RESIDENTS PREPAREDNESS LEVEL AGAINST EBOLA VIRUS DISEASE RESURGENNCE: A SURVEY IN THREE LOCAL GOVERNMENT AREAS IN LAGOS STATE

Residents Preparedness Level Against Ebola Virus Disease Resurgence

iBabatunde Olowookere 910706002

RESIDENTS PREPAREDNESS LEVEL AGAINST EBOLA VIRUS DISEASE RESURGENNCE: A SURVEY IN THREE LOCAL GOVERNMENT AREAS IN LAGOS STATE

SUBMITTED BY

OLOWOOKERE BABATUNDE ABIODUN

MATRIC NO: 910706002

SUBMITTED TO

THEDEPARTMENT OF COMMUNITY HEALTH AND PRIMARY HEALTH CARE, COLLEGE OF MEDICINE,

UNIVERSITY OF LAGOS

IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE AWARD OF (MSc) DEGREE IN PUBLIC HEALTH

(GENERAL OPTION)

SEPTEMBER 2015


DECLARATION

I Babatunde Abiodun Olowookere hereby declares that this project titled: Residents

Preparedness Level against Ebola Virus Disease Resurgence: a survey in three local

Government Areas in Lagos State was carried out by me under the supervision of Dr.

Robert A.A. I also declare that it has not been submitted either in part or in full for any other

examination.

NAME SIGNATURE

Babatunde Abiodun Olowookere

I BabatundeAbiodunOlowookerehereby declare that this project titled: A Survey of

Household on Community Mobilization for Ebola Virus Disease in three Local

Government Areas in Lagos State was carried out by me under the supervision of Dr.

Robert A.A. I also declare that it has not been submitted either in part or in full for any other

examination.

NAME


SIGNATURE

iiBabatunde Olowookere 910706002


DATE

iiiBabatunde Olowookere 910706002


DEDICATION

To Almighty God, for his grace and tremendous love.

To my wife for her love and support.

To our beloved son Jesse. Jese

ivBabatunde Olowookere 910706002


CERTIFICATION

CERTIFICATION

I certify that the research project titled Residents Preparedness Level against Ebola Virus

Disease Resurgence: a survey in three local Government Areas in Lagos State was carried out

by Babatunde Abiodun Olowookere under my supervision.

…………………... ………………….……….. ………………………………DR. A. A. ROBERTS DATESupervisor

……………………………………………… ………………………………… BABATUNDE ABIODUN OLOWOOKERE DATEStudent

vBabatunde Olowookere 910706002


……………………………………………… ……………………………… DR. OGUNNOWO DATE

Assessor DATEI certify that the research project Titled Residents Preparedness Level against Ebola Virus Disease Resurgence: A Survey in Three Local Government Areas in Lagos Statewas carried out byBabatundeAbiodunOlowookere under my supervision. The project work is adequate in scope and qualify for partial fulfillment of the requirement for the award of masters of Science Degree in Public Health.


viBabatunde Olowookere 910706002


ACKNOWLEDGEMENT

I wish to acknowledge the grace of the Almighty God upon my life from the time I was born

till this day; I give all the praise and honour to his holy name.

I wish to thank the past and present postgraduate co-coordinators, Dr Alero Roberts and Dr

Abiola for their assiduous efforts to ensure a smooth running of the MPH session. I am

indebted to my supervisor Dr. A.A Alero for heris calmness, maturity and mentors hip during

the study period despite heris busy schedule.

To my wife, Mrs. Hauwa Olowookere, I wish to say a big thank you for your support and

encouragement throughthroughout the academic year, may the Almighty God continue to

guide and protect you. To my adorable son, Jesse Olowookere, thank you for being sweet and

supportive during this period. To all my friends and colleagues, I thank you all.

I cannot but give thanks to all my colleagues at the National Emergency Management

Agency (NEMA), South West Zonal office particularly the Zonal Coordinator, Dr. Bemdele

Onimode for his support and advice during the course of the program.

Finally, I am extremely grateful to all those who participated in the study for their

willingness, time, commitment and sincere responses. I cannot end my acknowledgment

without appreciating Micheal Agoro an Industrial Attachment student with NEMA Zonal

office and also David Oyedepo an NYSC Corp member serving at the zonal office for their

assistance during the data gathering for the study.

viiBabatunde Olowookere 910706002


TABLE OF CONTENTSTITLE PAGE………………………………………………………………………………… ................i

DECLARATION................................................................................................................................... ii

DEDICATION...................................................................................................................................... iii

CERTIFICATION................................................................................................................................ iv

ACKNOWLEDGEMENT.....................................................................................................................v

TABLE OF CONTENTS......................................................................................................................vi

LIST OF TABLES...............................................................................................................................vii

LIST OF FIGURES....................................................................................................................... ixixviii

ABBREVIATIONS.............................................................................................................................. ix

SUMMARY...........................................................................................................................................x

CHAPTER ONE................................................................................................................................211

BACKGROUND TO THE STUDY..................................................................................................211

CHAPTER TWO...............................................................................................................................756

LITERATURE REVIEW..................................................................................................................756

CHAPTER THREE.....................................................................................................................312330

MATERIALS AND METHODOLOGY.........................................................................................3123

CHAPTER FOUR...........................................................................................................................3930

RESULTS........................................................................................................................................3930

DISCUSSION.................................................................................................................................5853

CONCLUSION...............................................................................................................................6155

RECOMMENDATIONS.................................................................................................................6256

REFERENCES................................................................................................................................6357

viiiBabatunde Olowookere 910706002


LIST OF TABLES

Table 1: Respondents used in the study……………………………………………………… 36

Table 2: Socio-demographic characteristics of respondents…………………………………..

39

Table 3: Socio -economic characteristics of respondents………………………………………. 40

Table 4: Knowledge score of respondents on causes of Ebola disease………………………..…..

41

Table 5: Table 4: Knowledge on the spread of Ebola Viral Disease…………………………………….

….. 42

Table 6:Table 5: Knowledge on when signs of illness of Ebola Viral Disease begins by

respondents (n=390)…………………………………………………………………… 44……

…

Table 7: Level of preparedness against Ebola Viral Disease resurgence………………………. 46

Table 8: Knowledge score of respondents on EVD across all domains………………………….. 48

Table 9: Association between Socio-demographic characteristics of respondents and their

Knowledge of EVD (n=390)…………………………………………………………… 49

Table 10: Association between Socio-economic characteristics of respondents and knowledge

of EVD…………..………………………………………………………………. 50

Table 11: Association between Socio-economic characteristics of respondents and their

Attitude and perception of EVD of EVD…………..………………………… 51


Attitude and perception regarding of EVD …………………………………………… 52

Table 13: Association between Socio-demographic characteristics of respondents

and their Level of Preparedness against of EVD resurgence…………………………. 53

Table 14: Association between Socio-economic characteristics of respondents

and their Attitude and perception regarding of EVD………………………….. 54

Table 15: Association between Socio-demographic characteristics of respondents and

practices regarding EVD………………………………………………………….. 55

Table 16: Association between Socio-economic characteristics of respondents and

practices regarding EVD resurgence…………………………………………… 56

ixBabatunde Olowookere 910706002


Table 6: Knowledge on drug /remedy to treat Ebola Viral Disease……………………………

Table 7: Knowledge on how to prevent contracting Ebola Viral Disease……………………..

Table 8: Attitude and perception regarding Ebola Viral Disease………………………………

Table 9: Attitude and perception regarding Ebola Viral Disease……………………………..

Table 10: Level of preparedness against Ebola Viral Disease resurgence……………………..

Table 11: Practices regarding Ebola Viral Disease…………………………………………….

Table 12: Knowledge score of respondents on EVD across all

domains………………………

Table 14: Association between Socio-demographic characteristics of

respondents and their Knowledge of EVD (n=416)

……………………………………………………………………

Table 13: Association between Socio-economic characteristics of

respondents

and their Knowledge of EVD (n=390) their Attitude and perception of

EVD (n=416)………..


respondents and their Attitude and perception of EVD (n=390)

……………………………………………………….


respondents

and their Attitude and perception regarding of

EVD…………………………………………

xBabatunde Olowookere 910706002



respondents

and their Level of Preparedness against of EVD

resurgence………………………………….


respondents

and their level of preparedness EVD

resurgence……………………………………………..


respondents

and practices regarding EVD

…………………………………………………………………


respondents

and practices regarding EVD

resurgence……………………………………………………..

xiBabatunde Olowookere 910706002


LIST OF FIGURES

Figure 21: Knowledge of Signs and Symptoms of Ebola Viral Disease

mentioned by respondents (n=390)……………………………………………. 3543

Figure 32: Knowledge on sources and channels of information regarding EVD (n=390)... 4539

Figure 31: Overview of Ebola virus pathogenesis………………………………………. 1471

Figure 2: Knowledge of Signs and Symptoms of Ebola Viral Disease

mentioned by respondents (n=390)……………………………………………. 35

Figure 3: Knowledge on sources and channels of information regarding EVD (n=390)... 39

xiiBabatunde Olowookere 910706002


LIST OF TABLES

Table 1: Socio-demographic characteristics of respondents ..............25

Table 1: Socio-demographic characteristics of respondents

Table 2: Socioeconomic characteristics of respondents

Table 4: Knowledge score of respondents on causes of Ebola

disease

Table 5: Knowledge on the spread of Ebola Viral Disease

Table 6: Knowledge on when signs of illness of Ebola Viral

Disease begins by

Respondents (n=390)

Table 7: Knowledge on drug /remedy to treat Ebola Viral Disease

xiiiBabatunde Olowookere 910706002


LIST OF FIGURES

xivBabatunde Olowookere 910706002


ABBREVIATIONS

CDC Center for Disease Control and Prevention

DRC Democratic Republic of Congo

ECOWAS Economic Community of West Africa State

EEOC Ebola Emergency Operation Center

EID Emerging infectious Disease

ELISA Enzyme-Linked Immunosorbent Assay

EVD Ebola Virus Disease

HF Health Facility

KAP Knowledge, Attitudes, and Practices

LGAs Local Government Areas

GOARN The Global Alert and Response Network

NHP Non-Human Primate

Ig Immuno-globulin

MCP Macrophage Chemotactic protein

NO

PCR

PHCC

Nitric Oxide

Polymerase Chain Reaction

Primary Health Care Centre

PHE

PPE

TF

VHF

UNICEF

Public Health Event

Personal Protective Equipment

Tissue Factor

Viral Hemorrhagic Fever

United Nations Children’s Fund

WHO World Health Organization

xvBabatunde Olowookere 910706002


xviBabatunde Olowookere 910706002


SUMMARY

Ebola is one of the most virulent human viral diseases with a case fatality ratio between 25%

to 90%. The West African outbreaks in 2014 are the largest and worst in history. The first

ever outbreak of Ebola virus disease (EVD) in Nigeria was declared in July, 2014 but Nigeria

and Liberia were however declared EVD free on 20th October 2014 and 9th May 2015 after no

new cases were reported within the period. A new confirmed case was however reported in

Liberia on Monday 29th June 2015. This latest resurgence of EVD in Liberia is an indication

of how difficult it is for Public Health authorities to eliminate a highly contagious viral

disease and its implications in Nigeria.

The objectives of the study are to determine knowledge, attitude, level of preparedness and

practices of hygiene amongst residents in Ikeja, Agege and Mushin Local Government Areas

of Lagos State.

The survey which assessed the preparedness level against Ebola Virus Disease resurgence in

three (3) Local Government Areas in Lagos State namely Ikeja, Agege and Mushin was

conducted among 416 residents. Selection was focused on Lagos State due to the fact that it

was once hit by an epidemic.

The study was a descriptive, community-based cross-sectional survey and 309 identified

residents were successfully surveyed, with a rate of 93.98%. Among the identified, we had

57.1% men, 48.1% women and majority of the respondents were Christians.

It was noticed that 6.02% have never heard about EDV, 6.2% possessed satisfactory

knowledge in all three domains. Fifteen percent, 24.5%, 2.9% and 13.1% possessed

satisfactory knowledge in signs and symptoms, preventive measures, mode of spread and

level of preparedness. Radio was the most used source of information. Majority (82.3%) of xvii

Babatunde Olowookere 910706002


the respondents mentioned regular hand washing with soap and water, while 55.6% said they

regularly used hand sanitizers.

It was discovered from the study that there was high level of preparedness amongst the

studied population against a re-emergence of EVD. Nonetheless, participating in burial rites

of a person that dies of Ebola disease remains a major key knowledge gap. For Nigeria, the

best protective measures are adequate levels of preparedness focused on knowledge, attitude

perception and practices preventing a further spread of the disease.

