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West Africa and the Burden of EVD

  1. Overview of the Ebola Virus Disease Outbreak

The 2014 Ebola Virus Disease outbreak has indeed been one of the most alarming Ebola outbreaks in World history, and the first in the West African sub region, that has severely hit Guinea, Liberia, Sierra Leone and Nigeria with a significant risk to the World at large. The Center for Disease Control (CDC) and Prevention in collaboration with other U.S. government agencies, the World Health Organization (WHO), and other domestic and international disease management teams is currently providing technical assistance and control measures to the affected countries, (CDC Ebola Website and USAID August, 2014). 

Research proves that the first human case of the Ebola virus disease leading to the 2014 outbreak was a 2-year-old boy who died on December 6th, 2013 in the village of Meliandou, Guéckédou, Prefecture, Guinea. The mother of the boy, his 3-year-old sister and grandmother then became ill with symptoms consistent with Ebola infection and later died. People infected by those victims spread the disease to other villages. By late May, the outbreak had spread to Guinea's capital, Conakry, a city of about two million inhabitants. 

In Liberia, the disease was first reported in Lofa and Nimba counties in late March, and by mid-April, the Ministry of Health and Social Welfare had recorded possible cases in Margibi and Montserrado counties. In mid-June the first cases in Liberia's capital Monrovia were reported.

Sierra Leone identified suspected cases of the disease by mid-April, but all clinical samples of suspected cases at the time tested negative for the Ebola virus. The first cases were reported on 25 May in the Kailahun District, near the border with Guéckédou in Guinea. By 20 June, there were 158 suspected cases, mainly in Kailahun, the adjacent district of Kenema, but also in the Kambia, Port Loko and Western districts in the north west of the country. By 17 July, the total number of suspected cases in the country stood at 442, and had overtaken those in Guinea and Liberia. By 20 July, cases of the pestilence had additionally been reported in the Bo District and the first case in Freetown, Sierra Leone's capital was also reported in late July. 

On 26 May, the WHO reported the first death of Ebola virus in Sierra Leone (Luis Sambo, WHO, June 2014).   Similarly, the first case in Nigeria was reported by the WHO on 25 July that Patrick Sawyer, a Liberian Ministry of Finance official, flew from Liberia to Nigeria after exposure to the virus, and died in Lagos soon after arrival. In response, the hospital where he was being treated was shut down and quarantined, and the health officials who were treating him were isolated in an attempt to stop the spread of the virus. However, on 4 August, it was confirmed that the doctor who treated Sawyer tested positive for Ebola, and on 6 August, authorities confirmed the Ebola death of a nurse who had treated him. (WHO and CDC   Reports, July 2014). The World Health Organization, in partnership with the Ministries of Health in Guinea, Sierra Leone, Liberia, and Nigeria as of 19th August, 2014 reported 2240 suspect and confirmed cases of EVD, including 1383 laboratory-confirmed cases, and 1229 deaths.

The disease 'Ebola Virus' (alternatively known as Ebola hemorrhagic fever) is a rare and fatal disease. The disease origin is associated with several African countries and is caused by infection with one of the Ebola viruses (Ebola, Sudan, Bundibugyo, or Taî Forest virus).  Research reveals that the Guinean strain of the Zaire Ebolavirus originated from a single group of patients living in the heavily forested town of Guéckédougou in the remote prefecture of Gueckedou. The town is a small governmental subdivision which shares both the forest and borders with both Liberia and Sierra Leone. The Guinean strain of the deadly virus is a member of the Ebolavirus genus, a group of pathogens which cause deadly hemorrhagic fevers in the infected. Research has also shown that it is not only part of that genus but it is also an extremely close relative of the Zaire Ebolavirus, which was not only the first species of Ebolavirus identified by humans, but was – and still is – the deadliest strain of the virus, killing about  97 percent of those it infects.(Andrew Waddell, July 14,2014). It is spread by direct contact with a sick person’s blood or body fluids and/or by contact with contaminated objects or infected animals. The symptoms exhibited by the disease include high fever, headache, joint and muscle pains, sore throat and weakness in series with diarrhoea, vomiting and stomach ache. In certain situations, skin rash, reddening of eyes and, internal and external bleeding may constitute the symptoms.The virus quickly swept through Guinea and on through to Liberia and Sierra Leone in a matter of weeks after the reports of the first cases in Gueckedou reached the ears of health officials. Since then, over 1,220 people have been slain by the microbe, overwhelming the number of people killed during every other outbreak since the disease was first identified in 1976 in the Central Africa (WHO).

