AN ASSESSMENT OF THE OUTBREAK AND MANAGEMENT OF EBOLA DISEASE AND ITS EFFECT ON THE SOCIAL INTERACTION OF LAGOS STATE RESIDENTS


Content

ABSTRACT

This Study Assessed The Outbreak And Management Of Ebola Disease And Its Effect On The Social Interaction Of Lagos State Residents. An instrument titled:  Assessment into the Outbreak and Management of Ebola Disease and its Effect on the Social Interaction (AOMEDESI) was used to collect relevant data for the study. The sample used for this study was selected from all wards in Lagos mainland local government Yaba cutting across general public, health providers in hospitals (public and private), market women, caregivers, and students which was based on purposive sampling techniques and the statistical tools employed to analyse the data collected were percentages while the inferential statistics of chi-square(x2) was used to test the stated hypotheses at 0.05 level of significance. 800 sample sizes were used for the study.  5 research questions and 5 research hypotheses were designed and formulated for the purpose of the study. The study revealed there would be a significant effect of high nervousness among Lagos state residents on the outbreak of Ebola Virus. It also revealed that there would be a significant effect of social rejection and stigmatization among Lagos state residents on the outbreak of Ebola virus. It also revealed that the economic implication on the Ebola outbreak is high. The study further revealed there is a significant effect on the containment effort by the government and international organization on the Ebola virus outbreak. The study further revealed that there was a significant gender difference of mobile phone usage on academic performance. Based on the findings of this study, recommendations and suggestions were made for students, parents, lecturers and university administrators and relevant agencies for further research.


 

     TABLE OF CONTENT

Title page                                                                                                   i

Certification                                                                                               ii

Dedication                                                                                        iii

Acknowledgments                                                                                     iv

Abstract                                                                                                     v

Table of contents                                                                             vi

Chapter One: Introduction

1.0 Background to The Study                                                                  1

1.1 Statement of Problem                                                                         9

1.2 Purpose of Study                                                                                11

1.3 Research Question                                                                    12

1.4 Research Hypotheses                                                                         12

1.5 Significance of The Study                                                                   12

1.6 Scope of Study                                                                                    13

1.7 Definition of Key Terms                                                                      13

Chapter Two: Literature Review

2.1 Brief History of Ebola Virus                                                               14

2.2 Ebola Hemorrhagic Fever Outbreak in West Africa

(Guinea, Liberia, Sierra Leone, and Nigeria)                                           15

2.3 Timeline of the Outbreak                                                          15

2.4 Recent Cases among Healthcare Workers                              17

2.5 Risk of Exposure to International Community

      And Travelers in Affected Countries.                                       21

2.6 Commodities                                                                                       31

2.7 Social Interaction in Lagos State                                                       24

2.8 Bush Meat Sellers Record Low Sales                                       24

2.9 Disinfectant, Hand Sanitiser Sales Shoot Up                                    25

2.10 Economic Effects                                                                              25

Chapter Three: Methodology

3.0 Introduction                                                                                        27

3.1 Research Method                                                                                27

3.2 Population of the Study                                                                               27

3.3 Sample and Sampling Technique                                                      27

3.4 Research Instrument                                                                          28

3.5 Data Analysis                                                                                               28

3.6 Pilot Study                                                                                           28

CHAPTER FOUR: RESULTS AND DISCUSSION

4.1 Introduction                                                                                        41

4.2 Discussion of Finding                                                                         52

CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATION

5.1 Summary of Findings                                                                         55

5.2 Conclusion                                                                                          57

5.3 Recommendations                                                                              58

REFERENCES

APPENDIX

 


 

CHAPTER ONE

INTRODUCTION

 