Ebola is one of the most virulent human viral diseases with a case fatality ratio between 25%

to 90%. The West African outbreaks in 2014 are the largest and worst in history. The first

ever outbreak of Ebola virus disease (EVD) in Nigeria was declared in July, 2014 although

Nigeria and Liberia were declared EVD free on 20th October 2014 and 9th May 2015 after no

new cases were reported within the period.

A new confirmed case was however reported in Liberia on Monday 29 th June 2015. This

latest resurgence of EVD in Liberia is an indication of how difficult it is for Public Health

authorities to eliminate a highly contagious viral disease and its implication in Nigeria.

The survey assessed the preparedness level against Ebola Virus Disease resurgence in three

(3) Local Government Areas in Lagos State was conducted among 416 residents. Selection

was focused on Lagos State due to the fact that it was once hit by an epidemic. From the

identified residents, 309 were successfully surveyed, with a rate of 93.98%. Among the

identified, we had 57.1% men, 48.1% women and majority of the respondents were

Christians.

It was noticed that 6.02% have never heard about EDV, 6.2% possessed satisfactory

knowledge in all three domains. Fifteen percent, 24.5%, 2.9% and 13.1% possessed

xviiiBabatunde Olowookere 910706002


satisfactory knowledge in signs and symptoms, preventive measures, mode of spread and

level of preparedness. Radio was the most used source of information. Majority (82.3%) of

the respondents mentioned regular hand washing with soap and water, while 55.6% said they

regularly used hand sanitizers.

The study highlights that there was high level of preparedness of the studied population

against re-emergence of EVD. For Nigeria, the best protective measures are adequate levels

of preparedness that focus on knowledge, attitude and perception and practices regarding

EVD to avoid further spread.

xixBabatunde Olowookere 910706002


CHAPTER ONEINTRODUCTION

BACKGROUND TO THE STUDY

Ebola Virus Disease (EVD) (Formally known as Ebola haemorrhagic fever) is an active

haemorrhagic illness with a case fatality (death) rate of up to 90%. The disease is caused by

filoviridae family that affects humans and non-human primates (monkey, gorilla and

chimpanzee).1

The World Health Organization (WHO) defines Ebola Virus Disease as a severe often fatal

illness in humans. EVD is transmitted from wild animals and then spread within the human

population through human to human transmission.2

Ebola viral fever, a highly contagious haemorrhagic disease has today become a major public

health concern particularly in developing world.3The first Ebolavirus specie was discovered

in the year 1976 in what has now become the Democratic Republic of Congo near the Ebola

River. The epidemic recorded 318 cases and 280 deaths for a case fatality of 88%.Since then

24 more outbreaks have occurred in multiple African countries.4 The disease in Sudan also

known as Sudan Ebola Virus (SEBOV) has caused six further epidemics in man and while

that of Zaire strain known as (EBOV) has caused 17 further epidemics.5

the World Health Organization (WHO) has reported over 11,306 casualties with an estimated

28,256 people confirmed or suspected of having contracted the disease in nine countries as at

xxBabatunde Olowookere 910706002


September 3rd 2015. A total of 869 confirmed healthcare workers infected with EVD and 507

confirmed dead.6 Majority of these cases occurred in West African Countries of Guinea,

Sierra Leone and Liberia. While Nigeria, Senegal, the USA, Spain, Mail, the United

Kingdom and Italy reported imported cases or import-related local transmission linked to the

epidemic in West Africa.

The recent resurgence of the disease in Liberia which has earlier been certified EVD free

with Nigeria by the World Health Organization is a cause for concern for all.7

NATURE OF THE PROBLEM

The first outbreak of the epidemic in the West African sub region was in 2014 and since then,

curbing the spread of the EVD has been a challenge. The fear that the disease could spread

further is palpable due to the situation in Liberia. The outbreak is also still very active in

Sierra Leone and Guinea.

The greatest mystery regarding the causative organism of EVD is the identity of its natural

reservoir and the mode of transmission from the reservoir to wild animals and man.8 In

addition, EVD present signs and symptoms of that Lassa fever or viral hemorrhagic fever

which is highly prevalent in West Africa; that can also cause delay diagnosis.

THE EXTENT OF THE PROBLEM

The current outbreak in West Africa was first reported in March 2014. It is the largest and

most complex Ebola outbreak since the Ebola virus was discovered in 1976.9 There have

been more cases and deaths in this epidemic than all others combined. It has also spread

between countries starting from Guinea and spreading across land borders to Sierra Leone xxi



and Liberia by air (1 traveller) to Nigeria and USA (1 traveller) and by land Senegal (1

traveller) and Mali (2 travellers).10

The West Africa outbreak is so large, so severe and so difficult to contain. The hardest-hit

countries are Guinea, Liberia and Sierra Leone.11 These countries are amongst the poorest in

the world. Both Sierra Leone (1991-2002) and Liberia (1989-2003) have only recently

emerged from protracted conflicts and Civil wars. The Ebola Virus Disease (EVD) epidemic

in West Africa has ravaged the social fabrics of three (3) countries (Guinea, Liberia and

Sierra Leone) with a death toll of over 11 263 people and over 27 642 cases as at July 15,

2015.

In August 2014 WHO declared it a Public Health Emergency of International Concern.

Travel-associated cases have now been documented in five (5) additional countries and

effects are being felt worldwide.12EVD is highly contagious in nature and can be easily

spread if not properly managed; in addition, the fact that the cure for the disease has not been

discovered and no vaccine to inoculate affected victims remains a major concern.

THE SIGNIFICANCE OF THE PROBLEM

The world Health Organization (WHO) declared Nigeria and Liberia Ebola Virus Disease

(EVD) free on 20th October 2014 and 9thMay 2015 after no new cases were

reported.13However, a new confirmed case was reported on Monday 29thJune 2015 in Liberia.

This latest resurgence of EVD in Liberia is an indication of how difficult it is for Public

Health authorities to eliminate a highly contagious viral disease.

xxiiBabatunde Olowookere 910706002


Nigeria is the most occupied country in Africa with an estimated population of about 180

million. It is also the world’s fourth largest oil producer and second largest supplier of natural

gas.14Lagos-State is the commercial nerve center of Nigeria. The State attracts travelers from

all over the world particularly people from other West African countries that are still battling

with the scourge of EVD. This portends danger if proper prevention and control measures are

not sustained to enhance the spread of the disease.

THE JUSTIFICATION AND RATIONALE FOR STUDY

Nigeria containment of Ebola Virus Disease (EVD) has been lauded as nothing short of

remarkable given both the population density in the country and particularly in cities such as

Lagos and Port Harcourt. The outbreak of the disease created public fear, panic and confusion

as is usually seen in outbreaks of previously unknown diseases or epidemics such as malaria,

poliomyelitisetc which are yet to be totally contained in the country. Nonetheless, there is the

need to continuously have a preventive behavior to reduce community transmission to human

by emerging infectious diseases (EIDs).

The trends in globalization including expansion in international travel and trade have also

extended the reach and increased the pace at which infectious diseases spread. Between the

periods of 1996-2009, research shows that 53% of the global EID outbreaks occurred in

Africa.15

As a nation, there is an urgent need to assess our readiness to manage and contain the EVD.

Periodic research through surveys of assessment of the level of preparedness of residents in

three (3) Local Government Areas in Lagos State against EVD Resurgence will further

enhance our response capability and reduce the burden on the health infrastructure caused by

the fatal epidemics.

xxiiiBabatunde Olowookere 910706002


AIM

The study is to assess the level of preparedness of residents in Ikeja, Agege and Mushin

Local Government Areas of Lagos State against EVD Resurgence.

OBJECTIVES

To achieve this aim the specific objectives are:

1. To determine the level of knowledge of EVD amongst the residents in Ikeja, Agege

and Mushin Local Government Areas of Lagos State.

2. To determine the attitude of residents in Ikeja, Agege and Mushin Local Government

Area of Lagos State on EVD.

[3.] To determine the level of preparedness and practices of hygiene amongstramongst

residents in Ikeja, Agege and Mushin Local Government Areas of Lagos State.

xxivBabatunde Olowookere 910706002


xxvBabatunde Olowookere 910706002


CHAPTER TWOLITERATURE REVIEW

DEFINITIONS AND BACKGROUND

Ebola Virus Disease (EVD):

EVD can be defined as a severe form of viral haemorrhagic fever or fatal zoonotic infection

caused by a virus of the filoviridae family and designated Ebola Haemorrhagic Fever

(EHF).16

Public Health Event (PHE):

A public health event is defined as any occurrence that may have negative consequences for

human health including those that have not yet caused disease or illness but that have

potential and those that may require a coordinated response.17

Public Health Preparedness:

These are actions taken by Healthcare and Public Health organizations to ascertain effective

response to emergencies that impact health especially events that have timing or scale that

overwhelms normal capacity.18

Individual Preparedness:

Action taken by an individual or family to prevent, protect against and minimize physical and

emotional damage that results from a disaster.18 18Preparedness is a fundamental concept in the

field of Disaster Research and Emergency Management. It is a measure taken prior to the

onset of a disaster to enhance the response capacity.

xxviBabatunde Olowookere 910706002


It also implies the ability of social units to accurately assess a hazard, realistically anticipate

likely problems in the event of an actual disaster and appropriately taken precautionary

measures to mitigate impacts and ensure an efficient and effective response.

Knowledge Attitude and Practice:

Knowledge: is defined as “the fact or condition of knowing something with a considerable

degree of familiarity through experience, association or contact’’.19

Three forms of knowledge are identified: explicit, tacit and implicit.

Explicit knowledge is that which is stated in detail and is termed as codified or formal

knowledge.20

Explicit knowledge can be accessed by anyone, for example, books, pictures, or recording

clips.

Tacit knowledge represents knowledge based on the experience of individuals, expressed in

human actions in the form of evaluation, attitudes, points of view, commitments and

motivation. Tacit knowledge is lost with the person who possesses it.21

Implicit knowledge is that which could be expressed, but has not been. In other words

implicit knowledge is that body of knowledge which exists without being stated.19 19

Attitude: Iis a predisposition or tendency to respond positively or negatively towards a

certain idea, object, person or situation. Attitude is un-expressed behavior. It influences an

individual’s choice of action.

Practice: Iis the utilization of rules and knowledge that leads to action. Good practice shares

a corresponding relationship with knowledge and technology.

xxviiBabatunde Olowookere 910706002


The union of Knowledge, Attitude, and Practice in a common action like the KAP study is an

educational diagnosis of community or subgroup of a community. It evaluates specific

understanding, feelings and actions regarding any matter of interest.

Ebola Resurgence:

Resurgence is bringing again into activity and prominence. Ebola resurgence is therefore the

re-emergence of new cases of Ebola Virus Disease in a place where it has been declared

Ebola-free.

Emergency:

A sudden occurrence that may be due to epidemics, natural, man-induced to technological

catastrophes that demands immediate action.22

Resident:

Someone who lives in a particular place for a prolonged period or who was born there.

EBOLA VIRUS DISEASE - AN OVERVIEW

Ebola Virus Disease (EVD) is caused by Ebola Virus responsible for viral hemorrhagic fever

like Lassa fever (LASV), Yellow fever (YFV), Marburge fever and Dengue fever. Ebola

viruses are the causative agents of a severe form of viral haemorrhagic fever in man,

xxviiiBabatunde Olowookere 910706002


designated Ebola Haemorrhagic Fever (EHF) and are endemic in regions of Central Africa.

They are called hemorrhagic because of the distinct scary bleeding that occurs during the

course of the illness. Nonetheless, the word hemorrhagic is now left out in the case of Ebola

because not all of Ebola patients developed significant hemorrhage symptoms, which usually

occurs only in the terminal phase of fatal illness.23

EVD is one of the most fatal viral diseases worldwide affecting human and non-human

primates. Ebola was first discovered in 1976 near the Ebola River in what is now called the

Democratic Republic of the Congo (DRC).The virus has the potential to spread globally and

is classified as a “category A” pathogen that could be misused as a bioterrorism agent.24

CLASSIFICATION OF EBOLA VIRUS

Ebola virus is a non-segmented, negative-sense highly infectious illness caused by a single-

stranded RNA virus similar to rhabdoviruses and paramyxoviruses in its genome organization

and replication mechanism.

