1-4 holes
5-9 holes
>10 holes
Reference group
2.403(0.825-7.001)
3.360(0.812-13.911)
3.054(0.594-15.687)
0.108
0.095
0.161
Surrounding of houses
Clean
Foliage overgrown
Heaps of refuse
Littered
Reference group
1.455(0.532-3.980)
0.192(0.054-0.678)
0.913(0.282-2.953)
0.465
0.010
0.879
Arrangement of tools in the premises
Tools neatly arranged
Heaps of tools seen
Tools scattered around
Reference group
4.969(1.663-14.848)
3.153(1.235-8.051)
0.004
0.016
Number of times surrounding bush is burnt in a
year
None
1-2
3-4
>5
Reference group
2.007(0.843-4.779)
0.669(0.168-2.672)
2.480(0.804-7.643)
0.116
0.570
0.114
Use of building
Purely residential
Residential plus industry
Residential plus trading
Reference group
11.425(3.080-42.371)
0.669(0.289-1.546)
0.000
0.347
Hygiene scores
Good
Poor
Fair
Reference group
50.645(13.718-186.973)
8.614(2.715-27.328)
0.000
0.000
In this study p-value was set at p < 0.05. There was no difference in awareness of the Lassa fever, types of apartment, state of houses, state of
windows, interior organizations of houses, presences of refuse bin, amounts of food item protected from rodents, location of kitchen, number of
houses with rat and quality of houses in the two districts. The p value is greater than 0.05 significant levels. However there was significant
difference in the number of confirmed cases of Lassa fever, type of houses, numbers of holes in houses, arrangement of tools in the premises,
surrounding of houses, bush burning per year, use of buildings and quality of hygiene in the two settlements.
It was found that 7.7% of the households studied in Eguare had a case of Lassa fever in the preceding year as against 1% in Ikekogbe.
There are more brick houses with well-fitted roof in Eguare (56.6%) than in Ikekogbe (46.2%). There are more mud houses with ill-fitted roof in
Eguare (16%) than in Ikekogbe (6.5%).
In both settlements only 36.8% of the immediate surroundings are absolutely clean however 40.4% of the immediate surroundings in Eguare are
clean while 30.8% of the immediate surroundings in Ikekogbe are clean.
In both settlements only 12.2% of the households have a clean, well-covered refuse bin while 58.3% of households do not have refuse bin. In
both communities’ collection and disposal of refuse is in adequate.
There is no statistical difference in the quality of houses in Eguare (51.9%) and Ikekogbe (51.6%) p=0.091, x2=6.469.
The quality of hygiene is better in Ikekogbe (56% has good hygiene) than Eguare (20.5% has good hygiene) p<0.000 x2=43.796.
Multivariate analysis was performed on only variables (housing factors) that show an association (using chi square test) with district that had
higher risk of Lassa fever disease. The result shows that houses that had brick walls and ill-fitted roofs had higher risk of reporting cases of lassa
fever with odds 2.212 ( CI 10.766-6.383), P=0.142 when compared to houses with brick walls and well-fitted roofs. Surrounding with foliage
over growth had higher risk of reporting cases of lassa fever with odds 1.455 (CI 0.532-3.980), p=0.465 well compared to houses with clean
surroundings. Houses that had household equipments, appliances, tools heaped up in the premises had higher risk of reporting cases of lassa
fever with odds 4.969 (CI 1.663-14.848), P=0.004 when compared to houses that had their tools neatly arranged within the premises. The use of
buildings for both residential and commercial purposes had higher risk of reporting cases of lassa fever odds 11.425 (CI 3.080-42.371), p=0.000
compared to buildings that are purely residential. Houses that had poor grade on the hygiene scores had higher risk of reporting cases of lassa
fever 50.645 (13.718-186.973), p=0.000 compared to houses that had good grade on the hygiene scores.
Discussion
This study has compared housing quality and hygiene in two settlements that are located within a large community. One of the settlements has
higher incidence of Lassa fever:-Eguare with 6-10 cases of lassa fever per year and the other district Ikekogbe has lower incidence with 0-1 case
per year. The hypothesis is that household housing quality and housing hygiene—are associated with the occurrence of Lassa fever in the
household and could be used as screening tools to identify Lassa fever risk households [8].