1.0 Background to the Study

Ebola virus disease (Ebola or EVD) is a severe, often fatal disease that was first detected near the Ebola River in the Democratic Republic of the Congo (DRC) in 1976. Originating in animals (such as monkeys, gorillas, and chimpanzees), EVD is spread to humans and among humans through contact with the blood, secretions, organs, or other bodily fluids of those infected. It is not transmitted through the air. Individuals who are not symptomatic are not contagious (Tiaji, 2014). Ebola hemorrhagic fever (Ebola HF) is one of numerous Viral Hemorrhagic Fevers caused by infection with a virus of the family Filoviridae, genus Ebolavirus. When infection occurs, symptoms usually begin abruptly. The first Ebolavirus species was discovered in 1976 in what is now the Democratic Republic of the Congo near the Ebola River. Since then, outbreaks have appeared sporadically. There are five identified subspecies of Ebolavirus. Four of the five have caused disease in humans: Ebola virus (Zaire ebolavirus); Sudan virus (Sudan ebolavirus); Taï Forest virus (Taï Forest ebolavirus, formerly Côte d’Ivoire ebolavirus); and Bundibugyo virus (Bundibugyo ebolavirus). The fifth, Reston virus (Reston ebolavirus), has caused disease in nonhuman primates, but not in humans.

The natural reservoir host of ebolaviruses remains unknown. However, on the basis of available evidence and the nature of similar viruses, researchers believe that the virus is zoonotic (animal-borne) with bats being the most likely reservoir. Four of the five subtypes occur in an animal host native to Africa. A host of similar species is probably associated with Reston virus, which was isolated from infected cynomolgous monkeys imported to the United States and Italy from the Philippines. Tiaji (2014) opined that the first human case of the Ebola virus disease leading to the 2014 outbreak was a 2-year-old boy who died on 6 December, 2013 in a village of Miliandou, Guéckédou Prefecture, Guinea. His mother, sister and grandmother then became ill with the symptoms consistent with Ebola infection and died. People infected by those victims spread the disease to other villages.

On 19th March 2014, the Guinean Ministry of Health acknowledged a local outbreak of an undetermined viral hemorrhagic fever; the outbreak, ongoing since February, had sickened at least 35 people and killed 23. Ebola virus was suspected, and on 25 March 2014, the World Health Organization (WHO) reported that the Ministry of Health of Guinea has reported the outbreak of Ebola virus disease in four southeastern districts, with suspected cases in the neighbouring countries of Liberia and Sierra Leone being investigated. In Guinea, a total of 86 suspected cases, including 59 deaths, had been reported as of 24 March, 2014.

In Liberia, the disease was reported in Lofa and Nimba countries in late march and by mid-April, the Ministry of Health and Social Welfare had recorded possible cases in Margibi and Montserrado Countries. In mid-June, the first cases in Liberia’s capital Monrovia were reported. In Sierra Leone, the outbreak next spread and progressed rapidly. The first cases reported on 25 May 2014 in Kailahun District, near the first case in Senegal, the disease was reported by the Senegalese Health minister, Awa Marie Coll Seck on 29 August 2014. He announced the first case of Ebola virus in Senegal. The case has been confirmed.

The first case in Nigeria was reported by the Federal Minister of Health Professor Chukwu Onyebuchi on 25th July, 2014. The victim was a Liberian-Patrick Sawyer, who flew from Liberia to Nigeria. He was seriously sick on arrival and died in the private hospital where he was admitted and diagnosed as been infected with Ebola Virus Disease. To contain the spread of the disease, the hospital was shut down and health officials treating him were quarantined. However, a doctor and nurse who treated him both died from Ebola.

As of September, 2014, West African countries like Guinea, Liberia, Senegal, Nigeria and Sierra Leone have recorded a total of 4, 846 cases and 2,375 deaths. Guinea with a total of 899 cases and 568 deaths, Liberia with a total of 2,415 cases and 1,307 deaths, Nigeria with a total of 22 cases and 8 deaths while Sierra Leone with a total of 3 cases and no death.

