Nigeria recorded a surge in the spread of Lassa fever in 2023, with the National Centre for Disease Control and Prevention (NCDC), raising alarm about its persistence. However, despite the severity of the disease and its dangerous trait, The ICIR findings revealed, that with the lack of state ownership, underfunding, poor release of funds, and lack of preparedness, Nigeria may continue to be plagued with the disease.

Living in a modest home with his family, in Guyaba, Kirfi LGA, of Bauchi state, Dauda Abdulkadir never imagined that a seemingly ‘innocuous’ rat could be deadly.

Although he, alongside his family members, often cut out the portion of food that rats had bitten and sometimes put their pots of soup away from reach, they were unaware of the true danger of consuming rat-contaminated food.

He says he occasionally would buy sniper to kill the rats when their numbers multiplied and their presence became a nuisance.

It was not until 2023 that his wife ran a fever, was vomiting, and had severe diarrhoea, that he thought a ‘drug’ from a makeshift shop in their locality would solve the problem, but that was their first mistake. 

For weeks, they tried to manage the illness, but eventually, took her to the Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) when her body had deteriorated and had lost weight due to the illness.

“I noticed a fever that wouldn’t go away for weeks,” he recalls. “By the time we reached the state hospital, the doctors, after several tests, diagnosed the disease to be Lassa fever. I had never even heard of it before,” he narrates.

Lassa fever is a deadly viral hemorrhagic illness that lowers the platelet count in the blood and its ability to clot, causing internal bleeding.

“She was instantly admitted and they made me and my children undergo a test but luckily we were negative. The doctor said we were so lucky(sic),”he notes.

Abdulkadir added that he witnessed how his wife went through a very severe pain that he would not wished on his enemies.

“So, some days later. My wife was proclaimed dead. She only spent 14 days at the hospital,” he narrates. 

Lassa fever is primarily transmitted to humans via contact with food or household items contaminated with urine or faeces from Mastomys rats. Though to a lesser extent, secondary human-to-human transmission can also occur through direct contact with infected persons’ blood, secretions, organs, or other body fluids, especially in health-care settings, according to the World Health Organization (WHO).

The WHO notes that despite increased capacity for preventing and controlling Lassa fever, including enhanced surveillance, diagnostic, and treatment capabilities, several factors continue to elevate the risk.

These factors include a rise in confirmed cases, surveillance gaps, inconsistent subnational response capacities, delays in sample shipments for laboratory testing, and chronic underfunding.

Also, The ICIR findings reveal a link between the surge in Lassa fever cases, the insufficient budgetary allocations from state governments, and the lack of effective advocacy. 

Outbreak in 2023

The endemic disease has continued to endanger lives not only in Bauchi but in at least 27 other states. The disease is known to be endemic in other African countries, including Benin, Ghana, Guinea, Liberia, Mali, and Sierra Leone, among others according to WHO.

Although about 80 per cent of those infected have no symptoms and do not get very ill, the death rate among those who end up in hospitals is 15 per cent.

In 2023, Nigeria recorded over 1,000 confirmed cases of the disease, with the National Centre for Disease Control and Prevention (NCDC), raising alarm over the surge in the reported cases.

Data from NCDC shows that 9,155 suspected cases were reported, of which 1,270 cases were confirmed to be Lassa fever cases in 2023.

The cases were reported largely among youths of the 21-30 age group across 28 states and 124 local government areas. 

Seventy-six per cent of all confirmed Lassa fever cases were reported from three states, which are Ondo, Edo, and Bauchi. 

Specifically, Ondo accounted for 34 per cent of the confirmed cases, having reported 433 confirmed cases out of the 2,665 suspected cases and Edo, which comes second on the list with 27 per cent, 349 confirmed of the 3,482 cases.

Bauchi accounted for 15 per cent of the confirmed cases, having reported 194 confirmed cases out of 1,048.

The remaining 24 per cent of cases were reported from 25 other states, including Taraba and Ebonyi, with confirmed Lassa fever cases.

Comparing the cases recorded to 2022 data, the country, between January, to December, reported a cumulative number of 8,207 suspected cases of Lassa fever with 1,067 confirmed cases, and 189 (17.7 per cent) deaths across 27 states. 

This shows an increase in the disease in 2023, which according to NCDC, is unprecedented.

Outbreak so far in 2024

Meanwhile, despite the alarm raised by the Centre, Nigeria between January to May 5, has reported 6,106 suspected cases, of which 869 were confirmed to be Lassa fever.

By this period in 2023, the suspected cases reported stood at 5,218 and confirmed cases at 929, meaning that there was an increase in the number of reported cases compared to the 2024 data.

This shows that Nigeria may as well report another unprecedented figure by the end of the year if the trend continues.

Sixty-three per cent of all confirmed cases were reported from Ondo, Edo, and Bauchi states, with Ondo accounting for 24 per cent, Edo for 22 per cent, and Bauchi for 17 per cent of the cases. The remaining 37 per cent of confirmed cases were reported from 25 other states.