Ebola Virus is amongst the most virulent pathogens that have been shown to cause disease in

humans and nonhuman, and has fast become one of the world’s most feared pathogen. Ebola

Virus alongside causative organisms of Rift valley fever, Crimean Congo hemorrhagic fever,

lassa fever, yellow fever and Dengue hemorrhagic fever are also classified as hemorrhagic

fever virus are all classified as hemorrhagic fever viruses.

xxixBabatunde Olowookere 910706002


Currently, there are five (5) genetically distinct members of thefiloviridae family (filovirus),

this includes: Zaire Ebolavirus (EBOV), BundibugyoEbolavirus (BDBV), Reston Ebolavirus

(RESTV), Sudan Ebolavirus (SUDV) and Tai Forest Ebolavirus (TAFV) all named after the

country or location where virus was first isolated.

Although, Reston ebolavirus has only caused disease in non-human primates (NHP) and was

found in swine suffering from porcine reproductive and respiratory disease syndrome in the

Philippines and in People’s Republic of Chain.25Zaire, Sudan and Bundibugyo Ebola viruses

are largely responsible for most of the Ebolahaemorrhagic Fever outbreaks in Africa.26The

fifth species, Tai forest ebolavirus was documented in a single human infection caused by

contact with an infected chimpanzee from the Tai forest in Ivory Coast. In sub-saharan Africa

the Zaire ebolavirus constitutes a particularly serious threat to both human and non-human

primates.

The Zaire species which has been identified as the most commonly occurring species in

previous outbreaks is the cause of the number of cases and deaths between 1976 and 2012.

The fatality percentage represents the percentage of people who die after contracting the virus

and Zaire has the highest at 69%, followed by the second most virulent species Sudan at

53%.27The Ebola outbreak (Zaire species) of 2014 has become larger than all previous Ebola

outbreaks combined since its discovery in 1976. Epidemic has occurred in the Sudan,

Democratic Republic of Congo, Gabon, Uganda and Congo.28

EPIDEMIOLOGY OF EBOLA VIRUS DISEASE

xxxBabatunde Olowookere 910706002


Two main modes of transmission into human populations have been suggested: either direct

contact to a reservoir or contact to other wildlife that also contracts EBOV from the

reservoir.29

The filoviruses Marburg and Ebola cause fulminant hemorrhagic fever were first recognized

in 1967 when the inadvertent importation of infected monkeys from Uganda resulted in

explosive outbreaks of severe illness among vaccine plant workers in Marburg, Germany and

Belgrade, Yugoslavia.30 Ever since, except in few instances of accidental laboratory

infections reported, all large outbreaks of filoviral disease have been confined to Sub-

Saharan Africa.31

The first recognized outbreaks in Africa occurred in Zaire and Sudan in 1976.Each outbreak

had over 300 people affected but did not spread greatly because of the location of the place.

The Zaire species caused several hundred cases in 1995 in Kikwit, Democratic Republic of

Congo and the Sudan virus infected more than 400 people in Gulu, Uganda in 2000.32

The 2013-2015 Ebola epidemic is the largest outbreak of Ebola virus ever recorded. It was

caused by the Zaire species of the virus. It is not only the first to occur in West Africa but the

effect far outweighs other previous outbreaks. The West African country of Guinea was

where the first case was first confirmed in December 2013 and it spread to Liberia and Sierra

Leone in 2014.33Subsequently, the cases of EVD outbreaks spread to Nigeria, Senegal and

Mail with isolated case in United Kingdom and another in Sardinia. There were also reported

imported cases in the United States and Spain which led to secondary infections of medical

workers but did not spread further.

Aside of causing human infections, Ebola virus has also spread to wild non-human primates

(NHPs). Fruit bats are considered to be the natural reservoir for Ebola virus in Africa. 34 This

xxxiBabatunde Olowookere 910706002


has contributed to a marked reduction in chimpanzee and gorilla populations in Central

Africa and has also triggered some human epidemics due to handling of and/or consumption

of sick or dead animals by local villagers as a source of food.

TRANSMISSION OF EBOLA VIRUS DISEASE

Ebola virus can be transmitted by direct contact with blood, bodily fluid or skin of EVD

patient or individuals who have died of the disease.35As soon as a person becomes infected,

the disease is spread to others through broken skin, mucous membranes, blood or body fluids.

Transmission via inanimate objects contaminated with infected bodily fluid (fomites) is

possible.36The principal mode of transmission in human outbreaks is human-to-human

transmission through direct contact with a symptomatic or dead EVD case or with

contaminated surfaces and materials (e.g. beddings, clothing’s etc.).

Prior to the epidemic in West Africa in 2014, outbreaks of EVD were typically controlled

within a period of weeks to a few months. This is as a result that most outbreaks occurred in

remote regions with low population density, where residents rarely travelled. However, the

epidemic in West Africa has shown that Ebola virus can spread rapidly and widely as a result

of the extensive movement of infected individuals (including undetected travel across

national borders), the spread of the disease to urban areas and the avoidance and/or lack of

adequate Personal Protective Equipment and Medical Isolation Center. Human Ebola

outbreaks usually occur abruptly from a vaguely defined source with subsequent rapid spread

from person to person.

Human-to-human: Human-to-human transmission is through direct or close contact with

infected patients and particularly through contact with blood and body fluids of an infected

patients or bodies of patients who die of the disease. EVD Ebola can also be transmitted in

postmortem care settings by laceration and puncture with contaminated instruments used

xxxiiBabatunde Olowookere 910706002


during postmortem care, through direct handling of human remains without recommended

PPE and through splashes of blood or other body fluids such as urine, saliva, feces, or vomit

to unprotected mucosa such as eyes, nose or mouth during postmortem care.37

Risk of transmission through bodily Fluids: Ebola virus can also be transmitted through

direct contact with bodily fluids. It remains one of the highest risks of contacting of the virus

between people. Circumstantial evidence from previous outbreaks, epidemiological data and

experiments in non-human primates all demonstrate that contact with ebola virus infected

fluid scan lead to infection. Contact with bodily fluids has also been implicated as the reason

why caregivers often become infected after contact with patients. In a study of the risk factors

associated with contracting Ebola virus during an outbreak in Kikwit, Sudan contact with

bodily fluids strongly predicted risk of infection as did sharing hospital beds.38

Risk of transmission through the airborne/aerosol route: Currently no data exists whether

Ebola virus disease can be spread from human-human by respiratory tract route. However,

epidemiological data have led to the understanding that the disease does not undergo

traditional airborne transmission. Although aerosolized filo viruses are highly infectious for

laboratory animals, in humans, airborne transmission has only been reported among

healthcare workers who were exposed during aerosol generating medical procedures.39

Ebola virus can also be spread through fomites and environmental Stability: A fomite

refers to any surface that a pathogen is able to persist on, and fomite transmission can occur

when an individual comes into contact with that infected surface. Potential routes of Ebola

virus fomite transmission include touching objects such as beddings, clothing and other

personal utensils (plates, cups) that have been in contact with person who is sick of Ebola

virus. Little is known about the stability of Ebola virus on surfaces as limited environmental

testing in outbreak locations has shown little evidence for Ebola virus persistence on surfaces. xxxiii



However, one experiment showed that EBOV viral load is reduced by 4 log10 after 5.9 days

when placed on glass and in the dark at 24°C and 40% relative humidity. Another experiment

showed that EBOV could be recovered after 50 days, when dried in culture media on glass at

4 °C.40

Nosocomial transmission: Nosocomial infections are infections that develop as a result of a

stay in hospital or are produced by microorganisms and viruses acquired during

hospitalization. Transmission to healthcare workers due to lack of resources for infection

control and Personal Protective Equipment (PPE) are the main reasons for nosocomial

transmission. Nosocomial transmission has been a major cause of morbidity and mortality in

EVD since the first outbreaks described in Sudan and Zaire (now Democratic Republic of the

Congo, DRC) in 1976. The current outbreak in West Africa had led to documented infection

in 876 health workers with 509 deaths as July 12, 2015.41

Essentially, there is no evidence on mosquitoes or other biting arthropods transmitting filo

viruses. Past epidemic may have been much and more difficult to control if the virus were

transmitted from person to person by these mechanisms.42,43

Due to the high mortality rate of the Ebola virus in human and non-human primate, it is

considered highly dangerous and is a bio-terrorism agent that could jeopardize global health.

PATHOGENESIS OF EBOLA VIRUS DISEASE

Little is known about the pathogenesis of filovirus infection. Almost all data on the

pathogenesis of Ebola virus disease have been obtained from laboratory experiments

employing mice, guinea pigs and non-human primates. Ebola virus disease can enter the host

body mostly via mucosal surfaces or injuries in the skin.44Also infection through the

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Iintact skin cannot be excluded, although it is considered unlikely. Aerosol infection

(RESTV) has been demonstrated in non-human primates under experimental conditions in

dispersion chambers.45,46

However, case reports and large-scale observational studies of patients in the 2014-2015

West African outbreaks are providing urgently needed data on the pathogenesis of the disease

in humans.47

Cell entry and tissue damage: — once the virus enters the body through mucous

membranes, it attacks the immune cell of the host namely macrophages and dendritic cells

are probably the first to be infected. The immune cell gets fooled and release large amounts

of cytokines that instead facilitate the entry of the virus into endothelial cells easily.

The virus genetic material (single-stranded RNA) is released into cytoplasm and produces a

new viral proteins/genetic material. The viral genomes migrate to regional lymph nodes

results in further rounds of replication, followed by spread through the bloodstream to

dendritic cells and fixed and mobile macrophages in the liver, spleen, thymus, and other

lymphoid tissues. Necropsies of infected animals have shown that many cell types (except for

lymphocytes and neurons) may be infected, including endothelial cells, fibroblasts,

hepatocytes, adrenal cortical cells and epithelial cells. Fatal infection is characterized by

multifocal necrosis in tissues such as the liver and spleen.

Gastrointestinal dysfunction: — Patients with Ebola virus disease commonly suffer from

vomiting and diarrhoea which can result in acute volume depletion, hypotension and shock.48

It is not clear if such dysfunction in Ebola virus disease is the result of viral infection of the

gastrointestinal tract or if it is induced by circulating cytokines or both.

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Systemic inflammatory response: — Ebola virus also induces a systemic inflammatory

syndrome by inducing the release of cytokines, chemokines and other pro-inflammatory

mediators from macrophages and other cells.49

Infected macrophages produce tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-

6, macrophage chemotactic protein (MCP)-1 and nitric oxide (NO).50 These disruption

products of necrotic cells also stimulate the release of the same mediators. This systemic

inflammatory response is thought to play a role in inducing gastrointestinal dysfunction as

well as diffuse vascular leak and multi-organ failure that is seen later in the disease.

Coagulation defects: — The coagulation defects seen in Ebola virus disease appear to be

induced indirectly through the host inflammatory response. Virus-infected macrophages

synthesize cell-surface tissue factor (TF), triggering the extrinsic coagulation pathway; pro-

inflammatory cytokines also induce macrophages to produce TF.51 The simultaneous

occurrence of these two stimuli helps to explain the rapid development and severity of the

coagulopathy in Ebola virus infection.

Additional factors may also play a role in the coagulation defects that are seen with Ebola

virus disease. As examples, blood samples from Ebola-infected monkeys contain D-dimers

within 24 hours after virus challenge and D-dimers are also present in the plasma of humans

with Ebola virus disease.52In Ebola virus-infected macaques, activated protein C is decreased

on day two but the platelet count does not begin to fall until day three or four after virus

challenge, suggesting that activated platelets are adhering to endothelial cells. As the disease

progresses, hepatic injury may also cause a decline in plasma levels of certain coagulation

factors.

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Impairment of adaptive immunity: — Failure of adaptive immunity through impaired

dendritic cell function and lymphocyte apoptosis helps to explain how filoviruses are able to

cause a severe, frequently fatal illness.53

Ebola virus acts both directly and indirectly to disable antigen-specific immune responses.

Dendritic cells, which have primary responsibility for the initiation of adaptive immune

responses, are a major site of filoviral replication. In vitro, studies show that infected cells fail

to undergo maturation and are unable to present antigens to naive lymphocytes, potentially

explaining why patients dying from Ebola virus disease may not develop antibodies to the

virus.54,55

Adaptive immunity is also impaired by the loss of lymphocytes that accompanies lethal Ebola

virus infection.56Although these cells appear to remain uninfected they undergo "bystander"

apoptosis, presumably induced by inflammatory mediators and/or the loss of support signals

from dendritic cells. A similar phenomenon is observed in septic shock. However, one study

has shown that at least in Ebola-infected mice, virus-specific lymphocyte proliferation still

occurs despite the surrounding massive apoptosis, but it arrives too late to prevent a fatal

outcome.57 Discovering ways to accelerate and strengthen such responses may prove to be a

fruitful area of research.

