Scientists from the Nigerian Institute of Medical Research (NIMR) have raised concerns over the frequent misdiagnosis of viral haemorrhagic fevers (VHFs) as malaria and typhoid by health facilities. They are advocating for an advanced diagnostics system to enhance proper diagnosis and significantly reduce negative patient outcomes in the country.
They have also called for improved surveillance systems at points of entry into the country, asserting that most VHFs are imported by asymptomatic immigrants. This underscores the need to screen febrile foreigners and citizens for effective control and management of these conditions.
The NIMR experts, comprising the Director-General, Prof. John Obafunwa; Deputy Director-General, Prof. Rosemary Audu; and Director of Research, Prof. Oliver Ezechi, made this submission at a media parley announcing the findings of Prof. Audu’s various studies on VHFs across the country from 2018 to 2024.
Audu, who is also a professor of Medical Virology at Lead City University, Ibadan, affirmed that VHFs, such as Lassa fever, Crimean-Congo haemorrhagic fever, Yellow Fever, Zika virus, Chikungunya virus, Dengue virus, and Mpox are endemic in Nigeria but are often misdiagnosed as malaria or typhoid due to inadequate diagnostic systems in most health facilities.
According to information from Mayo Clinic, viral haemorrhagic fevers (VHFs) are infectious diseases that can be life-threatening. They can damage the walls of tiny blood vessels, causing them to leak, and they can prevent blood from clotting. Native to tropical climates in Central and West Africa, VHFs respond to treatments and vaccines when detected early.
A patient infected with any of the VHFs, according to the health website, may present with symptoms such as fever, tiredness, weakness, muscle, bone, or joint aches, nausea, vomiting, and diarrhoea. More severe symptoms include bleeding under the skin, inside the body, or from the mouth, eyes, or ears; nervous system issues; coma; delirium; kidney failure; respiratory failure; and liver failure.
Need for improved diagnostics and surveillance
The virologist said, “There is a need to enhance diagnostic capabilities for detecting VHFs in patients with fever, as well as improve surveillance of emerging and re-emerging infectious diseases, especially at points of entry.
“This is critical because emerging and re-emerging infectious diseases are becoming more common and can cause widespread illness and death. Research is crucial to understanding how these diseases spread, change, and affect human health.”
She continued, “It helps develop better tools for diagnosis, vaccines, and treatments, allowing faster responses to outbreaks. Since viruses evolve and can spread quickly across borders, research helps us keep up with these changes and work together globally to prevent pandemics. Understanding these diseases also helps guide public health decisions and ensures timely action to avoid larger crises.”
She also emphasised the need for increased efforts to reduce the prevalence of rodents and mosquitoes across the country, as they often serve as reservoirs for these infections. Additionally, she highlighted the importance of public awareness campaigns and clinical suspicion of cases to curb the spread of these infections in Nigeria.
Key research findings
Prof. Audu outlined some of her team’s findings, stating, “In the 2018 Lassa Fever outbreak, we confirmed the endemicity of infection in Ondo State. However, the majority (≈80%) of suspected cases were confirmed negative, raising concerns about the actual diagnoses of these patients.
“Crimean-Congo haemorrhagic fever virus (2018-2020) was detected in febrile patients and herdsmen in Kwara State. Yellow fever virus was found in febrile patients and pools of mosquitoes (2021) in Delta State. Zika virus (2021-2022) was identified in febrile patients in Delta State, as was Chikungunya virus (2021-2022). Dengue virus was detected in febrile patients in Oyo (2022-2024) and Delta States (2021-2024), with an abundance of Aedes aegypti mosquitoes in both states.”
However, the virologist lamented that limited funding remains one of the major challenges her team faces, alongside irregular sampling and surveillance, and the high cost of serology kits. She expressed her willingness to collaborate with government and private institutions to expand research efforts across various states in the federation.
Concerns over misdiagnosis
The NIMR DG, Prof. Obafunwa, while responding to journalists’ questions on the recurrent misdiagnosis of VHFs as malaria and typhoid fever, expressed disappointment over the situation, which has persisted for years in Nigeria. He asserted that such a practice should not be acceptable by any standard.
He strongly condemned the long-term treatment of malaria, stating that it indicates either an incapacitated diagnostic system or self-medication. He called for an upgrade of diagnostic facilities and continuous training and retraining of health workers.
“If you had malaria last week and need to repeat treatment again this week, it implies something is missing. I’ve had people say that they went to a private doctor who is treating malaria again and putting them on an IV drip. Again, I’ve said enough.
“It all points to the need for training and retraining of young healthcare workers on how to detect the exact cause of illness in febrile patients, because even simple dehydration can cause elevated temperatures.”
Prof. Ezechi, for his part, elaborated on patients’ rights to seek a second opinion from another practitioner or facility if they are not receiving optimal outcomes from their current doctor.
“A patient has every right at any point in time to request a second opinion,” he stated. “What this means is that once you have a fever and the basic tests have been conducted and are negative, it becomes necessary to move on to more sophisticated diagnostics.”
He warned that delays in seeking appropriate medical care could be dangerous. He urged patients to seek diagnosis and treatment at proper facilities, reiterating their right to consult experienced practitioners for a second opinion.
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