Impact of Missed Diagnoses: The High Cost of Late Lassa Fever Recognition in Nigeria

Earlier this year, Musa experienced common symptoms—fever, headache, and stomach discomfort—while in Bauchi State. According to a statement from Doctors Without Borders (MSF), he received treatment for malaria at a private clinic and was sent home after five days.

However, his condition deteriorated further.

"They couldn't determine what was wrong with me," he recounted.

Eventually, a community outreach team directed him to the Lassa Fever Treatment Centre at the Abubakar Tafawa Balewa University Teaching Hospital, where he was diagnosed with Lassa fever—by then his health had severely declined.

“I thought I wouldn’t make it,” he shared.

Musa underwent 29 days of treatment before his recovery. His story exemplifies a broader issue in Nigeria's disease detection framework, where Lassa fever symptoms are commonly mistaken for malaria or typhoid, resulting in delays that can be fatal.

A disease that ‘disguises itself’

The initial signs of Lassa fever—fever, fatigue, and headaches—are significantly similar to those of malaria and typhoid, complicating timely diagnosis.

"Lassa fever tends to disguise itself," explained Ayokunnu Raji, MSF’s emergency medical programme manager, during a statement.

He added, "At first, the symptoms closely mimic those of many prevalent illnesses… thus, by the time numerous patients reach our treatment facility, they are critically ill."

The Nigeria Centre for Disease Control (NCDC) stresses that early detection and laboratory verification are pivotal in decreasing the mortality rate associated with Lassa fever outbreaks. Concurrently, the World Health Organisation (WHO) states that laboratory testing is crucial for confirming Lassa fever diagnosis, as clinical symptoms alone are not adequate due to their similarity with other conditions.

!A doctor administers treatment to a Lassa fever patient at the MSF-supported facility in Abubakar Tafawa Balewa University Teaching Hospital, Bauchi. (CREDIT: MSF)

Increasing cases, escalating dangers

Nigeria is presently dealing with a serious Lassa fever outbreak. The NCDC has reported 146 fatalities linked to Lassa fever from January to mid-March, with the case fatality rate (CFR) reaching 25.1 percent, which is notably higher than the 18.7 percent documented during the same period last year.

Healthcare professionals are increasingly at risk as well. The NCDC indicated that 38 healthcare workers have contracted the disease this year, which MSF notes is more than double the number reported in the comparable timeframe last year. In February, three MSF staff members were infected, with one fatality.

Fear, stigma, and late visits

In addition to clinical obstacles, fear and misinformation about Lassa fever are also significant barriers to timely care. In several communities, this disease is poorly understood and often misattributed to spiritual causes.

“At the start, people fled from me. They were afraid to approach… they believed it was a curse,” Musa recounted.

MSF has noted that stigma and myths can deter individuals from seeking immediate medical assistance, leading some to initially approach alternative healthcare providers instead of formal medical facilities. To counteract this, outreach initiatives are actively engaging community leaders, religious leaders, and local health workers to enhance awareness and promote early referrals of suspected cases.

Challenges after survival

Recovering from Lassa fever does not necessarily signify the end of its repercussions. MSF reports that some survivors might face prolonged issues, including hearing loss and neurological complications. Additionally, survivors might temporarily harbor the virus post-recovery, raising the risk of further transmission.

In response, MSF offers continuous care through survivor clinics, encompassing medical follow-ups, mental health support, and education on minimizing the risk of transmission.

A recurring health crisis

Lassa fever persists as an endemic issue in Nigeria, with seasonal outbreaks typically observed from October through April. Although case numbers might reduce as the dry season concludes, the fundamental challenge remains: initial symptoms that resemble common illnesses, inadequate laboratory testing protocols at the outset, and delays in patient referrals.

Public health authorities assert that bolstering early detection, testing, and primary diagnosis will be essential in curbing preventable deaths. For Musa, this message resonates deeply.

“I urge individuals not to presume it’s just malaria,” he stated.