CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
The World Health Organization (WHO, 2021) defines viral Hemorrhagic fevers (VHFs) as a class of diseases that are susceptible to outbreaks and are brought on by a variety of different virus families. These extremely infectious viruses lead to potentially life-threatening disease states marked by high body temperatures, lethargy, vomiting, mucosal and gastrointestinal (GI) haemorrhage, edema, and low blood pressure (Piggott, 2021). While some VHFs only cause comparatively minor illnesses, others can have severe, even fatal effects. For the majority of VHFs, there is presently no known treatment or vaccine (Centers for Disease Control, 2021).
The viruses involved in viral hemorrhagic fever are classified into 4 related families: Arenaviridae (Argentine, Bolivian, Brazilian, and Venezuelan hemorrhagic fever; and Lassa fever); Bunyaviridae (Hantavirus genus, Congo-Crimean hemorrhagic fever (CCHF) of Nairovirus genus, and Rift Valley fever virus of Phlebovirus genus); Filoviridae (Ebola and Marburg viruses); and Flaviviridae (dengue and yellow fever). The diseases they cause are grouped by viral family (Blumberg et al., 2014; Magnat, 2022).
Although VHFs are caused by several virus families, these viruses share some common features. All HF viruses are small, single-stranded RNA viruses with lipid enveloped membranes (CDC, 2021; Cobo, 2023). Other common elements are that they exist naturally in animal or insect populations, known as host populations, and generally in geographic areas where host species live (Blumberg et al., 2014; CDC, 2021).
They spread to humans when they come into contact with an infected animal or insect host. Exposure to the urine, feaces, and other substances of infected rodents can lead to human infection. People can also become infected with VHF through mosquito or tick bites, or even through crushing an infected tick. In some cases, it is unclear how people are infected.
Additionally, some types of VHF viruses - including Ebola, Marburg and Lassa - can be passed from person to person. They are spread through bodily fluids or through direct contact with an infected individual. People can also become infected through contact with contaminated objects such as needles or syringes (Minnesota Department of Health, 2022; CDC, 2021).
Globally, there is an increasing concern over the incidence and recurrence of viral hemorrhagic fever. VHFs put a larger portion of the world's population at risk. VHF outbreaks in humans can be difficult to prevent because they can occur sporadically and are not easily predictable (CDC, 2021). They cause large-scale epidemics and create critical situations that can disrupt the normal life of residents, businesses or social structures. The latter is more common in poor African countries, especially in the tropics; natural niche of these microorganisms (Ftika and Maltezou, 2013).
Hemorrhagic fever is now understood to be caused by numerous viruses, including Ebola, Marburg, and yellow fever in Africa. Lassa has a moderate case fatality rate compared to the filoviruses Ebola and Marburg, which can cause epidemics and have high fatality rates (Gomez and Anderson, 2022).
On March 23, 2014, the World Health Organization (WHO) reported an outbreak of Ebola Virus Disease (EVD) in the forested rural region of southeastern Guinea. The detection of these first cases marked the outbreak of the West African Ebola epidemic, the largest in history. This has raised international alarm due to severe symptoms, high mortality rates, and the threat of pandemic or epidemic spread associated with large-scale migration to disease-free African and European countries (CDC, 2019).
In Nigeria, viral Hemorrhagic fevers are a significant cause of morbidity and mortality. They have been responsible for thousands of deaths of Nigerians over the years. Six Hemorrhagic fever (HF) viruses, including: yellow fever virus, Lassa fever virus, dengue virus, Ebola virus, Rift valley fever virus, and Crimean-Congo Hemorrhagic fever virus, have been identified in the nation (Fagbami and Onoja, 2018).
However, only 4 of these have contributed to Hemorrhagic fever in Nigerians. Yellow fever and Lassa fever viruses were responsible for majority of the epidemics and deaths (WHO, 2012; Oladejo et al., 2016), while dengue and Ebola viruses (DENVs) have caused sporadic outbreaks affecting a small number of patients (Folarin et al., 2016; Onoja et al., 2016). No cases of Hemorrhagic fever caused by Rift Valley fever or Crimean Congo hemorrhagic fever virus have been reported so far in Nigeria (Fagbami and Onoja, 2018).
With the current high global disease burden and associated lethality, management of VHF relies primarily on strict adherence to recommended precautions, which are primarily avoidance of contact with susceptible species and administration of vaccines. It is important to note that there are no vaccines to prevent these diseases, except for yellow fever and Argentine hemorrhagic fever, for which vaccines have been developed (WHO, 2021).
However, the effectiveness of these measures largely depends on the public's knowledge, attitudes and risk perception. Ultimately, an individual's knowledge, attitude, and risk perception are key to influencing decisions regarding risky behavior, as people with low risk behaviors tend to reduce preventive behavior, while people with higher risk perceptions engage in preventive behavior.
It is not clear how much Nigerians know and understand the risk of viral hemorrhagic fever. It is therefore imperative to conduct knowledge and risk perception surveys on viral hemorrhagic fever in Nigeria. Hence, the purpose of this study.
1.2 Aim of the Study
The study is aimed at assessing the level of knowledge and risk perception of viral Hemorrhagic fevers in Nigeria.
1.3 Objectives of the Study
The study had the following specific objectives:
- To investigate the knowledge of Nigerians on the source of viral Hemorrhagic fevers.
- To assess Nigerians' understanding of the mode of transmission of viral Hemorrhagic fevers.
- To determine how much of a danger, the disease is perceived to pose.
1.4 Statement of the Problem
The goal of disease prevention is to lessen the burden of illness and associated risk factors through targeted measures that are both population- and person-based for primary and secondary (early detection) prevention (European Commission, 2021). Although the World Health Organization estimates that 80% of diseases are preventable, a large proportion of the world's population still die from disease infections (WHO, 2017). This is partly due to the lack of knowledge and understanding of the risk of the disease.
Good knowledge, and risk perception which refers to the way the diseases is understood/interpreted, is important in predicting an individual's response to an infection occurring in their own lives as well as the lives of others. Understanding people's perceptions of viral hemorrhagic fever is important because perceptions can act as triggers for precautionary measures, engaging in preventive health behaviors, and reporting suspected VHF cases.
However, there is a paucity of studies that assess the knowledge and understanding of viral hemorrhagic fever among Nigerians.
1.5 Justification of the Study
Although knowledge and risk perception studies have been conducted on VHF in Nigeria, these studies focused only on Lassa fever as part of the epidemic response and not on VHF in general. Therefore, this study aims to investigate the general knowledge and risk perception of viral hemorrhagic fever among Nigerians.
The findings of this study will be useful for students, teachers, health professionals, and policy makers in government and related parties to develop policies to help prevent the disease and promote health. Finally, the analysis presented in this study will convey important information for future research.
1.6 Scope of the Study
The scope of the study covers the knowledge and risk perception about viral Hemorrhagic fevers in general among Nigerians. Data for the study will be obtained from Nigerians, aged 18 years and above in the 36 states of Nigeria and the Federal Capital Territory.
