Knowledge, Attitude and Perception of Lassa Fever Among People Attending PHC
Chapter One
Purpose of the Study
The general objective of this research work is to assess the knowledge, attitude and perception of Lassa fever among people attending primary health care in Osun State in South-western Nigeria. The specific objectives are as follows;
- To assess the knowledge of Lassa fever among people attending PHC in Osun State
- To assess the attitude and perception of Lassa fever among people attending PHC in Osun State
- To assess the association of knowledge, attitude and perception with socio-demographics of respondents
- To identify causes, symptoms and consequences of Lassa fever in Osun State
CHAPTER TWO
LITERATURE REVIEW
Theoretical Framework
Background to Lassa fever outbreaks
The outbreak of Lassa Fever (LF) and Ebola Virus Disease (EVD) in the West African sub region in recent times is a testimony to a dire need for a strong epidemic preparedness system among member countries of the World Health Organization in the AFRO region. This requires that diseases be notified through a sustained disease surveillance and reporting system (WHO, 2006). Such disease surveillance system should adequately identify, define and recognize cases of illness on a timely and complete basis; and culminating into data driven forecast and advice on the trend of infections (WHO, 2009).
The implications of recent outbreaks of Viral Haemorrhagic Fevers on the health systems, international travels, movements and trades are enormous. This is more obvious with the changing epidemiological pattern being observed over the years. LF is among the diseases on the epidemic prone list being reported under disease surveillance and notification system (CDC, 1996). Poor sanitation, overcrowding, inadequate resources to manage cases, a weak health systems and most importantly poor epidemic preparedness underscored the need for greater understanding of these diseases and more effective control measures according to the WHO in 2000.
The last sporadic outbreak of Lassa fever in Nigeria was in 2012; until in October 2015 when significant human lives loss were recorded as a part of the on-going epidemics. While EVD had been put under control in Nigeria and the country certified EVD free in late 2014, the country is still battling with a significant spread of Lassa fever infections. Some factors that could have contributed to this trend include a lengthy dry season, weak health system, and poor public enlightenment programme in both urban and rural communities where over 60% of the population resides (Kelly et al., 2003). Lassa fever had been crying for the type of huge attention given to the EVD outbreak including strong political will, leadership and effective coordination of both local and international control efforts.
CHAPTER THREE
METHODOLOGY
Introduction
This chapter presents the research methodology including the data analysis technique, sample and sampling technique, research instrument, research design, reliability and validity of the instrument. These are presented in the following sections.
Research Design
This research project used descriptive cross sectional study to achieve the objectives earlier stated.
Study Population
Osun is one of the states in south-western Nigeria, with a population of about 3.8 million (NPC,2006). There are 3 senatorial districts distributed among 30 Local Government Areas (LGAs). There are 2 teaching hospitals, nine general hospitals, and numerous Primary Health Care centres and private hospitals providing primary care services in the state. People attending health care in public PHCs in Osun state constitutes the study population.
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
A total of 300 respondents returned completely filled and analysable questionnaires giving a response rate of 99.3%. Mean age of respondents was 36.2+7.8 years. One hundred and twenty four (41.3%) respondents were males, 220(73.3%) had up to tertiary level education, 226(75.3%) were married, 136(45.3%) and 99(33.1%) were nurses and Community Health Extension Workers respectively while 191(63.7%) had spent 5-10 years in hospital practice.- according to Table 1.
CHAPTER FIVE
DISCUSSION OF FINDINGS, RECOMMENDATIONS AND CONCLUSION
Discussion of Findings
Primary care health environs are generally more likely to be the first point of contact for persons seeking orthodox medical care in a developing country like Nigeria. In our study, about four-fifth of our respondents were aware of LF with media and other health care workers being the leading sources of information. In a similar supportive study among HCWs (Aigbiremolen et al., 2012), all were aware of LF, with the media being the most common source of information. The media remains a veritable means of disseminating information about health and health-related events, although listeners may be biased in interpretation depending on his or her perception and the channel of communication (Wilson et al., 2004; Young et al., 2008). The high awareness of these respondents could be regarded as a positive indicator of seeking more in-depth knowledge about the core subject under consideration, in this case LF.
Most studies reviewed did not break down the epidemiology of LF into occurrences, causes, transmission and prevention and control, rather they generalized knowledge towards LF as a disease entity unlike our study that considered these various sections. However, about two-thirds of our respondents had good knowledge of prevention and control of Lassa fever. In a similar Nigerian study, about three quarter had good knowledge of the control of the disease (Aigbiremolen, 2012). The difference in these figures could be because the comparative study was carried out in Edo state which had persistently recorded the highest prevalence of LF in Nigeria on a yearly basis in recent times (NCDC, 2012). Our findings was however a bit higher when compared to another Nigerian study that reported a overall knowledge of Lassa fever that was described as poor for about one third, fair for about two-fifth and good for about one fifth (Tobin et al.,2013).
