The recent outbreak of Ebola Virus Disease (EVD) in West Africa has ravaged many lives. Effective containment of this outbreak relies on prompt and effective coordination and communication across ...various interventions; early detection and response being critical to successful control. The use of information and communications technology (ICT) in active surveillance has proved to be effective but its use in Ebola outbreak response has been limited. Due to the need for timeliness in reporting and communication for early discovery of new EVD cases and promptness in response; it became imperative to empower the response team members with technologies and solutions which would enable smooth and rapid data flow. The Open Data Kit and Form Hub technology were used in combination with the Dashboard technology and ArcGIS mapping for follow up of contacts, identification of cases, case investigation and management and also for strategic planning during the response. A remarkable improvement was recorded in the reporting of daily follow-up of contacts after the deployment of the integrated real time technology. The turnaround time between identification of symptomatic contacts and evacuation to the isolation facility and also for receipt of laboratory results was reduced and informed decisions could be taken by all concerned. Accountability in contact tracing was ensured by the use of a GPS enabled device. The use of innovative technologies in the response of the EVD outbreak in Nigeria contributed significantly to the prompt control of the outbreak and containment of the disease by providing a valuable platform for early warning and guiding early actions.
Objective
Healthcare workers (HCWs) play pivotal roles in outbreak responses. Ebola virus disease (EVD) outbreak spread to Lagos, Nigeria, in July 2014, infecting 11 HCWs (case fatality rate of 45%). ...This study was conducted during the outbreak to assess HCWs' EVD‐related knowledge and practices.
Methods
A health facility‐based cross‐sectional study was conducted among HCWs across Lagos State using stratified sampling technique. An interviewer‐administered questionnaire was administered to elicit respondents' socio‐demographic characteristics, knowledge and practices. A checklist assessing health facility's level of preparedness and HCWs' EVD‐related training was employed. HCWs' knowledge and practices were scored and classified as either good or poor. Multivariate analysis was performed with confidence interval set at 95%.
Results
A total of 112 health facilities with 637 HCWs were recruited. Mean age of respondents was 40.1 ± 10.9 years. Overall, 72.5% had good knowledge; doctors knew most. However, only 4.6% of HCWs reported good practices. 16.6% reported having been trained in identifying suspected EVD patient(s); 12.2% had a triaging area for febrile patients in their facilities. Higher proportions of HCWs with good knowledge and training reported good practices. HCWs with EVD‐related training were three times more likely to adopt good practices.
Conclusion
Lagos State HCWs had good knowledge of EVD without a corresponding level of good practices. Training was a predictor of good practices.
Objectif
Les agents de la santé (AS) jouent un rôle essentiel dans les réponses aux épidémies. L’épidémie de la maladie du virus Ebola (MVE) s'est propagée à Lagos, au Nigeria, en juillet 2014, infectant 11 AS (taux de létalité de 45%). Cette étude a été menée au cours de l’épidémie pour évaluer les connaissances et les pratiques des AS liées à la MVE.
Méthodes
Une étude transversale basée sur les établissements de santé a été menée chez les AS dans l'Etat de Lagos, en utilisant la technique d’échantillonnage stratifié. Un questionnaire administré par un intervieweur a été appliqué pour obtenir les caractéristiques sociodémographiques, les connaissances et les pratiques des répondants. Une liste d’évaluation de l’état d'apprêtement de l’établissement de santé et de la formation des AS liée à la MVE a été employée. Les connaissances et les pratiques des AS ont été inscrites sur une échelle et classées comme bonnes ou mauvaises. L'analyse multivariée a été effectuée avec un intervalle de confiance fixé à 95%.
Résultats
Un total de 112 établissements de santé avec 637 AS ont été recrutés. L’âge moyen des répondants était de 40,1 ± 10,9 ans. Dans l'ensemble, 72,5% avaient une bonne connaissance; les médecins en savaient plus. Toutefois, seuls 4,6% des AS faisaient état de bonnes pratiques. 16,6% ont déclaré avoir été formés à l'identification des patients suspectés de la MVE; 12,2% disposaient dans leurs établissements d'une zone de triage pour les patients fébriles. Des proportions plus élevées d’AS ayant de bonnes connaissances et formations, rapportaient de bonnes pratiques. Les AS avec une formation liée à la MVE étaient trois fois plus susceptibles d'adopter de bonnes pratiques.
Conclusion
Les AS de l'Etat de Lagos avaient de bonnes connaissances sur la MVE sans avoir un niveau correspondant de bonnes pratiques. La formation était un prédicteur de bonnes pratiques.
Objetivo
Los trabajadores sanitarios (TS) juegan un papel primordial en las respuestas a los brotes epidémicos. Los primeros brotes de enfermedad por el virus del Ébola (EVE) aparecieron en Lagos, Nigeria, en Julio del 2014, infectando 11 TS (tasa de letalidad del 45%). Este estudio se realizó durante el brote, para evaluar los conocimientos y prácticas de los TS sobre la EVE.
