FEATURES: Rise in Monkeypox infection troubling Nigeria’s rural population
In this features, KELECHUKWU IRUOMA goes into the rural communities of Bayelsa State, south-south Nigeria to uncover the plight of residents plague with monkey pox disease, and the challenge of authorities to deal with it.
On a sunny afternoon in April 2021, Desmond Ere, 45, had just had his bath when his body began to itch.
Ere, who owns an online fashion store, thought his itchy skin would stop. But it didn’t.
“At first, I thought it was a waterborne disease because I started experiencing skin changes in the form of rashes,” he said.
Whenever he poured warm water on his body, he would be relieved for some minutes, but the itching would begin again.
When he could no longer bear the discomfort, he approached a chemist in Yenagoa, the capital of Bayelsa State in the Niger Delta, where he lives. He was told he had contracted Chicken Pox.
“They gave me some drugs for Chicken Pox and said I would be given an injection for five days,” he said. “Three days after I received the injection, there was no improvement,” he said.
Ere managed to complete the dose of the injection. Then the symptoms became severe. His entire body broke out in a rash. His head and face were swollen. He had to shave his hair.
Some of his family and friends told him the illness was spiritual. They suggested he seek traditional medicine to treat himself. They contributed money and got a traditional medicine, which cost N25,000, and asked Ere to take it. But he refused and said he would rather go to the hospital.
In late April, Ere met a doctor who instructed him to go to the Community Medicine and Public Health Department of the Federal Medical Centre, Yenagoa, where he would meet Doctor Stella Rotifa, a public health physician, who would help find out what the problem was.
At this stage, Ere became afraid of what was happening to him. He could not stand nor sit properly. He had to use a walking stick. Each time he had to use the bathroom, he was always restless.
When he got to the hospital, Rotifa observed his body and asked him some questions after which she took his blood samples and carried out a clinical laboratory test to find out what was wrong with him.
When the result came out, it was discovered that he was positive for Monkeypox.
“It was at this point that Rotifa started giving me the right drugs to take,” he said. “She would give me drugs that would serve me for one week because I was coming for treatment from home.”
Monkeypox situation in Nigeria
Monkeypox is a viral infectious disease that jumps from a non-human animal to humans and primarily occurs in rainforest areas of Central and West Africa. Typically, it comes with rashes, fever, and swollen lymph nodes. While it is mostly transmitted to people from wild animals, human-to-human transmission also occurs.
The virus is transmitted from one person to another by contact with lesions, body fluids, respiratory droplets, and contaminated materials such as bedding.
Data from the Nigeria Centre for Disease Control (NCDC) website revealed that between 1971 and 1978, ten human Monkeypox infections were reported in Nigeria. While three were laboratory-confirmed – two in 1971 and one in 1978.
However, between September 2017 and June 2021, Nigeria has had a surge in the number of suspected Monkeypox cases – 466 out of which 205 were confirmed. Out of the confirmed cases, there were 88 in 2017, 49 in 2018, 47 in 2019, 8 in 2020, and 13 in 2021.
There have been eight deaths from the disease since September 2017.
The number for 2021 is likely to be an under-representation because many people are said to have been avoiding healthcare facilities for fear of contracting COVID-19 disease.
A rare disease
A report from the Centre for Disease Control says Monkeypox is a rare zoonotic infection having been identified first in humans in the Democratic Republic of Congo back in 1970 during a period of effort to eliminate smallpox.
This was after the virus was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name ‘monkeypox.’
The first time that a case was reported in Nigeria was in 1978, when a 4-year-old child living in the southeastern part of the country fell ill with the disease, according to the NCDC.
It only came up again thirty-nine years later on September 22, 2017, when a suspected case was reported to the Nigeria Centre for Disease Control (NCDC).
It can easily be confused with other rash illnesses such as smallpox, chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies which makes it difficult to diagnose it easily.
Failure to detect and report on time will result In the further spread of the disease, which may cause death in at least one in 10 of those infected. The disease can spread quickly.
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Enugu State Epidemiologist, Dr. Chinyere Ezeudu, said that transmission of monkeypox virus occurs when a person comes in contact with the virus from an animal, human, or materials contaminated with the virus.
She explained that human-to-human transmission results from close contact with infected respiratory tract secretions, skin lesions of an infected person, or objects recently contaminated by patient fluids or lesion materials.
“Household members of a person infected with the virus also have a very high risk of infection through droplet respiratory particles during prolonged face-to-face contact,” she said.
