EXPLORING THE DIAGNOSTIC CHALLENGES OF LASSA FEVER IN PRIMARY HEALTHCARE FACILITIES IN EDO STATE

EXPLORING THE DIAGNOSTIC CHALLENGES OF LASSA FEVER IN PRIMARY HEALTHCARE FACILITIES IN EDO STATE

CHAPTER ONE: INTRODUCTION

1.1 Background of the Study

Lassa fever, an acute viral hemorrhagic illness caused by the Lassa virus, continues to pose a significant public health threat in Nigeria and other West African countries. The disease is endemic in Nigeria, with outbreaks reported almost annually, especially in Edo, Ondo, and Ebonyi States. The virus is transmitted to humans primarily through contact with food or household items contaminated with rodent urine or feces and can also be spread through direct contact with the bodily fluids of infected individuals. Due to its non-specific early symptoms—such as fever, weakness, headache, and vomiting—Lassa fever is often misdiagnosed, particularly at the primary healthcare (PHC) level where diagnostic capabilities are limited (World Health Organization [WHO], 2023).

Edo State, especially the southern senatorial districts, has remained one of the epicenters of recurrent Lassa fever outbreaks in Nigeria. However, early diagnosis remains a major challenge due to a combination of factors including the overlap of Lassa symptoms with those of common endemic illnesses such as malaria and typhoid, insufficient training of healthcare personnel, lack of diagnostic facilities, and inadequate surveillance mechanisms at PHCs. According to the Nigeria Centre for Disease Control (NCDC, 2022), delayed diagnosis often leads to delayed treatment, increasing the likelihood of complications and mortality.

Accurate and early diagnosis of Lassa fever is crucial to controlling its spread and ensuring positive health outcomes. This requires not only laboratory capacity and technology, but also clinician awareness, clinical suspicion, and standardized triage procedures. Unfortunately, most PHC facilities in Edo State operate under severe resource constraints, often lacking even basic laboratory infrastructure. In such settings, health workers are forced to rely on clinical symptoms alone, increasing the risk of misdiagnosis and inadequate infection prevention practices. This diagnostic gap undermines Nigeria’s broader infectious disease control efforts and highlights the urgent need for strategic health technology interventions.

Although there have been national policies and donor-driven initiatives aimed at strengthening Nigeria’s response to viral hemorrhagic fevers, limited research has been conducted at the level of primary healthcare, especially in the high-burden zones of Edo State. This study seeks to explore the specific diagnostic challenges faced by PHC facilities in identifying Lassa fever cases and to understand the implications for outbreak management, patient outcomes, and public health preparedness in the region.

1.2 Statement of the Problem

Despite ongoing efforts by federal and state health authorities, diagnostic delays and inaccuracies in the detection of Lassa fever persist in primary healthcare centers across Edo State. The result is frequent under-reporting, poor case management, and high case fatality rates. In many PHCs, healthcare workers lack both the training and the diagnostic tools required for early identification of the disease. Moreover, the early clinical presentation of Lassa fever is largely indistinguishable from that of other febrile illnesses, leading to misdiagnosis and further transmission risks within communities and health facilities (Eze et al., 2021).

Compounding these challenges is the limited integration of digital or point-of-care diagnostic technologies in rural and peri-urban PHCs. Without supportive technologies such as rapid diagnostic tests (RDTs), electronic case reporting systems, and telemedicine support, frontline healthcare providers are often left to make critical decisions based on incomplete information. Consequently, the lack of timely and accurate diagnosis hampers the ability to isolate suspected cases, initiate treatment protocols, and notify relevant disease surveillance authorities.

While Lassa fever management has attracted attention at the tertiary and national levels, little is known about the practical barriers to diagnosis at the primary care level, where patients often make their first contact with the health system. This study aims to address this research gap by identifying and analyzing the diagnostic limitations and needs of PHCs in Edo State, with a view toward improving early detection and response strategies.

1.3 Objectives of the Study

To examine the diagnostic capacity of primary healthcare facilities in Edo State in detecting Lassa fever.

To identify the key challenges hindering early and accurate diagnosis of Lassa fever at the PHC level.

To assess the awareness and diagnostic practices of healthcare workers regarding Lassa fever in PHCs.

1.4 Research Questions

What diagnostic resources are available in PHC facilities in Edo State for detecting Lassa fever?

What are the major challenges preventing accurate diagnosis of Lassa fever at the PHC level?

How knowledgeable and prepared are PHC health workers in diagnosing Lassa fever?

1.5 Research Hypotheses

H0₁: There is no significant relationship between diagnostic capacity at PHCs and the early detection of Lassa fever in Edo State.

H0₂: Healthcare worker awareness does not significantly affect the diagnostic accuracy of Lassa fever cases in PHC facilities.

1.6 Significance of the Study

This study is of great importance to public health stakeholders, including the Ministry of Health, the NCDC, healthcare managers, and development partners. It will provide evidence-based insights into the diagnostic gaps at the grassroots level of healthcare, where early detection of Lassa fever is most critical. The findings could inform policy improvements, capacity-building initiatives, and investment in point-of-care diagnostic technologies for infectious disease management. Furthermore, this research contributes to the academic understanding of how health technology constraints affect outbreak response in resource-limited settings.

1.7 Scope and Limitation of the Study

The study will focus on selected primary healthcare centers in Lassa fever–prone LGAs within Edo State. It will assess the availability of diagnostic tools, healthcare worker training, and institutional response protocols. The study will not cover tertiary or secondary health facilities. Limitations may include restricted access to clinical records, reluctance of healthcare workers to disclose operational weaknesses, and time constraints for extensive field assessments.

1.8 Operational Definition of Terms

Lassa Fever: A viral hemorrhagic illness endemic in West Africa, characterized by fever and bleeding disorders, caused by the Lassa virus.

Diagnostic Challenges: Constraints or difficulties encountered in accurately identifying a disease or medical condition.

Primary Healthcare (PHC) Facilities: Basic health centers offering first-contact medical care, typically located in rural or semi-urban areas.

Edo State: A state in southern Nigeria known for recurrent outbreaks of Lassa fever, serving as the location for this study.

1.9 Structure of the Study

This study is organized into five chapters. Chapter One introduces the research topic, background, and methodology. Chapter Two reviews relevant literature and theoretical perspectives. Chapter Three details the research design, population, and data collection methods. Chapter Four presents and analyzes the data. Chapter Five concludes the study and provides policy and research recommendations.

References

Eze, K. C., Okafor, E. M., & Alabi, T. O. (2021). Challenges of early diagnosis of Lassa fever in Nigeria: Implications for control. Nigerian Journal of Clinical Practice, 24(2), 169–175.

Nigeria Centre for Disease Control (NCDC). (2022). Lassa Fever Situation Report – Week 52. Retrieved from https://ncdc.gov.ng

World Health Organization. (2023). Lassa fever – Nigeria. Disease outbreak news. Retrieved from https://www.who.int