General Health and Medical Sciences, Vol(1), No (2), December, 2014. pp.

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Housing Factors and Transmission of Lassa Fever in a

Rural Area of South-south Nigeria
Ochei Oboratare *
Department of Community Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.

Abejegah Chukwuyem
Department of Community Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.

Okoh Emmanuel
Department of Community Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.

Abah Steve Obekpa

Department of Community Health, Ambrose Alli University, Ekpoma, Edo State, Nigeria.
*Corresponding author: dratare@yahoo.com

Keywords

Abstract

Housing
Factors
Transmission
Lassa fever

Background: Lassa fever is a severe hemorrhagic fever with devastating consequences that is transmitted via a virus from the
Mastomys rat which breed around human residences, to man. An alternate hypothesis is that household characteristicslike
housing quality and hygieneare associated with the occurrence of Lassa fever.
Aims: Assessment and comparison of housing quality and hygiene in two peri-urban settlements differentiated by the annual
incidence of Lassa fever. The study also assessed awareness and family history of Lassa fever in the preceding year of the
study.
Methodology: This was a descriptive cross sectional study carried out in two peri-urban settlements (Eguare and Ikekogbe) in
Irrua town of Edo State in 2012. Both communities are similar in terms of ethnicity and socio-economic developments but
differ in the incidence of Lassa fever: Eguare had 6-10 cases of Lassa fever per year while Ikekogbe had 0-1 case of Lassa
fever per year. Eguare has an estimated population of 911 and Ikekogbe 517. The sample size was obtained using the formula
for comparing two proportions. The minimum sample size for this study using this formula is 155 although a total population
survey was conducted. Information was obtained by Interviewer administered questionnaire with the head of each household
and in their absence; any household member above the age of 18years was interviewed. A checklist was used to elicit
information on quality and hygienic state of houses and its surrounding. One questionnaire and checklist per household was
administered.
Results: 7.7% of the households in Eguare reported a case of Lassa fever in the preceding year as against 1% in Ikekogbe (x2
=5.01, df=1, p=0.03). There was no difference in the housing quality between the two settlements (X2=6.469, df=2, P=0.091),
however there was a difference in hygienic state in the two settlements. 20.5% and 54.5% of households in Eguare had good
and poor hygiene respectively while 56% and 15.4% of households in Ikekogbe has good and poor hygiene
respectively(X2=43.796, df=2, P<0.000). This may account for the higher incidence of Lassa fever in Eguare.
Houses that had brick walls and ill-fitted roofs had higher risk of reporting cases of lassa fever with odds 2.212 (CI 10.7666.383), P=0.142 when compared to houses with brick walls and well-fitted roofs. Surrounding with foliage over growth had
higher risk of reporting cases of lassa fever with odds 1.455 (CI 0.532-3.980), p=0.465 well compared to houses with clean
surroundings. Houses that had household equipments, appliances, tools heaped up in the premises had higher risk of reporting
cases of lassa fever with odds 4.969 (CI 1.663-14.848), P=0.004 when compared to houses that had their tools neatly arranged
within the premises. The use of buildings for both residential and commercial purposes had higher risk of reporting cases of
lassa fever odds 11.425 (CI 3.080-42.371), p=0.000 compared to buildings that are purely residential. Houses that had poor
grade on the hygiene scores had higher risk of reporting cases of lassa fever 50.645 (13.718-186.973), p=0.000 compared to
houses that had good grade on the hygiene scores.
Conclusion: Poor hygiene and use of buildings for both residential and commercial purposes are likely risk factors for
transmission of Lassa virus in households. Cleaning up houses and surroundings should be seen as a way of controlling the disease.

