APPRAISAL ON THE KNOWLEDGE OF LASSA FEVER AMONG NURSING STUDENT IN MADONNA UNIVERSITY
ABSTRACT
Introduction: Lassa fever (LF) is a zoonotic acute viral hemorrhagic fever caused by the Lassa virus (LASV). Nosocomial infection with high case fatality rate of the disease has been described primarily in the hospital settings in many West African countries including Nigeria.
The nosocomial spread is due to the current state of the health system, leading to poor medical practice. Hospitalized patients with LF may pose a substantial risk to Nursing students (Nursing students) and to other patients (Lavergne et al., 2016).
Late diagnosis and wrong treatment are factors that can increase the likelihood of nosocomial transmission. Therefore, it is important that health care providers working in endemic communities have adequate knowledge on the disease, its clinical features and diagnosis (Ea, Da, Ec, Og, &Ebhodaghe, 2013).Objectives:
The study assessed knowledge of lassa fever among nursing students in Madonna University.Methods: A descriptive cross-sectional survey and quantitative approach was used to collect data. Pre-coded structured questionnaire were used to conduct interviews. All nursing students of Madonna University were enrolled into the study, if found eligible.
Statistical analysis was done in Stata (version 14.1) Software. Frequency distribution was done to compute proportions on good knowledgeable, gender, religion, educational level, and occupation.
Multiple logistic regression analysis was used to assess the strength of association between knowledge of lassa fever among nursing students and independent variable to assess the strength of association looking at the adjusted Odds Ratio (AOR) with 95% confidence interval (CI).
Results: Sixty-three out of the 195 respondents (32.3%) had no idea what Lassa fever was. Of the remaining one hundred and thirty-two, 67.7% (132/195) who had heard about Lassa fever, their knowledge was accessed with a sixteen item questionnaire on knowledge according to case definition.
Nearly forty-nine percent (64/132) had good knowledge about Lassa fever (p = 0.485; 95% CI = 0.4 – 0.6).Conclusion: The study revealed a general low level of knowledge of LF disease among the Nursing students. Age and number of years of in school were found to influence knowledge.
CHAPTER ONE
GENERAL INTRODUCTION
1.1 Background
1.1.1 Lassa Fever Burden Lassa fever (LF) is a zoonotic acute viral hemorrhagic fever caused by the Lassa virus (LASV). It was first described in north eastern Nigeria (Lassa, in Borno state, in the Yedseran River valley at the South end of Lake Chad) in 1969 (Ajayi et al., 2014).
It is endemic in Benin, Guinea, Liberia, Mali, Sierra Leone, and Nigeria with peaks in incidence closely related to season. Same cases have also been reported into western countries where LF is not endemic but was imported by returning travelers in Germany, Netherlands, Sweden, US and UK (Ea et al., 2013).
According to the World Health Organization LF affects between 100,000 to 300,000 persons in West Africa per year and approximately 5,000 deaths (WHO, 2007). Around 80% of infected individuals are asymptomatic or have mild symptoms while 20% progress to disease. Case fatality rate is estimated to be around 15% among those who develop severe disease.
However, in 2016, the mortality rate was reported to be above 50%. Pregnant women with LF have a high mortality rate especially in the third trimester. Recovered LF patients may experience hearing loss as well as other neurologic side effects (WHO, 2017).
Based on prospective studies performed in four of the most affected countries, Guinea, Sierra- Leone, Liberia, and Nigeria, Richmond and Baglole in the year 2003, estimated that 59 million people are at risk of primary LASV infections with an annual incidence of disease as high as 3 million and as many as 67,000 deaths per year (Lukashevich, 2012).
LF affects all age-groups and gender with a seasonal clustering around the late rainy season and dry season (Olowookere et al., 2017).1.1.2 Lassa Virus Infection Lassa fever is an acute and occasionally severe rodent- borne viral hemorrhagic fever, with cases in humans geographically constrained to sub-Saharan West Africa (Gibb, Moses, Redding, & Jones, 2017).
LASV is an arenavirus enveloped and contains two single-stranded RNA segments of ambience polarity encoding five proteins (N. E. Yun et al., 2012). The natural host of LASV is the multi-mammate rat, Mastomysnatalensis which is commonly found in human households and eaten as a delicacy in several African countries and lives in close contact with humans (Olugasa et al., 2014).
LF is symptomatic in about 20% of cases when it causes an acute illness with nonspecific symptoms such as fever and general weakness, headache, chest pain, vomiting, diarrhoea, cough, pleural effusion, bleeding from orifices, and in the late stages, sometimes disorientation and coma (Olowookere et al., 2017).
Deaths from LF is due to the effective reduction of circulating volume of the blood which can cause shock, and multi-organ system failure (Shaffer et al., 2014). Presently, there is no licensed vaccine or immunotherapy available for prevention or treatment of this disease.
