The yellow fever outbreak is a serious condition of public health concern. The majority of the patients with the disease present late as yellow fever has signs and symptoms similar to some known diseases like malaria, and Lassa fever. The case fatality rate for hospitalized patients was approximately 40% (WHO 2019) which is high; the severity of the disease condition most times results in death as 20% - 50% of cases die of complications caused by considerable tissue damage. This has financial, emotional, and social implications for both the family and the public at large. Managing the condition was expensive, due to its severe nature, especially as the persons most affected are of low social economic status [16] . Studies done in Congo show that most of the established cases were males, who had journeyed from the country of Angola where they have been infested and most were men [17] . Another study in Uganda also in agreement revealed that males were more affected, and they had a greater attack rate than females. The age range of the probable case patients was 3 - 64 (median: 32) years. Of all age groups, persons aged 30 - 39 years had the utmost attack rate. (19) The case fatality rate was 33%. The case fatality rate among males was 36% while for females was 22%. The age group of 20 - 30 years had the highest case fatality rate of 36% [17] . In their occupation, more than half (64%) of the cases were farmers; other occupations represented in case-persons included sand miners (5%), wood colliers (5%), small shop owners (3%), teachers (2%), and casual labor (3%). Of note, all case persons were involved in farming events to at least some extent, and the recent outbreak of yellow fever in Nigeria specifically in some communities in Delta State was observed to have affected a certain age range (14 - 35 years) and sex was more affected [17] . Due to the severity of this aliment, it is important to investigate the socio-demographic determinant of these patients to put in place targeted strategies to prevent outbreaks and disease burdens.

The yellow fever outbreak is a serious condition of public health concern. The severity of the disease condition most times results in death as 20% - 50% of cases die of complications caused by considerable tissue damage. This has so much effect on both the family and the public at large. Managing the condition is costly especially as the persons most affected are of low social economic status. Of concern is the severe nature of the condition. Therefore, it is imperative to assess the socio-demographic determinant of these patients to initiate early intervention to curb this malady.

Understanding the socio-demographic determinant of yellow fever patients will necessitate the need for the government and healthcare facilities to embark on massive sensitization and health education of the masses on yellow fever mostly in endemic communities. Furthermore, this study will help target the people who are usually affected as a result of their occupation and also after a better understanding of the need for early immunization and vaccination against yellow fever disease. There is a paucity of data on yellow fever studies in our environment. Findings from this study will contribute to the body of knowledge on yellow fever. The study can also help policymakers to make policies that will reduce overcrowding. Most of these patients were managed in the isolation center of Federal Medical Center Asaba. This study is aimed at assessing the socio-demographic determining factor of these patients, which will help the government and healthcare facilities to organize Health promotions geared at curbing the disease condition such as immunization of all age groups, especially those within the affected age range.

To examine the socio-demographic determinant of patients the yellow fever disease using data collected from Isolation Center, Federal Medical Center Asaba.

What is the socio-demographic determinant of patients with yellow fever in Federal Medical Center Asaba?

There is no significant relationship between patients’ genders and yellow Fever in Federal Medical Center Asaba.

There is a significant association between gender and yellow Fever in Federal Medical Center Asaba.

Table 1 shows that 48 (84.2%) were male, and 9 (15.8%) were female. Based on age group, 22 (38.6%) were from <20 years, 28 (49.1%) were from 20 - 39, 5 (8.8%) were from 40 - 59, 2 (3.5%) were above 60 years. 52 (91.2%) were <40 years while 4 (7%) were >40 years. On tribe, 36 (63.2%) were Igbo, 1 (1.8%) were Hausa, 19 (33.3%) were Ika and 1 (1.8%) were TV. On religion, 56 (98.2%) were Christians while 1 (1.8%) were African religion. On marital Status, 40 (70.2%) were single, 3 (5.3%) were cohabiting, 13 (22.8%) were married, and 1 (1.8%) were separated or divorced. Based on educational status, 16 (28.1%) attended the primary level of education, 21 (36.8%) attended the secondary level of education, 7 (12.3%) attended the tertiary level of education, 1 (1.8%) had nursery education, 12 (21.1%) had no formal education. In total, while 52 (91.2%) were poorly educated, 5 (8.8%) had tertiary education.

Figure 1 shows that 18 (31.6%) were cured, 37 (64.9%) died, 1 (1.8%) were transferred out, and 1 (1.8%) defaulted.

Table 2 shows that 56 (98.2%) were domiciled in the delta state while 1 (1.8%) were domiciled in Anambra state. Also, 51 (89.5%) were from rural

areas and 6 (10.5%) were from urban areas. Based on the place of domicile, 19 (33.3%) were from Nsukka, 26 (45.6%) were from Agbor, 7 (12.3%) were from Ogbe eku, 2 (3.5%) were from Iwa-oyibo, and 3 (5.2%) were from out kwale.

Table 3 reveals that 38 (66.7%) stayed in the hospital for <1 week, 11 (19.3%) remained in the hospital for >1 week <2 weeks, 7 (12.3%) stayed in the hospital for >2 weeks <1 month, and 1 (1.8%) stayed in the hospital for >1 month.

Table 4 shows that 18 (31.6%) take alcohol, 8 (14%) smoke, and 2 (3.5%) have a sedentary lifestyle.

From Figure 2 it shows that the majority of yellow fever patients presented with fever 55 (96.5%), followed by jaundice 50 (87.7%) and so on; those who presented consciously were 42 (73.7%) were conscious at presentation and 15 (26.3%) were not. 15 (26.3%) were unconscious at the presentation while 42 (73.7%) were not. 50 (87.7%) had jaundice and 7 (12.3%) were not. 23 (40.4%) had convulsions while 34 (59.6%) did not. 55 (96.5%) had a fever and 2 (3.5%) did not. 33 (57.9%) were bleeding and 24 (42.1%) were not bleeding. 5 (8.8%)

had rashes and 52 (91.2%) did not. Based on other presentations, 7 (12.3%) presented with vomiting, 14 (24.6%) presented with diarrhea, 16 (28.1%) presented with abdominal pains and 20 (35.1%) had other presentations.

