Journal of Epidemiology and Global Health

Volume 9, Issue 2, June 2019, Pages 107 - 115

Lassa Fever-associated Stigmatization among Staff and Students of the University of Benin, Nigeria

Authors
Stella Folajole Usifoh1, Amienwanlen Eugene Odigie2, *, Stephena Udinmande Ighedosa3, Edwin Aihanuwa Uwagie-Ero4, Isoken Tito Aighewi5
1Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Benin, Benin City, Nigeria
2Department of Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Benin, Benin City, Nigeria
3Department of Community Health, University of Benin Teaching Hospital, Benin City, Nigeria
4Department of Surgery, Faculty of Veterinary Medicine, University of Benin, Benin City, Nigeria
5Department of Environmental Management and Toxicology, Faculty of Life Sciences, University of Benin, Benin City, Nigeria
*Corresponding author. Email: eugene.odigie@uniben.edu
Corresponding Author
Amienwanlen Eugene Odigie
Received 26 February 2019, Accepted 21 April 2019, Available Online 11 June 2019.
DOI
10.2991/jegh.k.190514.001How to use a DOI?
Keywords
Associated stigmatization; Lassa fever; psychosocial; staff; students; University of Benin
Abstract

Lassa Fever (LF) remains a health burden in several endemic areas of Nigeria, and its toll remains unabated over several decades. Although most studies have focused on virological and clinical considerations, few studies have attempted to address the perceived psychosocial component of LF disease in Nigeria. Evaluation of stigmatization and discrimination faced by LF survivors is an important step in improving individual health and protecting public health. This study aimed to assess LF-associated stigmatization associated among staff and students of the University of Benin. Descriptive analyses of 600 consenting respondents (300 staff and 300 students) sampled using pretested questionnaires was conducted, and the Chi-square test was used to test for significant association between perceived LF stigmatization and predefined variables. LF was a potential cause of stigmatization in a higher proportion of student (n = 162, 57.9%) than staff (n = 112, 39.9%). LF-associated stigmatization among students was significantly associated with sex (p = 0.012) and poor knowledge (p = 0.013) of LF transmission and prevention. A greater tendency for stigmatization was observed among females than males. A comprehensive emergency response plan incorporating accurate knowledge dissemination about the disease may be a first step toward tackling perceived LF stigmatization.

Copyright
© 2019 Atlantis Press International B.V.
Open Access
This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

1. INTRODUCTION

Lassa Fever (LF) remains a health burden in several endemic areas of West Africa including Nigeria, and the toll in case fatality remains unabated over several decades. The disease results in 500,000 cases annually and approximately 5000 deaths in endemic West Africa. Although the overall case fatality rate is 1% [1], mortality can be as high as 15–20% in hospitalized LF patients and up to 50% during outbreaks [25]. LF was first described in 1969 in the town of Lassa, in present-day Borno State, Nigeria, and recurrent seasonal outbreaks occur in the Lassa belt of West Africa comprising Nigeria, Liberia, Sierra Leone, and Guinea. LF is also known to be endemic in Benin, Ghana, and Mali [1]. LF disease is an acute viral hemorrhagic disease caused by Lassa Virus (LASV), a bisegmented single-stranded RNA virus, which belongs to the family Arenaviridae [1,6]. The putative reservoir of LASV is the Mastomys natalensis, which is known to exhibit asymptomatic infection but results in copious shedding of the virus in the urine, feces, saliva, and blood of infected rats [1,7]. The presence of M. natalensis, a rodent indigenous to most of sub-Saharan Africa, within households is closely associated with LF outbreaks in rural settings and precipitated by accessibility to grains and sociocultural practices such as bush burning [8].

In 80% of human cases, the disease is asymptomatic, but in the remaining 20% a complicated course leading to death may result in nonspecific symptoms indistinguishable from other Viral Hemorrhagic Fevers (VHFs) such as Ebola and Marburg. Typically, human infection results from contact with secretions and excretions of infected rats and other infected persons through respiratory or gastrointestinal tracts. Inhalation of aerosolized infective viral LASV particles is the most significant means of exposure, although infection through mucous membranes and abraded skin has been reported [9,10]. The severity of LF correlates with the titers of LASV in blood and bodily secretions [11]. There is no evidence of LASV transmission during the incubation period or after recovery, apart from sexual transmission because of delayed clearance from the gonads of <3 months after acute infection. However, the frequency of transmission through sexual contact has not been established [12].