It was found in this study that 7.7% of the households in Eguare have reported a case of Lassa fever in the preceding year as against 1% in
Ikekogbe. However there was no statistically significant difference in the quality of housing in the two settlements studied. This also was not in
19 Housing Factors and Transmission of Lassa Fever in a Rural Area of South-south Nigeria
General Health and Medical Sciences Vol(1), No (2), December, 2014.
line with the study in Sierra Leone in which the quality of housing had statistically significant difference on the risk of disease after adjusting for
presence of rat burrows [8].
In this study housing hygiene was associated with the disease. The settlement with higher cases of lassa fever had poorer hygiene compare with
the one with fewer cases. 54.5% of households had poor hygiene in Eguare while 15.4% of households have poor hygiene in Ikekogbe. This has
further strengthened the study carried out by Bonner et al that the poorer state of houses the increase risk for rodent infestation and for
transmission of Lassa virus in the house’s immediate surroundings. The use of houses for both residential and commercial purposes also had
increase risk for transmission of lassa fever disease; 34% of the houses in Eguare are used as residential and commercial purposes while 8.7% of
the houses in Ikekogbe are use for residential and commercial purposes.
Conclussion
Poor hygiene and use of buildings for both residential and commercial purposes are likely risk factors for transmission of Lassa virus in
households. Cleaning up houses and surroundings should be seen as a way of controlling the disease.
Acknowledgements: Dr. Alphonsus O. Aigbiremolen
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20 Oboratare Ochei *, Chukwuyem Abejegah, Emmanuel Chuks Okoh, Steve Obekpa Abah
General Health and Medical Sciences Vol(1), No (2), December, 2014.
... Eighty percent of infected people are mild or asymptomatic [16,17,25]. Symptoms usually begin with ulike illness, fever, malaise, which may be accompanied by cough, sore throat, severe headache, chest and abdominal pain, vomiting, diarrhea; and may later result in bleeding from the mucosa openings, severe haemorrhagic fever, facial edema, multi-organ dysfunction, which could eventually lead to death [15,17,26,28]. ...
... This agrees with the report of Tobin et al. [3]. It has been discovered that this age group (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) give more attention to social media information than any other age group. The present study showed that the percentage of the participants who had up to secondary school was similar in both towns (Iwo 29%, Ayedire 29.8%). ...
... Part of the factors that could aid the spread of LF in an outbreak include lack of diagnostic facility in the rural areas, LF symptoms similar to other febrile illnesses, such as malaria and typhoid fever, thus leading to late presentation, un-curtailed rats in homes, poor knowledge, and poor prevention practices [1,7,11,17,25]. Although, early diagnosis will help reduce spread, diagnostic facilities are di cult to nd in many rural communities in Africa, as none could be found in the study areas. Lack of proper barrier, infection prevention, and control practices exposes health workers to infection [22,27]. ...
Awareness, Knowledge and Prevention Practices Related to Lassa Fever Among Residents of Rural Communities in Southwest Nigeria: Implications for Prevention and Control
Preprint
Full-text available
  • Jan 2021
Background: Lassa fever (LF) is a haemorrhagic illness caused by Lassa virus. The primary reservoir of the virus is the multimammate rat, Mastomys natalensis. More than 3,000 laboratory-confirmed cases of Lassa fever and over 800 deaths have been recorded in Nigeria. This could be attributed to poor rat control and poor sanitation especially in the rural communities where the rats are often found. Increasing awareness and health education about LF have been advocated for its prevention and control. This study investigated the level of awareness, knowledge and prevention practices related to LF among residents in rural communities within Iwo and Ayedire Local Government Areas, Osun State, southwest Nigeria sequel to an awareness campaign. Methods: Structured questionnaire was administered within rural communities in Iwo and Ayedire and 675 participants responded for the survey by a random sampling technique. Descriptive statistics, Chi-square test of association (p = < 0.05) and logistic regressions were used to determine associations between demographic variables, level of knowledge and prevention practices. Results: The average age range was 25-39 years, 365 (54.07%) were male, 270 (40%) were married, 199 (29.48%) had up to secondary school education and 536 (79.41%) have heard about LF before. Respondents in Iwo town were more aware of LF than respondent from Ayedire. Only 3 (0.44%) had good knowledge of the transmission and symptoms of the disease and 304 (45.04%) do not have effective means of preventing rats into their homes. About 296 (43.85%) will go to a hospital if symptoms occur, while 118 (17.48%) will do self-medication. Forty-four (6.52%) were aware of good prevention practices. Logistic regression analysis showed that respondents aged 25–39 years were significantly more aware of Lassa fever than other age groups. Educated and married respondents showed significant relationship with good prevention practices than those without education and were not married. Conclusions: Although, the awareness of LF among the respondents was high, only very few had good knowledge of the transmission and symptoms of the disease. Therefore, it is important for the people to be well informed about the disease and good prevention practices in order to curtail the spread.