Introduction
Lassa fever is a severe hemorrhagic fever that presents with fever, general weakness, headache, sore throat, muscle pain, cough, chest pain,
nausea, vomiting, diarrheoa, abdominal pain with or without bleeding. It can cause deafness which has psychosocial impact on the victim as well
as other multisystem complications [1]. The clinical features are similar to other febrile illnesses such as malaria and typhoid fever. In about 80%
of people infected the disease has mild or no symptoms [2].
The disease is caused by the Lassa virus which is transmitted by Mastomys genus (a multi-mammate rat) to man. Transmission by infected rats
occurs when man comes into contact with contaminated materials e.g. food, bedding and ingestion of contaminated rats [3]. The incubation
period is 6-21days [4].
It is an emerging disease with devastating and life threatening potentials. According to WHO statistics, an estimated 300 000-500 000 case and
5000 death occurs each year worldwide. The case-fatality rate as estimated by WHO is 1%-15% among hospitalized patients [5] within 14 days
of onset in fatal cases [5]. The prevalence of antibodies to the virus in the population is 8-52% in Sierra Leone, 6.4-55% in Guinea, and 7-21% in
Nigeria [2]. It affects all age groups; both gender and cut across all social class especially communities with poor housing and poor
environmental sanitation. It possibly can be used as an agent of Bioterrorism or Biological Warfare [5].
It affects all age groups; both gender and cut across all social class especially communities with poor housing and poor environmental sanitation.
It possibly can be used as an agent of Bioterrorism or Biological Warfare [5].
It is endemic and has epidemic potential in Sierra Leone, Nigeria, Guinea, Cote d Ivoire and Central African Republic. It is endemic in thirteen
states in Nigeria and endemic/epidemic in Esan area of Edo state where this study was conducted 4. Edo state accounts for the highest number of
cases in Nigeria.

Oboratare Ochei *, Chukwuyem Abejegah, Emmanuel Chuks Okoh, Steve Obekpa Abah

16

General Health and Medical Sciences Vol(1), No (2), December, 2014.

The Institution of Lassa fever Research and Control (ILFRC) Irrua Specialist Teaching Hospital (ISTH) Edo state was established in 2007,
primarily in response to the Lassa fever epidemic in Esan land, other parts of Edo State and neighboring states of Nigeria. It accounts for 1.6% of
all admissions in the hospital (ISTH) and 6% of febrile patients [4]. A total of 335 cases of Lassa fever have been confirmed and 100 deaths
reported (case fatality rate of 29.8%) in the institution between 2008 December 2011 though many remained undetected [4]. The case fatality
rate ranges from 18.3%-32.2% annually in ISTH [4] It is not constrained by age, sex, gender, social class, religion, race or ethnicity.
In the hospital setting, Lassa fever can be transmitted through the nosocomial route to patient and hospital staff which could lead to mortality
among the health care workers
One cost effective intervention known to prevent and control this disease is to terminate the route of transmission; the mastomys rats. Numerous
studies have shown that the rat breeds around houses, field crop and store food [2, 6, 7, 8, 11-13].
Earlier article published on Lassa fever epidemiology in Kenema, Sierra Leone found that rats in houses of infected people are seropositive for
the virus 10 times more often than those in control houses [2]. In another study in the eastern province of Sierra Leone, Mastomys spp.
comprised 5060% of rodents captured in houses and 1020% captured in surrounding agricultural and bush areas, suggesting that houses could
be an essential location for transmission of the virus [6]. In the same studies it was found that Mastomys natalensis does not move far from
houses where they have established residence [6]. Rodent populations in cultivated and fallow fields in Tanzania were sampled by trapping.
Mastomys natalensis was by far the most abundant rodent in these habitats (62% or more of samples) [11].
The odds of observing a rat burrow was higher in case than control houses (OR 24, 95% CI 6-93). In a study conducted to determine risk of
Lassa fever in households in Sierra Leonean refugee camps, case houses scored significantly worse in the quality of housing and external
hygiene [7]. In another study in north-west Liberia showed higher prevalence of indirect fluorescent antibodies (IFA) in Gbanwei, a roadside
village which did not maintain traditional sanitary measures, than in Zuwulo, similarly located but with maintenance of clean-swept areas
without shrubbery or rubble between the houses [12].
Fichet-Calvet, et al. conducted a study in Guinea to determine the prevalence of Lassa virus in Mastomys natalensis; the mean trapping of M.
natalensis was always higher inside houses than in proximal cultivations. Mean trapping of M. natalensis also increased 2-fold inside houses and
decreased up to 10-fold outside (p < 0.0001) in the dry season, suggesting aggregation of rodents inside houses due to restricted food supply.
53.5% (601/1123) of the animals were identified as M. natalensis using morphometric and molecular criteria while 14.5% (80/553) of M.
natalensis were tested positive for Lassa virus by reverse transcription-polymerase chain reaction [9].
McCormick, et al. (1987) found that houses with stores of food afford a perfect environment for rodents, where they can deposit virus-laden
urine on surfaces, such as eating utensils, beds, floors, and tables [8].
To effectively control Lassa fever, there is urgent need for exhaustive information on risk factors for the disease particularly those related to the
housing conditions and the application of the findings for the control of Lassa fever. We therefore compared the quality and hygienic states of
houses in a settlement with more cases of Lassa fever and another with few cases to determine if there is a difference in the quality of houses and
the hygienic states of houses located in these settlements. The study assessed knowledge of Lassa fever and family history of Lassa fever in the
preceding year. The null hypothesis is that there is no difference in the quality and hygienic factors of houses located in settlements where there
are more cases of Lassa fever and in settlements where there are fewer cases of Lassa fever.

