Assessment of the level of knowledge and universal cross-infection control practices against lassa fever among health workers in Sokoto, Nigeria: A hospital survey during lassa fever outbreak in Nigeria

Catherine Fidelis; Johnson Olajolumo

doi:10.4103/IJAMR.IJAMR_11_18

ORIGINAL ARTICLE

Year : 2018 | Volume : 5 | Issue : 2 | Page : 57-65

Assessment of the level of knowledge and universal cross-infection control practices against lassa fever among health workers in Sokoto, Nigeria: A hospital survey during lassa fever outbreak in Nigeria

Catherine Fidelis¹, Johnson Olajolumo²
¹ Department of Pharmacy, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
² Department of Internal Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria

Date of Submission	11-Mar-2018
Date of Acceptance	29-Aug-2018
Date of Web Publication	31-Dec-2018

Correspondence Address:
Catherine Fidelis
Department of Pharmacy, Usmanu Danfodiyo University Teaching Hospital, Sokoto
Nigeria

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/IJAMR.IJAMR_11_18

Abstract

Introduction: Lassa fever (LF) is an endemic West African viral hemorrhagic fever which presents acutely and is often fatal. This study assessed the level of knowledge about LF among the health workers in Sokoto State and also examined their cross-infection control practices against LF during ongoing outbreaks in health facilities in Nigeria. Methods: Data obtained from a total of 298 health workers in five hospitals in Sokoto metropolis, Nigeria, were used for this study. The study tool was a 25-item questionnaire. Data obtained were analyzed using the SPSS version 20 Software. Results: Three-tenth of the participants were within the age bracket of 26–30 years. About 54% were men, 54.4% were nursing officers, and 75.2% of the participants had practice ≤10 years. All of the surveyed medical doctors and dentists were aware of the ongoing LF outbreak in Nigeria. All of the dentists and medical laboratory scientists surveyed accurately identified the virus as the cause of LF. Only the dentists accurately identified Mastomys natalensis rodents as the vector for LF, and its transmission from person-person. Less than 20% of the participants in each occupational category did not know the universal precaution measures against infections, and about 12% of the respondents wore their personal protective equipment outside the surroundings of their duty posts. It was observed that more than 50% of the participants were below 60% on a scale of 1%–100% regarding their cross-infection and control practices. Conclusion: The findings obtained from this study revealed a very low level of knowledge about LF and very poor universal cross-infection control practices against LF among the health workers in Sokoto City, Nigeria.

Keywords: Health workers, Lassa fever, Nigeria, outbreak, universal precaution measures

How to cite this article:
Fidelis C, Olajolumo J. Assessment of the level of knowledge and universal cross-infection control practices against lassa fever among health workers in Sokoto, Nigeria: A hospital survey during lassa fever outbreak in Nigeria. Int J Adv Med Health Res 2018;5:57-65

How to cite this URL:
Fidelis C, Olajolumo J. Assessment of the level of knowledge and universal cross-infection control practices against lassa fever among health workers in Sokoto, Nigeria: A hospital survey during lassa fever outbreak in Nigeria. Int J Adv Med Health Res [serial online] 2018 [cited 2023 Mar 25];5:57-65. Available from: https://www.ijamhrjournal.org/text.asp?2018/5/2/57/249065

Introduction

Lassa fever (LF) is an endemic West African viral hemorrhagic fever which presents acutely and is often fatal.^{[1],[2],[3],[4]} Annual prevalence of 300,000–500,000 LF cases is being reported in Nigeria, Guinea, and Sierra Leone with mortality rate of over 5000.^[5],[6] LF is a highly infectious zoonotic disease caused by Lassa virus (LASV), a member of the Arenaviridae virus family.^[1],[3] The virus was first recognized in Nigeria in 1969.^[7]

