This Study Assessed The Outbreak And Management Of Ebola Disease And Its Effect On The
Social Interaction Of Lagos State Residents. An
instrument titled: Assessment into the Outbreak and Management of Ebola Disease and its Effect on the
Social Interaction (AOMEDESI)
was used to collect relevant data for the study. The
sample used for this study was selected from all wards in Lagos mainland local
government Yaba cutting across general public, health providers in hospitals
(public and private), market women, caregivers, and students which was based on purposive
and the statistical tools employed to analyse the data collected were
percentages while the inferential statistics of
chi-square(x2) was used to test the stated hypotheses at 0.05 level
of significance. 800
sample sizes were used for the study. 5
research questions and 5 research hypotheses were designed and formulated for
the purpose of the study. The study revealed there would be a significant effect of high
nervousness among Lagos state residents on the outbreak of Ebola Virus. It also
revealed that there would be a significant effect of social rejection and
stigmatization among Lagos state residents on the outbreak of Ebola virus. It
also revealed that the economic implication on the Ebola outbreak is high. The
study further revealed there is a significant effect on the containment effort
by the government and international organization on the Ebola virus outbreak. The study further revealed that
there was a significant gender difference of mobile phone usage on academic
performance. Based on the findings of this study, recommendations and
suggestions were made for students, parents, lecturers and university
administrators and relevant agencies for further research.
of contents vi
Chapter One: Introduction
1.0 Background to The Study 1
Statement of Problem 9
Purpose of Study 11
Research Question 12
1.4 Research Hypotheses 12
1.5 Significance of The Study 12
1.6 Scope of Study 13
1.7 Definition of Key Terms 13
Chapter Two: Literature Review
2.1 Brief History
of Ebola Virus 14
2.2 Ebola Hemorrhagic Fever Outbreak in West Africa
(Guinea, Liberia, Sierra Leone, and Nigeria) 15
2.3 Timeline of the Outbreak 15
2.4 Recent Cases among Healthcare Workers 17
2.5 Risk of Exposure to International Community
Travelers in Affected Countries. 21
2.7 Social Interaction in Lagos State 24
Bush Meat Sellers Record Low Sales 24
Disinfectant, Hand Sanitiser Sales Shoot Up 25
2.10 Economic Effects 25
CHAPTER THREE: METHODOLOGY
Research Method 27
Population of the Study 27
Sample and Sampling Technique 27
Research Instrument 28
Data Analysis 28
Pilot Study 28
CHAPTER FOUR: RESULTS
4.1 Introduction 41
4.2 Discussion of Finding 52
CHAPTER FIVE: SUMMARY, CONCLUSION
5.1 Summary of Findings 55
5.2 Conclusion 57
5.3 Recommendations 58
1.0 Background to the Study
Ebola virus disease (Ebola or EVD) is a severe, often fatal
disease that was first detected near the Ebola River in the Democratic Republic
of the Congo (DRC) in 1976. Originating in animals (such as monkeys, gorillas, and chimpanzees), EVD is spread to humans and among humans
through contact with the blood, secretions, organs, or other bodily fluids of
those infected. It is not transmitted through the air. Individuals who are not
symptomatic are not contagious (Tiaji, 2014). Ebola hemorrhagic fever (Ebola HF) is one of numerous Viral
Hemorrhagic Fevers caused by infection with a virus of the family Filoviridae, genus Ebolavirus. When infection
usually begin abruptly. The first Ebolavirus species was discovered in 1976 in what is now
the Democratic Republic of the Congo near the Ebola River. Since then,
outbreaks have appeared sporadically. There are five identified subspecies
of Ebolavirus. Four of the
five have caused disease in humans: Ebola virus (Zaire ebolavirus); Sudan virus (Sudan ebolavirus); Taï Forest virus (Taï Forest ebolavirus, formerly Côte d’Ivoire ebolavirus); and Bundibugyo virus (Bundibugyo ebolavirus). The fifth,
Reston virus (Reston ebolavirus),
has caused disease in nonhuman primates, but not in humans.
