As the Chief Medical Director [CMD] of Irruah Specialist Hospital Prof George Akpede glorious tenure ends Management of staff of the Teaching Hospital have continued to express happiness and pride that they have been parts of the great achievements recorded in the last ten years of his administration.
The tenure witnessed a lot of modest achievements in terms of provision of infrastructure and human capital development. Among the achievements include the take off of the school of post Basic Nursing, construction of a new children’s emergency room, full accreditation of the hospital for the training of Medical students, accreditation for the training of Resident Doctors in surgery, sustained staff welfare , the expansion of the Residency Training Programme which included the accreditation of more departments of the Institute. They include Family Medicine, Internal Medicine and Public Health and the establishment of the Institute of Lassa Fever Research and control.
The benefit of the Institute of Lassa Fever Research and control will better be appreciated if we go through some dangerous statistics of the Lassa Fever scourge in the country and the danger it portend to public health. According to statistics Nigeria has recorded the worst Lassa Fever epidermic in recent years. This was confirmed by Head of Nurses Lassa Fever Ward Irrua Specialist Hospital, Irrua Edo state Mrs Rebecca Atafo. She said in January 2012 Lassa Fever wiped out a whole family of three, made up of a man his wife and a daughter, who were brought to the Irrua Hospital after their situation had gone worse.
The scientist at the Research and Documentation of the centre Ikponwonsa Ordia said 100 patients of Lassa Fever were brought to the hospital in January 2013 alone out of which 40 have died. He also gave a breakdown of the reported cases. According to the breakdown Edo state has the highest figure of 38 reported cases out of which 15 had died Ondo. state has the second highest with 19 patients out of which 8 died, this was followed by Taraba state with 8 cases brought to the hospital out of which 3 died. Other states include Benue 6 patients, Plateau state 2 patients, Rivers state 1, Nasarawa 1, Ebonyi 1, Abuja 5 among others.
Ikponwonsa Ordia said by february ending the total number of lassa fever patients brought to the hospital had risen to 190. Out of the 190 brought he said onbe hundred patients have already died while 30 are still in critical condition. He said Edo, Ondo and Taraba states still has the highest number of patients explaining that these are only figures brought to the Irruah Specialist Hospital pointing out that many deaths would have occurred without across the country without people knowing it was as a result of Lassa Fever virus.
He added that these figures only represented cases brought to the hospital Irruah, when the situation has gotten too bad to handle explaining that millions of Nigerians live with the Lassa Fever virus without knowing it while some were mistakenly treating Malaria or Typhoid fever.
Prof Akpede said in 2010 Irrua Specialist Hospital treated 229 patients with suspected lassa fever, 30 died. In 2011 in January and February alone 161 patients were treated, again 25 died. In January this year we already have 100 patients more than half have died. We are yet to get statistics from other states and autopsies and we are yet to get the figure for February.
As parts of the efforts to tackle cases of Lassa fever Professor Akpede used his administrative competence and International connection to secure a partnership with some international organizations. These organizations and Institutions include the Harvard University USA, and the Bernard Notch Institute of Tropical Medicine, Hamburg, Germany. The Institute of Lassa fever Research and control is endowed with a BSL/ 3 Laboratory for the diagnosis of the disease which began operation in 2008 following the installation of the equipment donated Havard University and the Bernhard Notch institute. These two institutions also assisted with the training of staff. With this development Irruah Specialist Hospital became the only public tertiary hospital in the country with the capacity for confirmation of the diagnosis of Lassa fever.
The tenure of Prof Akpedi witnessed significant growth and development in the hospital in terms of infrastructure, manpower and service delivery. During his visit to the hospital in 2009 the former Heath Minister Professor Babatunde Osotimehin praised the praised the CMD achievements especially in the management of human and material resources of the institution, no wonder the minister did not waste time in recommending him for re appointment when his first tenure ended. It would be recalled that Professor Osotimehin visited the institution for the commissioning of Lassa Fever Research and Diagnostic Laboratory of the institute of Lassa Fever Research and Control, the Oxygen plant and Dialysis Centre.
WHAT IS LASSA FEVER:
Lassa fever is an acute febrile illness, with bleeding and death in severe cases, caused by Lassa virus. The disease was first described in the 1950’s while the virus was identified in 1969. Lassa fever is endemic in Nigeria, Sierra Leone, Guinea and Liberia.