The emergence of the 2014 Ebola epidemic in the Western Africa was not saluted with prompt and appropriate medical response.  The World Health Organization, along with other public-health oriented non-governmental organizations (NGOs) such as Doctors without Borders or Médecins Sans Frontières (MSF), have expressed ignorance of the disease as one of many significant factors contributing to the epidemic. The public health organizations supported this claim by referring to incidents where the infected either fled hospitals, or instances in which hospital workers themselves lacked the necessary training to contain the extremely contagious virus.   Prior to this year, Ebola outbreaks occurred primarily in Central Africa and had been doing so for about 38 years. Thus the threat of Ebola was not at the forefront of health ministers’ minds while directing the development of their nations’ health infrastructure and personnel capacity building programmes. Even MSF was more concerned with fighting HIV/AIDS, cholera outbreaks and malaria than Ebola, which did not become a top priority for the organization until March of 2014, Andrew Waddellemphasizes.

The epidemic, which has invaded between communities and states, leading to nothing but death, hazards and destitution, all started in the village of Gueckedou, a forested ecology, and over the years more and more forest islands appeared naked as the farmers encroached upon the forest reserve in search of better soils to ensure the attainment of higher yields. However, the sporadic human pattern of exploiting the forest ecosystems is not just limited to simple farming activities. Reports indicated that as the forest became more accessible; its citizens embarked on more mining exploration and hunting activities in the forested areas. This is where the virus was dislodged from its natural niche to cause this terrible outbreak. Zaire Ebolavirus is “zoonotic,” meaning that it is carried by animals who act as its source or “reservoirs,” the most likely being bats and, which if contacted by humans will cause infection. Meanwhile, the CDC is in active collaboration with all of the Ministries of Health (MOH) of the affected countries, WHO, MSF, and other partners regarding the outbreak and, has currently deployed its personnel in all four countries assisting the respective MOHs and the WHO-led international response to this isochronous 2014 Ebola outbreak.

According to the official Environmental Policy of the Economic Community of West African States, Western Africa has one of the worst deforestation rates in the world, losing 899,000 hectares of forest every year. The report also points to the “unexpected or irregular transfer” of forested land to “other sectors for other uses.” In other words, what happened in Gueckedou has been happening in the rest of the region for years. If the deforestation hypothesis is indeed correct and given the immense amount of improper land alterations which contribute to the loss of forest area, then West Africans must be aware of other similar deadly microbes as Ebola or even worse than this 2014 Ebola virus epidemic sooner or later.  All three of the neighboring infected countries (Guinea, Liberia and Sierra Leone) had been dealing with severe deforestation prior to the outbreaks, which occurred all over the region in a nonlinear manner.  Hitherto, unlike environmental degradation in other parts of the world, which harms mostly future generations, the three  neighbouring countries have damaged their shared environment in such a way that it is the current generation that must perish  and even die in the wake of an epidemic created by the weakness and oversights of their so-called elderly state figures.(ECOWAS, 2014)

