Thought Leadership

Lassa….the question no one was asking

When the UK media was the alight on the 23rd of January on the case of Lassa Fever in a patient who had returned from Nigeria, we highlighted in our blog thenif there is an importation into the UK…there must be a significant outbreak in Nigeria!…it seemed obvious.

…and it was!

We have also asked severally….if there was an outbreak, as there is now…who will respond to the public health threat in the absence of a national centre for infectious disease control?

…and we also have an answer for you! The Chief Medical Director of the National Hospital, Abuja (NHA), Dr Olusegun Ajuwon, is reported by the Leadership Newspaper to have confirmed the outbreak of Lassa fever in Abuja and the adjoining Nasarawa State! The report also states that Dr Ogugua Osi-Ogbu, Consultant Physician and co-ordinator of the Lassa Fever Infection Control at the National Hospital, told NAN that: “The outbreak usually occurs between January and April because of bush burning”. …”The rodents run out of the bush and move to houses within the area” Literature says that it is transmitted only through body fluids, but we are beginning to see from our staff who are contaminated (sic) that it could be air-borne as well,” Osi-Ogbu said.

If this is the case, then apart from controlling the outbreak…my colleague is in fact on the verge of a major breakthrough, he is potentially on the verge of the Nobel Prize and we must all be afraid!….very afraid!

Can you really imagine the possible consequences of airborne transmission of any of the viral haemorrhagic fevers?

If there is no hard evidence to support this then it is an extremely irresponsible statement to be making! Extremely….

We conclude today as we concluded then…

…while we invest considerable resources in the apparent modernisation of our teaching hospitals we need to remember the not so glamorous infectious diseases.

Surveillance, outbreak investigation and control are public health functions representing the first link in a chain of activities aimed at countering the threat of infectious viral and bacterial agents.

Nigeria needs a Centre for Infectious Disease Control, adequately staffed, equipped and resourced or we will pay a price. This is not a problem that the odd clinician at our National Hospital nor a Ministerial task force can solve…

We need one desperately! As it is now…we do not know how big the outbreak of Lassa is, we do not know who is infected, how many have died, how quickly it is spreading, to whom,

….and most of all, a clinican, even at the National Hospital in Abuja…cannot answer these questions. It is like asking a dentist remove your prostrate!

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

By Chikwe Ihekweazu

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

5 replies on “Lassa….the question no one was asking”

It is heart breaking that we do not have a center for disease control in Nigeria. According to WHO, infectious disease is the #1 cause of mortality in Nigeria. How is it that we do not have systems put in place for the things that kill us the most? What can we do to change this?

Hi Chikwe,
Excellent write up as usual. It’s just so depressing to hear these officials with big titles mouthing off sometimes.

Do you think it is possible to put together an outline on the need for a Centre for Disease or Infection Control, benefits, staff required, method of operation and maybe a budget. This we may publish in the dailies or present it to the FMOH.

Please note, Lassa Fever can indeed be transmitted by aerosols released from affected people. It is not the primary mode of transmission but becomes important like person to person contact when the cases begin to accumulate.

A really good piece, but I wonder if there is / are not already sutiable quangos to keep an eye and an ear on infectious diseases in the country before we add another that will end up poorly or inappropriately resourced. The first civilian infectious disease hospital was set up in calabar 105 years ago and every year there are outbreaks of meningitis and other diseases in various parts of the country and the federal and state ministries of health rush around trying to control each spisode with assistance from surveillance units of WHO and other international partners. Before a centre is set up can we be sure that there is no national unit currently charged with the responsibility because I was given the impression that there is when in 2007 we had an increased incidence of meningitis cases ( and we were worried that it might reach epidemic proportions. Thank goodness it did not )

The comment in your piece about ———–‘asking a Dentist to take out the prostate gland’
Well I have news for you—because somewhere in the country you may actually have a Dentist doing prostatectomy, austensibly because the general surgeon / urologist is too far away. In Nigeria too many physicians undertake surgical operations, almost immediately, after getting the MB BS and they take on all types of complex procedures, under general anaesthetic or regional block, often without assistance, coaching or mentoring and in dingy, poorly lit places, totally ill equipped for even basic minor procedures. Often the most basic pre operative preparation to control the metabolic, fluid and electrolyte and acid base imbalance is totally ignored in the rush to inflict the scaple on the patient. The result ofcourse is to deepen the pre-operative shock even though the surgery may be successful!!!!!. Most do not send any body parts they remove for histological examination— beacuse ‘it takes too long to get a result’. Women have been known to represent with terminal breast cancer months after a breast lump was removed and thrown in the waste bin. There are very few specialists in any field, therefore ‘general duty’ doctors have learnt by trial and error. We talk of unacceptable morbidity and mortality but until we re-train ALL health practitioners to understand and go back to basics, the iatrogenic component of our poor health indices will continue to rise exponentially.
I must hasten to add ( and seriously too) that my observation is not to denigrade any individual or group of practitioners in Nigeria, because I know that many do their best for their patients, and ALL work under the most trying conditions ( conditions that are unthinkable in Diaspora). But my sense of Duty of Care is to ‘protect the patient, whilst advocatiing training and reitraining for health practitioners in the country.’
In Nigeria, the knowledge, skills, positive attitude to patients and behaviour of ALL health workers needs urgent revamping and institutionalising across the country. I refer to it as ‘
‘Clinical Governance, Quality and Safety Initiative.’

Joseph Ana.

Lovely Piece,

Heard the hospital in question had started turning away patients because they could not cope?

Also heard there is a centre in Irrua for Lassa fever.

As usual in Naija it boils down to God helping us when there is no will power to put things in their peoper place!

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