Methodology
Study area
This study was carried out in Irrua a rural area endemic for Lassa fever. Irrua is the head quarter of Esan central local government area of Edo
state, Nigeria. Esan central is made up of four kingdoms namely: - Irrua, Opoji, Ewu, and Ugbegun. It occupies an area of 266.31sq.km and has
a population of 105311 people in 2006 [13]. The residents of this local government area are mainly; farmers [13]. The settlements are mainly
rural and the settlement pattern being mostly linear. Irrua has a teaching hospital, ISTH and a school of midwifery. Basic amenities, such as
piped water, electricity and good roads, are inadequate. The native language is Ishan [13].
Study population
The study was carried out in two settlements (Eguare and Ikekogbe) of Esan central of Edo state. Eguare has an estimated population of 911 and
6-10 cases of Lassa fever per year; Ikekogbe 517 and Ikekogbe 0-1 case per year [4]. The number of confirmed cases from these communities
was obtained from the Institute of Lassa fever Research and Control Irrua Specialist Teaching Hospital (ISTH). ISTH is an institute for
diagnosis, treatment, surveillance and research of Lassa fever in Nigeria [14]. The population size was obtained during the study and the number
of persons per household was counted.
Study design
A cross-sectional descriptive study in two populations.
Sample size
The sample size was obtained using the formula for comparing two proportions [15]. The minimal sample size for this study using this formula is
155 after adjusting for cluster or design effect although a total population study was carried out. Information was obtained from all households in
the study population since the difference between the calculated sample size and the total number of households in the settlement was minimal.
There are a total of 247 households; 156 households in Eguare and 91 households in Ikekogbe.
Sampling technique
In this study, a household is the sampling unit which was defined as a group of people living together and had common culinary arrangement
[16]. A total population study was done giving the minimal difference in total population and calculated sample size.
Inclusion criteria and exclusion criteria
All residential buildings were included in the study and purely industrial and commercial buildings were excluded from the study.
Data collection tools
A questionnaire and a checklist were designed to obtain information on the housing factors associated with lassa fever disease. One
questionnaire/checklist was administered per household. The questionnaire was to elicit information on personal data of the respondents,
awareness of Lassa fever, family history of Lassa fever and what type of health facility was the diagnosis made. The household members
interviewed were also asked for presences of rat in their houses. This information was obtained by the use of interviewer administered

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Housing Factors and Transmission of Lassa Fever in a Rural Area of South-south Nigeria
General Health and Medical Sciences Vol(1), No (2), December, 2014.