The symptoms of LF during the initial phase are nonspecific, and they mimic those of many other common febrile ailments such as typhoid, flu, yellow fever, and malaria; hence, detection of the illness in infected patients during the early phase of an outbreak can be difficult.^[1],[8] Transmission of the virus to humans are through contact with droppings, urine of infected rodents, and possibly through contact with the blood of infected Mastomys natalensis rodents; transmission of the virus also occurs through direct contact with infected blood or body fluids, especially in the hospital environment where there are deficient infection prevention and control measures.^{[1],[2],[8],[9]} LASV has been linked with nosocomial outbreaks which result in high mortality rate; therefore, it is important that health workers, due to their regular interaction with patients and their body fluids, ought to have adequate information on LASV infection.^[10],[11]

LF infection and outbreaks can be prevented through isolation of infected patients, rigorous contact tracing, and community hygiene among others. In the health-care settings, when caring for patients, health workers should apply universal cross infection control practices regardless of their presumed diagnosis such as basic hand hygiene, respiratory hygiene, and use of personal protective equipment among others.^[1] LF infection occurs very frequently in different parts of Nigeria,^{[9],[12],[13],[14],[15]} and currently, Nigeria is going through another LF outbreak especially among the health workers in different health-care facilities in the country.^{[16],[17],[18],[19]}

Nosocomial transmission and outbreaks among health workers in Nigerian health-care institutions have become a cause for concern for the health-care system. So far, there have not been any report of confirmed outbreak of LF in Sokoto State, but due to the increasing reports of outbreaks among health workers in different health-care institutions within the country, the need arises to assess the level of knowledge about LF among the health workers in Sokoto State, and also measure their level of preparedness against LF during ongoing outbreaks among health workers in other health facilities in Nigeria.

Methods

This study was a descriptive cross-sectional survey conducted in five hospitals in Sokoto State (two tertiary hospitals and three secondary hospitals): Usmanu Danfodiyo University Teaching Hospital, Federal Neuropsychiatric Hospital Kware, Specialist hospital, Maryam Abacha Hospital for Women and Children and Noman Children Hospital, from January to February 2018. The study population included health workers comprising of doctors, nurses, medical laboratory scientists, dentists, and radiographers.

The capital of Sokoto State is Sokoto. The state is located in the extreme northwest of Nigeria and shares a border with Niger Republic to the north. The state is located in the dry Sahel, and the major dialect spoken by the people of Sokoto State is Hausa.^[20]

Approval to conduct the study was officially obtained from the State Health Research Ethics Committee, Ministry of Health, Sokoto State, Nigeria (Ref. No: SKHREC/014/018). Permission to collect research data were also sought from the management of the participating hospitals.

The study tool was a 25-item questionnaire. Simple random sampling technique was used in the participants' selection for this study. The minimum sample size for this study (n = 102) was determined using the Leslie formula for study population <10,000 at an LF knowledge rate of 92.8% derived from a previous study conducted among health workers in Taraba State, Nigeria.^[21] A total of 355 health workers were approached at their duty posts for this study, 25 health workers declined to participate for various reasons such as: not interested in participating, too busy to participate, and cannot participate if not given any incentives. Consenting health workers completed a pretested and adjusted self-administered questionnaire drafted in English that assessed participants' general knowledge, control, and emergency preparedness against LF. The respondents were allowed to fill the questionnaire at their convenience and retrieved within 2 working days. Of a total of 330 questionnaires that were given to the participants at their various duty posts, only 298 were returned. Two improperly filled questionnaires were rejected.

Data were analyzed using the SPSS version 20 software (IBM). The frequency distribution of all variables was determined, and comparisons between variables were done using the Chi-square test with a P < 0.05 set to be the level of statistical significance. Results obtained were presented using tables.

Results

About three-tenth (29.5%) of the participants were within the age bracket of 26–30 years. About 54% were men, 54.4% were nursing officers, and majority of the participants had practice ≤10 years (75.2%) [Table 1].