Métodos
Se realizó un estudio croseccional en centros sanitarios y entre los TS, a lo largo del estado de Lagos, utilizando una técnica de muestreo estratificada. Un entrevistador administró un cuestionario sobre las características demográficas, conocimientos y prácticas del entrevistado. Mediante una lista de verificación se evaluó en nivel de preparación del centro de atención sanitaria y el entrenamiento recibido por los TS sobre la EVE. Los conocimientos y prácticas de los TS se puntuaron y clasificaron como “buenos” o “pobres”. Se realizó un análisis multivariado con intervalos de confianza del 95%.
Resultados
Se reclutaron 112 centros sanitarios con 637 TS. La edad media de quienes respondieron era de 40.1±10.9 años. En total, un 72.5% tenía un buen nivel de conocimientos; los médicos eran quienes más sabían. Sin embargo, solo un 4.6% de los TS reportaron buenas prácticas. Un 16.6% reportó haber sido entrenado en la identificación de pacientes con sospecha de EVE; un 12.2% tenía, en sus centros, un área de triaje para pacientes febriles. Una mayor proporción de TS con un buen nivel de conocimientos y entrenamiento reportó buenas prácticas. Los TS con entrenamiento sobre la EVE tenían tres veces más probabilidad de adoptar unas buenas prácticas.
Conclusión
Los trabajadores sanitarios del Estado de Lagos tenían un buen nivel de conocimientos sobre la EVE, sin un nivel correspondiente de buenas prácticas. El entrenamiento era un vaticinador de buenas prácticas.
Highlights • Outbreak, mostly a severe febrile gastroenteritis syndrome (85% fever, 70% fatigue, 65% diarrhea, 50% vomiting) in keeping with the West Africa EVD pattern. • Began in Africa's most ...populous city, spread to a 2nd large city but only 20 cases, mostly females and health workers, low CFR of 40%. No case-management worker infected. • Higher mortality in males, older age-group (>40 years), patients with diarrhea, vomiting, bleeding or late presentation to treatment center. • Early case-identification (survivors 3 ± 2 days, non-survivors 5 ± 2) due to effective contact tracing by epidemiologists/trainee-epidemiologists and prompt suspect-case evaluation/isolation achieving containment within 2-months.
The first ever outbreak of Ebola virus disease (EVD) in Nigeria was declared in July, 2014. Level of public knowledge, perception and adequacy of information on EVD were unknown. We assessed the ...public preparedness level to adopt disease preventive behavior which is premised on appropriate knowledge, perception and adequate information.
We enrolled 5,322 respondents in a community-based cross-sectional study. We used interviewer-administered questionnaire to collect data on socio-demographic characteristics, EVD-related knowledge, perception and source of information. We performed univariate and bivariate data analysis using Epi-Info software setting p-value of 0.05 as cut-off for statistical significance.
Mean age of respondents was 34 years (± 11.4 years), 52.3% were males. Forty one percent possessed satisfactory general knowledge; 44% and 43.1% possessed satisfactory knowledge on mode of spread and preventive measures, respectively. Residing in EVD cases districts, male respondents and possessing at least secondary education were positively associated with satisfactory general knowledge (p-value: 0.01, 0.001 and 0.000004, respectively). Seventy one percent perceived EVD as a public health problem while 61% believed they cannot contract the disease. Sixty two percent and 64% of respondents will not shake hands and hug a successfully treated EVD patient respectively. Only 2.2% of respondents practice good hand-washing practice. Television (68.8%) and radio (55.0%) are the most common sources of information on EVD.
Gaps in EVD-related knowledge and perception exist. Targeted public health messages to raise knowledge level, correct misconception and discourage stigmatization should be widely disseminated, with television and radio as media of choice.
In July 2014, Nigeria experienced an outbreak of Ebola virus disease following the introduction of the disease by an ill Liberian Traveler. The Government of Nigeria with the support of Technical and ...Development Partners responded quickly and effectively to contain the outbreak. The epidemiological profile of the outbreak that majorly affected two States in the country in terms of person, place and time characteristics of the cases identified is hereby described.
Using field investigation technique, all confirmed and probable cases were identified, line-listed and analysed using Microsoft Excel 2007 by persons, time and place.
A total of 20 confirmed and probable cases; 16 in Lagos (including the index case from Liberia) and 4 in Port Harcourt were identified. The mean age was 39.5 ± 12.4 years with over 40% within the age group 30-39 years. The most frequent exposure type was direct physical contact in 70% of all cases and 73% among health care workers. The total case-fatality was 40%; higher among healthcare workers (46%) compared with non-healthcare workers (22%). The epidemic curve initially shows a typical common source outbreak, followed by a propagated pattern.
Investigation revealed the size and spread of the outbreak and provided information on the characteristics of persons, time and place. Enhanced surveillance measures, including contact tracing and follow- up proved very useful in early case detection and containment of the outbreak.