As of 10 September 2014, The World Health Organization (WHO) and Centers for Disease Control (CDC) reported that a total of 4,846 suspected cases and 2,375 deaths; 2,898 cases and 1,386 deaths being laboratory confirmed. Many experts believe that official numbers substantially understate the size of the outbreak because of families’ widespread reluctance to report cases.

Ebola Hemorrhagic Fever Outbreak in Democratic Republic of the Congo: On August 26, 2014, the Democratic Republic of the Congo (DRC) Ministry of Health notified the World Health Organization of an outbreak of Ebola virus disease (EVD) in Equateur Province. The index case was a pregnant woman from Ikanamongo Village who butchered a bush animal. She became ill with symptoms of EVD, reported to a private clinic in Isaka Village, and died on August 11, 2014. Local customs and rituals associated with death meant that several healthcare workers were exposed to Ebola virus.

The gruesome death that frequently accompanies Ebola Haemorrhagic Fever has ensured that the disease is etched deeply into the public imagination. Initially, an Ebola patient is likely to complain of non-specific symptoms such as high fever, weakness, diarrhoea, nausea, headache and vomiting. However, their condition can deteriorate quickly and dramatically, to include rashes, impaired kidney and liver function, and in some cases, both internal and external bleeding. Those who die do so usually within two weeks of disease onset, often having exhibited the classical “deep-set eyes, ghost-like expressionless face, and extreme lethargy” (Kinsman, 2012.). Although it is rare, Ebola has a high case fatality rate. Just 2,306 cases have been reported since the disease was first recognised in 1976 in Zaire (now the Democratic Republic of Congo, or DRC), but 1,527 (66%) of these individuals died. There remains no specific therapy, and neither is there a vaccine, although recent experimental vaccine studies have shown some promise.

Social Interactions Change as Ebola Ravages in Lagos City

“I have switched to sale of GSM recharge cards to survive till this Ebola ‘wahala’ (problem) is over. Nobody was buying fruits from me again, they said fruit bats have Ebola virus and may have eaten from the fruits I was selling. I lost half of my capital because the fruits perished.” Those were the words of a fruits seller at the Lagos State Secretariat, who gave her name as Paulina. She is one of those bearing the brunt of the Ebola Virus Disease.

According to her, after desperate efforts to woo back her fleeing customers, she decided to change her line of business in order not to become impoverished. In Lagos the importation of the deadly Ebola Virus Disease into the country by a late Liberian American, Mr. Patrick Sawyer has changed the way of life of Lagosians. The fear of contracting the virus is now the beginning of wisdom in Africa’s most populous city and residents are taking precautionary measures not to fall victim of the disease. In every corner of the city, people are seen discussing the fears the disease has instilled in them and the life style changes they’ve adopted as a result. Around the city, people are seen wearing protective gears as they go about their activities. This development has also affected the socio-economic life style of the vibrant Lagos residents who ordinarily take delight in socialising. With the coming of Ebola, the hand shake which is one of the most popularly ways of exchanging pleasantries has since become a public anathema in Lagos. People shy away from having hand shake with others. What they do now is wave their hands at each other no matter their closeness. The Ebola scare has put asunder whatever they shared in the past. People are now seen engaging in frequent hand washing. They also carry about medicated soaps in the bags to quickly wash their hands anytime they feel suspicious of or are afraid of touching an object.

One of the sectors of the economy worst hit by the Ebola scare in Lagos currently is private schools and holiday coaching centers. Parents because of the scare of Ebola have stopped their children from attending holiday coaching classes so that they don’t contract the deadly disease. The long holiday coaching schools in Lagos have suffered a setback as parents have withdrawn their wards from them. Another category of persons also experiencing the effects of the outbreak of the disease is bush meat sellers. In Ikorodu, Lagos state, bush meat traders are counting their losses. This is because medical experts have been advising Nigerians to desist from consuming bats, primates and other edible games to avoid contracting the viral disease (Leadership Newspaper, 2014). “It is terrible. Our experience since the outbreak of Ebola is indescribable. This place used to be booming with business. Car traffic competed with human traffic, with buyers and sellers haggling and smiling. All that is gone now. Patronage is almost zero. Ebola has undone our business. Our customers now increase their acceleration when they reach this spot. People avoid us like plague,” Popoola lamented. (Leadership Newspaper, 2014).