questionnaire to the head of each household and in their absence; any household member above the age of 18years was interviewed. The
checklist was adapted from Bonner et al. It was used to elicit information on quality/hygienic state of houses and its surrounding by either one of
the researchers or one of the research assistants (see Box 1). The sanitary state of the interior and external surroundings of each house was
determined using the criteria as showed in box 1. The roof of a house is said to be ill-fitted or porous if there is a gap between the wall and the
roof and well-fitted if there is no gaps between the roof and the wall. The assessment of a toilet as clean was based on the inspection of the
following: presences of protection round the toilet, a toilet cover over the toilet pot, absence of littered faecal matter on the floor of the toilet and
proper disposal of used toilet paper. The study took approximately four months September 2012- December 2012. A team of fifteen persons
were recruited base on familiarity with the community and language spoken and trained.
Box 1. Criteria Used to Score Housing Quality and House Hygiene in the two Studied Districts

Housing Quality
Good housing---lives in a solid brick house or solid mud, a flat, roof tight fitted and roof protective, no holes or cracks on the outside
walls, windows/doors present and protective and floor in good condition. No holes or cracks on the floor
Poor condition--- brick or mud had many cracks or holes greater than 10, a passage or corridor house, roof ill-fitted or porous, no
windows/doors. Floor was covered with mud earth.
Fair condition--- had some of good and poor housing qualities, 1-9 holes or cracks on the outside walls, holes and cracks on floor
House Hygiene
Good hygiene---clean environs, items neatly arranged, waste bin with cover, presences of protection round the toilet, a toilet cover
over the toilet pot, absence of littered faecal matter on the floor of the toilet and proper disposal of used toilet paper. Plumbing system
closed, all food items covered and no rat present.
Poor hygiene---foliage overgrown, refuse dump less than 30meters from the house, heap of wood/metals/equipment/grains/old house
items/spare parts neglected around dwellings and inside house, no garbage bin, no protection round the toilet, no toilet cover over the
toilet pot, presence of littered faecal matter on the floor of the toilet and no proper disposal of used toilet paper. Plumbing system open,
food items not covered and had rats
Fair hygiene--- had some of good and poor hygiene variables.
Data analysis
The SPSS version 16.0 was used for data validation and analysis. The x2 test was used in the test for association between awareness of Lassa
fever, confirmed cases of Lassa fever, type of houses, types of apartment, state of houses, state of windows, numbers of holes in houses,
arrangement of tools in the premises, surrounding of houses, bush burning per year, use of buildings interior organizations of houses, presences
of refuse bin, amounts of food item protected from rodents, location of kitchen, number of houses with rat, quality of houses and house hygiene
in the two settlements.
In assessing the quality of a house a total of twenty-one questions were employed. The maximum possible score for quality of a house was 73.
Those who scored 51-73 had good housing, those who score 44-50.9 had fair housing and those who score 0-43.9 had poor housing.
In assessing the hygienic state of a house a total of eight questions were employed. The total score for each house was calculated. The maximum
possible score for hygienic state of a house was 20. Those whose scores were greater than 14 had good hygiene. Those whose scores were 13.910 had fair hygiene and less than 10 had poor hygiene.
Ethical clearance
Ethical clearance was obtained from Ambrose Ali University Department of Community Health. Permission to carry out the study was also
obtained from the head of Irrua community. Verbal consent was obtained from all participants before interview process began.

Results
Table 1. Socio-demographic data of study participants
No of households in the settlements, n
Total population
Sex
Male, n (%)
Female, n (%)
Age in years
18-24, n (%)
25-34, n (%)
35-44, n (%)
45-54, n (%)
55-64, n (%)
65 and above n (%)
Education
None, n (%)
Primary, n (%)
Secondary, n (%)
Tertiary, n (%)
Occupation
Professional
Trading
Student
Artisan
Unskilled
Unemployed
Others (clergy, housewives etc)

p value (X2)

Eguare Households(n=156)
156
911

Ikekogbe Households (n=91)

91
517

64(41)
92(59)

