Boko Haram and Lassa in Nigeria

Understanding Boko Haram activity and Lassa fever incidence in Nigeria, 2017-2018

Joan S. Concilio1, Dr. Gavin Macgregor-Skinner1, Dr. Benjamin Suleiman Tswabki2 and Dr. Eugene Lengerich1

1 Penn State College of Medicine, Department of Public Health Sciences
2 Ministry of Health, Jalingo, Taraba State, Nigeria

Project Objective

Two major public health issues faced Nigeria in 2017 and 2018:

  • Terrorist activity by the Boko Haram Islamist group
  • Unprecedented incidence of Lassa fever

The team’s goal was to determine if Boko Haram activity was temporally or spatially related to the incidence of Lassa fever in Nigeria for the time period, and, if so, to identify potential concurrent causes and mitigation measures.


Many studies have sought to explain potential causes of continued Boko Haram activity despite many mitigation efforts, or to describe potential reasons for increased Lassa fever incidence, especially in 2018.

Little has been done to talk about how the two issues intersect.

Although Lassa and Boko Haram may not be directly related, in a country with resources as limited as Nigeria’s, we believe understanding the cumulative effects of the two problems is of utmost importance.

Each is a potential public health crisis on its own, but in the first half of 2018, only one of Nigeria’s 36 states remained untouched by either issue. The other 35 faced the challenges caused by one or both.

Study Methodology

Our study was a mixed-methods design.

First, we conducted a secondary analysis of the Armed Conflict Location and Event Data (ACLED) Project for all known Boko Haram activity, and of the weekly Nigeria Centre for Disease Control (NCDC) Situation Reports for suspected Lassa fever cases.

Data were analyzed for January 2017 through June 2018.

The ACLED data were spatially overlaid with suspected Lassa cases for each of Nigeria’s 36 states.

Second, we conducted interviews with six aid workers in Nigeria regarding Boko Haram activities and Lassa fever cases.

About Joan Concilio

Joan is a May 2019 graduate of Penn State University’s Master of Professional Studies in Homeland Security – Public Health Preparedness program.

They are a full-time web developer for Penn State College of Medicine following a 16-year career in multimedia journalism.

Their investigative report on first Lassa fever death in the United States was named best news feature in Pennsylvania in 2015.

Joan is available for consulting and writing opportunities in a variety of areas, including:

  • Lassa and other viral hemorrhagic fevers
  • Accessibility and disaster response
  • Online tools for emergency preparedness and response
  • Strategic communications for disasters

Learn more and connect on LinkedIn

WADEM 2019 Poster and Proceedings

Joan Concilio was selected to present an abstract of this research as a poster at WADEM 2019, the congress of the World Association for Disaster and Emergency Medicine, and won a Best Poster award.

See the poster

See the abstract


Among the references cited in the full study are the following key sources:

  1. Burki T. Lassa fever in Nigeria: The great unknown. The Lancet. 2018;391:728. doi: 10.1016/S0140-6736(18)30432-X
  2. Campbell J. Nigeria Security Tracker. Council on Foreign Relations. 2018.
  3. Dollard J, Miller N, Doob L, et al. Frustration and aggression. New Haven, CT: Yale University Press. 1939. doi: 10.1037/10022-000
  4. Dunn G. The impact of Boko Haram insurgency in Northeast Nigeria on childhood wasting: a double-difference study. Conflict and Health. 2018;12:6,1-12. doi: 10.1186/s13031-018-0136-2
  5. Falode AJ. Countering the Boko Haram group in Nigeria: The relevance of hybrid doctrine. Small Wars Journal. 2016.
  6. Geisbert T. Predicting outcome and improving treatment for Lassa fever. The Lancet. 2018;18:594-595. doi: 10.1016/S1473-3099(18)30116-6
  7. Maxmen A. Deadly outbreak tests Nigerian health agency. Nature. 2018;555:421-422. doi: 10.1038/d41586-018-03171-y
  8. Nigeria Centre for Disease Control. An update of Lassa fever outbreak in Nigeria. 2018.
  9. Olakunde BO, Adeyinka DA, Wakdok SS, et al. Quantification of the effect of terrorism on the HIV response in Nigeria. The Lancet. 2018;391:1257-1258. doi: 10.1016/S0140-6736(18)30672-X
  10. Ordu GE. Trends and patterns of Boko Haram terrorist and militants’ aggression in Nigeria. Aggression and Violent Behavior. 2017;37:November-December. doi: 10.1016/j.avb.2017.08.006
  11. Pate A. Boko Haram: An assessment of strengths, vulnerabilities and policy options. Report to the Strategic Multilayer Assessment Office, Department of Defense, and the Office of University Programs, Department of Homeland Security. 2014.
  12. Premji A, Sholar PW, Hossain A, et al. Nigeria will become polio-free: Challenges, successes, and lessons learned for the quest to eradicate polio. Center for Global Development. 2016.
  13. Raleigh C, Linke A, Hegre H, et al. Introducing ACLED – Armed Conflict Location and Event Data. Journal of Peace Research. 2010;47:651-660.
  14. Roberts L. Nigeria hit by unprecedented Lassa fever outbreak. Science. 2018;359:1201-1202. doi:10.1126/science.359.6381.1201
  15. Siddle KJ, Eromon P, Barnes KG et al. Genomic analysis of Lassa virus during an increase in cases in Nigeria in 2018. The New England Journal of Medicine. 2018;379: 1745-1753. doi: 10.1056/NEJMoa1804498
  16. Tambo E, Adetunde OT, Olalubi OA. Re-emerging Lassa fever outbreaks in Nigeria: Re-enforcing “One Health” community surveillance and emergency response practice. Infectious Diseases of Poverty. 2018;7:1-7. doi: 10.1186/s40249-018-0421-8
  17. Tobin EA, Asogun D, Akpede N, et al. Lassa fever in Nigeria: Insights into seroprevalence and risk factors in rural Edo State: A pilot study. Journal of Medicine in the Tropics. 2015;17:51-55. doi: 10.4103/2276-7096.162258
  18. Van Den Hoek J. Agricultural market activity and Boko Haram attacks in northeastern Nigeria. West African Papers. 2017:No. 9.
  19. Weeraratne S. Theorizing the expansion of the Boko Haram Insurgency in Nigeria. Terrorism and Political Violence. 2017;29:610-634. doi: 10.1080/09546553.2015.1005742


Joan would like to thank Sarah Bronson, Jennifer Osetek, Rachael Reager, Robyn Reed and Bruce Rudy of Penn State College of Medicine and Kidane Mengisteab of Penn State for their guidance.

Kathy Erb, the U.S.-based Communications Manager of Christian Connections for International Health, provided invaluable connections to several Nigerian aid workers.

Those contacts were coordinated by Suleman Ari Maisule, director of Maitaimako Outreach Foundation, which provides free medical services to victims of insurgency in northeastern Nigeria.

Special thanks is given to those aid workers for their time spent communicating with the authors while participating in important and often dangerous outreach efforts in Nigeria.

This study was implemented through the Master of Professional Studies in Homeland Security – Public Health Preparedness Concentration program at Penn State College of Medicine.