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... This finding had been reported in previous studies in Nigeria and elsewhere. 4,9,12 It is therefore essential that this population access accurate information on Lassa fever to reduce the occurrence of this disease and stamp out the nearly yearly outbreaks. Also, radio was identified as the major source of information about Lassa fever for most respondents. ...
... Several studies had reported similar finding as this group of people have better personal hygiene and environmental sanitation practices. 7,[12][13][14] They also have access to information through various reliable sources. Therefore, it is necessary to focus on the less educated, those earning less income, such as traders and artisans, as they are likely to engage in behaviors that make them prone to Lassa fever infection. ...
... Furthermore, behavioral change in waste disposal, personal hygiene, and handwashing with universal precaution will curb the persistence of Lassa fever in the community. [10][11][12][13][14] Also, health-care workers will benefit from continuous training on recent and accurate information on Lassa fever diagnosis, treatment, control, and prevention. Isolated wards, personal protective equipment, and necessary drugs including Ribavirin in appropriate doses and route should be provided in such designated wards so that there will be no delay in attending to suspected cases. ...
Knowledge Attitude and Practices Toward Lassa Fever Control and Prevention Among Residents of Ile-Ife, Southwest Nigeria
Article
  • Apr 2017
Lassa fever had been reported as a cause of death especially in endemic parts of Nigeria. This study assessed the knowledge, attitude, and practices toward Lassa fever control and prevention among residents of Ile-Ife, southwest Nigeria. Descriptive cross-sectional study was conducted among consenting randomly selected adults using an interviewer administered questionnaire. Data were analyzed using descriptive and inferential statistics. A total of 400 questionnaires with completed data were analyzed (response rate 96%). Majority, 207 (51.8%), were males while 193 (48.2%) were females. Most, 234 (58.5%), had tertiary education while 148 (37%) had secondary education. Fifty-nine percent had heard of Lassa fever with radio as their major source of information. About 76% had inadequate knowledge, 54% had negative attitude while 51% had poor practice toward Lassa fever. Determinants of knowledge of Lassa fever include having higher education (Adjusted Odd Ratio (AOR) = 11.49, 95% CI [3.10, 42.69], p = .0001), being in civil service (AOR = 0.22, 95% CI [0.09, 0.51], p = .01), and earning higher income (AOR = 4.23, 95% CI [2.61, 6.84], p = .0001). In conclusion, the knowledge, attitude, as well as preventive practices to Lassa fever were poor. It is necessary to increase public education and improve hygienic practices.
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... This result was confirmed by a study conducted in rural communities of Ebonyi State which revealed that there was no health behaviour modification among the respondents in terms of regular hand washing, structural and goods arrangement in the house in spite of people's awareness of Lassa fever (Wogu,2018). The use of houses for both residential and commercial purposes also had increased risk of transmission of Lassa fever disease (Ochei, Abejegah & Okoh, 2014). Hence, good housing standard and clean environment as part of the methods of preventing and controlling the spread of Lassa fever (Olayinka et al., 2015). ...
... The high awareness level across the States was expected given that there has been constant outbreak of Lassa fever in the South-East since 2020 and concomitant constant sensitization and media awareness campaigns about the diseases since the beginning of the year. This finding corroborates the previous findings of Nigerian studies which revealed high level of awareness of Lassa fever among the sampled respondents (Odionye et al., 2019;Wogu, 2018;Ochei et al, 2014). However, the finding of another Nigerian study showed that males were significantly more aware of Lassa fever than females in Ogbese and Utese communities (Asogun et al, 20140. ...