Table 1: Characteristics of the respondents

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All the surveyed medical doctors and dentists were aware of the ongoing LF outbreak in Nigeria, unlike the participants in other occupational categories (P = 0.144, degree of freedom [df] = 8). It was observed that all the dentists and medical laboratory scientists surveyed were accurately able to identify virus as the cause of LF, in contrast to the participants from the other occupations (P = 0.233, df = 20). Interestingly, of all the occupational categories surveyed only the dentists were able to accurately identify M. natalensis rodents as the vector for LF (P = 0.671, df = 12) and knew that LF can be transmitted from person-person (P = 0.128, df = 8). It is worthy to note that a range of 12%–50% of the nurses, medical doctors, medical laboratory scientists, dentists, and radiographers surveyed in this study considered that it is not possible for a person to be infected with LF and still not show any symptoms (P < 0.0001, df = 8) [Table 2].

Table 2: Knowledge of respondents about Lassa fever

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The four most common symptoms of LF known to the participants were: fever, headache, vomiting, and hemorrhage [Table 3].

Table 3: The list of symptoms of Lassa fever known to the respondents

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Amidst other findings in [Table 4], it is notable that the three most frequently stated methods by which LF can be prevented in the community were: community health education, environmental sanitation, and proper food storage.

Table 4: The list of preventive measures against Lassa fever infection in the community known to the respondents

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Most of the surveyed participants (86.1%) considered themselves to be at risk of being infected with LF due to their roles as health workers (P = 0.098, df = 8). Furthermore, <20% of all the participants in each occupational category did not know the universal precaution measures against infections (P = 0.006, df = 8), although 56.6% of the participants always sanitized their hands after coming in contact with a patient at their duty post, 55.7% always wore hand gloves when handling patients at their duty posts, more than half of the participants (68.1%) always changed their hand gloves between cares of different patients, yet only 20% always put on facemask when handling patients at their duty post. Although the majority of the respondents always wore hand gloves when handling patients' blood, body fluids, or materials, yet <40% of the participants always wore protective clothing when caring for their patients at their duty posts. About 12% of the respondents wore their personal protective clothing outside their duty posts, more than half (60%) did not have a special wardrobe where their hospital wears could be kept, and more than 10% borrowed hospital wears from their colleagues [Table 5].

Table 5: Knowledge about cross-infection control practices

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It is interesting to also note that, when the participants were asked to self-rate on a scale of 1%–100% regarding their cross-infection and control practices, more than 50% of the participants were below 60% on the personal rating scale for the prevention of cross-infection, and <30% of the participants were prepared for LF outbreak in their healthcare facilities based on their cross-infection prevention and control practices [Table 6].

Table 6: Respondents readiness against Lassa fever outbreak in their health-care facilities

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Discussion

This study assessed the knowledge, attitude, and practices of health workers in the five major secondary and tertiary hospitals in the North-western part of Nigeria toward LF. These health workers come in daily contact with patients, or their body fluids at their duty post, also with their other coworkers, their families, and the public; hence, these health workers could be a source of spread of this life-threatening infection. The significance of this study is that it provides unique data different from many other similar studies that have been conducted among health workers in Nigeria on their level of knowledge, and their readiness toward LF as this study openly displays the various levels of knowledge and answers recorded by the study participants.

While the majority of the respondents were aware that LF is endemic in Nigeria, some were not; this observation is similar to those from other studies conducted in Nigeria.^{[12],[22],[23],[24],[25]} Although the result obtained in this study is not satisfactory, as every health worker is expected to be conscious so as to ensure maximum necessary precautions are observed to halt the ongoing outbreak, and be able to control it should there be any such occurrence in their health facilities.

The importance of the knowledge of a clinical practitioner about an infection such as LF especially during an outbreak cannot be overemphasized, because then only proper diagnosis, management, treatment, control, and reporting of such cases to the appropriate authority can be made. From the findings made in this study, it can be said that the knowledge of some of the survey health workers on LF was very poor.

First of all, some of the respondents did not know what the cause of LF is and what transmits it, as it was observed that some mentioned bacteria or fungi as the cause of LF and that it is transmitted by mosquitoes, nor did some know that LF can be transmitted from an infected person to another. This is vital because the respondents are actively involved in patient management; hence, deficiency in knowledge can be costly.

