Knowledge, Attitude And Perception Of Lassa Fever Among People
This study focused on the examination of the knowledge, attitude and perception of respondent towards Lassa fever. 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. Improvement and upgrading of disease surveillance is key to prevention of future outbreaks not only of Lassa fever but other epidemics.
1.1 Background of Study
Lassa fever is one of the diseases for which weekly epidemiological reporting to the health authorities is being done in Nigeria. A rapidly changing epidemiological pattern had been reported over the years (Ogbu, Ajuluchukwu and Uneke, 2007). It causes mortality and morbidity where outbreaks occur worldwide including Nigeria where it was first identified in 1969.
Lassa fever is caused by a single stranded RNA virus (Healing and Gopal, 2001; Johnson et al.,1987). The main feature of this fatal infection is impaired or delayed cellular immunity leading to fulminant viraemia, usually starting as fever of unknown origin (Chen and Cosgriff, 2000). The natural host for the virus are multimammate rats (Mastomysnatalensis), which breed frequently and are distributed widely throughout West, Central, and East Africa (Healing and Gopal, 2001). Both zoonotic and human to human contacts are possible (Ogbu, Ajuluchukwu and Uneke, 2007).
Population movements, poor sanitation, overcrowding, inadequate resources to manage victims and poor epidemic preparedness are some of the factors contributing to disease outbreak (WHO,2000). Increasing international travel and the possibility of use of the Lassa virus as a biological weapon may have escalate the potential for harm beyond the local level, and stressed the need for greater understanding of Lassa fever and more effective control and treatment programs.
Osun State is geographically close to Edo State that has persistently been having the highest number of both suspected and confirmed cases of LF in Nigeria in past years (NCDC,2012). With the symptoms of LF mimicking that of malaria which is endemic in Nigeria, the potential of missing the diagnosis of LF is high. Primary care workers in both public and private clinics are often the first set of personnel to handle suspected cases of Lassa fever which is also a possible source of nosocomial infection. In situation where health workers are not adequately equipped with requisite knowledge and materials to handle cases of LF, transmission and outbreak of the infection is likely. This informed the choice of Primary Health Care (PHC) workers as respondents in this study.
1.2 Statement of Problem
Though some studies have reported a fairly good knowledge of health workers about LF, many of such studies had health care workers from highly specialized health facilities as their respondents, with attitude to preventive measures still described as poor (Ajayi et al.,2013). This is happening in the midst of poor practice of universal precaution among Nigeria health workers (Kermode et al., 2005), though practice of universal precaution had improved over the years (Amoran and Onwube, 2013). This study assessed knowledge, attitude and perceptionof Lassa fever among people attending primary health care in Osun State in Southwestern Nigeria.
1.3 Purpose of the Study
The general objective of this research work is toassess the knowledge, attitude and perceptionof 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
1.4 Research Questions
The following research questions were formulated based on the objectives of this research project.
- What is the level of the knowledge of Lassa fever among people attending PHC in Osun State?
- What is the attitude and perception of Lassa fever among people attending PHC in Osun State?
- Is there any association of knowledge, attitude and perception with socio-demographics of respondents?
- What are the causes, symptoms and consequences of Lassa fever in Osun State?
1.5 Scope of Study
This research project assessed knowledge, attitude and perceptionof Lassa fever among people attending primary health care, using the Osun State in South-western Nigeria. Hence this research project is limited to Osun State in Nigeria.
1.6 Significance of Study
This research project will be of immense benefit to communities and health sector shareholders who are involved in policy decisions in the academia. The research project will have relevance to policies and major decisions made with regards the healthsector.
Also this work will serve as a reference to the works of future researchers who might be interested in studying this subject matter.
1.7 Operational Definition of Terms
An acute and often fatal viral disease, with fever, occurring chiefly in West Africa. It is usually acquired from infected rats.
Is a familiarity, awareness, or understanding of someone or something, such as facts, information, descriptions, or skills, which is acquired through experience or education by perceiving, discovering, or learning.
The ability to see, hear, or become aware of something through the senses.
1.8 Limitations of Study
This research project was limited by certain factors such as time, finances, uncooperative attitude of some of the respondents etc. These constituted limitations in this study as some of the respondents did not return their questionnaire. The researcher only made do with responses of the respondents whose questionnaire were correctly completed and returned.
Discussion of Findings, Recommendations and Conclusion
5.1 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 diseasedespite the fact that the disease has posed health challenge forso 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 thedissemination 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 toothers. 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.
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.
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.
5.4 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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