She advised that people who are caring for patients should wear gloves and face masks to avoid any direct or droplet contact, adding that the symptoms of the virus include fever, headache, muscle aches, and swollen lymph nodes.
To treat the virus, smallpox vaccination should be administered within two weeks of exposure to monkeypox.
Studies suggest that people vaccinated against smallpox have about 85% chance of being protected from monkeypox and that is because smallpox and monkeypox are closely related.
Every Tuesday of the month, Ere would go to the FMC for drugs and gradually, he started healing.
“I took it for the entire one month and I also had other antibiotics I was taking too,” he said.
He finally regained himself in early June when his drugs finished.
“Rotifa told me there was no need to keep coming.”
Out of pocket spending
For the entire one-month period he took his medication at FMC, Ere spent N10,00 daily because he had a drug he was taking every 2 hours which cost N2,500 per dose.
While it was easy for Ere to access healthcare due to the financial support from his family and friends, many symptomatic patients in Nigeria cannot afford to pay their bills.
“They fail to come for diagnosis and treatments,” said Oyaba Diemebonso, disease surveillance and notification officer in charge of Yenagoa LGA.
According to Diemebonso, treatment for Monkeypox, like other infectious diseases, which should be free is not in Bayelsa State and this is because the state government has not taken up that responsibility of paying bills for patients.
When the monkeypox virus broke out in 2017, the state government provided free treatment and that encouraged more positive patients to go for treatment. But now, people hardly present themselves, even when they are symptomatic.
“There ought to be a designated treatment center where patients will not have to pay for treatment, unlike the one we have at the Niger Delta University Teaching Hospital, Okolobiri where patients are made to pay,” Diemebonso said.
Difficulty in accessing treatment
He explained that the funding for Monkeypox ought to be tripartite, coming from the federal, state, and local governments. While the federal government is doing its best in terms of making funds available, the state and local governments are not doing enough.
Diemebonso and other disease surveillance and notification officers in the state have been trying to improve surveillance and response as well as raise awareness about the monkeypox virus and how to access treatment across Bayelsa State communities. With little funding support, there is only little they can achieve.
“How can we possibly do our surveillance across communities, send messages and do reports when we are not provided with enough financial support?” Diemebonso asked.
He said that a letter signed by all DSNOs, pointing out their challenges and demands had been written to the commissioner for health in the state. But nothing has been done about it.
He also said that the deputy governor had instructed Local government chairmen in the state to give DSNOs N20,00 monthly as a stipend. But since March when the instruction was given, some LGAs have refused to do that.
Challenges in tracing, diagnosis and treatment
Dr. Ezeudu said apart from lack of adequate funding, another major challenge associated with Monkeypox is that of stigmatization, which often makes it difficult for victims to present themselves at the hospital.
“Victims of Monkeypox often have big rashes all over their body, hence they resort to home management and that increases the risk of further spread of the disease which is highly infectious, “she said.
She however suggested that the best way to deal with the challenge of stigmatization would be for improvement in the sensitization and education of people on the need to always present themselves for treatment.
She explained that another challenge lies with the fact that although laboratories exist across the country, not all of them have the capacity for Monkeypox diagnosis which is specialized.
“Most often, we take our samples to the National Reference Laboratory in Abuja where it can be diagnosed and that takes time because we must transport the samples and wait for them to be checked and results produced,” she said.
She said that people must avoid contact with wild animals, especially monkeys and others known to be sources of monkeypox virus include apes and a variety of rodents (including rats, mice, squirrels, and prairie dogs) and rabbits as well as avoid eating any meat from such animals.
She further said that there was a need for the government to improve the capacity of laboratories across the country to aid diagnosis to save time.
On the challenge of funding, she said that the various governments both at the state and federal level might appear not to be providing enough funding for the treatment of Monkeypox cases because they have been engaged more in combating the COVID-19 pandemic and Lassa Fever which have been more ravaging.
Diemebonso said despite the challenges, DNSOs across the country are working hard to ensure that responses are given to all epidemic-prone diseases.
“In Bayelsa state, we have the manpower to handle monkeypox. All that remains is support”.
Ere is well now and wants to help in creating awareness about Monkeypox and the need for people to always present themselves at the hospital when they begin to notice symptoms.
“Whenever I see anyone with the symptoms, I will be willing to take them to the hospital,” he said. “There is nothing to be afraid of because the virus is treatable, and we need to let the people know about this,” he said.
This story was produced as part of the National Press Foundation’s Covering Rare Diseases Fellowship