Interestingly, some of the respondents had improper knowledge about the clinical presentation of LF in patients, and how LF infection can be prevented in the community. It was observed that some of the participants considered sweating as a symptom of LF, immunization, and vaccination as a means of prevention. Hence, it can be said that some of these health workers do not know that there is currently no vaccination against LF.^[1]

Although many of the respondents consider themselves at risk of being infected with LF due to their roles as health workers, yet many of the health workers do not comply with the universal standard precautionary measures. This result is similar to that obtained in other studies conducted among health workers in Nigeria.^{[26],[27],[28]} For instance, some of the health workers do not always wear hand gloves when handling patients' body fluids; some wear their protective clothing outside their duty posts; some do not always change their hand gloves between cares of different patients, and some do not have a special wardrobe where their hospital wears are kept. Hence, not only do these health workers endanger their lives, but also the lives of their patients, their colleagues, and the public. It is also interesting to note that, on a self-rating of their infection prevention and control practices, many fell below 70%, even though majority were mindful of the fact that if caught unaware by LF outbreak in their health-care facilities they could be in danger of being infected or spreading the infection.

This study has some limitations. First, this study did not seek to know the source of awareness about LF from the respondents; second, being a hospital-based study, only those who were met at their duty posts were enlisted for the study; and third, the study did not seek to know the type of the PPE wore outside the duty posts by the participants. Consequently, based on the findings, authors would like to suggest that infection control programs targeting LF are urgently required, as well as a continuing medical education with the objective of universal precautions, should be targeted at all health workers.