The natural reservoir host of ebolaviruses
remains unknown. However, on the basis of available evidence and the nature of
similar viruses, researchers believe that the virus is zoonotic (animal-borne)
with bats being the most likely reservoir. Four of the five subtypes occur in
an animal host native to Africa. A host of similar species is probably
associated with Reston virus, which was isolated from infected cynomolgous
monkeys imported to the United States and Italy from the Philippines. Tiaji
(2014) opined that the first human case of the Ebola virus disease leading to
the 2014 outbreak was a 2-year-old boy who died on 6 December, 2013 in a
village of Miliandou, Guéckédou Prefecture, Guinea. His mother,
sister and grandmother then became ill with the symptoms consistent with Ebola
infection and died. People infected by those victims spread the disease to
On 19th March 2014, the Guinean Ministry of Health acknowledged a
local outbreak of an undetermined viral hemorrhagic fever; the outbreak,
ongoing since February, had sickened at least 35 people and killed 23. Ebola
virus was suspected, and on 25 March 2014, the World Health Organization (WHO)
reported that the Ministry of Health of Guinea has reported the outbreak of
Ebola virus disease in four southeastern districts, with suspected cases in the
neighbouring countries of Liberia and Sierra Leone being investigated. In
Guinea, a total of 86 suspected cases, including 59 deaths, had been reported
as of 24 March, 2014.
In Liberia, the disease was
reported in Lofa and Nimba countries in late march and by mid-April, the
Ministry of Health and Social Welfare had recorded possible cases in Margibi
and Montserrado Countries. In mid-June, the first cases in Liberia’s capital
Monrovia were reported. In Sierra Leone, the outbreak next spread and
progressed rapidly. The first cases reported on 25 May 2014 in Kailahun
District, near the first case in Senegal, the disease was reported by the
Senegalese Health minister, Awa Marie Coll Seck on 29 August 2014. He announced
the first case of Ebola virus in Senegal. The case has been confirmed.
The first case in Nigeria
was reported by the Federal Minister of Health Professor Chukwu Onyebuchi on 25th
July, 2014. The victim was a Liberian-Patrick Sawyer, who flew from Liberia to
Nigeria. He was seriously sick on arrival and died in the private hospital
where he was admitted and diagnosed as been infected with Ebola Virus Disease.
To contain the spread of the disease, the hospital was shut down and health
officials treating him were quarantined. However, a doctor and nurse who
treated him both died from Ebola.
As of September, 2014, West African countries like Guinea,
Liberia, Senegal, Nigeria and Sierra Leone have recorded a total of 4, 846
cases and 2,375 deaths. Guinea with a total of 899 cases and 568 deaths,
Liberia with a total of 2,415 cases and 1,307 deaths, Nigeria with a total of
22 cases and 8 deaths while Sierra Leone with a total of 3 cases and no death.
As of 10 September 2014,
The World Health Organization (WHO) and Centers for Disease Control (CDC)
reported that a total of 4,846 suspected cases and 2,375 deaths; 2,898 cases
and 1,386 deaths being laboratory confirmed. Many experts believe that official
numbers substantially understate the size of the outbreak because of families’
widespread reluctance to report cases.
Ebola Hemorrhagic Fever
Outbreak in Democratic
Republic of the Congo: On August 26, 2014, the Democratic Republic of the
Congo (DRC) Ministry of Health notified the World Health Organization of an
outbreak of Ebola virus disease (EVD) in Equateur Province. The index case was
a pregnant woman from Ikanamongo Village who butchered a bush animal. She
became ill with symptoms of EVD, reported to a private clinic in Isaka Village,
and died on August 11, 2014. Local customs and rituals associated with death
meant that several healthcare workers were exposed to Ebola virus.
The gruesome death that frequently accompanies Ebola Haemorrhagic
Fever has ensured that the disease is etched deeply into the public
imagination. Initially, an Ebola patient is likely to complain of non-specific
symptoms such as high fever, weakness, diarrhoea, nausea, headache and
vomiting. However, their condition can deteriorate quickly and dramatically, to
include rashes, impaired kidney and liver function, and in some cases, both
internal and external bleeding. Those who die do so
usually within two weeks of disease onset, often having exhibited the classical
“deep-set eyes, ghost-like expressionless face, and extreme lethargy” (Kinsman,
2012.). Although it is rare, Ebola has a high case fatality rate. Just 2,306
cases have been reported since the disease was first recognised in 1976 in
Zaire (now the Democratic Republic of Congo, or DRC), but 1,527 (66%) of these
individuals died. There remains no specific therapy, and
neither is there a vaccine, although recent experimental
vaccine studies have shown some promise.
Social Interactions Change as Ebola Ravages
in Lagos City
“I have switched
to sale of GSM recharge cards to survive till this Ebola ‘wahala’ (problem) is
over. Nobody was buying fruits from me again, they said fruit bats have Ebola
virus and may have eaten from the fruits I was selling. I lost half of my
capital because the fruits perished.” Those were the words of a fruits seller
at the Lagos State Secretariat, who gave her name as Paulina. She is one of
those bearing the brunt of the Ebola Virus Disease.