43 (47.3)
48 (52.7)

0.341 (0.908)

31 (19.9)
48 (32.9)
31 (19.9)
18 (11.5)
17 (10.9)
11 (4.9)

17 (18.7)
25 (27.5)
15 (16.5)
15 (16.5)
15 (16.5)
4 (4.3)

0.301 (57)

19(12.2)
29(18.6)
70(44.6)
38(24.4)

10 (10.9)
21 (23.1)
30 (33)
30 (33)

0.241 (4.2)

15(9.6)
68(43.7)
29(18.7)
13(8.3)
11(7.2)
10(6.4)
10(6.4)

15(16.4)
29(32.1)
21( 23.2)
2(2.1)
13(14.2)
7(7.7)
4(4.3)

0.277 (23.24)

Oboratare Ochei *, Chukwuyem Abejegah, Emmanuel Chuks Okoh, Steve Obekpa Abah

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General Health and Medical Sciences Vol(1), No (2), December, 2014.

Table 2. Association between District Location and Housing Factors

Variables
Awareness of Lassa fever
Yes, n (%)
No, n (%)
Households that reported a case of Lassa fever
Yes, n (%)
No, n (%)
Type of houses
Brick with well-fitted roof, n (%)
Brick with ill-fitted roof, n (%)
Mud with well-fitted roof, n (%)
Mud with ill-fitted roof, n (%)
Type of apartment
Flat, n (%)
Passage house, n (%)
Corridor house, n (%)
State of the house
In good state, n (%)
In fair state, n (%)
In poor state, n (%)
State of windows
Present and adequate, n (%)
Present and inadequate, n (%)
No windows, n (%)
No of holes on houses
No hole, n (%)
1-4 holes, n (%)
5-9 holes, n (%)
>10 holes, n (%)
Surrounding of houses
Foliage overgrown, n (%)
Heaps of refuse, n (%)
Littered with refuse, n (%)
Clean, n (%)
Interior arrangement of household item
Heap of items seen, n (%)
Items scattered around, n (%)
Items neatly arrange, n (%)
Presences/states of refuse bin
No refuse bin (littered), n (%)
Bin full and overflowing, n (%)
Bin opened but clean, n (%)
Covered and clean, n (%)
Arrangement of tools in the premises
Heaps of tools seen, n (%)
Tools scattered around, n (%)
Tools neatly arranged, n (%)
Proportion of food items covered
All food covered, n (%)
Some food covered, n (%)
None covered, n (%)
Number of times surrounding bush is burnt in a year
None, n (%)
1-2, n (%)
3-4, n (%)
>5, n (%)
Use of building
Residential plus industry, n (%)
Residential plus trading, n (%)
Purely residential, n (%)
Location of cooking area
Main house, n (%)
Outside main house, n (%)
Sleeping room, n (%)
Number of houses with rats
Yes, n (%)
No, n (%)
Quality of houses score
Poor, n (%)
Fair, n (%)
Good, n (%)
Hygiene scores
Poor, n (%)
Fair, n (%)
Good, n (%)

Eguare Households (n=156) n(%)

Ikekogbe Households (n=91) n(%)

p value (X2)

146(93.6)
10(6.4)

84(92.3)
7 (7.7)

0.707 (0.147)

12(7.7)
144 (92.3)

1(1)
90(99)

0.03 (5.01)

82(52.6)
40(25.6)
9(5.8)
25(16)

42(46.2)
38(41.8)
5(5.5)
6(6.5)

0.026 (9.28)

69(44.2)
54(34.6)
33(21.2)

48(52.7)
21(23.1)
22(24.2)

0.135 (5.565)

83(53.2)
57(36.5)
16(10.3)

35(38.3)
47(51.6)
9(10.1)

0.057 (5.739)

88(56.4)
61(39.1)
7(4.5)

42(46.1)
41(45.1)
8(8.8)

0.183 (3.395)

97(62.2)
43(27.6)
11(7.1)
5(3.2)