Budget gaps, lack of state ownership

Besides all states failing to meet the Abuja declaration of 15 per cent budgetary allocation for health, most of the states including the most plagued states failed to make ‘significant’ budget provisions for tackling Lassa fever and epidemic preparedness in their 2024 budgets.

This, experts, bemoaned and described as a lack of proactiveness from states’ governments.

The ICIR reports that following the COVID-19 pandemic that ravaged the entire country, states have been charged, by the Global Health Advocacy Incubator (GHAI), to provide budget lines for epidemic preparedness and response. 

However, only Kano and Lagos states have created a line item to tackle and prepare for epidemics, as of 2023.

In 2020, Kano created a budget line for epidemic preparedness and response in the 2021 fiscal year, totaling N300 million and allocating two million naira each toward strengthening preparedness in the 44 local government areas in the state.

The funding increased by 33 percent for 2022 to N400 million as Lagos allocated N26.9 billion for the Public Health Services and Emergencies for 2022.

Given the spread of the disease, across the country, particularly Ondo, Edo and Bauchi, The ICIR check shows that the three states, which had reported 76 per cent of the total confirmed cases in 2023 earmark less than N50 million each for the disease, thereby relying completely on foreign donor and federal government intervention.

In Ondo, the state government in the 2024 fiscal year budgeted a total of N35 million for Lassa fever and related epidemic diseases, translating to 0.096 per cent of the total state budget for health (N36.5 billion).

Similarly, the Edo state government allocated N33.6 billion (9.8 per cent) out of the total state budget of N342.8 billion. However, the state only earmarked about 0.203 for Lassa fever surveillance and control.

This was as both Bauchi and Taraba also allocated 0.4 per cent and 0.28 per cent for the related projects.

Other challenges with the country’s budget allocation

Although Nigeria has experienced improved funding for health allocations in the past few years, the budget still falls short of the Abuja declaration’s target of allocating at least 15 per cent of the total allocation to the health sector.

In 2024, of the N28.7 trillion’s country budget, only N1.3 trillion, translating to 4.64 per cent was budgeted to the health sector.

The inadequate amount of money earmarked for Nigeria’s health sector has been compounded by the failure to fully utilise the allocated funds and constraints, such as low budget revenue, and restricted fiscal space for additional expenditure.

According to data from the Office of the Accountant General of the Federation and the Budget Office of the Federation quoted by Nigeria Health Watch, capital allocation for the Federal Ministry of Health and Social Welfare (FMoHSW) increased by 139.78 per cent, rising from N86.49 billion in 2018 to N207.40 billion in 2022.

However, the percentage of utilised released capital has decreased over the same period, dropping from 96.76 per cent in 2018 to 60.84 per cent in 2021, and further down to 47.74 per cent by the third quarter of 2022.

This means that despite a significant increase in the money earmarked for the sector, the capital release has continued to reduce, with the money being returned to the federation account at the end of each fiscal year.

This, the health experts, said could be attributed to late budget release and complexity in the procurement process.

Poor awareness 

For some of the rural communities in Nigeria, access to health care, sanitation, and economic hardship are some of the major public health challenges.

Due to limited resources communities affected by infectious diseases tend to care for the sick at home, with limited knowledge of the diseases. 

Like Abdulkadir, Amadi Guyaba’s household knew nothing about the disease until in 2023, when he contracted the disease himself.

According to him, members of the town were unbothered about eating food contaminated by animals as long as they cut out the affected portion. But since the outbreak of the disease in the area, they have become more aware of the risks.

He, however, said there was little he and the community leaders could do,  noting that before the outbreak, they received no government officials in the state to sensitise the populace about the disease.

Expert weighs in

Kano state Legislative Advocacy Initiative for Sustainable Development Goals (LISDEL) coordinator, Suleiman Muhammad, last year raised concerns over the issue of the state government not releasing the actual money budgeted for healthcare, noting that there would have been more improved healthcare delivery if the money were being released appropriately.

He also decried the lack of prioritisation of epidemic preparedness and disease control in the states’ budget, adding that despite the civil society organisations and concerned stakeholders’ clamour, many states are still not earmarking for the epidemic.

According to him “A budget is always a proposal of what’s expected from the revenue generation, at times it takes the whole year advocating for a single release. The Government mostly has some priorities from the physical structures and all that.”

Also, speaking with The ICIR, a public health physician and the founder of Quinta Health, Adewumi Enoch, posited that inadequate health infrastructure, poor sanitation or lack of proper WASH facilities, low awareness, and inadequate vaccination coverage are among the major reasons Nigeria grappled with recurrent diseases.

“Gaps in immunisation programmes leave individuals susceptible to vaccine-preventable diseases. They also contribute to disease outbreaks. A lack of public awareness about disease prevention and health practices can also hinder efforts to control diseases,” he added.

This report is supported by The Nigeria Health Watch.