A Comparative Study of the Influence of Lassa Fever Media Campaigns on Health Practices of Residents of Select States in South-East Nigeria
Article
Full-text available
  • May 2021
The yearly outbreak of Lassa fever in Nigeria which causes approximately 5,000 deaths per year has necessitated media awareness campaigns to curb the disease. Consequent this study comparatively assessed the influence of Lassa fever media campaigns on the awareness level and health practices of residents of 3 selected States in SouthEast Nigeria. The study was anchored on the Extended Parallel Process Model. Using structured questionnaire, 400 adult respondents were selected from 9 Lassa fever affected LGAs of the 3 sampled States through multistage sampling technique. Findings revealed high level of awareness of Lassa fever media campaigns among respondents in the sampled States. Major sources of information were television 280 (72.5%) and radio 267(69.4%). There were good preventive health practices against Lassa fever among the residents of Enugu and Abia States but very poor health practices among residents of Ebonyi State. Consequently, it was recommended the need for constant sensitisation of residents of the studied States, especially residents of Ebonyi State for better understanding of dangers of Lassa fever; this will improve healthy preventive practices.
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... semi-structured, self-administered questionnaire administered was designed to obtain information on the environmental conditions associated with the Lassa fever disease. Questionnaire was adapted from Oboratare et al., 2014 [10]. This instrument had 5 sections namely: Socio demographic factors, housing conditions, sanitation and hygiene condition, waste management and knowledge of Lassa fever. ...
... Onsite observation was done using a checklist to observe housing conditions, environmental sanitation & indoor hygiene sanitary facilities, toilet facilities, waste management facilities, vector control and general inspection of waste management. Checklist was adapted from Oboratare et al., 2014 [10]. Prompt onsite observations was conducted on each of the households selected using the observational checklist. ...
Environmental Conditions and Predictors of Lassa Fever Transmission in a Low Socioeconomic Community in Nigeria
Article
Full-text available
  • Mar 2021
Lassa fever is of public health concern in West Africa due to its endemic nature. Housing conditions have been revealed to be important sites for primary transmission. This study assessed environmental and housing conditions of a low-income community for factors that could contribute to the transmission of Lassa fever. The study employed a cross-sectional design with a field component. Observational checklist and an interviewer-administered questionnaire were used to assess environmental conditions and respondents' hygiene knowledge and practices respectively. Rodent traps were also placed in selected households. Data collected were analysed using SPSS Version20. 40% of the respondents had poor housing conditions, 80% had good hygiene practice while 20% had poor knowledge. Respondents with good housing condition were 1.9 times more likely to have good hygiene practice compared to houses with poor housing condition (OR= 1.941, p= 0.009). Rodents trapped from the households were Rattus rattus (43.2%), Rattus fuscipes Original Research Article Ana et al.; IJTDH, 42(1): 25-39, 2021; Article no.IJTDH.65448 26 (38.6%) and Rattus norvegicus (18.2%). Houses with most rats trapped had the poorest housing conditions and hygiene practices. The results suggest that households in the community are susceptible to the transmission of Lassa fever. Therefore, effective awareness campaigns on the transmission of Lassa fever and good hygiene and sanitation practice should be encouraged in and around the home.
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... Certain factors related to human and rodent behaviour have been identified as important risk factors in the transmission of Lassa fever. These include poor housing, poor personal and domestic hygiene, unsafe food practices, unkempt and bushy house surroundings and insanitary waste management practices [6][7][8]. ...
... In terms of distribution of cases by LGAs, Esan West had the highest number. The area, being part of Esan land, has been noted to have high prevalence of Lassa fever in previous reports [7,25]. ...
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... A case-control study by Bonner, et al. in refugee camps in Sierra Leone found that recent LF cases had elevated odds of living in homes with rodent burrows or with poor external hygiene, with the presence of rodent burrows being in turn associated with poor housing quality 20 . Other work has been more equivocal, with a study in Nigeria finding no significant difference in housing quality between LASV positive and negative individuals, though they did find a positive association between poor hygiene and self-reported LF case status 21 . The aforementioned study by Kernéis, et al., also found no association between LASV seroprevalence and the presence of rodents in the home in Guinea 22 . ...
