Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 22  |  Issue : 1  |  Page : 1-7

Knowledge, attitude, and practice toward Lassa fever prevention and control among health care providers in Sabon Gari local government area, Kaduna State, Nigeria


1 Department of Community Medicine and Primary Health Care, College of Health Sciences, Bingham University, Karu, Nasarawa State, Nigeria
2 Department of Political Science and International Studies, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
3 College of Medical Sciences, Department of Community Medicine, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
4 461 Nigerian Air Force Hospital, Kaduna State, Nigeria

Date of Submission11-Apr-2019
Date of Decision18-Oct-2019
Date of Acceptance18-Nov-2019
Date of Web Publication20-May-2020

Correspondence Address:
Sunday Asuke
Department of Community Medicine and Primary Health Care, College of Health Sciences, Bingham University, Karu, Nasarawa State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jomt.jomt_10_19

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  Abstract 


Background: Lassa fever is an acute viral hemorrhagic disease of public health concern causing recurrent outbreaks that often involve healthcare providers. Effective hospital infection control limits the impact of this disease. Objective: To assess the knowledge, attitude, and practice of health care providers toward Lassa fever prevention and control in Sabon Gari local government area, Kaduna State, Nigeria. Materials and methods: It was a cross-sectional descriptive study in which data were collected using a self-administered semi-structured questionnaire and analyzed using SPSS version 20.0. Associations between practice and other variables were tested using chi-square at P < 0.05. Results: A total of 131 health care providers participated in the study. Of these, 119 (96.0%) respondents were aware of Lassa fever. Overall a good knowledge of Lassa fever was only in 46 (35.1%) of them, while attitude toward prevention and control of Lassa fever was good in 110 (84.0%). However, only 91 (69.5%) had good practice of prevention and control of Lassa fever. Practice of prevention and control showed statistically significant association with knowledge (P = 0.01) and ethnicity (P = 0.006), but not with the other factors tested. Conclusion and recommendations: Despite the fairly good knowledge of Lassa fever, attitude and practice toward Lassa fever prevention and control were good. There is a need for continuous awareness of prevention and control among the health care providers.

Keywords: Health care providers, Lassa fever, practice


How to cite this article:
Asuke S, Agubamah E, Ibrahim MS, Ovosi JO. Knowledge, attitude, and practice toward Lassa fever prevention and control among health care providers in Sabon Gari local government area, Kaduna State, Nigeria. J Med Trop 2020;22:1-7

How to cite this URL:
Asuke S, Agubamah E, Ibrahim MS, Ovosi JO. Knowledge, attitude, and practice toward Lassa fever prevention and control among health care providers in Sabon Gari local government area, Kaduna State, Nigeria. J Med Trop [serial online] 2020 [cited 2020 Oct 1];22:1-7. Available from: http://www.jmedtropics.org/text.asp?2020/22/1/1/284631




  Introduction Top


Lassa fever is an acute viral hemorrhagic disease caused by Lassa virus. It belongs to a group called viral hemorrhagic fevers (VHFs).[1]

West Africa is said to be endemic for Lassa fever with a prevalence of 100,000 to 300,000 per annum with mortality approaching 5000.[2],[3],[4],[5] A study by Richmond and Baglole[6] in Sierra Leone, Guinea, and Nigeria revealed that up to 60 million sero-negative population is at risk with three million coming down with the disease yearly and with a mortality of about 70,000. According to the Nigeria Center for Disease Control (NCDC),[7] from January to March 2019, there were 495 confirmed cases of Lassa fever from 21 states including Kaduna with 114 deaths; 16 health care workers were affected with two deaths.

The primary mode of transmission is from rodents to humans through contact with food or household items contaminated with rodent droppings. The virus has the capacity for person-to-person spread.[8] Out of every 100 people who get infected, only 20 have symptoms with an incubation period of 6–21 days.[4]

Signs and symptoms can be slow onset of fever, general weakness, and malaise and some constitutional symptoms.[9] During epidemics, case fatality rate can go up to 50%. The disease affects all age groups with no preference, it has an untoward effect on pregnancy particularly in the last trimester with maternal and perinatal mortality occurring in 95 out of 100 pregnant women in late pregnancy.[10]