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Figure 1: Overview of Ebola virus pathogenesis

SIGNS AND SYMPTOMS OF EBOLA VIRUS DISEASE

EVD begins to affect infected individuals with a non-specific flu-like symptom. The

incubation period from the time of infection with the virus and onset of signs and symptoms

may appear from about2 to 21 days after exposure (average incubation period is eight (8) to

(ten) 10 days). The signs and symptoms are characterized by sudden onset of fever, headache,

intense weakness, nausea, muscle pain and sore throat.

The symptoms are then followed by vomiting, diarrhea, rash, impaired liver and kidney

function and internal and external bleeding (in some cases). Due to the extensive amount of

bleeding, most patients die of hypovolemic shock and/or systematic organ failure within 2 to

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21 days of contracting Ebola virus. Death usually occurs as a result of shock due to body

fluid loss rather than blood loss. However, some patients do defervesce after about 14 days

and are able to survive the virus.58

DIAGNOSIS, TREATMENT AND VACCINE FOR EBOLA VIRUS DISEASE

In considering the diagnosis of Ebola Virus Disease, some of the more common diseases

should not be overlooked (e.g.malaria, cholera, meningitis, hepatitis). A definitive diagnosis

of EVD is confirmed through laboratory testing. No vaccine is available and there is no

specific treatment for EVD. Severely ill patients require intensive supportive care and are

usually dehydrated and at risk for other infectious diseases.

Within a few days after symptoms develop and it has been confirm that it is EVD, test such

as enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction (PCR) and virus

isolation can provide definitive diagnosis. Later in the disease or if the patient recovers, IgM

and IgG antibodies against the infecting Ebola strain can be detected. . Similarly, studies

using immunohistochemistry testing, PCR, and virus isolation in deceased patients are also

done usually for epidemiological purposes.48

There is no yet approved vaccine or medicine (antiviral drug) available for treatment of Ebola

virus disease. According to Centres for Diseases Control and Prevention, standard treatment

for Ebola hemorrhagic fever is still limited to supportive therapy. Supportive therapy is

balancing the patient's body fluid and electrolytes, maintaining their oxygen status and blood

pressure, and treating such patients for any complicating infections.59

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INFECTIOUS PREVENTION AND CONTROL MEASURES FOR EBOLA VIRUS

DISEASE

Preventive interventions include the following:-

Avoid handling bush meat (wild animals hunted for sustenance) and contact with bats

(which may be the primary reservoir of Ebola virus). This can reduce the risk of initial

introduction of Ebola virus into humans. Appropriate protective clothing’s, thorough

cooking of animal products before consumption is also very necessary.

Meticulous infection control in health care settings. The greatest risk of transmission is

not from patients with diagnosed infection but from delayed detection and isolation.

Since the early symptoms of EVD — fever, nausea, vomiting, diarrhea and weakness

are nonspecific. Patients may expose family caregivers, health care workers and other

patients before the infection is diagnosed.

Community engagement is vital key to successful control of EVD spread. Educating and

supporting the community to practice save burial of persons who may have died from

EVD.

Reduce direct or close contact with people with Ebola symptoms particularly with

bodily fluids of the infected. Gloves and appropriate Personal Protective Equipment

(PPE) should be worn when taking care of ill patients at home. Regular hand washing is

required after visiting patients in hospitals as well as after taking care of patients at

homes.

GLOBAL TRENDS ON EBOLA VIRUS DISEASE OUTBREAKSxl



The 2014 West African Ebola crisis represents the largest global outbreak of a high mortality,

non-vaccine preventable contagious illness in recent history. While the outbreak has been

largely confined to Liberia, Guinea and Sierra Leone, its effects have been felt throughout

Africa and the entire world. Thousands of West Africans have succumbed to Ebola as the

outbreak has extended into densely populated areas and crossed international borders.

The ability of EVD to spread rapidly across several West African states within the short time

of the onset of the disease is a cause of concern. The virus now threatens to undermine the

security and economic prospects of the entire region. Till date, the World Health

Organization (WHO) has reported over 11,306 casualties with an estimated 28,256 people

confirmed or suspected of having contracted the disease in nine countries as at September 3rd

2015. A total of 869 confirmed healthcare workers infected with EVD and 507 confirmed

dead.60

Previous outbreaks of Ebola Virus Disease (EVD) have predominantly occurred in Central

African rainforest. Until the outbreaks of 2014 in West Africa, all known previous outbreaks

originated in Democratic Republic of Congo (than Zaire) or country sharing its border. Since

1976, 26 outbreaks of Ebola virus cases have occurred in ten(10) countries of Africa,

including Democratic Republic of Congo (DRC), Sudan, Gabon, Cote d’Ivoire, South Africa,

Uganda, Congo, Guinea, Sierra Leone and Liberia; one imported case in Nigeria, Senegal

Spain and United States of America.3

Till date DRC is the country with the highest number of outbreaks with (7) outbreaks

followed by Uganda (5), Sudan (3) and (3) in Gabon. The unprecedented magnitude and

geographic extent of the Ebola virus Disease has overwhelmed the local response capacity,

posing as extreme challenge for the whole world.29

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An outbreak outside Africa was the Reston subtype of Ebola virus; first identified in 1989 in

the United States of America, through monkeys housed in a quarantine facility in Reston,

Virginia. At least four humans became infected but none became ill. Additional outbreaks of

the Reston subtype occurred between 1989 and 1996 in Texas, Pennsylvania and Italy. No

humans suffered illness in any of these cases. The source of all the Reston subtype outbreaks

was late traced to a single facility in the Philippines that exported the monkeys.61

On 13th March 2014, the Guinean Ministry of Health issued an alert concerning an

unidentified disease. World Health Organization (WHO) announced its involvement that

same day thinking that the outbreak was Lassa fever or viral hemorrhagic fever which is

highly prevalent in West Africa. After laboratory tests, it was confirmed that the hemorrhagic

fever outbreak was caused by the Ebola virus.62

The first victim of this outbreak was an 18-month-old boy from an area close to where

Guinea shares a border with northern Liberia. The child died on 28 thDecember,

2013.Guineashares borders with Liberia and Sierra Leone, other factor is the socio cultural

ties amongst these countries make it easy for the virus to spread quickly. Within days of the

WHO announcement of the EVD outbreak in Guinea, both Liberia and Sierra Leone had

announced EVD cases outbreaks.63

On April 1, 2014, Guinea reported 24 confirmed cases of EVD. Liberia had 2 confirmed

cases to report and Sierra Leone was monitoring 2 probable cases of EVD infection. By late

April 2014, Guinea had reported 208 “clinical cases” of EVD and 136 deaths. Efforts to

identify those who had come into contact with individuals suffering from the illness led

medical authorities to place 217 others in Guinea under medical observation.64

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According to World Health Organization, Liberia had 34 probable cases of EVD with 6

confirmed cases and 6 deaths at the time. Liberia had 162 total contacts to trace, 59 of whom

had completed the 21-day follow-up period and were no longer under medical observation.

Sierra Leone reported its first EVD case on 25thMay 2014.By the end of May 2014, WHO

reported that Sierra Leone had 50 clinical cases of EVD and 6 deaths spread across 5 distinct

geographical regions. Guinea had 291 clinical cases of EVD with 193 deaths spread across

seven regions.65

On 17thJune 2014, the Liberian government announced that Ebola was present in its capital,

Monrovia. Later that month, health authorities reported a total of 618 EVD cases and 357

EVD deaths. Infection and fatality statistics as at 30thJuly 2014 indicated that the total number

of cases of EVD had reached 1,440 with 826 deaths. By the end of month, the Government of

Liberia had quarantined communities most at risk and put troops in place to enforce the

quarantine.66

On 2ndAugust2014, an American doctor who had been working as a missionary physician in

Liberia was flown to Atlanta, Georgia, for treatment after contracting EVD. A second

American, a missionary nurse with EVD was flown to Atlanta from Liberia for treatment 3

days later. On 8thAugust 2014, the World Health Organization (WHO) declared that EVD

represent a “Public Health Emergency of International Concern” (PHEIC) and urged the

international community to take action to stop the spread.67

A Spanish priest who had been working in Monrovia, Liberia, contracted EVD and was

flown to Spain for treatment where he died on 12thAugust 2014. On August 2014, a British

healthcare provider was also flown back to the United Kingdom after reportedly contracting

EVD in Sierra Leone.

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Mali reported its first confirmed Ebola case on October 23, 2014 when a two-year-old girl

admitted to a hospital in Mali on 22nd October 2014 died on 24th October 2014. No secondary

infections linked to this case. There was also a case of an Imam from Guinea that was

admitted to hospital for renal failure in a hospital in Mali that subsequently died. Diagnosis

not made until after one of his caregivers became ill and after thousands attended his funeral

7 additional cases and 5 deaths were linked to this case.

Following a heightened sense of panic, tightened restrictions on travel and trade have begun

to take a toll on the economies of the countries affected. Tourism and export revenues have

been hit hard while multinational companies have threatened to halt their operations in the

region. There is no doubt that the epidemic is becoming a global pandemic with potential to

continue to spread beyond the West African stronghold further.

The wider risks and implications of the epidemic are becoming more evident in endemic

region as entire communities are placed in quarantine and frontiers closed. Riots have erupted

in certain areas where the infected – and those with whom they have had contact – have

simply been confined without proper medical attention or even food and water. Furthermore,

border closures and travel bans are largely ineffective (or even counterproductive) given the

region’s porous land frontiers.

Global responses and the current collective mood is one of crisis management, efforts to

improve local healthcare capacities in Liberia, Sierra Leone and Guinea. The Centers for

Disease Control and Prevention (CDC), its leading public institution for infectious diseases

(with over 15,000 employees and a yearly budget of $11.3 billion), has sent a rotating team of

70 experts to assist West Africa and gather any information which could assist in the

effective diagnosis and further understanding. The experimental treatment ZMapp (already

used for Ebola patients with a varying degree of success) is made by the American firm Mapp

xlivBabatunde Olowookere 910706002


Biopharmaceutical, a company with which the US Department of Health has signed a $25

million contract.

The international community’s response to Ebola particularly African institutions such as the

Economic Community of West African States (ECOWAS) and the African Union (AU) have

expressed their support for the fight against Ebola, their resources are scarce and local leaders

seek primarily to protect their own countries.

The success of containment is therefore in large part contingent on the ability of international

actors to act fast – and in concert – so as to ensure that the spread of Ebola is effectively

halted and that the disease is ultimately vanquished.

THE OUTBREAK OF EBOLA VIRUS DISEASE IN 2014 IN NIGERIA

An acutely ill traveller from Liberia arrived Lagos by air on 20 th July 2014 via Lome, Togo,

and Accra, Ghana. He was hospitalized immediately at the First Consultant Hospital,

Obalende; blood specimen examined at Lagos University Teaching Hospital (LUTH)

indicated the presence of acute Ebola virus infection. On arrival at the airport the index case

had contacts with 15 airport staff and 44 persons at the hospital. The index case died 5 days

later.68

Prior to the current outbreak, Nigeria has not had an occurrence of the disease hence the

scenario created public fear, panic and confusion, as is usually seen in outbreaks of

previously unknowndunknown diseases.69 Consequent upon the above, the Federal Ministry

of Health and the Nigerian Centers for Disease control (FMOH/NCDC) in collaboration with

the Lagos State Ministry of Health and partner Agencies established an Ebola Emergency

Operations Centre (EEOC), the use of an Incident Management System (IMS) and all public

health assets available to the Federal and Lagos State government were used to contained the

spread of the disease.

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On the 20th of October 2014, the WHO declared Nigeria free of EVD. This was after 42 days

with no new case of EVD and now considered free of Ebola transmission. Modern-day

mobility is a widely recognized conduit for the rapid spread of highly contagious diseases as

demonstrated by one particular case in Senegal which involved several actors from the same

family spread across the region. In Nigeria, a cluster of Ebola cases were sparked by a

traveller from Liberia.

The fundamental controls for all infectious outbreaks are based on enhanced hand-hygiene,

cough and sneezing etiquette, social distancing, sick-contact isolation and environmental

cleaning. Appropriate messaging, supplies and signage are often the best preventative

strategies to mitigate infectious diseases.

We all live in a global community; strategic plans assert a human outbreak anywhere means

risk everywhere. With the recent EVD resurgence in Liberia and Sierra Leone, Nigeria must

note relent in strengthening her preparedness and readiness against the reemergence of EVD.