According to her,
after desperate efforts to woo back her fleeing customers, she decided to
change her line of business in order not to become impoverished. In Lagos the
importation of the deadly Ebola Virus Disease into the country by a late
Liberian American, Mr. Patrick Sawyer has changed the way of life of Lagosians.
The fear of contracting the virus is now the beginning of wisdom in Africa’s
most populous city and residents are taking precautionary measures not to fall
victim of the disease. In every corner of the city, people are seen discussing
the fears the disease has instilled in them and the life style changes they’ve
adopted as a result. Around the city, people are seen wearing protective gears
as they go about their activities. This development has also affected the
socio-economic life style of the vibrant Lagos residents who ordinarily take
delight in socialising. With the coming of Ebola, the hand shake which is one
of the most popularly ways of exchanging pleasantries has since become a public
anathema in Lagos. People shy away from having hand shake with others. What
they do now is wave their hands at each other no matter their closeness. The
Ebola scare has put asunder whatever they shared in the past. People are now
seen engaging in frequent hand washing. They also carry about medicated soaps
in the bags to quickly wash their hands anytime they feel suspicious of or are
afraid of touching an object.
One of the sectors
of the economy worst hit by the Ebola scare in Lagos currently is private
schools and holiday coaching centers. Parents because of the scare of Ebola
have stopped their children from attending holiday coaching classes so that
they don’t contract the deadly disease. The long holiday coaching schools in
Lagos have suffered a setback as parents have withdrawn their wards from them.
Another category of persons also experiencing the effects of the outbreak of
the disease is bush meat sellers. In Ikorodu, Lagos state, bush meat traders
are counting their losses. This is because medical experts have been advising
Nigerians to desist from consuming bats, primates and other edible games to
avoid contracting the viral disease (Leadership Newspaper, 2014). “It is
terrible. Our experience since the outbreak of Ebola is indescribable. This
place used to be booming with business. Car traffic competed with human
traffic, with buyers and sellers haggling and smiling. All that is gone now.
Patronage is almost zero. Ebola has undone our business. Our customers now
increase their acceleration when they reach this spot. People avoid us like
plague,” Popoola lamented. (Leadership Newspaper, 2014).
It’s not all gloomy, however. While bush meat
sellers are counting their losses, sellers of hand washing soaps, disinfectants
and sanitisers are smiling to the banks, following advice by medical experts
that constant washing of hands could save one from contracting the virus. In
Lagos, a 60 ml bottle of hand sanitiser that was previously sold at N200 is now
sold at N600.
Despite the hike in the price, lots of
residents throng super stores and chemist shops in search of hand sanitiser to
buy to fortify themselves against the Ebola Virus. Also, some bank cashiers,
security guards, and taxi drivers can be spotted within the city wearing gloves
while conducting their businesses.
Churches Modify Worship Proceedings
The Ebola scare
has also forced churches to modify worship. The Catholic Church for instance,
has modified proceedings including the rite of peace and administering of Holy
Communion. Last Sunday during mass in many dioceses of the church across the
country, it was announced that the exchange of handshakes and hugs as a rite of
peace has been temporarily suspended following the Ebola outbreak. Similarly,
Holy Communion is no longer given from the hand of the priest to the receiver’s
mouth as the receiver now has to receive it on their palm and place same on the
tongue by themselves. Also, in some Pentecostal churches, where it was the
practice for the cleric to shake hands with first time worshippers, that has
also been replaced with waving towards them.
There is high nervousness in the Lagos
city due to reported cases of Ebola. Even among medical personnel, the
situation is not different, especially with the death of Dr. Ameyo Stella
Adadevoh, the senior consultant endocrinologist, who became infected with the
deadly Ebola virus while treating the Liberian-American, Patrick Sawyer. As it
is now, some health managers, who should help in managing the diseases, are
shying away from their primary responsibility for fear of being infected
(Guardian Newspaper, 2014).
Already, there are rumours that some
hospitals are now sending away patients suspected to have traits of the Ebola
virus. Visits to some of these hospitals indicate that patients, who exhibit
symptom associated with malaria, typhoid fever, including those vomiting are
usually advised by doctors to go home to manage their sickness. This it was
learnt has left patients with no option than to settle for self-medication,
taking all sorts of drugs without prescription.