Domestic risk factors for increased rodent abundance in a Lassa fever endemic region of rural Upper Guinea
Article
Full-text available
  • Oct 2021
Lassa fever (LF) is a viral haemorrhagic fever endemic in West Africa and spread primarily by the multimammate rat, Mastomys natalensis . As there is no vaccine, reduction of rodent-human transmission is essential for disease control. As the household is thought to be a key site of transmission, understanding domestic risk factors for M. natalensis abundance is crucial. Rodent captures in conjunction with domestic surveys were carried out in 6 villages in an area of rural Upper Guinea with high LF endemicity. 120 rodent traps were set in rooms along a transect in each village for three nights, and the survey was administered in each household on the transects. This study was able to detect several domestic risk factors for increased rodent abundance in rural Upper Guinea. Regression analysis demonstrated that having > 8 holes (RR = 1.8 [1.0004–3.2, p = 0.048), the presence of rodent burrows (RR = 2.3 [1.6–3.23, p = 0.000003), and being in a multi-room square building (RR = 2.0 [1.3–2.9], p = 0.001) were associated with increased rodent abundance. The most addressable of these may be rodent burrows, as burrow patching is a relatively simple process that may reduce rodent entry. Further study is warranted to explicitly link domestic rodent abundance to LF risk, to better characterize domestic risk factors, and to evaluate how household rodent-proofing interventions could contribute to LF control.
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... LF is caused by Lassa virus belonging to the arenaviradae family, it is present in the urine and feces of infected multimammate rats (Mastomys natalensis) [5] . The primary transmission route to human is through direct contact with the mastomys rats or through food and household items contaminated with the urine and feces of infected rats [6][7] . The secondary (human-tohuman) transmission route is through direct contact with the blood-secreting organs or other body fluids of infected persons. ...
Community Engagement in the Prevention and Control of Lassa Fever in Africa: A Systematic Review
Article
Full-text available
  • May 2021
Aims: This study aimed to determine community-initiated Lassa fever prevention and control strategies in Africa. Materials & Methods: Literature search was performed on four databases, including PubMed, Google Scholar, African Journal OnLine (AJOL), and BioMed Central, using different combinations of the following search terms. A three-stage methodology was employed to conduct the study. At first, related articles were identified using pre-defined key terms, such as Lassa fever, Lassa fever control, Lassa fever prevention, community engagement and Lassa fever, and community participation and Lassa fever. Thereafter, articles were screened to remove duplicates and articles not relevant to the study objectives. Findings: Community mobilization and sensitization and risk communication were some of the community-directed activities towards Lassa fever prevention and control. Also, stakeholders’ advocacy and engagement, rodent control practices, environmental sanitation, and proper food processing and preservation were practiced to prevent Lassa fever. In addition, a referral mechanism from the community to the health facility was constituted through the engagement of community health workers. Conclusion: Health program managers should strive to provoke coordinated and sustainable community-initiated efforts to improve rodent preventive and control measures. Strategies should be developed and implemented to promote environmental sanitation and restrict cultural practices facilitating contact with rodents or infected persons.
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... It shares borders with Ughele, Ihumudumu, Emuhi and Egoros (all these communities have also recorded cases within the time of this study). Eguare has an estimated total population of 31,500 [8,9]; with children under five years having a population of 1,260 and women of child bearing age, a population of 6,930. The community has one functional primary health care centre, one secondary health facility and seven private hospitals. ...
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... This poor knowledge is worrisome despite the [21]. The finding of a high awareness of LF in this study, is similar to community-based studies in Lafia by Reuben and Gyar [22], and in Irrua by Ochei et al. [23] A low community awareness of LF in Owo, Ondo State has been reported by Ilesanmi et al. [24] and in Oshogbo by Adebimpe et al. [25] Respondents in Abakaliki LGA had a better knowledge of LF risk factors compared to its symptoms suggesting a gap in risk communication information dissemination in the state and the need for risk communication content in the state to contain more LF symptoms for early identification of suspected cases. Fever, bleeding, body weakness and headache were the symptoms most correctly known by the respondents. ...