It’s not all gloomy, however. While bush meat sellers are counting their losses, sellers of hand washing soaps, disinfectants and sanitisers are smiling to the banks, following advice by medical experts that constant washing of hands could save one from contracting the virus. In Lagos, a 60 ml bottle of hand sanitiser that was previously sold at N200 is now sold at N600.

Despite the hike in the price, lots of residents throng super stores and chemist shops in search of hand sanitiser to buy to fortify themselves against the Ebola Virus. Also, some bank cashiers, security guards, and taxi drivers can be spotted within the city wearing gloves while conducting their businesses.

Churches Modify Worship Proceedings

The Ebola scare has also forced churches to modify worship. The Catholic Church for instance, has modified proceedings including the rite of peace and administering of Holy Communion. Last Sunday during mass in many dioceses of the church across the country, it was announced that the exchange of handshakes and hugs as a rite of peace has been temporarily suspended following the Ebola outbreak. Similarly, Holy Communion is no longer given from the hand of the priest to the receiver’s mouth as the receiver now has to receive it on their palm and place same on the tongue by themselves. Also, in some Pentecostal churches, where it was the practice for the cleric to shake hands with first time worshippers, that has also been replaced with waving towards them.

There is high nervousness in the Lagos city due to reported cases of Ebola. Even among medical personnel, the situation is not different, especially with the death of Dr. Ameyo Stella Adadevoh, the senior consultant endocrinologist, who became infected with the deadly Ebola virus while treating the Liberian-American, Patrick Sawyer. As it is now, some health managers, who should help in managing the diseases, are shying away from their primary responsibility for fear of being infected (Guardian Newspaper, 2014).

Already, there are rumours that some hospitals are now sending away patients suspected to have traits of the Ebola virus. Visits to some of these hospitals indicate that patients, who exhibit symptom associated with malaria, typhoid fever, including those vomiting are usually advised by doctors to go home to manage their sickness. This it was learnt has left patients with no option than to settle for self-medication, taking all sorts of drugs without prescription.  

On what could be responsible for the situation, Dr. Francis Duru, Associate Professor, College of Medicine, University of Lagos, argued that because many of these hospitals know that Ebola virus is highly contagious, most private hospitals may be avoiding patients because they lack facilities like isolation or quarantine units, personal protection equipment (PPE) and trained personnel to carry out the necessary care. 

Economic Effects.

In addition to the loss of life, the outbreak is having a number of significant economic impacts. Markets and shops are closing due to  travel restrictions, cordon sanitaire, or fear of human contact, leading to loss of income for producers and traders. Movement of people away from affected areas has disturbed agricultural activities. Tourism is directly impacted in affected cities like Lagos. Many airlines have experienced reduced traffic. Some airlines have suspended flights to affected areas. The U.N Food and Agricultural (FAO) have warned that the outbreak could engender harvest and food security in West Africa.

Containment Efforts

Various aids organizations and international bodies, including Economic community of West African States (ECOWAS), US Centers for Disease and Control (CDC), and the European Commission have donated funds and mobilized personnel to help counter the outbreak: charities including Médicins Sans Frontiéres, the Red Cross and Samaritan’s Purse are also working in the area. Affected countries have encountered many difficulties in their attempt to control the spread of this epidemic, the first that West African nations have experienced. In some areas, people have become suspicious of both the government and hospitals; some hospitals have been attacked by angry protesters who believe that the disease is a hoax or that the hospitals are responsible for the disease. Many of the areas that have been infected are areas of extreme poverty without even running water or soap to help control the spread of disease. Other factors include belief in traditional folk remedies and cultural practices that predispose to physical contact with the disease, especially death customs such as washing the body of the diseased.