Treatment involves the use of an antiviral drug Ribavirin that has recorded successes in Lassa fever patients. This is most effective when administered early in the course of the disease, however it should not be in isolation, but involve other resuscitatory measures.[9] Effective prevention measures for Lassa fever involve encouraging good community hygiene that will prevent rodents from gaining access to people’s homes and food stuff. These include, “storing grain and other foodstuffs in rodent-proof containers, disposing of garbage far from the home, maintaining clean households, and keeping cats”.[5]

Despite the outbreak across the country and in other African countries, primary health care workers who are the first point of call during outbreaks have been documented to have poor knowledge of Lassa fever that reflects on infection control.[12] There is also dearth of knowledge concerning Lassa fever control among primary health care workers in the northern part of the country. This study therefore assessed knowledge, attitude, and practice toward Lassa fever control among health care providers in Sabon Gari local government area (LGA), Kaduna State.


  Materials and methods Top


Sabon Gari LGA is one of the 23 LGAs in Kaduna State. It has a projected population of 393,782 based on 2006 census. It is bordered to the south-west by Soba LGA, to the west by Giwa LGA, to the east by Zaria LGA, and to the north by Sabon-Gari LGA. Sabon Gari LGA has 11 political wards. There are many road networks in the LGA that connect the area with other towns within and outside Kaduna State, and they are mostly motorable all year round. There is one general hospital, 25 primary health care centers, 16 heath centers, and 20 private clinics in the LGA.

The study was a cross-sectional descriptive study. The study population comprised health care workers who were involved in patient management in the selected health facilities for the past one month. This involved a mix of health care workers in the public and private sector.

Data were collected using a pretested self-administered questionnaire adapted from other works.[13],[15] This was cleaned and analyzed using SPSS version 20.0. Microsoft Office Excel 2013 was used for construction of charts, presentation of tables and figures. Chi-square was used to test for statistical significance of association between variables at P-value of <0.05.


  Results Top


A total of 131 health care providers participated in the study. Their mean age was 34.3 ± 9.8. Majority of them were females (68.7%) and married (65.6%). The most predominant designation was Community Health Extension Workers (CHEW) (24.4%). The mean years of practice were 11.5 ± 9.3 years [Table 1] .
Table 1: Socio-demographic characteristics of health care providers

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Overall knowledge of Lassa fever was good only in 46 (54.0%) of the respondents, while attitude toward prevention and control of Lassa fever was good in 107 (93.7%). However, only 83 (76.9%) exhibited good practices of prevention and control of Lassa fever [Table 2]. The determinants of practice were ethnicity (P = 0.006) only [Table 3].
Table 2: Overall knowledge, attitude, and practice toward Lassa fever among health care providers

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Table 3: Determinants of practice of prevention and control of Lassa fever among health care providers

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Of the 131 health care providers studied, 119 (96.0%) were aware of Lassa fever. The most known mode of transmission was contact with urine of rats (65.1%) and the most known method of community prevention of Lassa fever was safe food storage (81.5%) [Table 4]. The most known symptom of Lassa fever was mouth bleeds (86.1%) and the least was deafness (4.1%) [Figure 1]. Health education (93.1%) and hand washing (73.1%) were the most known methods of Lassa fever prevention within health facilities [Figure 2]. Most respondents would use gloves when touching blood or other body fluids (82.5%) and a majority said that they would use a face mask (84.6%) when procedures are likely to generate splashes. Majority of the respondents (75.6%) reported using gowns when attending to a suspected infectious disease case. The most common method used to manage sharps among the respondents was the disposal of sharps immediately into safety box after use (98.4%). [Table 5]
Table 4: Knowledge of health care providers on Lassa fever

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Figure 1: Symptoms and signs of Lassa fever known by respondents.

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Figure 2: Methods of prevention of Lassa fever known by health workers in health facilities.

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Table 5: Practice in prevention and control of Lassa fever among respondents

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Cross tabulation revealed statistically significant association between practice and knowledge (P = 0.01) [Table 6].
Table 6: Relationship between attitude, knowledge, and practice

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  Discussion Top


Human resource for health (HRH) plays an integral part in the health system as outlined in the six building blocks of the health system. Hence, health care providers are pivotal in the delivery of quality care and services in a country.