PUBLIC HEALTH EMERGENCY PREPAREDNESS AGAINST EBOLA VIRUS

DISEASE

The World Health Organization (WHO) declared on August 8 th, 2014 that EVD “Public

Health Emergency of International Concern” and urges the international community to take

action to stop the spread.62EVD is an active haemorrhagic illness with 90% case fatality rate, is

currently an epidemic in some countries in West Africa; although the WHO had declared

Nigeria and Liberia free of Ebola its reemergence in Liberia on May 9 th, 2015 make it a

public health concerns.

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Based on the anticipated risks for the resurgence of Ebola to Nigeria, the WHO organization

recommends that all high risk and medium risk countries strengthen their respective country

preparedness and readiness to EVD.70

Public health emergency preparedness and response efforts seek to prevent epidemics and the

spread of disease, protect against environmental hazards, prevent injuries, promote healthy

behaviors, and assure the quality and accessibility of health services. Each of these is

expected by the public and each is evident in effective preparedness and response related to

public health emergencies. Together they make preparedness and response a special and

particularly critical component of modern public health practice.

Public health emergencies, preparedness and response are inextricably linked.71 Preparedness

is based on lessons learned from both actual and simulated response situations. Effective

response and containment of a potential outbreak of EVD in any country can only be

achieved through anticipation, preparedness and readiness for response in the event of an

outbreak.

With proper preparedness and readiness at country level, Ebola can easily be contained, and

the consequential possible impact on health care systems and the society at large can be

minimized. Against this background, the WHO overarching objectives for the Ebola response

roadmap includes strengthening preparedness of all countries to rapidly detect and respond to

the potential introduction of Ebola in States currently not affected by the outbreak and in

response to the on-going outbreak in West Africa.72

This study tends to assess the level of preparedness of residents in Agege, Ikeja and Mushin

Local Government Areas of Lagos State against EVD Resurgence. Ebola outbreak is a health

related event or disaster, that could come in various forms and may seem to be increasing in

xlviiBabatunde Olowookere 910706002


frequency, scale and complexity. As a result, households, organizations, and residents must

continue to devise effective means for protecting themselves against those threats.

In discussing and thinking about preparedness, several important points should be kept in

mind. First, preparedness can be viewed and measured at different levels of analysis. At one

extreme, for instance, individuals and households can take protective measures such as

engaging in good hygienic behavior like watching hands with soap and water, using hand

sanitizer and avoiding contact with a person who is sick of Ebola disease etc.

At another extreme, as part of support to Member States, and within the context accounting to

the context of the International Health Regulations (IHR 2005).73 Countries can provide

capacity-building for public health events.

Preparedness is a matter of degree, ranging from low to high and very over time and across

locations with some households engaging in few or no preparedness activities and others

undertaking as many precautionary measures as possible.

At the household and organization levels of analysis, researchers typically use checklists to

measure disaster preparedness, asking respondents to indicate which activities they have

undertaken.74

KNOWLEDGE, ATTITUDE AND PRACTICES (KAP) ON EBOLA

VIRUS DISEASE STUDIES IN AFRICA AND BEYOND Literature review was conducted based on the study’s specific objectives. The information

gathered was used to have a broader view on the public knowledge, attitude and practices on

Ebola Viral Infection. However, there was paucity of information on EVD preparedness level

before the recent outbreak in Liberia.

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Within the continent, EVD outbreaks have been confined to Central and East Africa until the

2014 outbreak in West Africa (WA). Since EVD was discovered in Africa in 1979, about

twenty six (26) outbreaks have occurred.75

Studies on Knowledge of Ebola Viral Disease

In September 2014, Saheed Gidado Abisola, M. Oladimeji,Alero Ann Roberts et al carrired

out a study on Public Knowledge, Perception and source of information on Ebola virus

Disease in Nigeria. The objectives were to assess the public preparedness level to adopt

disease preventive behavior which is premised on appropriate knowledge, perception and

adequate information.84 An interview administered questionnaire on 5,322 respondents in the

twenty LGAs of Lagos State. Thirty three percent of respondents do not know the cause of

EVD, Forty one percent of the respondents possessed satisfactory general knowledge; 44%

and 43.1% possessed satisfactory knowledge on mode of spread and preventive measures,

respectively. Sixty-six percent and 49% of respondents mentioned regular hand washing

with soap and water, and avoiding contact with EVD case or suspect, respectively as a

preventive measure to prevent EVD. Sixteen percent mentioned avoiding eating bush meat

while 5% mentioned not participating in the burial rite of a person who died of EVD.

The findings indicate a gap in EVD related Knowledge and perception. There is a need for

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 a similar study on Public Knowledge, Attitudes, and Practices Relating to Ebola Virus

Disease (EVD) Prevention and Medical Care in Sierra Leone 2014. It was observed that the

comprehensive knowledge on EVD prevention by the public is generally low. Only 39% of

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the respondents were able to identify three means of prevention and rejected three

misconceptions. Also it was found out that everyone (100%) is aware of EVD and 97% of the

respondent surveyed belief EVD exist in Sierra Leone.76

Comprehensive knowledge of Ebola transmission and prevention is a prerequisite, although

Insufficient in itself, for the adoption of behaviors that reduce the risk of EVD. Correct

knowledge of the false modes of transmission is as important as knowing the correct modes –

and enables one to better understand how to protect oneself.

In August 2014, UNICEF and partners carried out a study on public Knowledge, attitudes

and practices related to EVD prevention and medical care in Sierra Leone. The objectives

were to examine public KAP related to EVD, identify barriers hindering containment of

disease, and use the study to inform evidence based strategies in preventing the transmission

of EVD and caring for those infected and affected by the outbreak.77 Key findings of the

study highlighted good level of awareness and low denial of EVD, low comprehensive

knowledge.

Another study was sponsored by Start Fund in Sierra Leone.78 The aim was to find out if

sensitization was effective in changing behavior to prevent Ebola transmission. One month

after the first case of EVD was reported in the country. Start Fund through its partners

responded by focusing on social mobilization and sensitization for 6 weeks. From 28 June to

12 August, the campaign reached 26% of the country’s approximately 6 million people.

Eighty eight percent of the people reached opined that the campaign against Ebola was a way

for the government and NGO’s to make money. At the end of the 45 day campaign, there was

an increase from 39% to 85% of households that could correctly identify EVD prevention

methods but there was no significant improvement in the time it takes for potential cases to

seek care.77 Importantly though, specific changes like reduced attendance at funerals,

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increased hand washing and using gloves, decreased hand shaking and better precautions

from frontline health workers were observed.

Studies on Attitude of Ebola Viral Disease

A study on Public Knowledge, Attitudes, and Practices Relating to Ebola Virus Disease

(EVD) Prevention and Medical Care in Sierra Leone 2014.

A positive attitude towards preventive measures was also reported. Majority of respondents

reported behavioral change due to the comprehensive knowledge on the causes of EVD.

Radio was the preferred mean of receiving information and 96% of respondents reported

some discriminatory attitude towards suspected victims and survivors of disaster.76

Respondents mentioned that health professionals and government agencies are the most

trusted sources of information.

However, a study in Sierrra Leone conducted by Catholic Relief Service in conjunction with

UNICEF and FOCUS 1000, found out that nearly everyone (95%) is reporting some change

in behavior since learning about Ebola. However, the percentage of people reporting that they

avoid physical contact is alarmingly low (36%).76

Studies on Practices of Ebola Viral Disease

In March 2015, the Knowledge, Attitudes and Practice (KAP) study was conducted between

December 7th and 22nd , 2014, to gauge the success of social mobilization efforts to educate the

general public on key Ebola prevention messages in the country. The study design included

quantitative and qualitative components. A questionnaire survey from a representative sample

of 1,140 households was conducted in 6 purposively selected counties (Montserrado, Grand

Gedeh, Lofa, Nimba, River Cess and Grand Cape Mount). Counties were selected to cover a li



range in the timing and impact of the Ebola epidemic in different parts of Liberia. The

findings of the study indicated that the results demonstrate a high degree of community

mobilization against Ebola in all of the sampled counties. Virtually all Liberians had heard

about Ebola, accepted that Ebola was real, could identify the most common symptoms and

name at least 3 ways of avoid becoming infected. Overwhelming agreement with intended

behaviours such as isolation of those with symptoms, early treatment and safe burial show a

newly emerged consensus supporting public health recommendations. Comparable levels of

reported behaviour change in areas such as increased hand washing and reduced physical

contact suggest new behaviour norms were being put into action across sampled communities

by this stage in the Ebola epidemic. Perhaps the most striking finding is the high degree of

community engagement in the response, where people were not only changing their own

behaviour but interacting with family, friends, and neighbours to encourage them to do the

same. Survey results found nearly half of respondents had engaged in some form of

community action since the start of the epidemic.

Overall 93% of respondents reported they first learned about Ebola through the radio. The

next most common sources of information about Ebola were interpersonal communication

with family, friends and neighbors (39%) and house to house visits by health extension

workers (36%). Focus group discussions suggested radio reports, health visits and person-to-

person interaction sometimes worked to mutually reinforce each other.79

A study on the KAP of care professional regarding EVD was carried out in India in

August/September 2014. The study found satisfactory knowledge, attitude and practices

(<50% score) among 73.6%, 83.1% and 69.2% of the participants respectively.80

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CHAPTER THREEMATERIALS AND METHODOLOGY

DESCRIPTION OF STUDY AREA

Lagos State was created in 1967 out of the former western region by the then regime of the

Military Head of State; General Yakubu Gowon (GCON) with its capital in Ikeja.

Location/Extent

The State is located ion the south- western part of Nigeria on the narrow coastal flood plain

of Bight of Benin. It lies approximately on longitude 20 420 E and 3 220 E East respectively

and between latitude 600 220 N. Lagos State shares boundaries with Ogun State of Nigeria

both in the North and East and is bounded on the west by the Republic of Benin and in the

South by the Atlantic Ocean. It has five administrative divisions of Ikeja, Badagry, Ikorodu,

Lagos Island and Epe.

Lagos State has population of about 17.5 million.81 Administratively, the State has 20 Local

Government Areas (LGAs).82 Lagos is a highly heterogeneous state comprising ethnic

groups from virtually all over the country and home to significant international populations.

There are 379 wards spread across these 20 LGAs with 276 Primary Health Care Centers

(PHCC) which serve as the first points of contact for citizens seeking health care services.

The smallest State in the Federation, it occupies an area of 358,862 hectares or 3,577 square

kilometers, 22% (or 787sq. km) which consists of lagoons and creeks. Lagos State is the

nation's economic nerve center with over 2,000 industries. Sixty five percent of the country's

commercial activities are carried out in the state. In addition, it served as the nation busiest

airport with two terminals international and cargo. Two of the nation's largest seaports -

Apapa and Tin-Can Ports are located in the State. The State is also a tourist center with many

livBabatunde Olowookere 910706002


tourism zones namely: Bar Beach Water; Lekki-Maiyegun resort; Kuramo Water; Epe-

Marina Cultural zone; Badagry Marina Recreation etc. Other prominent tourist attractions in

the State include; City Hall (Headquarters of the Lagos Island Local Government); the

National Arts Theatre, Iganmu; National Museum, Onikan; Holy Cross Cathedral, Lagos, the

seat of Catholic Archdiocese; Relics of Brazilian and other colonial quarters; the site of the

fallen Agia tree, Badagry, where Christianity was first preached in Nigeria in 1842; Oso-

Lekki Breakwaters.

There is also the Eyo festival which is held to mark important events in the state. While the

State is essentially a Yoruba speaking environment, it is nevertheless a socio-cultural melting

pot attracting both Nigerians and foreigners alike.

The population of the three local Government Areas covered by this survey includes; Agege

with an estimated population of 1,033,064, Ikeja 648,720 and Mushin 1,321,517.83 There are

30 Primary Health Care Centers (PHCC) in these three Local Government Areas which serve

as the first points of contact for citizens seeking health care services.

STUDY DESIGN

The study was a descriptive; community-based cross-sectional survey assessing the level of

preparedness amongst residents of Agege, Ikeja and Mushin Local Government Areas of

Lagos State against EVD Resurgence.

STUDY POPULATION

The population was individuals aged 18 years and above who live or trade in the

communities studied. The criteria for any respondent to be eligible for recruitment for the

survey was that (s)he must have lived in the area for not less than three (3) months.

lvBabatunde Olowookere 910706002


SAMPLE SIZE DETERMINATION

The minimum sample size was determined using Cochran’s formula.84 The sample size for a

Cross-sectional study design is given as n=Z2pq/d2

p = estimated prevalence rate of knowledge of (58%). Gotten from previous similar

work done on the topic.85

q = 1-p

d = margin of error (0.05)

z = Confidence interval (Z score for 95% CI = 1.96)

n=1.962∗0.58(1−0.58)

0.05²=374.32

Anticipating a response rate of 90% was made by dividing the sample size calculated with a

factor f that is n/f, where f is the estimated response rate. Thus the calculated sample size

=374/0.09. The sample size is 416.