Currently, Ribavirin is the only effective drug of choice for LF treatment. Ribavirin (1-β-d-ribofuranosy-l-1,2,4-triazole-3-carboxamide), a guanosine analog, when administered intravenously within the first 6 days of illness reduces mortality from 55% to 5% [13,14]. Although the precise mechanism of action is in dispute, Ribavirin appears to interfere with viral replication in inhibiting RNA-dependent nucleic acid synthesis. The drug has been used in varying degrees in the treatment of other arenavirus infection (Junin and Machupo viruses), hemorrhagic fever with renal syndrome, Crimean–Congo hemorrhagic fever, hepatitis C, respiratory syncytial virus pneumonia, La Crosse encephalitis, influenza, and other adenovirus infections [14]. Research in recent years has focused on finding alternative therapeutics, and results in experimental animals using ST-193 developed by SIGA Technologies Inc., Corvallis, Oregon, 97333, United States, are promising [15].

Psychosocial manifestations of stigmatization and discrimination (perceived or real) in disease outbreaks have been described as a global phenomenon that is as old as the disease itself—a term that essentially induces a sense of stigma [1618]. Stigma has been defined as a mark of shame or an attribute that is deeply ­discrediting within a particular social interaction. Stigma and discrimination against infected individuals pose significant barriers, negatively affecting access to care and treatment [15,1921]. These can substantially increase the suffering of infected individuals and can be strong disincentives for individuals in seeking prompt medical care. Consequent to such delays in treatment is the propensity for affected individuals to remain undetected in the community. In addition, stigmatization against professionals and volunteers working in the field has been implicated as a leading cause of high rates of stress and burnout. As noted by Person et al. [22], this attitude toward infected persons stems from the evolving nature and inherent scientific uncertainties associated with infectious diseases.

Some studies have focused on stigmatization associated with such infectious diseases as Severe Acute Respiratory Syndrome (SARS), AIDS, tuberculosis, avian influenza, Ebola, and neglected tropical diseases [16,21,2325]. For example, Bennis et al. [26] observed that neglected tropical disease such as cutaneous leishmaniasis had a psychosocial impact in high school students in a province in Morocco, leading to self- and social-stigma even though the disease is not life-threatening [9]. Although most studies have focused on virological and clinical considerations, few studies have attempted to address the psychosocial component of LF disease in Nigeria. The focus has been more on the impact the disease on the mental health status of health professionals than the potential level of stigmatization experienced from the social cycle—institutional, community, state, regional, and national. In the study by Ji et al. [23], both healthcare workers who treated patients with hemorrhagic fever and their survivors were found to be prone and demonstrated psychological symptoms following outbreaks. Among healthcare workers, psychological effects included coping with the deaths of colleagues, anxiety, fear of contamination, threats to their lives, and working excessive number of hours—which reduce work efficiency and increase occupational risks. Sources of mental stress for Ebola viral disease survivors included sufferings and deaths of family members and friends; the collapse of national, social, and ­economic security; high mortality rate; and strict biosecurity restrictions [23].

Evaluation of perceived LF-associated stigmatization toward LF patients and survivors are an important first step in early disease reporting and protection of public health. This study aimed to assess the perceived stigmatization associated with LF outbreaks among staff and students of the University of Benin (UNIBEN), Benin City, Nigeria.

2. METHODS

2.1. Study Design

This work was designed as a cross-sectional study using a stratified random sampling of staff of the UNIBEN on both campuses.

2.2. Study Area

The study was conducted at the two campuses (Ugbowo and Ekenhuan) of the UNIBEN, which is in Nigeria’s South–South geopolitical zone, Benin City, Edo state, Nigeria. The university, which was established in 1975, is one of Nigeria’s first-generation federal universities with two campuses, located at Ugbowo and Ekenhuan Road in Benin City. At present, the university has about 18 faculties and schools that offer courses at postgraduate, undergraduate, diploma, and certificate levels.

Investigations in the 1970s and 1980s pointed to the existence of three disease-endemic zones within Nigeria, which includes the northeastern, central, and southern regions [27]. Since 2003–2004, when a hospital-based survey was first conducted in Irrua, Edo State, increases in LF cases have consistently been demonstrated over the years in the state.

2.3. Study Population

The total student enrolment currently stands at more than 80,000, made up of both full- and part-time students shared among the various faculties, with staff strength of about 8000 academic and nonacademic staff. The university has eight hostels in Ugbowo and two hostels in Ekenhuan campus with a total population of about 15,000 resident students, whereas other students live off-campus.