Conclusion

The findings obtained from this study reveal that there is generally a very low level of knowledge about LF and poor universal cross-infection control practices against LF among the health workers who serve as the first point of contact with possible cases of LF in Sokoto City, Nigeria.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	WHO. World Health Organization Media Centre: Lassa Fever Fact Sheet; July 2017. Available from: http://www.who.int/mediacentre/factsheet/fs179/en/. [Last assessed on 2018 Jan 24].
2.	Viral Hemorrhagic Fever Consortium (VHFC). Fevers Consortium: Lassa Fever; 2007. Available from: http://www.vhfc.org/lassa_fever. [Last accessed on 2018 Jan 22].
3.	Richmond JK, Baglole DJ. Lassa fever: Epidemiology, clinical features, and social consequences. BMJ 2003;327:1271-5.
4.	Enria DA, Mills JN, Bausch D, Shieh W, Peters CJ. Arenavirus infections. In: Guerrant RL, Walker DH, Weller PF, editors. Tropical Infectious Diseases: Principles, Pathogens, and Practices. 3^rd ed. Philadelphia, PA: Churchill Livingstone; 2011. p. 449-61.
5.	Sogoba N, Feldmann H, Safronetz D. Lassa fever in West Africa: Evidence for an expanded region of endemicity. Zoonoses Public Health 2012;59 Suppl 2:43-7.
6.	Omeh DJ, Achinge GI, Echekwube PO. Lassa fever in West Africa: A clinical and epidemiological review. JAMMR 2017;24:1-12.
7.	Yun NE, Walker DH. Pathogenesis of Lassa fever. Viruses 2012;4:2031-48.
8.	Frame JD, Baldwin JM Jr., 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.
9.	Saka JM, Gubio AB, Kerecvel YS, Saka AO, Oyemakinde A. Lassa fever epidemic in Nigeria-outbreak investigation, risk factors and empirical analysis from 2012 to 2016. J Community Public Health Nurs 2017;3:170.
10.	Ogbu O, Ajuluchukwu E, Uneke CJ. Lassa fever in West African sub-region: An overview. J Vector Borne Dis 2007;44:1-1.
11.	Fisher-Hoch SP, Tomori O, Nasidi A, Perez-Oronoz GI, Fakile Y, Hutwagner L, et al. Review of cases of nosocomial Lassa fever in Nigeria: The high price of poor medical practice. BMJ 1995;311:857-9.
12.	Adebayo D, Nwobi EA, Vincent T, Gonzalez JP. Response preparedness to viral hemorrhagic fever in Nigeria: Risk perception, attitude towards Lassa fever. Epidemiol (Sunnyvale). 2015;5:199.
13.	Federal Ministry of Health. What you need to know about Lassa fever. Nigeria: Federal Ministry of Health; 2008. p. 4-9.
14.	ACAPS. ACAPS Briefing Note: Nigeria-Lassa Fever; 2016. Available from: http://www.reliefweb.int/sites/reliefweb.int/files/resources/start-acaps-nigeria-lassa-epidemic-briefing-note.pdf. [Last accessed on 2018 Jan 22].
15.	Mofolorunsho KC. Outbreak of Lassa fever in Nigeria: Measures for prevention and control. Pan Afr Med J 2016;23:210.
16.	World Health Organization: Emergencies Preparedness, Response > Disease Outbreak News (DONS). Lassa fever – Nigeria; 01 March, 2018. Available from: http://www.who.int/csr/don/01-March-2018-lassa-fever-nigeria/en/. [Last accessed on 2018 Jun 20].
17.	Report from Government of Nigeria. Reported Clusters of Lassa fever Among Health Care Workers in Ebonyi State; 15 January, 2018. Available from: https://www.reliefweb.int/report/nigeria/reported-clusters-lassa-fever-among-health-care-workers-ebonyi-state. [Last accessed on 2018 Jan 24].
18.	Polycarp N. Lassa Fever: Kogi NMA Tasks Health Workers on Safety Precautions; 21 January, 2018. Available from: https://www.google.com.ng/amp/s/www.vanguardngr.com/2018/01/lassa-fever-kogi-nma-tasks-health-workers-safety-precautions/amp/. [Last accessed on 2018 Jan 24].
19.	Polycarp N. Lassa Fever: Take Universal Precaution, Expert Tell Health Workers; 23 January, 2018. Available from: http://www.google.com.ng/amp/s/www.vanguardngr.com/2018/01/lassa-fever-take-universal-precaution-expert-tell-health-workers/amp/. [Last accessed on 2018 Jan 24].
20.	Wikipedia: The Free Encyclopedia. Sokoto, St Petersburg (FL): Wikimedia Foundation, Inc.; 2017. Available from: https://www.en.m.wikipedia.org/wiki/Sokoto_State. [Last updated on 2017 Nov; Last accessed on 2018 Jun 03].
21.	Nwaekpe CN, Mansur S, Nwankiti A, Usman Y, Abaye B, Nnaji R, et al. Knowledge, attitude and practice of health care workers on Lassa fever in Taraba State Nigeria. Pan Afri Med J Conf Proc 2018;8:40.
22.	Nigeria Centre for Disease Control and Prevention. National Centre for Emerging and Zoonotic Infectious Diseases. Division of High-Consequence Pathogens and Pathology. Archived 31 January, 2018. Abuja: Nigeria Centre for Disease Control and Prevention; 2018.
23.	Ijarotimi IT, Ilesanmi OS, Aderinwale A, Abiodun-Adewusi O, Okon I. Knowledge of Lassa fever and use of infection prevention and control facilities among health care workers during Lassa fever outbreak in Ondo state. Pan Afr Med J 2018;30:56.
24.	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.
25.	Adeimpe WO. Knowledge and preventive practices against Lassa Fever among primary health care workers in Osogbo. Univ Mauritius Res J 2015;21:579-93.
26.	Abdulraheem IS, Amodu MO, Saka MJ, Bolarinwa OA, Uthman MM. Knowledge, awareness and compliance with standard precautions among health workers in North Eastern Nigeria. J Community Med Health Educ 2012;2:3.
27.	Ogoina D, Pondei K, Adetunji B, Chima G, Isichei C, Gidado S, et al. Knowledge, attitude and practice of standard precautions of infection control by hospital workers in two tertiary hospitals in Nigeria. J Infect Prev 2015;16:16-22.
28.	Izegbu MC, Amole OO, Ajayi GO. Attitudes, perception and practice of workers in laboratories in the two colleges of medicine and their teaching hospitals in Lagos state, Nigeria as regards universal precaution measures. Biomed Res 2006:17:49-54.