PERCEIVED EMOTIONAL EFFECT OF LASSA FEVER AMONG NURSES AND MIDWIVES WORKING IN GENERAL HOSPITAL

ABSTRACT 

The study assessed emotional effect and determined factors influencing them among health care providers working in five general hospitals of Lagos state in western nigeria (the general hospitals, two health centres in the urban area and another two health centres in the urban area). A descriptive cross-sectional survey and quantitative approach was used to collect data. Pre-coded structured questionnaire were used to conduct interviews. All health professionals who were working in these selected general hospitals 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 emotions, gender, religion, educational level, and occupation. Multiple logistic regression analysis was used to assess the strength of association between the knowledge and attitudes and each independent variable to assess the strength of association looking at the adjusted Odds Ratio (AOR) with 95% confidence interval (CI). The study revealed a general low level of knowledge of LF disease among the HCWs. Most of the HCWs had good attitudes and all of them had good practices towards LF. Age and number of years of work were found to influence knowledge but not attitudes and practices. There was not statistical significant difference in the emotions of HCWs working in the general hospital compare to those working in the health centres. HCWs in urban HC had better attitude compare to those in the rural ones. The Ministry of Health, Nigeria should plan more training on Lassa Fever with emphasis on other professionals as much as medical doctors.

CHAPTER ONE

INTRODUCTION

 

1.1   Background

 

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   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 general hospitals in Nigeria (30% of consultations). It is very difficult for HCWs 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 health care workers 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 emotional effect of health providers.

 

1.3   Justification of Study

This study seeks to assess Emotional effect among health care workers towards LF in 5 general hospitals of the prefecture of Lagos in Nigeria.

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. Secondly, the level of the emotions and the quality of the attitudes and practices of nurses and midwives make them most vulnerable to a disease as transmissible as LF and therefore deserves to be evaluated and known by the authorities in charge of health in 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 health care workers, medical researchers, the Governments of other countries in west 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.

1.4   Research Questions

• What is the emotional effect of lassa fever among nurses and midwives working in general hospital?
• How does    socio-demographic    factors    influence    practices    of            healthcare professionals?
• Is there a (statistically significant) difference between the emotions of HCWS who are working at the General hospital and the emotions of those who are working in the health centres?
• Is there a (statistically significant) difference between the emotions of HCWs who are working in the urban health centres and those who are working in rural health centres?

1.5   Objectives General objective

To assess emotional effect of lassa fever among nurses and mid wives working in general hospitals in 5 general hospitals of Lagos state in western Nigeria and determine whether emotions differ by place of work (Rural vs Urban or Regional vs Health Centres)

The specific objectives of study are

1. To determine the proportion of nurses and mid wives having good knowledge about LF.

 

2. To determine the proportion of nurses and midwives having good attitudes and good practices in dealing with a suspected case of L.F.
3. To identify socio-demographic factors that could influence the emotions of HCWs working in these 5 general hospitals on
4. To assess whether emotions of HCWs vary by type of facility (General Hospital vs Health centres) and place of work ( Rural vs Urban)

 

CHAPTER TWO

 

2.0   LITERATURE REVIEW

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