  1. Quantitative Portrayal of the Infection since 2014 Outbreak

Table 2.1: Quantitative Report on the Infection since 2014 Outbreak


Country

Suspected and Confirmed Cases

%

Suspected Death Cases

%

Laboratory Confirmed Cases

%

Guinea

543

24.24

394

32.06

396

28.63

Liberia

834

37.23

466

37.91

200

14.46

Sierra Leone

848

37.86

365

29.70

775

56.04

Nigeria

15

0.67

4

0.33

12

0.87

Regional Total

2240

100.00

1229

100.00

1383

100.00

Source: WHO Report at as August, 19 2014

The above reports are sourced from official information from the affected countries' health ministries and WHO has stated that the reported figures "vastly underestimate the magnitude of the outbreak"

In Guinea, 543(24.24%) cases of EVD, including 396(28.63%) laboratory confirmed cases, and 394(32.06%) deaths were reported by the Ministry of Health of Guinea and WHO. Active surveillance continues in Conakry, Guéckédou, Dubreka, Pita, Siguiri, Kourourssa, Macenta, Yamou, and Nzerekore Districts.

The Ministry of Health and Social Welfare of Liberia and, WHO reported 834(37.23%) clinical cases of EVD, including 200(14.46%) laboratory confirmations and 466(37.91%) fatal cases. Suspect and confirmed cases have been reported in 9 of 13 Counties. Laboratory testing is being conducted in Monrovia.

In Nigeria, WHO and the Nigerian Ministry of Health reported 15(0.67%) suspect cases, including 12(0.87%) laboratory confirmations, and 4(0.33%) deaths

In similar vein, the WHO and the Ministry of Health and Sanitation of Sierra Leone reported 848(37.86%) suspect and confirmed cases of EVD, including 775(56.04%) laboratory-confirmed cases, 365(29.70%) deaths. All districts are now reporting clinical patients with EVD. Reports, investigations, and testing of suspect cases continue across the country. On 29 July, the leading Ebola doctor Sheik Umar Khan from Sierra Leone died in the outbreak, and the ravage continued to be inflicted on other medical personnel in their efforts of containing the epidemic in the country.

The significance of the above report is that though Sierra Leone has the highest percent both for the suspected and confirmed cases (37.86%) and laboratory confirmed cases (56.04%), yet Liberia faces the highest fatality so far at as August 19, 2014. This implies that the death toll in Sierra Leone is greatly underestimated due the fact that many deaths occurring of Ebola epidemic in the country are hidden from the public domain and therefore not included in the count. The tendency for not reporting sickness or death of a family member is highest in the rural areas   among   farming communities where illiteracy and conservatism largely influence the behaviour of the people from adhering to the recommended practices and regulations in the crisis situation or the likes. This therefore suggests that the government of Sierra Leone in collaboration with WHO, MSF, FAO and other humanitarian organizations must set up a transparent and effective mechanism to reach out to the suffering communities in the rural areas where Ebola outbreak is not only massively killing the people but also distorting their farming operations and severely impairing their other livelihood means activities

Meanwhile, the CDC is in constant communication with all of the Ministries of Health (MOH), WHO, MSF, and other partners regarding the outbreak and has currently deployed personnel in all four countries assisting the respective MOHs and the WHO-led international response to this Ebola outbreak.

The Médecins Sans Frontières (Doctors Without Borders) at a regional front is currently having a team of 676 staff working in Guinea, Sierra Leone and Liberia, and has set up several specialist centers to give technical assistance and medical care and supports to affected people. In Sierra Leone in particular, which MSF chooses as the epicentre of the Ebola crisis, MSF has 22 international and 250 Sierra Leonean staff working in the country and opened a 64-bed Ebola treatment centre on the 25th June. On 8th August MSF declared that it had reached the limit of its capacity.  In addition to emergency response medical assistance being rendered to the four Ebola outbreak countries by the aforementioned medical institutions, WFP on18 August 2014,   revealed plans to mobilise food assistance for an estimated 1 million people living in restricted access areas.

Momodu  Kanu, Sheik Dyfan Massaquoi, Edwin J. J. Momoh
Njala University
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