By September 2014, an outbreak of Ebola Viral Disease (EVD) in West African countries of Guinea, Liberia, Sierra Leone, Senegal and Nigeria, had recorded over 4500 and 2200 probable or confirmed ...cases and deaths respectively. EVD, an emerging infectious disease, can create fear and panic among patients, contacts and relatives, which could be a risk factor for psychological distress. Psychological distress among this subgroup could have public health implication for control of EVD, because of potential effects on patient management and contact tracing. We determined the Prevalence, pattern and factors associated with psychological distress among survivors and contacts of EVD and their relatives.
In a descriptive cross sectional study, we used General Health Questionnaire to assess psychological distress and Oslo Social Support Scale to assess social support among 117 participants who survived EVD, listed as EVD contacts or their relatives at Ebola Emergency Operation Center in Lagos, Nigeria. Factors associated with psychological distress were determined using chi square/odds ratio and adjusted odds ratio.
The mean age and standard deviation of participants was 34 +/ - 9.6 years. Of 117 participants, 78 (66.7%) were females, 77 (65.8%) had a tertiary education and 45 (38.5%) were health workers. Most frequently occurring psychological distress were inability to concentrate (37.6%) and loss of sleep over worry (33.3%). Losing a relation to EVD outbreak (OR = 6.0, 95% CI, 1.2-32.9) was significantly associated with feeling unhappy or depressed while being a health worker was protective (OR = 0.4, 95% CI, 0.2-0.9). Adjusted Odds Ratio (AOR) showed losing a relation (AOR = 5.7, 95% CI, 1.2-28.0) was a predictor of "feeling unhappy or depressed", loss of a relation (AOR = 10.1, 95% CI, 1.7-60.7) was a predictor of inability to concentrate.
Survivors and contacts of EVD and their relations develop psychological distress. Development of psychological distress could be predicted by loss of family member. It is recommended that psychiatrists and other mental health specialists be part of case management teams. The clinical teams managing EVD patients should be trained on recognition of common psychological distress among patients. A mental health specialist should review contacts being monitored for EVD for psychological distress or disorders.
On July 20, 2014, an acutely ill traveler from Liberia arrived at the international airport in Lagos, Nigeria, and was confirmed to have Ebola virus disease (Ebola) after being admitted to a private ...hospital. This index patient potentially exposed 72 persons at the airport and the hospital. The Federal Ministry of Health, with guidance from the Nigeria Centre for Disease Control (NCDC), declared an Ebola emergency. Lagos, (pop. 21 million) is a regional hub for economic, industrial, and travel activities and a setting where communicable diseases can be easily spread and transmission sustained. Therefore, implementing a rapid response using all available public health assets was the highest priority. On July 23, the Federal Ministry of Health, with the Lagos State government and international partners, activated an Ebola Incident Management Center as a precursor to the current Emergency Operations Center (EOC) to rapidly respond to this outbreak. The index patient died on July 25; as of September 24, there were 19 laboratory-confirmed Ebola cases and one probable case in two states, with 894 contacts identified and followed during the response. Eleven patients with laboratory-confirmed Ebola had been discharged, an additional patient was diagnosed at convalescent stage, and eight patients had died (seven with confirmed Ebola; one probable). The isolation wards were empty, and 891 (all but three) contacts had exited follow-up, with the remainder due to exit on October 2. No new cases had occurred since August 31, suggesting that the Ebola outbreak in Nigeria might be contained. The EOC, established quickly and using an Incident Management System (IMS) to coordinate the response and consolidate decision making, is largely credited with helping contain the Nigeria outbreak early. National public health emergency preparedness agencies in the region, including those involved in Ebola responses, should consider including the development of an EOC to improve the ability to rapidly respond to urgent public health threats.
The recent outbreak of Ebola Virus Disease (EVD) in West Africa has ravaged many lives. Effective containment of this outbreak relies on prompt and effective coordination and communication across ...various interventions; early detection and response being critical to successful control. The use of information and communications technology (ICT) in active surveillance has proved to be effective but its use in Ebola outbreak response has been limited. Due to the need for timeliness in reporting and communication for early discovery of new EVD cases and promptness in response; it became imperative to empower the response team members with technologies and solutions which would enable smooth and rapid data flow. The Open Data Kit and Form Hub technology were used in combination with the Dashboard technology and ArcGIS mapping for follow up of contacts, identification of cases, case investigation and management and also for strategic planning during the response. A remarkable improvement was recorded in the reporting of daily follow-up of contacts after the deployment of the integrated real time technology. The turnaround time between identification of symptomatic contacts and evacuation to the isolation facility and also for receipt of laboratory results was reduced and informed decisions could be taken by all concerned. Accountability in contact tracing was ensured by the use of a GPS enabled device. The use of innovative technologies in the response of the EVD outbreak in Nigeria contributed significantly to the prompt control of the outbreak and containment of the disease by providing a valuable platform for early warning and guiding early actions.
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