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Poor Housing Quality Increases Risk of Rodent Infestation and Lassa Fever in Refugee Camps of Sierra Leone

Lassa fever, a viral hemorrhagic fever endemic in parts of West Africa, is a severe febrile illness transmitted to humans by the rodent Mastomys natalensis. To determine risk of Lassa fever in households in Sierra Leonean refugee camps, we analyzed the spatial relationships between households with a Lassa case and focal locations of potential rodent habitats. Quality and hygiene factors of households were assessed to determine possible risk factors for household rodent infestation and occurrence of Lassa fever. The odds to have a rat burrow were higher in case houses than in control houses (OR 24, 95% CI 6.0–93). Case houses scored significantly worse in the quality of housing and external hygiene. These findings suggest that risk of Lassa fever in refugee camps depends on individual housing quality and the hygiene of the immediate surrounding environment.

Received September 10, 2006. Accepted for publication April 10, 2007.

Acknowledgments: We acknowledge the invaluable contributions of Merlin—London and Merlin’s outreach field staff and drivers in Kenema, Sierra Leone, for their help in data collection and logistic support that made this research possible. We thank UNHCR for their support regarding access to the refugee camps and Dan Bausch (Tulane University) for sharing the validation results of clinical Lassa diagnoses with us. We also express our gratitude to the community leaders in the refugee camps for their knowledge, assistance, and kindness in finding patients and houses.

Financial support: Funding for this work was provided in part by the London School of Hygiene and Tropical Medicine Trust Fund.

^* Address correspondence to Matthias Borchert, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail: Matthias.Borchert{at}lshtm.ac.uk

Authors’ addresses: Phillip Cullison Bonner, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom. Wolf-Peter Schmidt, Disease Control & Vector Biology Unit, London School of Hygiene & Tropical Medicine, London, United Kingdom. Steven R. Belmain, Natural Resources Institute, University of Greenwich, United Kingdom. Ba-bafemi Oshin and Debbie Baglole, Merlin, Freetown, Sierra Leone; Merlin, London, United Kingdom. Matthias Borchert, Infectious Disease Epidemiology Unit, London School of Hygiene & Tropical Medicine, London, United Kingdom

Reprint requests: Matthias Borchert, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail: Matthias.Borchert{at}lshtm.ac.uk.