Some hospitals lack basic supplies and are understaffed, which has increased the likelihood of staff catching the virus themselves. In August 2014, the WHO reported that ten percent of the dead have been health care workers.

By the end of August 2014, the WHO reported that the loss of so many health workers was making it difficult for them to provide sufficient number of foreign medical staff. By September 2014, Médicins Sans Frontiéres, the largest NGO working in the affected regions, had grown increasingly critical of the international response. On 3rd September, 2014, the international president spoke out concerning the lack of assistance from the United Nations member countries saying, “six month into the worst Ebola epidemic in history the world is losing the battle to contain it”. The Director-General of the WHO, Margret Chan called the outbreak “the largest, most complex and most severe we’ve seen” and said that it “is racing ahead of control efforts”. A United Nations spokesperson stated “they could stop the Ebola outbreak in West Africa in 6 to 9 months, but only if a ‘massive’ global response is implemented”.

Ebola virus remains as an ongoing, but, in the grand scheme, relatively minor threat to global health. Nonetheless, it is clear from the Nigerian experience that the responses to an outbreak can be very dramatic, and perhaps disproportionate to the actual danger presented. Indeed, in some cases, the responses during this outbreak actively inhibited control and containment measures. An important objective for any future outbreak control strategy must be to prevent excessive fear, which, it is expected, would reduce stigma and other negative outcomes.

Strategies for containing the EVD in Nigeria have remained the same, focusing on appropriate information, education and communication; sustaining surveillance systems; provision and equipping of isolation wards/centres; provision of adequate care for confirmed cases; active and aggressive contact tracing; and reduction in harmful practices that promote the spread of the virus.

1.1 Statement of Problem

The magnitude of Ebola outbreak, especially in Liberia, sierra Lone and Nigeria, has been underestimated especially for a number of reasons.

Many families hide infected loved ones in their homes. As Ebola has no cure yet, some believed infected loved ones will be more comfortable dying at home.

Others deny that a patient has Ebola and believe that care in an isolation ward- viewed as incubator of the disease will lead to infection and certain death.

Most fear the stigma and social rejection that come to patients and families when diagnosed of Ebola is confirmed.

These are fast-moving challenges for many international partners providing support. Quantities of staff, supplies, and equipment, including personal protective equipment, cannot keep up with the need. Hospitals and diagnostic capacities have been overwhelmed.

Many treatment centres and general clinic have been closed. Fear keeps patients out and causes medical staff to flee.

Diseased corpses are buried without notifying health official and with no investigation of the cause of death. In some instances, epidemiologists fear to travel to affected places.

The pastor of The Synagogue of All Nation, Pastor TB Joshua has directed West African victims, who would otherwise have thronged his church to stay in their countries. Speaking on the deadly disease, Pastor Joshua said, “What makes you a good citizen makes you a good Christian. There is a general law in every country that binds against crossing borders, obey the law of the land by not crossing the borders of your land with Ebola virus”.

Airlines are the ones that bring foreign tourist, investors and expatriates to Nigeria especially to Lagos. It is therefore logical to say that as long as flight are suspended, there wouldn’t be new tourists, investors and expatriates visiting the region, even those in Lagos will be making frantic effort to leave. The impact will become harder as suspension of air flight enters days, weeks and months.

 Lagos is a city where Nigeria’s commercial capital is dominant, pandemonium would break out if there was to be full blown Ebola outbreak.  A sector such as small and medium-scale enterprise would collapse completely starting with the informal markets that are patronized daily by thousands of Lagos residents.

In a typical Lagos market, there are interaction and physical contacts due to competition for small spaces and the haphazard arrangement of the stalls. Thus if there is Ebola outbreak, such markets would be shutdown to prevent fatal outcome and widespread infection of previously unexposed individuals. It will be very serious if markets such as Oshodi, Tejuosho and several others are shut down in the advent of an Ebola outbreak. Anything that would affect these markets would cripple the economy at the citizenry level and the local government would also suffer since there would be great depletion in the internally generated revenues.