Table 5 shows that 2 (3.5%) were bleeding from the nose, 6 (10.5%) were bleeding from the eyes, 14 (24.6%) were bleeding from all orifices, 15 (26.3%) were bleeding from the mouth, 20 (35.1%) were not bleeding.

Table 6 illustrates that 1 (1.8%) had rashes on the face, 4 (7%) had rashes on the trunk, 2 (3.5%) had rashes all over the body, 50 (87.7%) had no rash.

There is a significant association between Yellow fever and gender, X²=26.6, p value= 0.00, Table 7.

This study on the socio-demographic determinant of Yellow fever of patients managed in CCDRC showed that most of them (49.1%) were between ages 20 - 39 followed by ages less than 20 (38.6%); this could be that men in that age range are strong and engages in such activities as farming, hunting, and fishing in areas where they could be infected. Men were more (84.2%) than women (15.8%), buttressing the fact that men are more exposed to YF because they are more engaged in agricultural activities, which agrees with the study in Uganda and Angola. The majority of confirmed cases were in males aged 15 - 19; in the same vein a chi-square test of a single variable to test the hypothesis showed that gender was statistically relevant with x² 26.6 and p value 0.00, showing that an association exists between gender and YF transmission probably due to above-mentioned reasons. On educational status, the majority of the patients (36.8%) had secondary education, but then 21.1% had no formal education. Most of the individuals affected were single 40 (70.2%), and the numbers of married affected were 13 (22.8%). The majority of the affected individuals were Igbo 36 (63.2%), and ika 19 (33.3%) were of the minority. Almost all the patients were from Delta state 56 (98.2%), mainly from rural areas 51 (89.5%) in which most of them reside in Nsukwa 19 (33.3%) and agbor (45.6%). The major occupation of residents in this area is farming and hunting where young people below the age of 40 years go to the forest and jungle area. Where they encounter the vector (mosquitoes Aedes) constituting the jungle cycle of transmission (24), where there may be transmission from monkeys and small mammals by mosquitoes Aedes Africans.

However, the findings of the research also revealed that the length of hospital stay of the patients was less than one week to greater than one month whereby the majority of the patients 38 (66.7%) stayed in the hospital less than a week. This is directly related to the severity of the presentation. The case fatality rate for hospitalized patients was approximately 40% (5) which is high. This agrees with our study that a majority of 37 (64.9%) and 18 (31.6%) were managed and recovered. The clinical findings revealed that most of the patients 42 (73.7%) presented as conscious, with 55 (96.5%) presenting with fever, followed by jaundice 50 (87.7%) then bleeding 33 (53.9%) mostly from all orifices followed by convulsion 23 (40.4%) then rashes 5 (8.8%). This study agrees with the study done in Brazil by Surly Hiromi, which shows that 234 (94.4%) presented with fever and 150 (69.1%) presented with jaundice. However, the limitation of this study is the fact that the sample size of patients managed with YF is small, however, one case of Yellow fever is reportable and requires immediate action from public health leadership and authority.

This study recommends broad sensitization of the general public most especially, the affected areas on the cause, mode of transmission, sign, and symptoms, and prevention of yellow fever. Educating the public will raise the sense of awareness which will lead to early presentation to the health care facilities. In addition, routine vaccination campaigns should be elaborated by the health care workers such that a greater proportion of the affected community can be immunized. Lastly, genome sequencing research should be carried out on affected persons to know if there is a cellular reason for males being more affected than women.

Socio-demographic factors play a great role in the prevention and control of yellow fever outbreaks. Population or areas of an outbreak should be given high priority in health promotion and sensitization, so therefore, people in the rural community, especially in the agricultural industry like farmers, hunters, fishermen, and palm wine tappers should be targeted for those promotion/as they are at high risk of transmission; also vaccination must be given high priority and in case of vaccine unavailability, research has shown that as little as 0.5 mls can prevent from YF. Personal protective garments should be given to those who work in the forest and jungle. In other to minimize the outbreak, there is a need for wider coverage of immunization and sensitization of the public on the route of transmission, signs, and symptoms of the disease condition. These will help to curb the spread, reduce the severity and minimize the outbreak of the disease condition.

In addition, the breading site of the vector (aedes aegypti), usually the forest where hunting and farming take play, needs to be destroyed or fumigated. Environmental sanitation will go a long way to reduce community spread.

The authors wish to acknowledge the State government for building a Centre for Communicable disease and Research and Control in Federal Medical Centre and others who contributed in one way or the other.

The authors declare no conflicts of interest regarding the publication of this paper.

Ezunu, N.E., Egeonu, J.I., Osihro, A.H., Onyemushani, U.-O., Said, A., Oyakhire, O.C., Wayemeru, O.E., Okey-Ezufo, C.O., Eze-Otulaka, C., Inegbejie, F., Oghale, C.A., Ofomata, D.C., Onubogu, G.N., Okpomo, O.P., Okorhi, E.U., Agbele, O.T., Ojimba, A.O., Aigbokhaode, A.Q., Ugoeze, F.C., Osiatuma, V.A., Ezunu, E.O., Jisieike, O.N. and Omoyibo, E.E. (2022) Socio-Demographic Determinant of Yellow Fever Patient: A Retrospective Study (2020), Federal Medical Center, Asaba. Journal of Biosciences and Medicines, 10, 225-238. https://doi.org/10.4236/jbm.2022.1012018