Knowledge and risk perception towards Lassa fever infection among residents of affected communities in Ebonyi State, Nigeria: implications for risk communication
Article
Full-text available
Background: Lassa fever (LF) is an epidemic-prone zoonotic disease prevalent in Nigeria and Ebonyi State is a high burden area in Nigeria. Low risk perceptions have been reported to prevent appropriate preventive behaviours. We investigated the knowledge and risk perception of residents towards LF and determined the factors influencing their risk perception in communities that have reported confirmed cases of LF. Methods: We conducted a cross-sectional study in the affected wards in Abakaliki Local Government Area (LGA). We interviewed 356 adult respondents recruited across 6 settlements in 3 of the affected wards through multistage sampling technique. Information on participants' knowledge of LF, their risk perception using the health belief model as well as factors influencing risk perception were obtained. We estimated the proportions of respondents with good knowledge and high risk perceptions. We also explored the relationship between risk perception, knowledge and sociodemographic characteristics using Chi Square and logistic regression at 5% level of significance. Results: The mean age of the participants was 33.3 ± 12.2 years, 208 (63.2%) were females, 230 (69.9%) were married and 104 (31.6%) had attained tertiary education. Though 99.1% were aware of LF infection, 50.3% among them had poor knowledge of LF symptoms and risk factors, 92.9% had high risk perception of severity, 72.4% had a high feeling of susceptibility towards LF infection, 82.5% had a high perceived self-efficacy towards LF infection, 63.5% had a low perceived benefit of LF preventive practices and 31.8% had high perceived barrier towards LF preventive practices. Good knowledge of LF was the only significant factor influencing risk perception; perceived severity: (COR: 3.0, 95%CI: 1.2-7.8), perceived susceptibility (AOR: 2.0, 95%CI: 1.25-3.3) and perceived benefit (COR: 2.1, 95%CI: 1.3-3.3). Conclusions: Good knowledge of LF influences risk perception towards LF which has great import on LF preventive practices. A gap exists in the content and acceptance of LF risk communication information in the LGA. There is a need to review the risk communication messages in the state towards LF in the community with special focus on the males and younger population.
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... However, Olayinka et al., 32,33 Ochei et al., 34 and Reuben and Gyar, 35 observed that the rate of awareness of Lassa fever disease in Nigeria particularly among the Owo people of Ondo State and Irrua households in Edo State is very high. Nevertheless, they argue that it may be so because these areas were hotspots for Lassa fever outbreaks. ...
Mass media awareness campaign and the prevention of the spread of Lassa Fever in the rural communities of Ebonyi State, Nigeria: Impact evaluation
Article
Full-text available
  • Dec 2018
This paper investigates the impact of media Campaign on the prevention and spread of Lassa fever in Ebonyi state. 354 respondents were randomly selected from six rural communities in the state as study sample, while structured questionnaires was used for collecting data. SPSS version 20.0 was used to analyse the data. Results of Analysis reveal that the media campaign has rural reach but has little or no impact. The results also reveal that the campaign failed to create appropriate awareness of the disease, its preventive /curative health behaviours. It further reveals that there are no health behaviour modifications among the people because of the campaign. Therefore, this paper recommends the modification of media contents to incorporate the required preventive/curative health behaviours. Secondly, mandatory mass media awareness campaign and jingles in every news hour is recommended.
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Home range and abundance of Mastomys natalensis (Smith, 1834) in habitats affected by cultivation
Article
Full-text available
Rodent populations in cultivated and fallow fields in Tanzania were sampled by trapping. Mastomys natalensis (Smith) was by far the most abundant rodent in these habitats (62% or more of samples). Estimates of densities of this rodent were obtained by removal trapping at scattered localities in Tanzania (range 23–236 ha-1) and from a catch-mark-release (CMR) study through a seasonal cycle (range 40–384 ha-1). Home ranges were analysed using CMR data. Seasonal variation in home-range size was not found, but reproductive males “had larger ranges than females and subadults. On a prélevé au moyen de piéges des échantillons des populations de rongeurs dans des champs cultivés et dans d'autres en jachère. Mastomys natalensis (Smith) était de loin le rongeur le plus abondant dans ces habitats (62% ou plus des échantillons). On a obtenu des estimations de la densité de ce rongeur au moyen de pièges dispersés dans différentes localités en Tanzanie, les animaux n'étant pas relâches (distribution 23–236/ha), et par une étude de capture-marquage-recapture (CMR) pendant un cycle saisonnier (distribution 40–384/ha). On a analysé les espaces vitaux en se servant des données de CMR. On n'a pas trouvé de variation saisonnière de la taille de l'espace vital mais les mâles reproducteurs ont des territoires plus vastes que les femelles et les subadultes.