On what could be responsible for the
situation, Dr. Francis Duru, Associate Professor, College of Medicine,
University of Lagos, argued that because many of these hospitals know that
Ebola virus is highly contagious, most private hospitals may be avoiding
patients because they lack facilities like isolation or quarantine units,
personal protection equipment (PPE) and trained personnel to carry out the
In addition to the loss of life, the outbreak is having a
number of significant economic impacts. Markets and shops are closing due to travel restrictions, cordon sanitaire, or fear
of human contact, leading to loss of income for producers and traders. Movement
of people away from affected areas has disturbed agricultural activities.
Tourism is directly impacted in affected cities like Lagos. Many airlines have
experienced reduced traffic. Some airlines have suspended flights to affected
areas. The U.N Food and Agricultural (FAO) have warned that the outbreak could
engender harvest and food security in West Africa.
aids organizations and international bodies, including Economic community of
West African States (ECOWAS), US Centers for Disease and Control (CDC), and the
European Commission have donated funds and mobilized personnel to help counter
the outbreak: charities including Médicins Sans Frontiéres, the Red Cross and
Samaritan’s Purse are also working in the area. Affected countries have
encountered many difficulties in their attempt to control the spread of this
epidemic, the first that West African nations have experienced. In some areas,
people have become suspicious of both the government and hospitals; some
hospitals have been attacked by angry protesters who believe that the disease
is a hoax or that the hospitals are responsible for the disease. Many of the
areas that have been infected are areas of extreme poverty without even running
water or soap to help control the spread of disease. Other factors include
belief in traditional folk remedies and cultural practices that predispose to
physical contact with the disease, especially death customs such as washing the
body of the diseased.
hospitals lack basic supplies and are understaffed, which has increased the
likelihood of staff catching the virus themselves. In August 2014, the WHO
reported that ten percent of the dead have been health care workers.
the end of August 2014, the WHO reported that the loss of so many health
workers was making it difficult for them to provide sufficient number of
foreign medical staff. By September 2014, Médicins Sans Frontiéres, the largest
NGO working in the affected regions, had grown increasingly critical of the
international response. On 3rd September, 2014, the international
president spoke out concerning the lack of assistance from the United Nations
member countries saying, “six month into the worst Ebola epidemic in history
the world is losing the battle to contain it”. The Director-General of the WHO,
Margret Chan called the outbreak “the largest, most complex and most severe
we’ve seen” and said that it “is racing ahead of control efforts”. A United
Nations spokesperson stated “they could stop the Ebola outbreak in West Africa
in 6 to 9 months, but only if a ‘massive’ global response is implemented”.
Ebola virus remains as an
ongoing, but, in the grand scheme, relatively minor threat to global health.
Nonetheless, it is clear from the Nigerian experience that the responses to an
outbreak can be very dramatic, and perhaps disproportionate to the actual
danger presented. Indeed, in some cases, the responses during this outbreak
actively inhibited control and containment measures. An important objective for
any future outbreak control strategy must be to prevent excessive fear, which,
it is expected, would reduce stigma and other negative outcomes.
Strategies for containing the EVD in Nigeria
have remained the same, focusing on appropriate information, education and
communication; sustaining surveillance systems; provision and equipping of
isolation wards/centres; provision of adequate care for confirmed cases; active
and aggressive contact tracing; and reduction in harmful practices that promote
the spread of the virus.
1.1 Statement of Problem
The magnitude of Ebola outbreak, especially
in Liberia, sierra Lone and Nigeria, has been underestimated especially for a
number of reasons.
Many families hide infected loved ones in
their homes. As Ebola has no cure yet, some believed infected loved ones will
be more comfortable dying at home.
Others deny that a patient has Ebola and
believe that care in an isolation ward- viewed as incubator of the disease will
lead to infection and certain death.
Most fear the stigma and social rejection
that come to patients and families when diagnosed of Ebola is confirmed.
These are fast-moving challenges for many
international partners providing support. Quantities of staff, supplies, and
equipment, including personal protective equipment, cannot keep up with the
need. Hospitals and diagnostic capacities have been overwhelmed.
Many treatment centres and general clinic
have been closed. Fear keeps patients out and causes medical staff to flee.
Diseased corpses are buried without notifying
health official and with no investigation of the cause of death. In some
instances, epidemiologists fear to travel to affected places.
The pastor of The Synagogue of All Nation,
Pastor TB Joshua has directed West African victims, who would otherwise have
thronged his church to stay in their countries. Speaking on the deadly disease,
Pastor Joshua said, “What makes you a good citizen makes you a good Christian.