Knowledge of health care providers on a particular disease is very important as it determines how the health workers manage patients who are present with these diseases. In this study, the knowledge of the health care providers on the prevention and control of Lassa fever was good for less than half of the health care providers. This finding contrasts the study findings from Edo State[11] that reported an overall poor knowledge. Infection control is the premise on which the effective management of Lassa fever hinges on, in another study by Tobin et al.[12] on infection control among health workers, contrasted this study by revealing that half of the respondents actually had good knowledge of infection control.

Majority of the respondents in this study were however aware of Lassa fever, knew that contact with urine and feces of rats was a major mode of transmission, knew the major symptoms of Lassa fever, and knew the causative agent to be a virus. There was however a major gap between the level of awareness of this disease and the actual level of knowledge reflecting the importance of awareness creation campaigns and trainings being organized to deliver information in the form that it can really be processed for onward transmission.

Attitude of health care providers is important toward the prevention and control of Lassa fever in an endemic region like Nigeria. The right attitude when exhibited by health care providers could possibly influence prevention and control practices of Lassa fever hence reducing the morbidity and mortality from the disease. Majority of health care providers in this study had good attitude (84.0%) toward prevention and control of Lassa fever. This finding has been corroborated by findings by other studies among health workers on Ebola virus disease [13] and Crimean–Congo haemorrhagic fever (CCHF) in Iran.[14]

Majority of the health care workers believed that by virtue of their occupation, they were at risk of being infected with the disease. This is particularly true where there are inadequate personal protective equipment or where they are not readily available particularly in rural health facilities as reported by Tobin et al.[12] This finding was found to be similar to a study in Uyo Nigeria,[15] which reported that health care providers were being indifferent or refusing to care for suspected Lassa fever cases for fear of contagion.

In this study, most of the health care providers (84.7%) will use face mask when undertaking procedures likely to generate splashes, when 1–2 meters close to patients with productive cough (57.7%), and when working in a dusty environment (71.5%). This finding slightly contrasts that by Tobin et al.[11] on standard precaution in Edo State among primary health care providers. Also, majority said that they would use a gown when attending a suspected infectious disease case. This is an important component of the Personal Protective Equipment (PPE). National guidelines on infection prevention and control of VHFs states that the standard outfit for any viral hemorrhagic fever should include scrub suit, coverall, gloves, head cover, high filtration mask, goggles or face shield, closed puncture and fluid-resistant shoes, and water-proof apron.[16]

Concerning the management of sharps, most health care providers said that they will dispose sharps immediately in safety boxes (98.4%) and would not reuse needles and syringes to save cost (91.3%). This study corroborates the findings by Aigbiremolen et al.[17] regarding the use of syringes and needles but contrasts the findings from the study in Edo State[12] on standard precaution which reported poor sharp management.Health education and hand washing were good practices reported as methods of prevention of Lassa fever in facilities. This finding contrasts findings in Edo State[12],[17] that revealed poor hand hygiene practices.

The determinants of attitude were ethnicity and year of practice while the determinants of practice were knowledge and ethnicity. This basically highlights the importance of the years of practice. There was also a statistically significant relationship between attitude and practice of Lassa fever prevention. This finding contrasts the finding from other studies.[17],[18],[19],[20]

Conclusion and recommendation

Findings from this study revealed fair knowledge of Lassa fever with some gaps still existing among the health care providers, particularly the primary health care providers. The attitude and practice of prevention and control of Lassa fever were generally good and the major determinant of practice was found to be ethnicity and knowledge. The Kaduna State government in conjunction with the State Primary Health Care Development Agency should organize training and re-training of health care providers using the standard guidelines on prevention and control of VHFs with particular emphasis on Lassa fever as developed by NCDC. It should also provide standard PPE equipment to its health care providers and teach them how to appropriately use them. Owners of private practice should also be enjoined to follow suite.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Frame JD, Baldwin JM, Gocke DJ, Troup JM. Lassa fever, a new virus disease of man from West Africa. I. Clinical description and pathological findings. Am J Trop Med Hyg 1970;19:670-6.  Back to cited text no. 1
    
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Bowen MD, Rollin PE, Ksiazek TG, Hustad HL, Bausch DG. Genetic diversity among Lassa virus strains. J Virol 2000;74:6992-7004.  Back to cited text no. 2
    