INCLUSION CRITERIA

Individuals of the household must be 18 years and above and live or trade in Agege, Ikeja and

Mushin LGAsthe communities studied for not less than 3 months.

EXCLUSION CRITERIA

Individuals of the household below 18 years who do not live or trade in Agege, Ikeja and

Mushin LGA for less than 3 months.the communities studied.

lviBabatunde Olowookere 910706002


SAMPLING METHODOLOGY

A multi-stage sampling was used. Multistage refers to sampling plans where the sampling is

carried out in stages using smaller and smaller units at each stage.

Stage one:

Using simple random sampling (SRS) method, three local government areas (LGAs) were

selected from the sampling frame of twenty (20) LGAs in Lagos State. The selected local

government areas were Agege, Ikeja and Mushin.

Stage two:

The three (3) selected LGAs have 22 political wards from which, 5 wards per LGA were

selected from each LGA using simple random sampling method from the list of wards in each

LGA making a total of 15 wards. To select residents for the study, I divided my sample size

(416) by three (3) which represent the LGAs. This gave 139 study participants per LGA.

Thereafter, I divided the 139 per LGA by five (5) which represent the wards in each LGA

selected, this cumulated to 28 residents per ward in each of the three (3) selected LGAs.

To this end, having gotten the street names per ward from the three (3) LGAs information

officers, each street per ward was listed alphabetically by thein their name. i r names.

Stage three:

Using SRS method, four streets in each ward were selected The list of streets in each ward

alphabetically alphabetically interviewers visited the first street house starting from the first

house on the right side of street. Any respondent who met the inclusion criteria was selected

from each house, in other to meet the 28 residents per ward. arranged. Interviewers visited the lvii



first street, house starting from the first house on the right side of street. Any respondent who

met the inclusion criteria was selected from each house using SRS method.

In multi-dwelling houses, one household was selected using SRS method from each house

by balloting. A total of 28 residents interviewed per ward to ensure a sample size of 139 per

LGA. Multiple by 3 to give a total of 416. n=z2pq/d

DATA COLLECTION TOOL AND TECHNIQUE

Data was collected using a structured paper-based interviewer administered questionnaire; it

was both open-ended and close-ended. The questionnaire was written in English Language.

The three (3) interviewers who are Corps members serving with National Emergency

Management Agency (NEMA) were trained to administer the questionnaires and interpret it

to respondents who may not understand English well enough. The collection of data lasted

for two (2) months (July and August 2015).

The survey questionnaire which contains 21 items was adapted and modified from several

studies on knowledge, attitude and perception, level of Preparednessa against EVD

resurgence and practices regarding EVD.19 19 The questionnaire was structured in this format

to elicit response from the respondents.

Section A: Socio-demographic characteristics

The variables are:

Age: in years as at last birthday.

Sex: male and female.

Occupation: categories (professional, intermediate, manual skilled, non-manual skilled,

unskilled)86

lviiiBabatunde Olowookere 910706002


Professional: medical doctors, lawyers, architects

Intermediate: civil servant, banker, insurance brokers, stock brokers

Manual skilled: artisans

Non- manual skilled: office clerk, office assistants

Unskilled: traders, unemployed, housewives, students

Religion: Christian, Islam, Traditional and other

Highest level of education: None, Primary, Secondary, Tertiary

How long have you been resident here? Individuals of the household must be 18 years and

above and live or trade in the communities studied for not less than 3 months

Have you ever heard about Ebola Disease? Only residents that have heard of Ebola were

interviewed and submitted for analysis.

Section B: Knowledge of Ebola Viral Disease

The variables are:

What causes Ebola disease? (multiple responses allowed)

How can EbolaEbola can be spread

When the signs of illness are begin after the Ebola virus enters the body

Is there a specific drug/ remedy to treat Ebola disease

Is there a specific vaccine to treat Ebola Disease?

How can you prevent yourself from contracting Ebola Disease?

Section C: Sources and Channel of Information regarding EVD

The variable is: How did you hear about Ebola virus disease (multiple responses allowed)

Section D: Attitude and Perception regarding EVD

lixBabatunde Olowookere 910706002


The variables are:

Do you think Ebola virus disease is a problem in Lagos (multiple responses allowed)

Do you think you are in danger of infection with Ebola virus disease?

Do you think government can do more to contain Ebola virus disease?

Section D: Level of Preparedness against EVD resurgence

The variable: What is done to prevent risk of spread of EVD at home or work, using five key

practices, which are regular hand washing with soap and water, regular use of hand sanitizer,

avoidance of bushmeat, not touching people with EVD, non-participation in burial rites and

what is done if a family member, relative/neighbor develop signs of Ebola.

PRE-TESTING

The questionnaires were pre-tested in assigned selected streets in Suru-lere LGA of Lagos

State which is not included in the sample. Feedbacks from the pre-test were used to improve

the questionnaire.

INFORMED CONSENT

Respondent’s informed consent duly obtained after explaining the purpose and procedure of

the Research. This is in line with the “Helsinki Declaration” which emphasis the need for

confidentiality of their responses, assured of voluntary participation and the opportunity for

them to withdraw at any time without prejudice.

ETHICAL CONSIDERATIONSlx



Ethical approval was gotten from the Human Research and Ethics Committee (HREC) of the

Lagos University Teaching Hospital and Informed consent was sought from each participant

before the commencement of the exercise.

METHODS OF DATA ANALYSIS

The data gathered were analysed by Epi-info 3.5.4 and reported as frequencies and

percentages. Also associations between variables were tested statistically using Chi-square

and reported at a significance level of p < 0.05. The knowledge will be based on three EVD

domains; mode of spread, symptoms and signs and preventive and control measures. scores

were assigned to correct responses mentioned by respondents. Furthermore stratified analysis

was done on satisfactory knowledge to access knowledge across each domain.83 78 77

Scoring of response

Knowledge of Ebola Viral Disease-each correct response of the knowledge question was

scored 1 mark and a wrong answer or non-response was scored 0. Total score achievable was

27 marks: 16 marks and above was categorized as satisfactory, below 16 marks was

categorized as poor.

Attitude and perception regarding Ebola Viral Disease- a set of 9 questions were used to

evaluate overall level of attitude and perception of respondents to EVD. The maximum

achievable score for attitude and perception was 9 marks.

Rrespondentsrespondentsespondents who scored 6 marks and above were categorized as

positive attitude and perception while respondents that scored below 5 marks had a negative

attitude and perception.

lxiBabatunde Olowookere 910706002


Practices regarding Ebola viral Disease- Overall level of preparedness by Respondents

against EVD resurgence. The maximum achievable for level of preparedness was 6 marks.

Respondents who scored 4 marks and above were categorized as high level of preparedness

while respondents that scored below 4 marks had low level of preparedness.

LIMITATION OF THE STUDY

`Self-Reported behaviours may not always be arrayed with respondent’s actual practices.

Current desirable responses may be claimed due to high awareness, sensitization of EVD

being undertaken. Moreover, the study is a new research area; literature reviews documents

particularly preparedness level against EVD resurgence was difficult to get.

lxiiBabatunde Olowookere 910706002


CHAPTER FOUR RESULTS

A total of 416 questionnaires were administered to the respondents. Three hundred and ninety

said yes they have heard about Ebola Disease (93.98%) and were interviewed and submitted

for analysis. While 26 respondents said they have not heard about Ebola Disease (6.02%) and

no further analysis was done.

Table 31: Respondents used in the study

Heard about Ebola Disease (n=416) Number of respondents (%)

Yes 390 ( 93.98)

No 26 (6.02)

lxiiiBabatunde Olowookere 910706002


Table 42: Socio-demographic characteristics of respondents

lxivBabatunde Olowookere 910706002


Socio-demographic characteristics (n= 390) Number of

respondents (Frequency (%)

Age distribution (in years)

<20 19 (4.6%)

21-30 130 (31.3%)

31-40 153 (36.8%)

41-50 70 (16.8%)

51-60 23 (5.5%)

> 60 21 (5.0%)

Sex

Male 215 (51.7)

Female 200 (48.1)

Religion

Christianity 249 (59.9)

Islam 158 (38.0)

Traditional 8(1.9)

Others 1 (0.2)

A total of 390 respondents were interviewed. Fifty one point seven percent were male; the

mean age was 41 years (+35.7 years). Majority of the respondents were Christians (59.9%)

(Table 2).

lxvBabatunde Olowookere 910706002


Table 53: Socioeconomic characteristics of respondents

Highest level of formal education Frequency (%)

None 5 (1.2)

Primary 24 (5.8)

Secondary 140 (33.7)

Tertiary 247 (59.4)

Occupation

Professional 25 (6.0)

Intermediate 38 (9.1)

Manual Skilled 50 (12.0)

Non- Manual Skilled 27 (6.5)

Unskilled 209 (50.2)

Duration of Residency

< 1Year 93 (22.3)

> 1Year 323 (77.6)

lxviBabatunde Olowookere 910706002


Highest level of formal education Frequency (%)

None 5 (1.2)

Primary 24 (5.8)

Secondary 140 (33.7)

Tertiary 247 (59.4)

Occupation

Professional 25 (6.0)

Intermediate 38 (9.1)

Manual Skilled 50 (12.0)

Non- Manual Skilled 27 (6.5)

Unskilled 209 (50.2)

Duration of Residency

< 1Year 93 (22.3)

> 1Year 323 (77.6)

The respondents were largely with tertiary education (59.4%) and (77.6%) of the respondents

have lived in the survey area for more than one year and were mainly traders, unemployed,

students or housewives (50.2%) (Table 3).

lxviiBabatunde Olowookere 910706002


Table 4: Knowledge score of respondents on causes of Ebola disease

What causes Ebola disease Correct (%) Incorrect (%)

From infected animals 301 (77.0) 89(23)

Contact with a person who is sick of Ebola disease

241 (57.9) 149 (42.1)

Touching blood, urine, stool or saliva from a person who is sick with Ebola disease

190 (48.6) 200 (51.4)

Sharing sharp objects such as razors, needles, etc. with a person who has Ebola disease

148 (37.9) 242 (62.1)

Contact with beddings, clothing and

other personal utensils (plates, cups)

119 (30.4) 271 (69.6)

Participating in burial rites of a person

who has died from Ebola Disease

98 (25.1) 292 (74.1)

98 (25.1)

lxviiiBabatunde Olowookere 910706002


28 (7.2)

35 (9.0)

Seven-seven percent of the respondents believed that EVD is caused by infected animals to man,

57.9% of the respondents mentioned that it is caused by contact with a person who is sick of EVD

EVDwhile 9.0% of the respondents do not know the cause of EVD (Table 4).. However, 74.1%

incorrectly said that participating in burial rites of a person who has died from Ebola disease

cannot cause EVD. This is a major key knowledge (Table 4).

Table 5: Knowledge on the spread of Ebola Viral disease (n=390)

What causes Ebola disease Correct (%) Incorrect (%)

From infected animals to man 271 (69.3) 119 (30.7)

Touching blood, urine, stool or saliva from a person who is sick with Ebola disease

221 (56.5) 169 (43.5)

Contact with a person who is sick of Ebola disease

201 (51.4) 189 (48.6)

Sharing sharp objects such as razors, needles, etc. with a person who has Ebola disease

139 (35.5) 251 (64.5)

lxixBabatunde Olowookere 910706002


Contact with beddings, clothing and other personal utensils (plates, cups) of a person who is sick of Ebola disease

130 (33.2) 260 (66.8)

Participating in burial rites of a person

who has died from Ebola Disease

110 ( 28.1) 280 (71,9)

Sixty nine point three percent of the respondents correctly mentioned believed that EVD is

spread through infectious animals to man. While 56.5% of the said that is through touching

blood, urine, stool, or saliva from a person who is sick of EVD and 71.9%28.1 % incorrectly

mentioned bythat by not participating in burial rites of a person who has died from Ebola

disease cannot spread the disease (Table 5).

