Introduction 

A rodent of the Arenaviridae family, the reservoir host,  transmits of the Lassa virus to humans through direct exposure  to the rodent fluids such as urine, saliva, and blood or by indirect  exposure from surfaces and foodstuffs contaminated by these fluids  [1]. The signs and symptoms of Lassa fever include increased body  temperature, bleeding, seizures, coma, and death [2] the disease  affects all ages and non-gender specific. The high mortality is  due to misdiagnosis of early symptoms of Lassa fever: fever, loss  of appetite, and weakness, are similar to malaria disease. Lassa  fever is a global public health problem and one of the emerging  infectious diseases and with scanty information available such as  diagnosis, treatments, vaccinations, and control [3]. 

QoL is fundamental to the human experience and is affected  by multiple cultural factors such as age, gender, marital status, and  education, place of living, health status, work productivity, and  socioeconomic status [4]. In a study carried out in Eastern Province  

of Sierra Leone, about 70% of Lassa fever survivors developed  bilateral sudden-onset sensorineural hearing loss [5]. Lassa fever  created self-stigma among survivors, which resulted to other  unorthodox therapeutic alternatives [6]. After being discharged  home, this study found as expressed by some participants, they  faced the stigma of the disease.  

Before this study, there was a lack of information on the QoL  of Lassa fever survivors and their experiences with coping and  living with the damages that the disease has caused. Most studies  available on Lassa fever involved hospital-based surveillance which  focused on who the disease affected, clinical manifestations, and  transmission [7]. To understand the experiences of the survivors  and the impact of Lassa fever on their lives, a cultural perspective  was used to structure participants’ interviews and interpreted the  information shared by the participants. Culture could be viewed as  the blueprint for guiding human actions and decisions of any group  or individual [8].  

For the purpose of this qualitative descriptive was to describe  the meanings of the lived experiences of Lassa fever survivors  using the research questions (Figure 1): 

The following research questions guided this study: 

1. What are the lived experiences related to quality of life for  adults affected with Lassa fever? 
2. How do those who survive Lassa fever describe their lives?

Figure 1: A Diagrammatic Connection between Cultures, Care &  QoL. 

Note: The diagram shown above depicts that care to client is  client-centered, meaning that client is the source of control and is  a full partner in collecting relevant information based on respect  for client preferences, values, beliefs, needs and level of literacy.  These interactions based on quality of care and ultimately leading  to quality of life. 

Design 

The design was a qualitative descriptive approach. After  receiving Ethical Committee approval from the appropriate  institutions, the recruited survivors were interviewed in person and  one-on one method.  

Participant Selection 

Participants for this study were recruited from among adults,  18 years or older, who had been infected and survived Lassa  fever disease and who lived in Southsouth Nigeria. Purposive and  snowball sampling to locate other survivors were used.  

Setting  

Because of the COVID-19 pandemic, I interviewed  participants in two settings at a large government facility, a secured  conference room where participants were assembled and a secured  room where the interviews were conducted on one-on-one basis. 

Data Collection Process 

A semi-structured interviews were conducted in English that  lasted 30 minutes with each participant. Data collection focused  on obtaining culture beliefs and practices, explicating where  they lived, kinship, social activities in their daily lives, cultural  practices and beliefs, religious beliefs, and economic issues. Data  were gathered by asking each participant 13 structured and open 

ended questions as well as follow-up questions where necessary  to clarify their responses. Some of the questions asked were (a)  “When did you contract Lassa fever disease?” (b) “What has  helped you seek out and received care?” (c) “What experiences  did you have with the disease?” (d) “What do you think helped  in accessing Lassa fever disease treatment(s)?”and (e) “What are  your thoughts about this disease and your whole experiences?” 

Data Analysis Procedure  

Raw collected data were transcribed and analyzed after  the interview sessions. The immersed data, were then coded for  meanings using NVivo 12 software program [9]. And reducing the  data into themes.  

Results 

The purpose of this qualitative study was to describe the  meanings of the lived experiences on Lassa fever survivors.  

Description of the Participants 

A total of 15 participants participated in this study (Table 1).  In-depth interviews and analysis of the raw data led to the discovery  of five themes: culture care and therapeutic communication,  emotional support, physical symptoms, social activities, and work  productivity.

Table 1: Demographics of Participants. 

Theme 1: Culture Care and Therapeutic Communication was essential 

Culture care and therapeutic communication by healthcare providers was essential to the survivors’ sense of well-being. Responses  from all participants interviewed took early signs and symptoms such as fever, headache, and loss of appetite to be that of malaria, hence,  resulted to self-treatment by ways of traditional remedies such as a herb called “agbo”.  

Participants felt that healthcare providers demonstrated caring by spending quality time with them, showed respect, asked about  their cultural preferences, beliefs, and traditions, explained procedures and treatments, and informed or told them what to expect. The  treatments given as expressed by participants improved their general well-being. 

