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Summary Background Lassa fever is a viral haemorrhagic fever endemic in parts of west Africa. New treatments are needed to decrease mortality, but pretrial reference data on the disease characteristics are scarce. We aimed to document baseline characteristics and outcomes for patients hospitalised with Lassa fever in Nigeria. Methods We did a prospective cohort study (LASCOPE) at the Federal Medical Centre in Owo, Nigeria. All patients admitted with confirmed Lassa fever were invited to participate and asked to give informed consent. Patients of all ages, including newborn infants, were eligible for inclusion, as were pregnant women. All participants received standard supportive care and intravenous ribavirin according to Nigeria Centre for Disease Control guidelines and underwent systematic biological monitoring for 30 days. Patients' characteristics, care received, mortality, and associated factors were recorded using standard WHO forms. We used univariable and multivariable logistic regression models to investigate an association between baseline characteristics and mortality at day 30. Findings Between April 5, 2018, and March 15, 2020, 534 patients with confirmed Lassa fever were admitted to hospital, of whom 510 (96%) gave consent and were included in the analysis. The cohort included 258 (51%) male patients, 252 (49%) female patients, 426 (84%) adults, and 84 (16%) children (younger than 18 years). The median time between first symptoms and hospital admission was 8 days (IQR 7–13). At baseline, 176 (38%) of 466 patients had a Lassa fever RT-PCR cycle threshold (Ct) lower than 30. From admission to end of follow-up, 120 (25%) of 484 reached a National Early Warning Score (second version; NEWS2) of 7 or higher, 67 (14%) of 495 reached a Kidney Disease–Improving Global Outcome (KDIGO) stage of 2 or higher, and 41 (8%) of 510 underwent dialysis. All patients received ribavirin for a median of 10 days (IQR 9–13). 62 (12%) patients died (57 [13%] adults and five [6%] children). The median time to death was 3 days (1–6). The baseline factors independently associated with mortality were the following: age 45 years or older (adjusted odds ratio 16·30, 95% CI 5·31–50·30), NEWS2 of 7 or higher (4·79, 1·75–13·10), KDIGO grade 2 or higher (7·52, 2·66–21·20), plasma alanine aminotransferase 3 or more times the upper limit of normal (4·96, 1·69–14·60), and Lassa fever RT-PCR Ct value lower than 30 (4·65, 1·50–14·50). Interpretation Our findings comprehensively document clinical and biological characteristics of patients with Lassa fever and their relationship with mortality, providing prospective estimates that could be useful for designing future therapeutic trials. Such trials comparing new Lassa fever treatments to a standard of care should take no more than 15% as the reference mortality rate and consider adopting a combination of mortality and need for dialysis as the primary endpoint. Funding Institut National de la Sante et de la Recherche Medicale, University of Oxford, EU, UK Department for International Development, Wellcome Trust, French Ministry of Foreign Affairs, Agence Nationale de Recherches sur le SIDA et les hepatites virales, French National Research Institute for Sustainable Development.

BackgroundThere exists paucity of information regarding successfully managed Lassa Fever (LF) patients. This study is aimed at determining the perceived risk factors for LF infection among patients who had been managed and on follow up at Federal Medical Centre, Owo, Ondo State. MethodsA cross sectional study of 101 LF survivors who had been managed and attending follow up clinic at Federal Medical Centre, Owo was done. Data were collected using semi-structured interviewer-administered questionnaire. Respondents were assessed for symptoms and factors that may have predisposed them to LF, and data analyzed with SPSS version 23. Those who had more than three identifiable risks were categorised as high risk. Descriptive statistics was done, and association between socio-demographic characteristics and high risk were explored using chi square test. ResultsThe median age of respondents was 33 years (range 8-85 years), 61.4% were males, 92.1% have heard of LF prior to being diagnosed, 55.9% heard through the mass media. The perceived cause of Lassa fever infection among respondents included consumption of food contaminated by rats’ feces among 57(56.4%) persons, while 16 (15.8) attributed their infection to contact with LF-infected persons. Among respondents with primary education and below, 5 (29.4%) had high risk of Lassa fever infection compared to 7 (8.3%) with secondary education and above (p=0.014). ConclusionMass media and other sources of information should be well harnessed in the communication of risks and preventive practices for LF. Health education should be intensified both in hospitals and schools to capture both young and old in LF prevention activities.

Background Lassa Fever (LF), is a severe viral disease prevalent in Western Africa. It is classified as a priority disease by the World Health Organization (WHO). Ribavirin is the recommended therapy despite weak evidence of its efficacy. Promising therapeutic agents are becoming available for evaluation in human. Before launching therapeutic trials, we need data on the evolution of the disease under the best possible conditions of care. Methods We have initiated a prospective study in Nigeria to better understand the clinical course and prognostic factors of LF while implementing high quality standardized care. Inclusion criteria are: suspected or confirmed LF and informed consent. Participants are followed 60 days from admission and receive free of charge standardized supportive care and biological monitoring, as well as intravenous ribavirin for those with confirmed LF. Data are collected using standardized case report forms (CRF). Primary and secondary outcomes are fatality and severe morbidity, with special focus on acute kidney dysfunction and pregnancy complications. Factors associated with outcomes will be investigated. Results The cohort is planned for 3 years. Inclusions started in April 2018 at the Federal Medical Center Owo in Ondo State. A second site will open in Nigeria in 2020 and discussions are underway to open a site in Benin. 150 to 200 new participants are expected per year. Conclusions This cohort will: provide evidence to standardize LF case management; provide key inputs to design future clinical trials of novel therapeutics; and establish clinical research teams capable of conducting such trials in LF-endemic areas. Study registration The LASCOPE study was registered on ClinicalTrial.gov (NCT03655561).

Background: Chronic liver disease (CLD) is a disease with significant morbidity and mortality in Nigeria. This study assessed the sexual functions of women with chronic hepatitis B infection (CHB), liver cirrhosis (LC), and hepatocellular carcinoma (HCC) designated as cases and normal women as controls. Methods: A prospective, comparative, case–control study of CHB, LC, HCC, and controls. Consenting cases and controls completed a self-administered Female Sexual Function Questionnaire (FSFI). Bio-data was obtained for all participants and cases were graded using the Child–Turcotte–Pugh scores (CTP). Data obtained were entered into SPSS version 20 and analyzed using descriptive and inferential statistics. Results: A total of 176 women completed the study, comprising 88 cases and 88 controls. Mean age (standard deviation) was 39.5 + 8.5 years and 40.5 + 8.2 years for cases and controls, respectively. Cases comprised CHB – 46, LC – 25, and HCC – 17, and their CTP classes were CTP A, 54; CTP B, 22; and CTP C, 12. The FSFI scores for CHB compared with controls were not statistically significant in all domains of the FSFI. The FSFI scores for LC and HCC in all domains were statistically significant compared with controls. Total mean FSFI scores for cases in CTP Class C showed sexual dysfunction, where 13.6% of CLD and 6.8% of all participants had sexual dysfunction and none among the controls. Conclusions: Females with advanced CLD had sexual dysfunction. Sexual concerns of females with CLD should be inquired for and treated.