There is a general law in every country that binds against crossing borders,
obey the law of the land by not crossing the borders of your land with Ebola
Airlines are the ones that bring foreign
tourist, investors and expatriates to Nigeria especially to Lagos. It is
therefore logical to say that as long as flight are suspended, there wouldn’t
be new tourists, investors and expatriates visiting the region, even those in
Lagos will be making frantic effort to leave. The impact will become harder as
suspension of air flight enters days, weeks and months.
is a city where Nigeria’s commercial capital is dominant, pandemonium would
break out if there was to be full blown Ebola outbreak. A sector such as small and medium-scale
enterprise would collapse completely starting with the informal markets that
are patronized daily by thousands of Lagos residents.
In a typical Lagos market, there are
interaction and physical contacts due to competition for small spaces and the
haphazard arrangement of the stalls. Thus if there is Ebola outbreak, such
markets would be shutdown to prevent fatal outcome and widespread infection of
previously unexposed individuals. It will be very serious if markets such as
Oshodi, Tejuosho and several others are shut down in the advent of an Ebola
outbreak. Anything that would affect these markets would cripple the economy at
the citizenry level and the local government would also suffer since there
would be great depletion in the internally generated revenues.
West African countries are already aware of
the threat the disease pose to their economies and are making concerted efforts
to combat the disease; they are also looking inwards and campaigning from one
place to another on what to do prevent the disease and how to make provisional
Lagos state government is however expected to cascade trainings down to the
LGAs with support from the development partners, whom we are already talking
with in this regard among others. These trainings are as follows:
i. Training of Trainer (TOT) for Health
Workers on the Ebola Virus Disease (EVD) outbreak and other Viral Haemorrhagic
ii. TOT for State Health Educators on
awareness creation, community sensitization and mobilization. Arrangement has
been made to include the military and para-military in the training.
The populace have been advised to wash their
hands frequently with using soap and water and the use of sanitizers.
buying or eating of wild animals, including nonhuman primates, sold in local
Caregivers should avoid contact with the
infected person’s body fluids and tissue, including blood, semen, vaginal
secretions and saliva. If you are a health worker, it will be very
precautionary to wear protective clothing, such as gloves, masks, gown and eye
shields. It is also very important to keep infected people isolated from
1.2 Purpose of Study
The purpose of this study is to assess the outbreak of Ebola disease and its effect on the
social interaction of Lagos State.
To assess the past and present outbreak
of Ebola virus
To examine the effect on the social
interaction of Lagosians.
To assess the risk of exposure.
To examine the social rejection and
stigmatization of Ebola virus.
To examine the economic implication on
To examine the level of awareness
campaign on Ebola outbreak.
To examine the level of containment
effort by the government and international organizations.
1.3 Research Question
on the issues raised in the background, the study will attempt to answer the
following research questions:
Would there be any significant effect of
high nervousness among Lagos state residents as regards to Ebola virus
Would there be any significant effect of
social rejection and stigmatization among Lagos state residents on the Ebola
What is the level of economic
implication of the Ebola outbreak?
What is the level of campaign awareness?
Is there any significant effect on the
level of containment effort by the government and international organization?
1.4 Research Hypotheses
The following assumptions will be tested in
would be no significant effect of high nervousness among Lagos
state residents on
the outbreak of Ebola Virus.
would be no significant effect of social rejection and stigmatization among Lagos
state residents on
the outbreak of Ebola virus.
economic implication on the Ebola outbreak is low.
is low level of campaign awareness.
is no significant effect on the containment effort by the government and
international organization on the Ebola virus outbreak.
1.5 Significance of The Study
The research study will be of great help to the both the
federal, state and local government health stakeholders, health officials, and
the general public on the containment effort.
research will also help to keep an occasionally panicky populace from excessive
over-reaction, and thereby contribute to containing the virus, as well as to
reducing stigma and other negative consequences.
suffering an Ebola outbreak in the future may well benefit in their attempts to
combat the disease by taking on board the important lesson from this research.
1.6 Scope of Study
for the study comprises of the general public, health providers such as
hospitals (both public and private), market women, caregivers, and students in
Definition of Key Terms
Ebola Virus: Ebola
hemorrhagic fever (Ebola HF) is one of numerous Viral Hemorrhagic Fevers caused
by infection with a virus of the family Filoviridae, genus Ebolavirus.
Outbreak: is a term used in epidemiology to
describe an occurrence of disease greater than would otherwise be expected at a
particular time and place. It affects a small and localized group or impact
upon thousands of people across an entire continent.
Social Interaction: is the way people talk and act with
each other and various structures in the society. It may include the
interaction a family has together (eating, sleeping, living together) or
bureaucracies that are formed out of the need to create other within the