West African countries are already aware of the threat the disease pose to their economies and are making concerted efforts to combat the disease; they are also looking inwards and campaigning from one place to another on what to do prevent the disease and how to make provisional diagnoses.

The Lagos state government is however expected to cascade trainings down to the LGAs with support from the development partners, whom we are already talking with in this regard among others. These trainings are as follows:

i. Training of Trainer (TOT) for Health Workers on the Ebola Virus Disease (EVD) outbreak and other Viral Haemorrhagic Fevers (VHFs)

ii. TOT for State Health Educators on awareness creation, community sensitization and mobilization. Arrangement has been made to include the military and para-military in the training.

The populace have been advised to wash their hands frequently with using soap and water and the use of sanitizers.

 Avoid buying or eating of wild animals, including nonhuman primates, sold in local markets.

Caregivers should avoid contact with the infected person’s body fluids and tissue, including blood, semen, vaginal secretions and saliva. If you are a health worker, it will be very precautionary to wear protective clothing, such as gloves, masks, gown and eye shields. It is also very important to keep infected people isolated from others.

 

1.2 Purpose of Study

The purpose of this study is to assess the outbreak of Ebola disease and its effect on the social interaction of Lagos State.

Specifically the study desires:

1.   To assess the past and present outbreak of Ebola virus

2.   To examine the effect on the social interaction of Lagosians.

3.   To assess the risk of exposure.

4.   To examine the social rejection and stigmatization of Ebola virus.

5.   To examine the economic implication on Ebola outbreak

6.   To examine the level of awareness campaign on Ebola outbreak.

7.   To examine the level of containment effort by the government and international organizations.

1.3 Research Question

Based on the issues raised in the background, the study will attempt to answer the following research questions:

 

1.   Would there be any significant effect of high nervousness among Lagos state residents as regards to Ebola virus outbreak?

2.   Would there be any significant effect of social rejection and stigmatization among Lagos state residents on the Ebola outbreak?

3.   What is the level of economic implication of the Ebola outbreak?

4.   What is the level of campaign awareness?

5.   Is there any significant effect on the level of containment effort by the government and international organization?

1.4 Research Hypotheses

The following assumptions will be tested in this study:

1.   There would be no significant effect of high nervousness among Lagos state residents on the outbreak of Ebola Virus.

2.   There would be no significant effect of social rejection and stigmatization among Lagos state residents on the outbreak of Ebola virus.

3.   The economic implication on the Ebola outbreak is low.

4.   There is low level of campaign awareness.

5.   There is no significant effect on the containment effort by the government and international organization on the Ebola virus outbreak.

1.5 Significance of The Study

The research study will be of great help to the both the federal, state and local government health stakeholders, health officials, and the general public on the containment effort.

This research will also help to keep an occasionally panicky populace from excessive over-reaction, and thereby contribute to containing the virus, as well as to reducing stigma and other negative consequences.

Countries suffering an Ebola outbreak in the future may well benefit in their attempts to combat the disease by taking on board the important lesson from this research. 

1.6 Scope of Study

The population for the study comprises of the general public, health providers such as hospitals (both public and private), market women, caregivers, and students in Lagos state.

1.7       Definition of Key Terms

Ebola Virus: Ebola hemorrhagic fever (Ebola HF) is one of numerous Viral Hemorrhagic Fevers caused by infection with a virus of the family Filoviridae,  genus Ebolavirus.

Outbreak: is a term used in epidemiology to describe an occurrence of disease greater than would otherwise be expected at a particular time and place. It affects a small and localized group or impact upon thousands of people across an entire continent.

Social Interaction: is the way people talk and act with each other and various structures in the society. It may include the interaction a family has together (eating, sleeping, living together) or bureaucracies that are formed out of the need to create other within the interaction itself.

 


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