43(47.3)
25(27.5)
12(13.2)
11(12)

0.009 (11.584)

43(27.6)
32(20.5)
18(11.5)
63(40.4)

34(37.4)
8(8.8)
21(23)
28(30.8)

0.005 (12.935)

30(19.2)
45(28.8)
81(52)

10(11)
34(37.4)
47(51.6)

0.156 (3.715)

98(62.8)
15(9.6)
22(14.1)
21(13.5)

46(50.5)
14(15.4)
22(24.2)
9(9.9)

0.072 (6.991)

50(32.1)
49(31.4)
57(36.5)

35(38.5)
40(44)
16(17.5)

0.006 (10.185)

121(77.6)
33(21.2)
2(1.2)

72(79.1)
17(18.7)
2(2.2)

0.783 (0.487)

88(56.3)
36(23.1)
16(10.3)
16(10.3)

31(34.1)
33(36.3)
8(8.8)
19(20.9)

0.003 (14.237)

9(5.8)
53(34)
94(60.2)

24(26.4)
17(8.7)
50(54.9)

<0.0001 (23.28)

71(45.5)
81(51.9)
4(2.6)

33(36.3)
58(63.7)
0(0)

0.085 (4.9)

122(78.2)
34(21.8)

72(79.1)
19(20.9)

0.866 (0.029)

21(13.5)
54(34.6)
81(51.9)

21(23.1)
23(25.3)
47(51.6)

0.091 (6.469)

85(54.5)
39(25)
32(20.5)

14(15.4)
26(28.6)
51(56)

<0.000 (43.796)

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Housing Factors and Transmission of Lassa Fever in a Rural Area of South-south Nigeria
General Health and Medical Sciences Vol(1), No (2), December, 2014.

Table 3. Multivariate Regression Analysis of Housing Factors with an impact on District that had higher Risk of Lassa fever
Housing Factors

Odds (confidence interval)

p-value

Reference group
2.212(0.766-6.383)
0.936(0.165-5.309)
0.324(0.067-1.569)

0.142
0.940
0.161

Reference group
2.403(0.825-7.001)
3.360(0.812-13.911)
3.054(0.594-15.687)

0.108
0.095
0.161

Surrounding of houses
Clean
Foliage overgrown
Heaps of refuse
Littered

Reference group
1.455(0.532-3.980)
0.192(0.054-0.678)
0.913(0.282-2.953)

0.465
0.010
0.879

Arrangement of tools in the premises

Tools neatly arranged
Heaps of tools seen
Tools scattered around

Reference group
4.969(1.663-14.848)
3.153(1.235-8.051)

0.004
0.016

Number of times surrounding bush is burnt in a

year
None
1-2
3-4
>5

Reference group
2.007(0.843-4.779)
0.669(0.168-2.672)
2.480(0.804-7.643)

0.116
0.570
0.114

Use of building
Purely residential
Residential plus industry
Residential plus trading

Reference group
11.425(3.080-42.371)
0.669(0.289-1.546)

0.000
0.347

Hygiene scores
Good
Poor
Fair

Reference group
50.645(13.718-186.973)
8.614(2.715-27.328)

0.000
0.000

Type of houses
Brick with well-fitted roof
Brick with ill-fitted roof
Mud with well-fitted roof
Mud with ill-fitted roof
No of holes on houses
No hole
1-4 holes
5-9 holes
>10 holes