There are a number of ways in which Lassa fever can be transmitted to humans. The virus is shed in the urine and droppings of rats, Mastomis Matolenses. The virus can therefore be transmitted through direct contacts, touching objects or eaten food contaminated with urine or droppings on excreta of these rats. As the rats often live in and around homes and scavenge on human food remain or poorly stored food, transmission of this sort is common.
Contacts with virus may also occur when a person inhales tiny particles or aerosols in the air contaminated with rodent excretions. Infections may also occur via direct contact when they are caught and prepared for food. Lassa fever may also spread through person to person contact. This occurs when a person comes in contact with virus in the blood, tissue, secretion or excrements of an individual infected with Lassa virus. This can happen in rural and healthcare settings.
The virus may also spread in contaminated medical equipment in health care settings when materials such as needles, syringes and scalpel blades are reused. Symptoms of Lassa fever occur after about 3-2 days after the patient comes into contact with the virus. They include fever, pain behind the sternum, sore throat, back pain, cough, abnominal pain, vomiting, diarrhea, conjunctivitis, facial swelling, protein in the urine and mucosal bleeding.
Experts say the central nervous system may also be involved with hearing loss, tremors, and sighs of infection of the brain such as convulsions and coma. The symptoms of Lassa fever can be confused with common illness, such as malaria, typhoid fever, septicemia and dysentery
Deafness is the most common complication of Lassa fever. It occurs in approximately one third of cases and is often permanent. Spontaneous abortion is another serious complication.
According to Prof George Akpede the Chief Medical Director of Irrua specialist teaching hospital in Irrua Edo state, Lassa fever have been suspected to be the cause of some deafness and high maternal mortality.
The death rate are particularly high for woman in the third trimester of pregnancy and for fetus, about 95 percent of which die in the uterus of infected pregnant mothers.
Irrua specialist teaching hospital is one of the designated centre for the treatment of Lassa fever in Nigeria . Others include the university of Maiduguri Teaching Hospital. Professor Akpede said that the upper level estimate of the at-risk population in Nigeria is about 51 million, annual number of illness is about 3 million and annual number of deaths about 58,330.
He said 15-20 percent of patients hospitalized for Lassa fever die from the illness.” the death rate during epidemic is however far higher, ranging between 30-60 percent. There had been an upsurge of the disease in Nigeria between December 2011 and January 2013. There had been 60 percent increase in suspected cases and 80 percent increase in confirmed cases.
There had been very serious and dangerous cases of Lassa fever in Nigeria. This is because it is often confused with typhoid fever or malaria fever. Lassa fever is really an acute viral hemorrhage fever (VHF) and does not respond to anti malaria or anti biotic drugs.
The Edo state former commissioner of Health or Moses Momoh disclosed to me that there is really a Lassa fever epidemic in the state. He said actually the disease which was seasonal and restricted to Edo central has now spread to all parts of Edo state and now occurs all year round. “It is no longer a seasonal disease”
The commissioner who was the chairman of the state Lassa fever awareness campaign disclosed that ”if your treatment for malaria is not responding, then you should quickly go for Lassa fever treatment.”
The commissioner said the source of Lassa fever virus include rats, infected food through excreta and urine, Especially cereals, garri, groundnut, egusi, Ogbono, etc.
WHAT WE ARE EXPECTED TO DO
There is no immunization or vaccine against Lassa fever. But there is treatment. We are expected to keep a good and healthy personal hygiene. Take care of our environment and clean our compound.. Some of these rats are not domestic rats . They are bush rats but come to our homes when there is bush burning.
There was no Lassa fever diagnostic facilities in Nigeria before, tests were taken to south Africa for confirmation. However such tests are now available in Nigeria. Diagnostic equipment such as polymerase Chain Reaction (PCR) is now available at Irrua specialist teaching Hospital.
Professor Akpede said primary transmission of Lassa fever virus from rats to humans can be prevented by avoiding contact with the rats. This can be done by putting food in rat proof containers and keeping the home clean to discourage rats from entering.
When caring for patient, with Lassa fever, the transmissions of disease through person to person contact can be avoided by taking preventive precautions against contacts with the patients secretions. These precautions include wearing of protective clothing, such as masks, gloves, gowns and goggles. Adherence to infection control measures such as complete equipment sterilization and the isolation of infected patients to prevent them from contacts with unprotected persons until the disease has run its course.