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stigma

Post-exposure management and stigma 

Social scientists have a long history of studying stigma.  Whilst there is little specific literature on stigma in relation to Lassa fever, we can take insights from wider social science research and work on HIV/AIDS and Ebola in particular.  Stigma can affect patients, damaging the psychosocial welfare of people who are already vulnerable, who are sometimes rejected by family and friends who may no longer want to spend time with them or care for them. Stigma also shapes practices of and experiences of health workers and may also be experienced by family members. The process of stigmatization has significant implications for those already placed at a disadvantage when accessing and seeking healthcare. Considerations of the lived experience of stigma are crucial for intervention planning. Anecdotal evidence from the 2018 Lassa fever outbreak in Nigeria shows that healthcare workers sometimes kept their distance and restricted care for those who they suspected of having Lassa fever, because of fear of becoming infected.  In some places people who had been in contact with sick people were asked to stay in their houses and avoid contact with other people, an experience many people found stigmatising. Health care workers working on Lassa fever also often experience stigma because of their association with the disease. 

People who survive Lassa fever can also experience stigma when they have recovered, as can their families. Hearing loss in one or both ears is a common sequelae of Lassa affecting approximately one third of Lassa fever survivors. Hearing loss can occur during the active or convalescent phases of infection. Hearing loss is thought to be caused by the immune response to the virus. Treatment with ribarvin does not seem to affect the acquisition of hearing loss, and the actual mechanism of hearing loss is unclear.

Policy Recommendations:

  • Provide support and resources for the deaf community in Lassa fever endemic areas.
  • Providing people with information in formats that they can access (for example in their own language, and using oral rather than written forms as appropriate) is one way to raise understanding of the disease and reduce or minimise incorrect information that can be the genesis for discrimination and stigmatisation

Resources

Lassa fever: Epidemiology, clinical features, and social consequences

This resource describes the epidemiology of Lassa fever and its vector, as well as the clinical course and management of the disease. It then reports on current treatment efforts, surveillance and disease control before presenting community perspectives through a knowledge, attitude and practice survey and a qualitative study.  

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Sensorineural hearing loss in Lassa fever: Two case reports

This resource reports on two female patients aged 19 and 43 years old with clinical features suggestive of Lassa fever and confirmed by immunoserological/Lassa-virus-specific reverse transcriptase polymerase chain reaction. Both patients developed severe sensorineural hearing loss at acute phases of the infections.

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Healthcare providers on the frontlines: A qualitative investigation of the social and emotional impact of delivering health services during Sierra Leone’s Ebola epidemic

This paper describes the stigma experienced by health care workers during the Ebola epidemic in Sierra Leone, and recommends psychological support mechanisms for medical staff working in epidemic contexts.

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Lassa fever–induced sensorineural hearing loss: A neglected public health and social burden

This resource summarises clinical findings of hearing loss in Lassa fever (LF) patients highlighting the association between Lassa virus infection and sudden-onset sensorineural hearing loss (SNHL), as well as the potential mechanism(s) for LF-induced SNHL. The study highlights that further research is necessary to identify the mechanism and the epidemiology of LF-induced SNHL.

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Therapy management: Concept, reality, process

This resource described the two concepts of "therapy management" (diagnosis, selection, and evaluation of treatment, as well as support of the sufferer) and "therapy management group" (the set of individuals who take charge of therapy management with or on behalf of the sufferer) as developed in medical anthropology research in Central Africa. It explores their historical development, current use by researchers, and potential future uses in contextually sensitive analyses. 

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