2.4. Ethical Consideration

Ethical approval for the study was obtained from the Ethics Committee of the University of Benin Teaching Hospital. All information obtained was kept confidential.

2.5. Sample Size Determination

The Cochran formula [23,28] for sample size determination with an LF prevalence of 21%, which has been described in previous studies reported by the authors [5,2931], was applied that gave a sample size of 255. Using a 10% attrition rate, we had 285 respondents each for staff and students. However, a total of 600 respondents (300 staff and 300 students) were sampled to make room for nonresponses (Ugbowo and Ekenhuan). The inclusion criteria called for UNIBEN students who were official residents in the hostels, as well as academic and nonacademic staff of UNIBEN, whereas those excluded were UNIBEN students who were squatters in the halls of residence, those in staff residence, as well as contractual staff of the University.

2.6. Sampling Technique

A stratified random sampling technique was used. The sampling frame for students was the total student population resident in all hostels (n = 10) on both campuses. A sampling fraction was determined by dividing the calculated sample size by the sampling frame. The sampling fraction was applied to the population of students’ resident in each hostel of residence to determine the effective sample size for the stratum. The number of rooms to be sampled was determined by dividing the number of rooms per hostel by the effective sample size. The selection of the sampling unit (respondents) was done by balloting.

The sampling frame for staff was the total population of academics and nonacademics in all Faculties/Colleges, Schools, Registry, Vice Chancellor’s Office (VCO), Bursary, and Library. The effective sample size was determined by application of the sampling fraction on the population. The proportion of the effective sample allocated to the departments was determined by the staff population within that department. The sampling units were selected by balloting within the departments.

2.7. Data Collection

A self-administered pretested questionnaire that was presented in different sections was given to consenting respondents. Data on respondents’ sociodemographic details, LF-associated stigmatization, and knowledge, attitude, and practices on LF transmission, prevalence, and predisposing factors were obtained. A probability random sampling by balloting was used, and questionnaires administered to selected respondents. A total of 600 (300 for students and 300 for staff) questionnaires were randomly distributed and retrieved among consenting students and staff in their rooms and offices.

2.8. Statistical Analysis

Data were collected and inputted into Microsoft Excel (Microsoft Corporation, Redmond, WA, USA), sorted, checked for accuracy, and thereafter exported into SPSS (version 22; IBM Corp., Armonk, NY, USA) and analyzed. Perception of LF-associated stigmatization was assessed on the basis of the respondents’ disposition toward willingness to relate or patronize LF survivors, promptly report cases of LF in family members, and acceptance of approved vaccines, when available. Specific questions to assess knowledge of respondents were also obtained and a score was assigned to each correct response. Based on the total score, a scale of respondents’ perceived stigmatization and knowledge was categorized as high or low and good or poor, respectively.

Similarly, the level of education was ranked based on the highest certificate acquired by respondents. Basic education described respondents who have obtained West African Senior School Certificate Examinations/General Certificate in Examinations/National Examinations Council (WASSCE/GCE/NECO), whereas higher education describes respondents who have diploma, Bachelor of Science (BS), Master of Science (MS), or Doctor of Philosophy (PhD) degrees. A scale was developed for both perceived risk awareness and risk perception and ranked as either high or low, respectively.

Inferential analysis between the various categorical variables was conducted using the Chi-square test.

3. RESULTS

A total of 600 consenting respondents (300 staff and 300 students) participated in the study Table 1. The mean ages of staff and students of the University were 38.09 ± 9.41 years and 20.84 ± 4.61 years, respectively. The duration of employment for staff displayed a median of 4 years (interquartile range = 2–7) with a higher proportion of nonacademics (n = 274, 72.9%).