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Fluctuation of Abundance and Lassa Virus Prevalence in Mastomys natalensis in Guinea, West Africa
Article
Full-text available
  • Feb 2007
Based on empiric surveillance data, the incidence of human Lassa fever (LF) cases in Guinea and other West African countries has been reported to increase during the dry season compared to the rainy season. To investigate possible links with the ecology of the rodent reservoir of the virus, we conducted a 2-year longitudinal survey of Mastomys natalensis in a region of high human Lassa virus (LASV) seropositivity in Guinea. Standardized rodent trapping with similar trapping efforts between seasons was performed in three villages and 53.5% (601/1123) of the animals were identified as M. natalensis using morphometric and molecular criteria. Mean trapping success (TS) of M. natalensis was always higher inside houses than in proximal cultivations. In the dry season, mean TS increased 2-fold inside houses and decreased up to 10-fold outside (p < 0.0001), suggesting aggregation of rodents inside houses due to restricted food supply. 14.5% (80/553) of M. natalensis were tested positive for Lassa virus by reverse transcription-polymerase chain reaction (RT-PCR; range, 5%-30%) and prevalence of the virus was two to three times higher in rodents captured in the rainy season than in the dry season (p < 0.05). Inside houses, however, the LASV prevalence fluctuated nonsignificantly with season. These data suggest that in Guinea the risk of LASV transmission from rodents to humans is present both in the rainy and the dry season, reflected by the occurrence of LF cases throughout the year. In the dry season, however, the increased risk of humans encountering Mastomys and their excreta inside of houses may result in an increase of human Lassa fever cases.
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Prevention of Lassa Fever in Nigeria
Article
Although specific treatment is available for Lassa fever, early diagnosis is still difficult in most Nigerian primary and secondary health centers. This study was carried out to compare the case-fatality rates of Lassa fever and other medical diseases commonly seen in adult medical wards, to determine the community habits that make Lassa fever endemic in Edo Central District of Nigeria, with the aim of prescribing preventive measures for its control in Nigeria. The records of 908 inpatients in the adult medical wards of Irrua Specialist Teaching Hospital, Irrua and responses from respondents interviewed by trained interviewers on their knowledge, attitudes and practices pertaining to Lassa fever were used for this study. The case-fatality rate of Lassa fever in this center was 28%. Cultural factors and habits were found to favor endemicity of Lassa fever in Edo Central District of Nigeria. Preventive measures were prescribed for families and communities.
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Epidemiology and Control of Lassa Fever
Article
The history of recognized human arenavirus infection in Africa began in 1969 with the mysterious death of two medical missionaries and the near-fatal illness of a third (Frame et al. 1970). An arenavirus was isolated from two of these patients and given the name of Lassa virus after the town of Lassa, Nigeria, where the disease, known as Lassa fever, occurred (Buckley et al. 1970). An earlier description of a febrile syndrome in Sierra Leone was, in retrospect, very likely to have been the first account of Lassa fever; however, no etiologic agent was sought (Rose 1956, 1957).