Theme 2: Emotional and social support were essential for  survival 

All participants when initially diagnosed of disease felt  frustrated due to conditions which was related to the information  received about the disease. They expressed decreased emotional  state as well as social support and QoL because they were isolated  from family members and friends.  

Theme 3: Physical Symptoms 

Participants described debilitating effects experienced  before treatments and while undergoing treatments. Some of the  commonly effects were physical pain, fever, headache, fatigue,  abdominal pain, vomiting, joint pain, sore throat, and gravely  witnessed the demise of patients who were unable to survive  this terrible disease, Physical symptoms formed a major part that  affected participants’ QoL.  

Theme 4: Social relationships a and social stigma were common  among survivors 

Participants stated that Lassa fever interfered with their  family and community social activities. Participant 4 reported, “I  was breastfeeding a baby when I had the disease and had limited  access to my baby”. 

Theme 5: Work Productivity  

Reduced work productivity while with the disease and  during the course of their treatments as described by participants.  The participants reported the disease effects on their QoL and day to-day activities presented enormous challenge to them. These  included lost earnings as well as the burden of the disease on their  physical and psychological state.  

Discussion 

This study supported Usifoh et al. (2019) [10] found that  Lassa fever disease created self-fear and self-stigma among  survivors, resulted in self-health seeking behaviors, promoted self medication and other unorthodox therapeutic alternatives. Three  participants in this study experiences self-fear and self-stigma. 

This study findings were also supported by those of Coyle  (2016) [11] that access to diagnostic laboratory existed, hence self diagnosis, which led to misdiagnosis and culminated in their being  treated for malaria, instead of Lassa fever disease.  

Limitations of the Study 

The findings of this study were self-reported data from the  participants who are living evidence of the effects of Lassa fever  disease. Though all the participants shared experiences that were  in accord with previous studies, however, this study was limited  geographically to Southsouth Nigeria. 

Recommendations  

Future research could also focus on how the healthcare providers  perceive lived experiences of Lassa fever survivors and include  healthcare providers who work in acute and primary care settings.  It is also important to evaluate the lived experiences of Lassa fever  survivors with other groups such as those under 18 years old who  survived disease. 

Implications 

The initial earlier symptoms of Lassa fever disease are  similar to malaria: fever, headache, and weakness. Hence, they  started self-medicating for malaria. When initially hospitalized,  misdiagnosed, and malaria treatment continued until later stages  of the disease, blood samples finally sent to the only designated  diagnostic laboratory if results come out positive for Lassa fever  virus, then immediate right treatment start. This late diagnostic test  often led to complications, long hospital stays and in some cases  the demise of some Lassa fever patients. 

By providing adequate information on Lassa fever disease  will positively enhance Lassa fever survivors’ well-being. This  study can serve as a blueprint for other studies on the views, QoL  and experiences of Lassa fever survivors thereby leading to a  better understanding of the disease.  

Conclusion 

Physical symptoms are just one of the debilitating aspects of  Lassa fever disease, emotional distress, reduced social activities,  and non-work productivity are also frequently reported. Together,  the physical symptoms and emotional distress caused by Lassa  fever disease presented a serious barrier to Lassa fever patients’  day-to-day activities, work productivity, and healthy social lives.  Findings from this study may provide a better understanding of  the everyday life experiences of survivors of Lassa fever. A better  understanding of experiences of Lassa fever survivors will lead to  an increased awareness of the resources that these individuals need  which hopefully lead to improved interventions for survivors. 

Acknowledgements 

My unblemished gratitude goes to the God Almighty; with  His journey mercy has made my Doctoral endeavour a reality. I am  most indebted to Dr. Leslie Hussey, the Chair of this dissertation,  for sharing her research expertise, patience, motivation, and  wisdom in respect to this humble journey. I would like to thank  my Second Member committee, Dr. Lynda Crawford, for her  invaluable input, inspiring suggestions, questions/feedback, and  support of the dissertation. I want also to thank Dr. Deborah Lewis,  my URR, for making me realize my dreams. I would like to thank  Dr. Ephraim Ogbaini-Emovon, the Director, Institute of Lassa  Fever Research and Control, Irrua Specialist Teaching Hospital  (ISTH), Edo State of Nigeria for his assistance in screening and  recruiting participants for inclusion in this study. My thanks go to  both Dr. Abubakar Taju, ISTH HREC Assistant Administrator, and  Sonia Okoiruele, ISTH HREC Frontdesk Officer of the Dept of  Res-Ethics (ISTH), for their immeasurable assistance. 

This research would not have been possible without the  support of my family living in Nigeria, especially Dr. Joshua  Oyeribhor, my son, who served as the Liaison Officer and who  never stopped encouraging me to push forward and to fulfil  my dream. Finally, I thank all of the Lassa fever survivors who  participated in this study. 

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