Variable Respondents Category Frequency (n= 300)a

Staff, n(%) Students, n(%)
Age (years) 15–24 6 (2.0) 268 (89.9)
25–34 112 (38.2) 23 (7.7)
35–44 109 (37.2) 5 (1.7)
45–54 50 (17.1) 1 (0.3)
>55 16 (5.5) 1 (0.3)
Sex Male 130 (45.9) 139 (46.5)
Female 153 (54.1) 160 (53.5)
Marital status Single 81 (27.6) 291 (98.0)
Married 204 (69.4) 6 (2.0)
Divorced 4 (1.4)
Widowed 5 (1.7)
Level of education Secondary 18 (6.6) 230 (84.6)
Graduate 133 (48.7) 36 (13.2)
Postgraduate 122 (44.7) 6 (2.2)
Rank Staff Academic staff 76 (27.1)
Nonacademic 204 (72.9)
Staff category Senior 218 (77.3)
Junior 64 (22.7)
Years of employment 1–10 150 (80.2)
11–20 21 (11.2)
21–30 9 (4.8)
31–40 7 (3.7)
Level of study Student 1st year 162 (60.2)
2nd year 38 (14.1)
3rd year 25 (9.3)
Final year 36 (13.4)
Postgraduate 8 (3.0)
a

Total number of responses for each variable varied from the total number of respondents because of nonresponse.

Table 1

Sociodemographic data of staff and students of the University of Benin

In the event of LF disease, 13.78% of staff (n = 39) and 21.6% of students (n = 62) were either unsure or unwilling to accept an approved LF vaccine for themselves even when this becomes available Table 2. Neither will 12.7% (n = 36) staff nor 18.1% (n = 48) students willingly approve vaccination of their children against LF when available. Meanwhile, 14.2% (n = 41) staff and 22.9% (n = 65) students (n = 65, 22.9%) indicated that they would refrain from reporting the LF when it occurs in a family member.

Assessment of perception Responses Staff, n(%) Student, n(%)
Would you accept to take an approved vaccine? No 19 (6.7) 33 (11.5)
Yes 244 (86.2) 225 (78.4)
Not sure 20 (7.1) 29 (10.1)
Would accept a vaccine for your children? No 16 (5.6) 24 (9.1)
Yes 248 (87.3) 217 (81.9)
Not sure 20 (7.0) 24 (9.1)
Would you keep it secret if a family member contracted LF? No 248 (85.8) 219 (77.1)
Yes 19 (6.6) 26 (9.2)
Not sure 22 (7.6) 39 (13.7)
Would you buy from the shop of a recovered patient of LF? No 109 (38.2) 156 (55.7)
Yes 121 (42.5) 76 (27.1)
Not sure 55 (19.3) 48 (17.1)
Would you relate freely with a colleague who recovered from LF? No 33 (11.7) 66 (23.5)
Yes 206 (73.0) 149 (53.0)
Not sure 43 (15.2) 66 (23.5)
a

Total number of responses for each variable varied from the total number of respondents due to nonresponse.

LF = Lassa fever.

Table 2

Assessment of perceived level of stigmatization among staff and students of the University of Benina

Lassa fever-associated stigmatization was high among students (n = 162, 57.9%) than among staff members (n = 112, 39.9%). By contrast, more staff (n = 169, 58.9%) showed a low LF-associated stigmatization in comparison with students (n = 118, 41.1%) with a significant association of p < 0.0001 (not shown in Table 1). The perceived stigmatization among staff was not significantly associated with age, sex, level of education, knowledge, risk awareness, and risk perception Table 3. In contrast, LF-associated stigmatization among students was significantly associated with sex (p = 0.012) and knowledge (p = 0.013) of LF transmission and prevention Table 4. The result of knowledge of LF prevalence, transmission and predisposing factors as well as risk awareness and perception are presented in Table 5 and 6 respectively. In the study population, perceived LF-associated stigmatization was higher among female respondents than their male counterparts.

Respondents Category Perceived stigmatization 95% CI SE OR p


High, n (%) Low, n (%) Lower Upper
Age (years) Young adult 145 (90.6) 104 (88.1) 0.28 1.88 0.49 0.721 0.503
Adult 15 (9.4) 14 (11.9)
Sex Male 66 (40.7) 65 (55.1) 1.06 3.10 0.27 1.814 0.029
Female 96 (59.3) 53 (44.9)
Education Basic 132 (88.6) 95 (88.8) 0.58 3.54 0.46 1.44 0.431
Higher 17 (11.4) 12 (11.2)
Knowledge Good 28 (17.3) 9 (7.6) 0.18 0.99 0.44 0.42 0.048
Poor 134 (82.7) 109 (92.4)
Risk awareness High 74 (45.7) 49 (41.5) 0.48 1.42 0.27 0.84 0.518
Low 88 (54.3) 69 (58.5)
Risk perception High 149 (93.1) 109 (93.2) 0.35 2.58 0.51 0.95 0.921
Low 11 (6.9) 8 (6.8)
a

Total number of responses for each variable varied from the total number of respondents because of nonresponse.