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A Prospective Study of the Epidemiology and Ecology of Lassa Fever
Article
  • Apr 1987
In studies of Lassa fever in Sierra Leone, the prevalence. of human antibody to Lassa virus ranged from 8% to 52%. Mastomys natalensis, the reservoir of Lassa virus, constituted 50%–60% of the rodents captured in houses but only 10%–20% of those captured in surrounding agriculture and bush areas (χ2 = 90.2, P < 10−6 , dƒ = 1), a finding suggesting that houses are the most-important location for transmission of Lassa virus. Viral infection of Mastomys from houses ranged from 0% to 80%. The incidence of seroconversions in susceptible persons ranged from 5% to 22% per year; the ratio of illness to infection ranged from 9% to 26%, and the proportion of febrile illness associated with seroconversion was 5%–14%. Eightfold rises in titer of antibody occurred in 1%–18% of the antibody-positive population, a result suggesting reinfection. We estimate the ratio of fatalities to infection to be 1%–2%, a rate lower than estimates based on hospitalized cases. The high incidence of Lassa fever makes it a major problem in West Africa.
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Endemic Lassa fever in Liberia. VI. Village serological surveys for evidence of Lassa virus activity in Lofa County, Liberia
Article
  • Feb 1984
Six villages in Lofa County, north-west Liberia, and one near the coast were surveyed for the presence of indirect fluorescent antibodies (IFA) to Lassa virus (LV). Prevalences were similar among males and females, and among various age groups. The prevalence of IFA positive sera, 6·4%, in two roadside villages was significantly higher than in two matched villages “in the bush”, 1·9%. It was also higher in Gbanwei, a roadside village which did not maintain traditional sanitary measures, than in Zuwulo, similarly located but with maintenance of clean-swept areas without shrubbery or rubble between the houses. In another pair of villages, the one adjacent to a Mission Clinic with a very high prevalence of IFA positive staff members had significantly higher prevalence, 14·1%, than did the other, a roadside village with 5·1% seropositives. LV antibodies were also found in 4·3% of the inhabitants of a small coastal village near Robertsfield International Airport. Though LV infections are more common in villages in which traditional practices have been modified, they are present even in villages which are relatively unchanged. In the former they appear to be continuous while sporadic in the latter. The prevalences of IFA in the villages with the highest rates are about one third of what is found in personnel of hospitals near them, suggesting that hospital staff members acquire infections from patients as well as from the communities in which they live.
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Lassa Fever: Epidemiology, Clinical Features, and Social Consequences
Article
Lassa fever is endemic in west Africa, where it probably kills several thousand people each year. With access to the region improving, the opportunity, and the need, to improve our understanding of this disease are increasing.
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Lassa fever in West African sub-region: An overview
Article
  • Apr 2007
Lassa fever is an acute viral zoonotic illness caused by Lassa virus, an arenavirus known to be responsible for a severe haemorrhagic fever characterised by fever, muscle aches, sore throat, nausea, vomiting and, chest and abdominal pain. The virus exhibits persistent, asymptomatic infection with profuse urinary virus excretion in the ubiquitous rodent vector, Mastomys natalensis. Lassa fever is endemic in West Africa and has been reported from Sierra Leone, Guinea, Liberia, and Nigeria. Some studies indicate that 300,000 to 500,000 cases of Lassa fever and 5000 deaths occur yearly across West Africa. Studies reported in English, that investigated Lassa fever with reference to West Africa were identified using the Medline Entrez-PubMed search and were used for this review. The scarcity of resources available for health care delivery system and the political instability that characterise the West African countries would continue to impede efforts for the control of Lassa fever in the sub-region. There is need for adequate training of health care workers regarding diagnostics, intensive care of patients under isolation, contact tracing, adequate precautionary measures in handling infectious laboratory specimens, control of the vector as well as care and disposal of infectious waste.
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Poor Housing Quality Increases Risk of Rodent Infestation and Lassa Fever in Refugee Camps of Sierra Leone
Article
  • Aug 2007
Lassa fever, a viral hemorrhagic fever endemic in parts of West Africa, is a severe febrile illness transmitted to humans by the rodent Mastomys natalensis. To determine risk of Lassa fever in households in Sierra Leonean refugee camps, we analyzed the spatial relationships between households with a Lassa case and focal locations of potential rodent habitats. Quality and hygiene factors of households were assessed to determine possible risk factors for household rodent infestation and occurrence of Lassa fever. The odds to have a rat burrow were higher in case houses than in control houses (OR 24, 95% CI 6.0-93). Case houses scored significantly worse in the quality of housing and external hygiene. These findings suggest that risk of Lassa fever in refugee camps depends on individual housing quality and the hygiene of the immediate surrounding environment.
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