title: Constraints in the diagnosis and treatment of Lassa Fever and the effect on mortality in hospitalized children and women with obstetric conditions in a rural district hospital in Sierra Leone.
abstract: BACKGROUND
  Lassa fever (LF) is an acute viral haemorrhagic infection, endemic in West Africa. Confirmatory diagnosis and treatment (ribavirin) is difficult, expensive, and restricted to specialised hospitals. Among confirmed and suspected LF cases, we report on clinical and laboratory features, timing and administration of ribavirin and the relationship with case fatality.
  
  
  METHODS
  We conducted an audit of patient files of suspected LF cases admitted to a pediatric and obstetric referral hospital in rural Sierra Leone (April 2011 to February 2012).
  
  
  RESULTS
  There were 84 suspected LF cases; 36 (43%) were laboratory-confirmed cases, of whom only 20 (56%) received ribavirin after a median duration of eight days (IQR 314 days) of hospital admission. Of 16 patients who did not receive ribavirin, 14 (87%) died before ribavirin treatment could be commenced. Starting ribavirin within six days of admission was associated with a case fatality of 29% (2/7), while starting ribavirin later than six days was associated with a case fatality of 50% (6/12). Among the 48 suspected LF cases without laboratory confirmation, there were 21 (44%) deaths.
  
  
  CONCLUSIONS
  These findings highlight shortcomings in LF management, including diagnostic and treatment delays. More research and development efforts should be devoted to this 'neglected disease'.
authors.affiliation: Médecins Sans Frontières, Medical Department (Operational Research), Brussels Operational Center, Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Dahmane
authors.forename: J
authors.initials: J
authors.lastname: van Griensven
authors.forename: M
authors.initials: M
authors.lastname: Van Herp
authors.forename: R
authors.initials: R
authors.lastname: Van den Bergh
authors.forename: Y
authors.initials: Y
authors.lastname: Nzomukunda
authors.forename: J
authors.initials: J
authors.lastname: Prior
authors.forename: P
authors.initials: P
authors.lastname: Alders
authors.forename: A
authors.initials: A
authors.lastname: Jambai
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D054869:Clinical Audit; D019468:Disease Management; D005260:Female; D017052:Hospital Mortality; D006767:Hospitals, District / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007835:Lassa Fever / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D008297:Male; D012254:Ribavirin / Q000627:therapeutic use; D012424:Rural Population; D012807:Sierra Leone; D013997:Time Factors; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin
keywords: Case fatality; Children; Lassa fever; Operational research; Ribavirin; Sierra Leone