CI, confidence interval; LF, Lassa fever; OR, odds ratio; SE, standard error.

Table 3

A bivariate logistic regression showing the test of association between LF-associated stigmatization and sociodemographics, LF risk awareness, perception, and knowledge among students of the University of Benin (n = 300)a

Respondents Category Perceived stigmatization 95% CI SE OR p


High, n (%) Low, n (%) Lower Upper
Age (years) Young adult 79 (73.8) 131 (78.9) 0.65 2.25 0.32 1.208 0.553
Adult 28 (26.2) 35 (21.1)
Sex Male 48 (42.9) 86 (50.9) 0.88 2.52 0.27 1.492 0.135
Female 64 (57.1) 83 (49.1)
Education Basic 15 (14.3) 16 (10.4) 0.27 1.32 0.41 0.591 0.199
Higher 90 (85.7) 138 (89.6)
Knowledge Good 91 (81.3) 130 (76.9) 0.42 1.49 0.32 0.795 0.476
Poor 21 (18.8) 39 (23.1)
Risk awareness High 70 (62.5) 119 (70.8) 0.74 2.25 0.29 1.287 0.377
Low 42 (37.5) 49 (29.2)
Risk perception High 104 (97.2) 158 (96.3) 0.18 3.16 0.73 0.752 0.697
Low 3 (2.8) 6 (3.7)
a

Total number of responses for each variable varied from the total number of respondents because nonresponse.

CI, confidence interval; LF, Lassa fever; OR, odds ratio; SE, standard error.

Table 4

A bivariate logistic regression showing the test of association between LF-associated stigmatization and sociodemographics, LF risk awareness, perception, and knowledge among staff of the University of Benin (n = 300)a

Respondents Staff, n (%) Students, n (%)
Knowledge of LF prevalence
Have you heard of LF?
  No 5 (1.7) 8 (2.7)
  Yes 290 (96.3) 289 (96.0)
  Not sure 1 (0.3) 3 (1.0)
What is the cause of LF?
  Virus 264 (87.7) 240 (79.7)
  Bacterium 13 (4.3) 12 (4.0)
  Animal 2 (0.7) 1 (0.3)
  Witches/wizard 1 (0.3) 3 (1.0)
  Not sure 14 (4.7) 34 (11.3)
What is the reservoir of LF virus?
  All rats 26 (8.6) 49 (16.3)
  Long nose rat 59 (19.6) 68 (22.6)
  House rat 5 (1.7) 8 (2.7)
  Mastomys rat 188 (62.5) 146 (48.5)
Can rat transmit LF to man?
  No 29 (9.6) 24 (8.0)
  Yes 233 (77.4) 242 (80.4)
  Not sure 19 (6.3) 27 (9.0)
Knowledge of transmission of LF
LF is transmitted through
Contact with blood/secretions of infected rat
  No 137 (45.5) 98 (32.6)
  Yes 164 (54.5) 203 (67.4)
Contact with urine/feces of infected rats
  No 99 (32.9) 96 (31.9)
  Yes 202 (67.1) 205 (68.1)
Eating bush meat
  No 250 (83.1) 248 (82.4)
  Yes 51 (16.9) 53 (17.6)
Eating rat meat
  No 243 (80.7) 201 (66.8)
  Yes 58 (19.3) 100 (33.2)
Exposure to infectious body fluid and secretion
  No 168 (55.8) 162 (53.8)
  Yes 133 (44.2) 139 (46.2)
Curses and spells
  No 282 (93.7) 283 (94.0)
  Yes 19 (6.3) 18 (6.0)
Sexual intercourse
  No 273 (90.7) 270 (89.7)
  Yes 28 (9.3) 31 (10.3)
Caring for LF patient
  No 201 (66.8) 233 (77.4)
  Yes 100 (33.2) 68 (22.6)
Inhalation of viral particles
  No 242 (80.4) 237 (78.7)
  Yes 59 (19.6) 64 (21.3)
Handling of corpses
  No 235 (78.3) 248 (82.4)
  Yes 65 (21.7) 53 (17.6)
Knowledge of respondents on the predisposing factors to LF
What factors predispose to LF?
Residence or visit to rural areas
  No 255 (84.7) 265 (88.0)
  Yes 46 (15.3) 36 (12.0)
Poor compliance to standard precautions
  No 139 (46.2) 180 (59.8)
  Yes 162 (53.8) 121 (40.2)
Traditional handling of corpses
  No 243 (80.7) 258 (85.7)
  Yes 58 (19.3) 43 (14.3)
Contact with persons infected with the disease
  No 148 (49.2) 185 (61.5)
  Yes 153 (50.8) 116 (38.5)
Eating of rodent
  No 244 (81.1) 243 (80.7)
  Yes 57 (18.9) 58 (19.3)
Insanitary disposal of waste
  No 199 (66.1) 189 (62.8)
  Yes 102 (33.9) 112 (37.2)
Which age group is at risk?
  Children 5 (1.7) 18 (6.0)
  Adult 6 (2.0) 1 (0.3)
  Elderly 1 (0.3) 2 (0.7)
  All age group 279 (92.7) 261 (86.7)
a