Table 5: Knowledge on the spread of Ebola Viral Disease

How can Ebola be spread Frequency (%)

From infected animals to man 271 (69.3)

lxxBabatunde Olowookere 910706002


Touching blood, urine, stool, or saliva from a person

who is sick with Ebola disease 221 (56.5)

Contact with a person who is sick of Ebola disease 201 (51.4)

Sharing sharp objects such as razors, needles etc

with a person who has Ebola disease 139 (35.5)

Contact with beddings, clothing and other personal utensils (plates, cups)

of a person who is sick of Ebola disease 130 (33.2)

Participating in burial rites of a person who has

died from Ebola disease 110 (28.1)

Through spiritual attack 50 (12.8)

Through insect bites 44(11.3)

Through the air 37 (9.5)

I don’t know 14 (3.6)

Sixty nine point three percent of the respondents believed that EVD is spread through

infectious animals to man. While 56.5% of the said that is through touching blood, urine,

stool, or saliva from a person who is sick of EVD and 28.1 % mentioned by not participating

in burial rites of a person who has died from Ebola disease (Table 5).

lxxiBabatunde Olowookere 910706002


Figure 12: Knowledge of Signs and Symptoms of Ebola Viral Disease mentioned by

respondents (n=390)

The top three signs and symptoms of EVD mentioned by respondents were diarrhea (94.0%),

fever (52.6%) and weakness (45.9) (Figure 12).

lxxiiBabatunde Olowookere 910706002

Rash on the body

Sore throat

Body pains

Abnormal bleeding from any part of the body

General feeling of unwell

Headache

Weakness

Vomiting

Fever

Diarrhoea

0.0 20.0 40.0 60.0 80.0 100.0

21.9

24.0

26.4

32.2

36.1

43.8

45.9

47.1

52.6

94.0

Percentage (%)


Table 6: Knowledge on when signs of illness of Ebola Viral Disease begins by

Respondents (n=390)

When do signs of illness begin after

the EVD enters the body

Correct (%) Incorrect (%)

Between 2 and 21 days 208 (60.5) 182 (39.5)

Only (60.5% 0.0%) of the respondents knew the correct duration before signs of illness of

Ebola Viral Disease begins. Indicated that the signs of illness of EVD begin between 2 and

21 days which is good knowledge (Table 6).

Majority (50.0%) of the respondents indicated that the signs of illness of EVD begin between

2 and 21 days which is good knowledge. While (11.5%) indicated that the signs of illness of

EVD begin less than 2 days (Table 6).

Knowledge of causes of EVD Correct Incorrectlxxiii



When do signs of illness begin after the EVD enters

the body

208 () 182 ()

Is there a specific drug/remedy to treat Ebola disease 153 () 237 ()

Knowledge of spread of EVD Correct Incorrect


the body

208 () 182 ()

Is there a specific drug/remedy to treat Ebola disease 153 () 237 ()

Knowledge of signs of EVD Correct Incorrect


the body

208 () 182 ()

153 () 237 ()

lxxivBabatunde Olowookere 910706002


Knowledge of treatment and prevention of EVD Correct Incorrect

Is there a specific drug/remedy to treat Ebola disease

lxxvBabatunde Olowookere 910706002


Table 7: Knowledge on drug /remedy to treat Ebola Viral Disease

Is there a specific drug/remedy to treat

Ebola disease Frequency (%)

Yes 150 (36.1)

No 153 (36.8)


Is there a specific vaccine to treat Ebola disease?(Multiple responses allowed)

Yes 94 (22.6)

No 135 (32.5)

I don’t know 161 (44.9)

Thirty-six point eight percent of respondents indicated that there is either no specific drug or

specific remedy to treat EVD while 32.5% affirmed that there is no specific vaccine to

prevent the disease (Table 7).lxxvi



Table 8: Knowledge on how to prevent contracting Ebola Viral Disease

How can you prevent yourself from

Contracting Ebola disease Frequency(%)

Regular hand washing with soap and water307 (78.5)

By not touching a person with suspected Ebola infection 232 (59.5)

Regular use of hand sanitizer 215 (55.0)

Avoid eating bush meat 132 (33.9)

Regular hand washing with water only 45 (11.5)

By not participating in burial rites of a person that dies of Ebola disease 104 (26.7)

Eating bitter kola 57 (14.6)

lxxviiBabatunde Olowookere 910706002


Drinking salt water 34 (8.7)

By staying at home 36 (9.3)

Going for special prayers 35 (9.0)

Bathing with salt water 32 (8.2)

Regular hand washing with ash 31 (7.9)


Of the various EVD preventive measures 78.5% of respondents mentioned regular hand washing with soap and water, 59.5% affirmed to not touching a person with suspected Ebola infection. Fifty-five percent mentioned regular use of hand sanitizer while 33.9% mentioned avoid eating bush meat and 26.7% said not participating in burial rites of a person that dies of Ebola disease. This show that there is knowledge gap concerning respondent’s knowledge in not participating in burial rites of a person that dies of EVD (Table 8).

Figure 23: Knowledge on sources and channels of information regarding EVD (n=390)

lxxviiiBabatunde Olowookere 910706002


Figure 2

shows the

sources of

information on EVD. Majority respondents 84.1% heard about EVD from radio, 83.8% got

the information through television. While 7.7%, 14.3%, 6.1%, 7.2%, 17.4%, 12.6%, 10.3%,

11.5%, 10.6%, 25.6%, 15.4%, 25.6%, 24.8%, 23.5% heard about EVD from journal,

newspapers, town announcer, mosque, church, family member, peers, health facility, flyer,

internet site, social media, GSM/SMS, market, neighbourhoods respectively (Figure 23).

lxxixBabatunde Olowookere 910706002

Radio

Televi

sion

Journal

Newspap

er

Town an

nouncer

Mosque

Church

Family

mem

ber

Peers

Health fa

cility

Flyer

Internet

sites

Socia

l med

ia N

GSM/SM

S

Market

Neighbourh

ood

0

10

20

30

40

50

60

70

80

90


Table 79: Attitude and perception regarding Ebola Viral DiseaseLevel of preparedness

against Ebola Viral Disease resurgence

What do you do at Home/work to

Reduce the risk of exposure?

Correct (%) Incorrect (%)

Regular hand wash with soap and water 321 (82.3) 69 (17.7)

Regular use of hand sanitizer 217 (55.6) 173 (44.4)

Avoid eating bush meal 112 (28.7) 278 (71.3)

By not touching a person with suspected Ebola

infection

92 (23.6) 298 (76.4)

By not participating in burial rites of a person

that dies of Ebola disease

57 (14.7) 333 (85.3)

Do you think Ebola Virus Disease

is a problem in Lagos? Frequency (%)

Yes 195 (46.9)

No 161 (38.7 )


If yes, specify(multiple responses allowed)

It is a deadly disease 153 (76.1)

It creates a lot of panic 90 (44.8)

It is highly infectious 85 (42.3)

It has no cure 82 (40.8)

It is an attack by the Western world 45 (22.4)

If no, specify(multiple responses allowed)

There are only few cases 87 (53.0)

lxxxBabatunde Olowookere 910706002


It is just being exaggerated 74 (45.1)

I do not believe that there are cases of EVD 66 (40.2)

People just want to make money with Ebola drug 35 (21.3)

Majority (82.3%) 46.9 % of respondents correctly identified regular hand wash with soap and

water, 55.6% the respondents said they use hand sanitizer. while 28.7% respondents avoid

eating bush meat and 85.3% incorrectly said they will participate in burial rites of a person

that died of Ebola disease (Table 7).

perceived EVD as a problem in Lagos State. Seventy-six percent believed that EVD is a

deadly diseaseasdiseases the reasons for this perception while 53% believed that there are

only few cases (Table 9).

lxxxiBabatunde Olowookere 910706002


Table 10: Attitude and perception regarding Ebola Viral Disease

Do you think you are in danger of infection

with Ebola Virus Disease? Frequency (%)

Yes 185 (44.5)

No 158 (38.0)


Do you think government can do more to contain Ebola Virus Disease outbreak?

Yes 218 (52.4)

No 90 (21.6)

I don’t know 82 (26)

About 44.5% of respondents thought that they are in danger of infection with Ebola virus

disease while 38.0 % thought otherwise. 52.4% of respondents also thought that government

is doing enough to contain Ebola virus disease outbreak. (Table 10).

lxxxiiBabatunde Olowookere 910706002


Table 11: Level of preparedness against Ebola Viral Disease resurgence

What do you do at Home/work to

reduce the risk of exposure?Frequency (%)

Regular hand wash with soap and water 321 (82.3)

Regular use of hand sanitizer 217 (55.6)

Avoid eating bush meat 112 (28.7)

By not touching a person with suspected Ebola infection 92 (23.6)

Regular hand wash with water only 66 (16.9)

By not participating in burial rites of a person that dies of Ebola disease 57 (14.7)

Regular hand wash with ash 56 (14.4)

Going for special prayers 39 (10.0)

Drinking salt water 21 (5.4)

Eating bitter kola 27 (6.9)

Bathing with salt water 27 (6.9)

By staying at home 24 (6.2)

lxxxiiiBabatunde Olowookere 910706002



Majority (82.3%) of the respondents mentioned regular hand wash with soap and water,

55.6% the respondents said they use hand sanitizer. While 28.7% respondents avoid eating

bush meat and14.7% not participating in burial rites of a person that died of Ebola disease

as precautionary measures to reduce risk of exposure to EVD (Table 11).

Table 12: Practices regarding Ebola Viral Disease

What do you do if you develop signs of Ebola(multiple responses allowed) Frequency (%)

Go to the hospital 339 (86.9)

Call the Ebola help number 197 (50.5)

Pray 125 (32.1)

Go to religious centre 31 (7.9)

Go to a traditional healer 28 (7.2)

lxxxivBabatunde Olowookere 910706002


Treat myself 16 (4.1)

Hide 9 (2.3)

Stay at home 8 (2.1)

Do nothing 6 (1.5)

If a family member, relative/neighborneighbour develop signs of Ebola(multiple responses allowed)

Go to the hospital 337 (86.4)

Call the Ebola help number 195 (50.0)

Pray 125 (32.1)

Go to religious centre 28 (7.2)

Go to a traditional healer 27 (6.9)

Treat myself 14 (3.6)

Hide 10 (2.6)

Stay at home 9 (2.3)

Do nothing 7 (1.8 )F

Eighty-six point four percent of respondents mentioned that they will go or advise someone

to go to hospital if they develop EVD-like signs and symptoms; 50.0% would call or tell

someone to call the Ebola Alert number. Thirty-two point one said they will pray or ask

someone to pray if they develop signs and symptoms of EVD (Table. 12).

lxxxvBabatunde Olowookere 910706002


Figure 3:Table 7: Overall level of knowledge of respondents on EVD

135; 32%

281; 68%

PoorSatisfactory

The overall level of knowledge shows thatof the the 309 respondents, 281.68% possessed

ssatisfactory knowledge on the Ebola while 135.32% possessed poor knowledge.( (Figure 3).

lxxxviBabatunde Olowookere 910706002


Table Table 813: Knowledge score of respondents on EVD across all domains

Respondents with good knowledge across all domains

LGA Mode of

spread

Symptoms

& Signs

Preventive

measure

Level of

Preparednes

s

Knowledge in all

domains

Ikeja (139) 21(15.1%) 41(29.5%) 4(2.9%) 3 (2.2%) 10 (7.2%)

Agege (136) 21 (15.4%) 32 (23.5%) 2 (1.5%) 2 (1.5%) 3 (2.2%)

Mushin

(141)

20 (14.2%) 29 (20.6%) 6(4.3%) 8 (5.7%) 13 (9.2%)

All

respondents

62 (15.0%) 102 (24.5) 12(2.9%) 13 (3.1%) 26 (6.2)

lxxxviiBabatunde Olowookere 910706002


Knowledge across all domains shows that of the 390 respondents, 6.2% possessed

satisfactory knowledge in all three domains. 15%, 24.5%, 2.9% and 13.1% possessed

satisfactory knowledge in signs and symptoms, preventive measures and mode of spread and

level of preparedness (Table 138).


their Knowledge of EVD (n=416)

lxxxviiiBabatunde Olowookere 910706002


Variable Knowledge of EVD (%)X2 df p-value

Poor Satisfactory

Age

< 20 8 (42.1%) 11 (57.9%) 19 8.476 6 0.205

21-30 42 (32.3%) 88 (67.7%) 130

31-40 43 (28.1%) 110 (71.9) 153

41-50 23 (32.9) 47 (67.1%) 70

51-60 9 (39.1%) 14(60.1%) 23

> 60 10 (43.5%) 11 (56.5%) 21

Sex

Female 59 (29.5%) 141 (70.5%) 200 1.531 1 0.216

Male 76 (35.2%) 140 (64.8%) 216

Religion

Christian 70 (28.1%) 179 (71.9%) 249 6.034 3 0.110

Islam 62 (39.2) 96 (60.8) 158

Traditional 3 (37.5%) 5 (62.5%) 8

Others 0 (0%) 1 (100.0%) 1

There was no statistically significant relationship between age and knowledge (p=0.205), sex

and knowledge (p=0.216) and religion and knowledge (p=0.110). This means age, sex and

religious does not determine the level of knowledge of respondents towards the prevention

and spread of EVD (Table 149).