In this study p-value was set at p < 0.05. There was no difference in awareness of the Lassa fever, types of apartment, state of houses, state of
windows, interior organizations of houses, presences of refuse bin, amounts of food item protected from rodents, location of kitchen, number of
houses with rat and quality of houses in the two districts. The p value is greater than 0.05 significant levels. However there was significant
difference in the number of confirmed cases of Lassa fever, type of houses, numbers of holes in houses, arrangement of tools in the premises,
surrounding of houses, bush burning per year, use of buildings and quality of hygiene in the two settlements.
It was found that 7.7% of the households studied in Eguare had a case of Lassa fever in the preceding year as against 1% in Ikekogbe.
There are more brick houses with well-fitted roof in Eguare (56.6%) than in Ikekogbe (46.2%). There are more mud houses with ill-fitted roof in
Eguare (16%) than in Ikekogbe (6.5%).
In both settlements only 36.8% of the immediate surroundings are absolutely clean however 40.4% of the immediate surroundings in Eguare are
clean while 30.8% of the immediate surroundings in Ikekogbe are clean.
In both settlements only 12.2% of the households have a clean, well-covered refuse bin while 58.3% of households do not have refuse bin. In
both communities collection and disposal of refuse is in adequate.
There is no statistical difference in the quality of houses in Eguare (51.9%) and Ikekogbe (51.6%) p=0.091, x2=6.469.
The quality of hygiene is better in Ikekogbe (56% has good hygiene) than Eguare (20.5% has good hygiene) p<0.000 x2=43.796.
Multivariate analysis was performed on only variables (housing factors) that show an association (using chi square test) with district that had
higher risk of Lassa fever disease. The result shows that houses that had brick walls and ill-fitted roofs had higher risk of reporting cases of lassa
fever with odds 2.212 ( CI 10.766-6.383), P=0.142 when compared to houses with brick walls and well-fitted roofs. Surrounding with foliage
over growth had higher risk of reporting cases of lassa fever with odds 1.455 (CI 0.532-3.980), p=0.465 well compared to houses with clean
surroundings. Houses that had household equipments, appliances, tools heaped up in the premises had higher risk of reporting cases of lassa
fever with odds 4.969 (CI 1.663-14.848), P=0.004 when compared to houses that had their tools neatly arranged within the premises. The use of
buildings for both residential and commercial purposes had higher risk of reporting cases of lassa fever odds 11.425 (CI 3.080-42.371), p=0.000
compared to buildings that are purely residential. Houses that had poor grade on the hygiene scores had higher risk of reporting cases of lassa
fever 50.645 (13.718-186.973), p=0.000 compared to houses that had good grade on the hygiene scores.

Discussion
This study has compared housing quality and hygiene in two settlements that are located within a large community. One of the settlements has
higher incidence of Lassa fever:-Eguare with 6-10 cases of lassa fever per year and the other district Ikekogbe has lower incidence with 0-1 case
per year. The hypothesis is that household housing quality and housing hygieneare associated with the occurrence of Lassa fever in the
household and could be used as screening tools to identify Lassa fever risk households [8].
It was found in this study that 7.7% of the households in Eguare have reported a case of Lassa fever in the preceding year as against 1% in
Ikekogbe. However there was no statistically significant difference in the quality of housing in the two settlements studied. This also was not in

Oboratare Ochei *, Chukwuyem Abejegah, Emmanuel Chuks Okoh, Steve Obekpa Abah

20

General Health and Medical Sciences Vol(1), No (2), December, 2014.

line with the study in Sierra Leone in which the quality of housing had statistically significant difference on the risk of disease after adjusting for
presence of rat burrows [8].
In this study housing hygiene was associated with the disease. The settlement with higher cases of lassa fever had poorer hygiene compare with
the one with fewer cases. 54.5% of households had poor hygiene in Eguare while 15.4% of households have poor hygiene in Ikekogbe. This has
further strengthened the study carried out by Bonner et al that the poorer state of houses the increase risk for rodent infestation and for
transmission of Lassa virus in the houses immediate surroundings. The use of houses for both residential and commercial purposes also had
increase risk for transmission of lassa fever disease; 34% of the houses in Eguare are used as residential and commercial purposes while 8.7% of
the houses in Ikekogbe are use for residential and commercial purposes.

Conclussion
Poor hygiene and use of buildings for both residential and commercial purposes are likely risk factors for transmission of Lassa virus in
households. Cleaning up houses and surroundings should be seen as a way of controlling the disease.
Acknowledgements: Dr. Alphonsus O. Aigbiremolen

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