Total number of responses for each variable varied from the total number of respondents because of nonresponse.

Table 5

Knowledge of Lassa fever (LF) prevalence, transmission, and predisposing factors among respondents (n = 600)a

Response Staff, n (%) Students, n (%)
Risk awareness
Which age group is at risk?
  No response 9 (3.0) 18 (6.0)
  Children 5 (1.6) 18 (6.0)
  Adult 6 (2.0) 1 (0.3)
  Elderly 1 (0.3) 2 (0.7)
  All age groups 279 (93.0) 261 (87.0)
Is there currently an outbreak of LF in Edo State?
  No response 13 (4.3) 10 (3.3)
  No 37 (12.3) 39 (13)
  Yes 204 (68.0) 173 (57.7)
  Not sure 46 (15.3) 78 (26.0)
Have you heard, seen or know anyone who suffered from LF?
  No response 5 (1.7) 14 (4.7)
  No 225 (75.0) 224 (74.7)
  Yes 70 (23.3) 62 (20.7)
Are vaccines available for treatment?
  No response 6 (2.0) 8 (2.7)
  No 86 (28.7) 66 (22.0)
  Yes 108 (36.0) 94 (31.3)
  Not sure 100 (33.3) 132 (44.0)
Can LF be cured?
  No response 8 (2.7) 10 (3.3)
  No 204 (68.0) 140 (46.7)
  Yes 28 (9.3) 39 (13.0)
  Not sure 60 (20.0) 111 (37.0)
Risk perception
How do you feel about the possibility of LF infection?
  No response 12 (4.0) 6 (2.0)
  Very seriously 227 (75.7) 209 (69.7)
  Slightly serious 36 (12.0) 62 (20.7)
  Not very serious 25 (8.3) 23 (7.7)
How serious is LF?
  No response 8 (2.7) 7 (2.3)
  Very serious 249 (83.0) 230 (76.7)
  Slightly serious 27 (9.0) 43 (14.3)
  Not very serious 11 (3.7) 12 (4.0)
  Not sure 5 (1.7) 8 (2.7)
a

Total number of responses for each variable varied from the total number of respondents because of nonresponse.

Table 6

Assessment of Lassa fever (LF) risk awareness and perception among staff and students of the University of Benin (n = 600)a

4. DISCUSSION

The study reveals that there remains a potential for stigmatization against individuals with LF in Nigeria even as the current (2018) outbreak portends more challenges in the following years. The Nigeria Centre for Disease Control (NCDC) reported that the total number of confirmed and suspected cases was 175 from 19 states as of February 7, 2016 [32]. In comparison, 731 suspected and 275 confirmed cases have been reported from January 2018 to February 2019 [33]. Prompt health-seeking “behaviors” for the LF containment is influenced by psychosocial factors such as fear of self- or social-stigma. In consequence, fear of stigma or outright stigmatization will influence health-seeking behaviors and promote engagement in self-medication or other unorthodox therapeutic alternatives—thus hampering efforts at effective LF surveillance system. The public health implication is that the chain of LF infection is likely to be sustained because of ignorance of risk factors, which in turn leads to risky behaviors. Improved preventive practices and reduced social stigmatization to LF hinge on continued dissemination of accurate information on LF disease.

However, as postulated by Person et al. [22], a behavioral strategy that addresses the needs of a segment of the population at risk of becoming stigmatized and discriminated against is the best way of containing fear. However, this should be complemented by specific campaigns targeted at the other factions of the population with a high tendency to stigmatize. We also propose that education and communication campaigns be tailored to fill specific knowledge gaps on available therapeutics and strategy for support and reintegration of survivors into the social cycle.