The antiviral drug ribavirin has been demonstrated to reduce fatality from 55% to 5%, but only if it is administered within 6 days after the onset of symptoms (Branco et al., 2011). LF presents with nonspecific symptoms similar to many other endemic illnesses in West Africa, that making it difficult to diagnose clinically; therefore, laboratory testing is needed to confirm the diagnosis (Raabe& Koehler, 2017)
.Humans contract LASV primarily through contact with excreta of its natural host. Although uncommon, secondary transmission of LASV between humans may occur through direct contact with infected blood or bodily secretions, such as saliva, vomit, stool, or urine (Bausch, Hadi, Khan, &Lertora, 2010).
Human infections tend to be focal with periodic familial or village clusters with secondary cases due to person-to-person spread. Infections peak between January and May – during the dry season, but cases are seen year round (Gibb et al., 2017). In this second type of contamination nosocomial transmission plays an important role.
According to Lavergne et al., nosocomial infection with high case fatality rate has been described primarily in the hospital settings in many West African countries including Guinea. The nosocomial spread is due to the current state of the health system, leading to poor medical practices.
Hospitalized patients with LF may pose a substantial risk to Nursing students (Nursing students) and to other patients (Lavergne et al., 2016). This nosocomial hazard can be minimized by proper
and timely infection-control measures, careful management of infected patients, and, in some cases, administration of prophylactic therapy to Nursing students after exposure.
Late diagnosis and wrong treatment are factors that can increase the likelihood of nosocomial transmission (Ea et al., 2013). Since no human vaccine exists and therapeutic options are limited to
the broad-spectrum antiviral ribavirin, rodent control and adjusting human behavior are currently considered to be the only options for LASV prevention (Mariën, Kourouma, Magassouba, Leirs, &FichetCalvet, 2018).
Late diagnosis and wrong treatment are factors that can increase the likelihood of nosocomial transmission and adverse outcomes.
1.2 Problem Statement
Viral haemorrhagic fevers like Lassa fever are among the most feared diseases due to their high case fatality rates, severe clinical presentations and ease of transmission. Unlike most viral haemorrhagic fevers, which are recognized only when outbreaks occur.
LF is endemic in West Africa, with an estimated tens of thousands of cases annually (Shaffer et al., 2014). Since the identification of LASV, human- to-human transmission has been documented in several nosocomial outbreaks, leading to an initial perception that the virus was both highly contagious and virulent (Lo Iacono et al., 2015).
The availability of laboratory testing has been limited by the designation of Lassa virus as a category (Raabe& Koehler, 2017). A pathogen by the National Institute of Allergy and Infectious Diseases (NIAID). Biosafety level 4 (BSL-4) precautions are recommended for handling potentially infectious specimens (Raabe& Koehler, 2017).
Existence of signs common to LF and other diseases such as malaria (fever, asthenia, vomiting) which is an endemic disease, leading cause of consultation in health facilities in Guinea (30% of consultations). It is very difficult for Nursing students to identify Lassa fever’s patient because of similarity of its signs and symptoms of another tropical diseases.
Additionally in West African towns and villages where there are no facilities for laboratory diagnosis, most Lassa fever infections are treated as malaria (Ogbu, 2014). Therefore it is imperative that Nursing students in endemic communities are adequately sensitized on the disease, it’s clinical features and diagnosis (Ea et al., 2013).
The difficulty of distinguishing between patients with LF and other patients suffering from most tropical diseases due to the similarity of symptoms and clinical signs and the absence of a diagnostic laboratory in this endemic area endanger health providers and increase the risk of developing nosocomial infections due to LASV.
Hence the need to assess the knowledge of LA among nursing students.
1.3 Research Questions
What is the level of knowledge of Nursing students of Madonna University on Lassa fever?
What is the attitude and practice of nursing students towards the prevention and control of Lassa Fever?
1.4 Objectives General objective
To assess the knowledge of lassa fever among nursing students of Madonna university.
The specific objectives of study are
To determine the proportion of Nursing students having good knowledge about Lassa fever.
To determine the attitude and practice of nursing students towards the prevention and control of Lassa Fever.
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1.5 Justification of Study
This study seeks to assess Knowledge of Lassa fever among Nursing students of Madonna University. The reasons for this study are first of all, no studies has yet been published on of health care personnel regarding infections (nosocomial) LF in this locality of the country.
In addition to significantly enriching the medical literature, this study will provide novel empirical evidence to support efforts of previous basic research on LF in Nigeria.
It will also be of great value to Nursing students, medical researchers, the Governments of other countries in sub-Saharan Africa where this disease is endemic, as it provides general overview of the problem.
Finally, this study will serve as a resource for other researchers who may want to undertake a similar study in other cities in the country or in other countries.
APPRAISAL ON THE KNOWLEDGE OF LASSA FEVER AMONG NURSING STUDENT IN MADONNA UNIVERSITY
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