A case study of high burden disease lassa fever in resource constrained setting implementing primary health care services

The challenge of hyperendemicity of Lassa fever in tropics amidst the current covid -19 pandemic is more devastating. Nigeria and the entire west coast of Africa needs more research, advocacy and welfare support in order to curb the narrative. A 43 year old multiparous pregnant woman at term was referred from a Clinic in Kamuru Ikulu, Zangon kataf LGA to a Mission Hospital in Zonkwa, Kaduna State, Nigeria on February 2016. She exhibited overt vaginal bleeding and absence of foetal movements at presentation. Placental previa was revealed through ultra sound that necessitated an emergency Caesarean Section on the patient by the Medical practitioner, assisted by his team a Nurse and a Community Health Worker. The patient’s Glasgow Coma Scale post up was 6/15. The patient died after the surgery while the doctor and the nurse manifested symptoms of Lassa fever. Following the observation, the doctor and the nurse eventually died after 2 and 3 days respectively. Contact tracing involving 33 persons that had physical contact with the index case was carried out in Lisiru, the clinic in Kamuru as well as the Hospital in Zonkwa using structured verbal interviews and blood sample testing.  Seventeen (17) of the 33 persons however, exhibited suspected indices of Lassa fever. Blood samples of the index case, 3 health personnel that were involved in the surgery were sent to the Laboratory at Irrua Specialist Hospital, Edo State, Nigeria for Lassa virus molecular investigations. The ELISA test confirmed the index case, the doctor, nurse and one of the 17 suspected contacts as Lassa virus positive while the community health worker and rest 16 turned out to be negative. The positive contact patient was transferred to the contact.  Furthermore, the Lassa positive individual was withdrawn to the Infectious Disease Control Centre Kaduna for effective medical care. She recovered and was discharged after 10 days of management with Ribavirin and other supportive therapeutic agents. However, the other 16 and the health worker were followed up for 14 days in other to ascertain their health status. There was delay in the diagnosis of the index case as a result of emergent circumstance that required urgency.  The epidemiological knowledge gathered from this case is that Lassa fever is likely endemic in Zangon Kataf LGA and that Ribavirin proved to be the effective drug used in the management of the female positive case that survived the Lassa fever.