Ribavirin has remained the drug of choice for decades, although uniform guidelines for use, dose, or duration of therapy remain a challenge [7,14,18,24]. This study shows LF-associated perception to acceptance of vaccination in the event of LF diseases as 13.8% of staff and 21.6% of students either will not or are unsure of accepting any vaccination against LF even when it becomes available. Staff (12.7%) and students (18.1%) were unlikely to allow their children to get immunized and accept such a vaccine in the event that they are affected by the disease. This may be attributable to the various side effects associated with the current Ribavirin therapy [14] or other factors. Ribavirin has been associated with many adverse effects such as hemolytic anemia, nausea, and vomiting, myalgia, fatigue, diarrhea, abdominal pain, headache, jaundice, skin rash, tachycardia, and thrombocytopenia—all of which are known to be reversible. Although the questionnaire did not ask specifically for perceived unacceptance, this may be linked with LF misinformation and associated social stigmatization.

Results of this study showed that female students were potentially more likely to stigmatize against LF patients than their male counterparts in the event of an LF infection. Conversely, a study on the psychosocial impact of scars due to cutaneous leishmaniasis by Bennis et al. [26] reported that more females than males were more vulnerable to self-stigma and often expanded the effects of social-stigma associated with the disease. They, however, did not find a significant association between self-stigma and sex or personal experiences. The findings of our study and those of Bennis et al. [26] may indicate that females are not only vulnerable to self-stigma but are also more likely to stigmatize against others in the event of an epidemic with the high social impact such as LF. This may be related to the level of self-consciousness in sub-Saharan Africa and accentuated by the cultural roles of females in domesticity and the high value placed on social acceptance. Hence, comprehensive campaigns should focus on dissemination of accurate information of LF transmission and prevention particularly among females may be a first step toward tackling perceived LF stigmatization.

Additionally, adequate and accurate information about knowledge, attitude, and practices associated with LF disease remains poor as indicated by several studies conducted in Nigeria [2931,3437], which is consistent with the finding of this study. In this study, a higher proportion of LF-associated stigmatization was observed among students (57.9%), which generally demonstrated poor knowledge (82.7%) of LF transmission and prevention. By comparison, knowledge of LF disease was good among staff (81.3%), and they also demonstrated a perceived lower level of social stigmatization (39.9%) to LF disease. Poor knowledge was found to be significantly associated with the level of perceived social stigmatization to LF disease (p = 0.013). This demonstrates a strong association between knowledge of LF disease transmission and prevention, and LF-associated social stigmatization. This finding is consistent with that reported by Des Jarlais et al. [21], who found a significant association between lower level of education and endorsement of a variety of stigmatization methods for the control of SARS and AIDS. However, the low level of education may simply reflect a generally poor knowledge about disease transmission and prevention.

5. CONCLUSION

The perceived stigmatization against LF in Nigeria is a grim reminder that the disease remains a public health threat. This study shows an association between perceived high level of LF stigmatization and poor knowledge of LF transmission. A comprehensive emergency response plan should incorporate accurate knowledge dissemination about the disease, its transmission, as well as available therapeutics as a first step toward tackling perceived LF stigmatization.

CONFLICTS OF INTEREST

The authors declare no conflicts of interest.

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Journal
Journal of Epidemiology and Global Health
Volume-Issue
9 - 2
Pages
107 - 115
Publication Date
2019/06/11
ISSN (Online)
2210-6014
ISSN (Print)
2210-6006
DOI
10.2991/jegh.k.190514.001How to use a DOI?
Copyright
© 2019 Atlantis Press International B.V.
Open Access
This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

Cite this article

TY  - JOUR
AU  - Stella Folajole Usifoh
AU  - Amienwanlen Eugene Odigie
AU  - Stephena Udinmande Ighedosa
AU  - Edwin Aihanuwa Uwagie-Ero
AU  - Isoken Tito Aighewi
PY  - 2019
DA  - 2019/06/11
TI  - Lassa Fever-associated Stigmatization among Staff and Students of the University of Benin, Nigeria
JO  - Journal of Epidemiology and Global Health
SP  - 107
EP  - 115
VL  - 9
IS  - 2
SN  - 2210-6014
UR  - https://doi.org/10.2991/jegh.k.190514.001
DO  - 10.2991/jegh.k.190514.001
ID  - Usifoh2019
ER  -