The possibility of nosocomial transmission of Lassa fever necessitates that health care providers should have comprehensive knowledge about the virus, the modes of transmission including person-to-person, through contaminated medical equipment such as reused needles, and the role of domestic rodents (WHO, 2005). A good knowledge of the role of good housekeeping such as putting food away in rodent-proof containers, keeping a healthy non crowded environment and safety precautions in health care practice is also important (Fisher-Hoch, 1995).
About two third of our respondents said they would like to regularly use personal protective devices or equipment at work while majority said they would like to regularly use protective devices, most especially during outbreaks. This attitude towards LF control supports findings from another study, though eventual practice of the use of these protective devices and procedures such as barrier nursing and hand washing was reported not encouraging (Aigbiremolen, 2012). Similar findings were obtained from Turkish (Ozeer, 2010), Iran (Rahnarardi et a;.,2008) and Balochista (Sheikh, Sheikh and Sheikh, 2004) studies. Therefore contributing factors to hospital-acquired Lassa infection in this study include poor knowledge of the disease and poor infection control techniques on the part of the health personnel, and this is supported by another study (VHFC, 2014).
In support of another Nigerian study on nosocomial infections (Adebimpe et al.,2012), respondents in this study had poor practice of having reported LF as a nosocomial infection amidst good attitude towards reporting. LF though less stigmatizing compared to a disease like HIV, usually attract a lot of attention whenever there is an outbreak, most especially in known high endemic areas of Nigeria such as Edo state. This may influence health care workers willingness to notify such cases of LF as well as other hospital acquired infections. The non-significant association between awareness of LF and the selected variables supports findings from another study (Aigbiremolen, 2012). Though use of protective devices and practice of reporting may be related to prior awareness of LF, the non-statistically significant observation made with respondent’s designation could be due to many similarities between training curriculum and job description of these cadres of workers at primary care level which may lead to having similar exposure and extent of basic health knowledge received by each cadre of staff. Therefore, more efforts towards sustained awareness and improve in-depth knowledge,, training and re-training of all cadres of health workers at the primary care level are required to curtail nosocomial transmission of LF as well as disease prevention and control.
The result of this study also revealed that after 48 years of the first case of LF in Nigeria, the knowledge and understanding of LF disease, transmission, prevalence and factors were poor amongst respondents. However, the respondents knew about some non-specific signs such as fever, malaise, headache, sore throat and vomiting. Poor knowledge has also been reported amongst health care workers. Some of the respondents only recently (2014 and 2015) heard about LF disease despite the fact that the disease has posed health challenge for so many years. Some respondents learned about LF from newspaper and current campus campaign on LF. This findings support the need for continuous campaigns and news items in the public media to sustain the dissemination of information on LF. Effective surveillance of LF could predict an outbreak and provide opportunity for massive public mobilization for ‘Health Action’, to break the chain of transmission of LF in the community. Tomori rightly noted that improvement and upgrading of disease surveillance is key to prevention of future outbreaks not only of Lassa fever but other epidemics. The association between preventive practices and level of study was significant. More respondents in reported good preventive practices in comparison to others. Good value systems are first and best acquired at home and strengthened by good tutelage in the primary and secondary schools.
Knowledge of the LF transmission process is key to breaking the chain of infection. In this study, it was found that over 50% of respondents did not know the mode of transmission of LASV which include direct and direct contact through blood or body fluids, urine and faeces of infected rat; unprotected handling of corpses or caring for Lassa fever patients without Viral haemorrhagic Fever (VHF) Infection Precautions. Ignorance of risk factors is likely to be associated with ‘risky behaviours’ that sustains the chain of LF infection. Bias or corrupt information can predispose to ignorance to believe that LF disease can occur through a curse or spell. Such suspicion can lead to stigma. Fear of stigma can influence health-seeking behaviours by promoting engagement in self-medication or other unorthodox therapeutic alternatives with consequence of being lost to surveillance.
Conclusion
Health care workers are faced with the daunting task of attending to suspected cases of Lassa fever and similar cases even when they are at great risk of being infected themselves. High awareness, a fair knowledge of the disease, and poor infection control measures on the part of the people attended to by health personnel characterize the epidemiology of LF among studied respondents, There is a need for sustained education, training and re-training of all cadres of health workers at the primary care level to create further awareness, improve basic knowledge to curtail nosocomial transmission of LF as well as disease prevention and control.
Recommendations
Based on the findings of the research project, the following recommendations were made.
- There is a need for sustained education, training and re-training of all cadres of health workers at the primary care level to create further awareness among people attending Primary health care.
- Improve basic knowledge to curtail nosocomial transmission of LF as well as disease prevention and control.
- Continued dissemination of accurate information on Lassa fever disease is advised to be adopted to improve preventive practices and reduce risk of Lassa fever disease amongst the population.
Suggestion for Further Research
This research project was focused on assessing the knowledge, attitude and perception of Lassa fever among people attending primary health care. Further research could be done on Knowledge, attitude and practice of Lassa fever prevention by students and on Pre-epidemic preparedness and the control of Lassa fever.
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