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Gunther S, Emmerich P, Laue T, Kuhle O, Asper M, Jung A et al. Imported Lassa fever in Germany: molecular characterization of a new Lassa virus strain. Emerg Infect Dis 2000;6:466-76.  Back to cited text no. 3
    
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World Health Organization. WHO Lassa fever fact sheet No 179 Geneva: WHO; 2000.  Back to cited text no. 4
    
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World Health Organization. Lassa fever. WHO Newsletter: Geneva; 2005.  Back to cited text no. 5
    
6.
Richmond JK, Baglole DJ. Lassa fever: epidemiology, clinical features, and social consequences. BMJ 2003;327:1271-5.  Back to cited text no. 6
    
7.
Nigeria Center for Disease Control (NCDC). Situation report: Lassa fever outbreak in Nigeria: Epi-week 11, serial number 11; 2019.  Back to cited text no. 7
    
8.
Fisher-Hoch SP. Lessons from nosocomial viral haemorrhagic fever outbreaks. Br Med Bull 2005;73-74:123-37.  Back to cited text no. 8
    
9.
McCormick JB, Webb PA, Krebs JW, Johnson KM, Smith ES. A prospective study of the epidemiology and ecology of Lassa fever. J Infect Dis 1987;155:437-44.  Back to cited text no. 9
    
10.
Price ME, Fisher-Hoch SP, Craven RB, McCormick JB. A prospective study of maternal and fetal outcome in acute Lassa fever infection during pregnancy. BMJ 1988;297:584-7.  Back to cited text no. 10
    
11.
Tobin EA, Asogun DA, Isah EC, Ugege OG, Ebhodaghe P. Assessment of knowledge and attitude towards Lassa fever among primary care providers in an endemic suburban community of Edo state: implications for control. J Med Med Sci 2013;4:311-8.  Back to cited text no. 11
    
12.
Tobin EA, Asogun DA, Odia I, Ehidiamhen G. Knowledge and practice of infection control among health care workers in a tertiary hospital in Edo State Nigeria. Direct Research Journal of Health and Pharmacology 2013;1:20-7.  Back to cited text no. 12
    
13.
Bilqisu Jibril Idris, Victor Inem, Mobolanle Balogun. Comparing the knowledge, attitude and practices of health care workers in public and private primary care facilities in Lagos State on Ebola virus disease. Pan Afr Med J 2015;22:19.  Back to cited text no. 13
    
14.
Rahnarardi M, Rajaeinejad M, Pourmalek F, Mardani M, Holakoule-Naieri K, Dowlatshahi S. Knowledge and attitude towards Crimean-congo haemorrahgic fever in occupationally at risk Iranian health care workers. J Hosp Infect 2008;69:77-85.  Back to cited text no. 14
    
15.
Ekuma AE, Akpan IS. Lassa fever and infection control: knowledge, attitudes and practice in a university teaching hospital in Uyo, Nigeria. Ibom Medical Journal 2017;10:40-7.  Back to cited text no. 15
    
16.
Nigeria Center for Disease Control (NCDC). National Guidelines on Infection Prevention and Control of Viral Haemorrhagic Fevers. 2017.  Back to cited text no. 16
    
17.
Aigbiremolen AD, Duru CB, Awunor NS, Abejegah C, Abah SO, Asogun AD et al. Knowledge and application of infectious disease control measures among primary health care workers in Nigeria. The Lassa fever example. IJBAIR 2012;1:122-9.  Back to cited text no. 17
    
18.
Taneja J. Evaluation of knowledge and practice amongst nursing staff toward infection control measures in tertiary care hospital in India. The Can J Infect Control 2009;24:104-7.  Back to cited text no. 18
    
19.
Chan MF, Ho A, Day MC. Investigating the knowledge, attitudes and practice patterns of operating room staff towards standard and transmission-based precautions: results of a cluster analysis. J Clin Nurs 2008;17:1051-62.  Back to cited text no. 19
    
20.
Luo Y, He GP, Zhou JW, Luo Y. Factors impacting compliance with standard precautions in nursing, China. Int J Infect Dis 2010;14:1106-14. Available at: http://dx.doi.org/10.1016/j.ijid.2009.03.037 (accessed 23 May 2013).  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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