lxxxixBabatunde Olowookere 910706002



Knowledge of EVD (n=390)

Variable Knowledge of EVD (%) X2 df p-value

Poor Satisfactory Total

Highest level Education

None 5 (100.0%) 0 (0%) 5 23.968 3 0.000

Primary 14 (58.3%) 10 (41.7%) 24

Secondary 52 (37.1%) 88 (62.9%) 140

Tertiary 64 (25.9%) 183 (74.1%) 247

Occupation

Professional 1 (4.0%) 24 (96.0%) 38 21.124 5 0.001

Intermediate 4 (10.5%) 34 (89.5%) 36

Manual

skilled17 (34.0%) 33 (66.0%) 50

Non-manual

skilled9 (33.3%) 18 (66.7%) 27

Partly skilled 26 (38.8%) 41 (61.2%) 67

Unskilled 78 (37.3%) 131 (62.7%) 209

Variable Knowledge of EVD (%) X2 df p-value

Poor Satisfactory Total


None5 (100.0%) 0 (0%) 5 23.968 3 0.000

xcBabatunde Olowookere 910706002


Primary 14 (58.3%) 10 (41.7%) 24

Secondary 52 (37.1%) 88 (62.9%) 140

Tertiary 64 (25.9%) 183 (74.1%) 247

Occupation

Professional 1 (4.0%) 24 (96.0%) 38 21.124 5 0.001

Intermediate 4 (10.5%) 34 (89.5%) 36

Manual

skilled17 (34.0%) 33 (66.0%) 50

Non-manual

skilled9 (33.3%) 18 (66.7%) 27

Partly skilled 26 (38.8%) 41 (61.2%) 67

Unskilled 78 (37.3%) 131 (62.7%) 209

Table 10: Association between Socio-economic characteristics of respondents and their Knowledge of EVD (n=390)

There was a statistically significant association between educational status and knowledge

(p=0.000) and occupation and knowledge (p=0.001). This buttresses the fact that the higher

the educational level and professionalism, the higher the knowledge of respondents on EVD

prevention (Table 150).


Attitude and perception of EVD (n=390).

Variable Attitude and perception (%)

xciBabatunde Olowookere 910706002



Attitude and perception of EVD (n=416390) X2 df

p-value

Negative Positive Total

Age

< 20 15 (78.9%) 4 (21.1%) 19 8.802 6 0.185

21-30 66 (50.8%) 64 (49.2%) 130

31-40 83 (54.2%) 70 (45.8%) 153

41-50 43 (61.4%) 27(38.6%) 70

51-60 14 (60.9%) 9 (39.1%) 23

> 60 15 (77.3%) 6 (22.7%) 21

Sex

Female 111 (55.5%) 89 (44.5%) 200 0.238 1 0.626

Male 125 (57.9%) 91(42.1%) 216

Religion

Christian 138 (55.4%) 111 (44.6%) 249 6.034 3 0.110

Islam 92 (58.2%) 66 (41.8%) 158

Traditional 5 (62.5%) 3 (37.5%) 8

Others 1 (0%) 0 (100.0%) 1

There was no statistically significant relationship between age and attitude and perception

(p=0.185), sex and attitude and perception (p=0.626) and religion and attitude and

xciiBabatunde Olowookere 910706002


perception (p=0.110) this indicates that age, attitude and perception, sex and religion does not

determine a person’s level of knowledge towards the prevention of EVD (Table 161).

Variable Attitude and perception (%) Total X2 X2X2 df p-value

Negative Positive


None 4 (80.0%) 1 (20.0%) 5 3.916 3 0.271

Primary 17 (70.8%) 7(29.2%) 24

Secondary 74 (52.9%) 66 (47.1%) 140

Tertiary 141 (57.1%) 106 (42.9%) 247

Occupation

Professional 18 (72.0%) 7 (28.0%) 38 21.124 5 0.001

Intermediate 23 (60.5%) 15 (39.5%) 36

Manual

skilled

26 (52.0%) 24 (48.0%) 50

Non-manual

skilled

19 (70.4%) 8 (29.6%) 27

xciiiBabatunde Olowookere 910706002


Attitude and perception regarding of EVD


Partly skilled 37 (55.2%) 30 (44.8%) 67

Unskilled 113 (54.1%) 96 (45.9%) 209


Attitude and perception regarding of EVD.


None 4 (80.0%) 1 (20.0%) 5 3.916 3 0.271

Primary 17 (70.8%) 7(29.2%) 24

Secondary 74 (52.9%) 66 (47.1%) 140

Tertiary 141 (57.1%) 106 (42.9%) 247

Occupation

Professional 18 (72.0%) 7 (28.0%) 38 21.124 5 0.001

Intermediate 23 (60.5%) 15 (39.5%) 36

Manual

skilled

26 (52.0%) 24 (48.0%) 50

Non-manual

skilled

19 (70.4%) 8 (29.6%) 27

Partly skilled 37 (55.2%) 30 (44.8%) 67

Unskilled 113 (54.1%) 96 (45.9%) 209

Table 17: Association between Socio-economic characteristics of respondents and their Attitude and perception regarding of EVD

There was no statistically significant relationship between highest level of education and attitude and perception (p=0.271). However, there was statistically significant relationship between occupation and attitude and perception (p=0.001). This supports the fact that

xcivBabatunde Olowookere 910706002

Variable Attitude and perception (%) Total X2 df p-value


professionalism can determine attitudinal change and perception towards EVD prevention (Table 17).

There was no statistically significant relationship between highest level of education and

attitude and perception (p=0.271). However, there was statistically significant relationship

between occupation and attitude and perception (p=0.001). This supports the fact that

professionalism can determine attitudinal change and perception towards EVD prevention

(Table 12).


their Level of Preparedness against of EVD resurgence

Variable

Level of preparedness (%) X2 Df p-value

Low High Total

Age

< 20 16 (84.2%) 3 (15.8%) 19 8.9333 6 0.177

21-30 88 (67.7%) 42 (32.3%) 130

31-40 95 (62.1%) 58 (37.9%) 153

41-50 48 (68.6%) 22(31.4%) 70

51-60 18 (78.3%) 5 (21.7%) 23

> 60 18 (86.7%) 4 (13.3%) 21

Sex

Female 141 (70.5%) 59 (29.5%) 200 1.081 1 0.298

Male 142 (65.7%) 74 (34.3%) 216

xcvBabatunde Olowookere 910706002


Religion

Christian 156 (66.3%) 84 (33.7%) 249 1.532 3 0.675

Islam 112 (70.9%) 46 (29.1%) 158

Traditional 5 (62.5%) 3 (37.5%) 3

Others 1 (100.0%) 0 (0.0%) 1

There was no statistically significant relationship between age and level of preparedness

(p=0.177), sex and level of preparedness (p=0.298) and religion and level of preparedness

(0.675). Preparedness against EVD re-emergence do not determine by age, sex and religion

(Table 138).

xcviBabatunde Olowookere 910706002



level of preparedness EVD resurgence

Variable Level of preparedness (%) X2 Df p-value

Low High Total


None 5 (100.0%) 0 (0.0%) 5 4.916 3 0.185

Primary 18 (75.0%) 6 (25.0%) 24

Secondary 100 (71.4%) 40 (28.6%) 140

Tertiary 160 (64.8%) 87 (35.2%) 247

Occupation

Professional 14 (56.0%) 11 (44.0%) 25 3.235 1 0.072

Intermediate 20 (52.6%) 18 (47.4) 38

Manual

skilled30 (60.0%) 20 (40.0%) 50

Non-Manual

skilled20 (74.1%) 7 (25.9%) 27

Partly

skilled50 (74.6%) 17 (25.4%) 67

Unskilled 149 (71.3%) 60 (28.7%) 209

There was no statistical significance between the highest level of education and level of

preparedness (0.185). However there was a statistical significant association between

occupation and level of preparedness (p=0.072). This affirmed to the fact that preparedness is

a function of availability of resources and social class (Table 149).

xcviiBabatunde Olowookere 910706002



practices regarding EVD

Variable Practices regarding (%) X2 df p-value

Negative Positive Total

Age

< 20 2 (10.5%) 17 (89.5%) 19 3.852 6 0.697

21-30 22 (16.9%) 108 (83.1%) 130

31-40 18 (11.8%) 135 (88.2%) 153

41-50 7 (10.0%) 63 (90.0%) 70

51-60 4 (17.4%) 19 (82.6%) 23

> 60 2 (13.3%) 19 (86.7%) 21

Sex

Female 23 (11.5%) 177 (88.5%) 200 0.995 1 0.319

Male 32 (14.8%) 184 (85.2%) 216

Religion

Christian 146 (58.6%) 103 (41.4%) 249 4.119 3 0.249

Islam 106 (67.1%) 52 (32.9%) 158

Traditional 6 (75.0%) 2 (25.0%) 8

Other 1 (100%) 0 (0%) 1

xcviiiBabatunde Olowookere 910706002


There was no statistically significant relationship between age and practices (p=0.697), sex

and knowledge (p=0.319) and sex and practices (p=0.249). This shows that the age and sex

do not determine practices towards EVD prevention (Table 1520).

Table 216: Association between Socio-economic characteristics of respondents and

practices regarding EVD resurgence

Variable Practices regarding EVD Total X2 df p-value

Negative Positive


None 3 (60.0%) 2 (40.0%) 5 24.048 3 0.000

Primary 8 (33.3%) 16 (66.7%) 24

Secondary 23 (16.4%) 117 (83.6%) 140

Tertiary 21 (8.5%) 226 (91.5%) 247

Occupation

Professional 0 (0.0%) 25 (100.0%) 25 10.359 5 0.066

xcixBabatunde Olowookere 910706002


Intermediate 1 (2.6%) 37 (97.4%) 38

Manual

skilled7 (14.0%) 43 (86.0%) 50

Non-Manual

skilled3 (11.1%) 24 (88.9%) 27

Partly skilled 13(19.4%) 54 (80.6%) 67

Unskilled 31 (14.8%) 178 (85.2%) 209

However there was a statistically significant association between educational status and

practices (p=0.000) and occupation and practices (0.066). This implies that educational level

and professionalism enhanced positive practices in EVD prevention and mode of spread

(Table 216).

CHAPTER FIVE

DISCUSSION

Preparedness is a function of availability of resources, satisfactory knowledge, positive

attitude and standard practices/protocols. It envisages entire health system from physician’s

preparedness; hospital preparedness, laboratory and diagnostic preparedness to the public

health preparedness.

cBabatunde Olowookere 910706002


Ebola Virus Disease Preparedness has been underscored worldwide and in countries away

from the epicenters of the current outbreak.87 Worthy of note is the fact that there was little

interest in EVD preparedness level before the recent occurrence.88

The demographic pattern of participants in this study shows that majority of the respondents

were male (51.7%) and are Christians (59.9%). More than half (58.1%) of the respondents

had tertiary education and 50.2% were mainly traders, unemployed, students or housewives

which had the highest number of respondents.

The study also revealed that majority of the respondents have moderate knowledge of the

signs of EVD (94%), spread of EVD (69.3%), signs of illness (50.0%), likely wise 78.5% of

the respondents affirmed that to prevent contracting EVD by regular hand washing with soap

and water, 59.5% of the respondents stated that not touching persons with suspected EVD

infection, 55.0% mentioned regular use of hand sanitizer while 3.8% of the respondents do

not know how to prevent contacting EVD.

The findings above is not in tandem with the report of International Federation of Red cross

and Red Crescent Societies stating that Liberian citizens have limited knowledge regarding

the mode of transmission of the Ebola virus.89

Preparedness is a function of availability of resources, satisfactory knowledge, positive attitude and standard practices/protocols. It envisages entire health system from physician’s preparedness, hospital preparedness, laboratory and diagnostics preparedness to the public health preparedness.Ebola Virus Disease Preparedness has been underscored worldwide and in countries away from the epicenters of the current outbreak.90 Worthy of note is the fact that there was little interest in EVD preparedness level before the recentoccurrence.91

The demographic pattern of participants in this study shows that majority of the respondents were male (51.7%) and are Christians (59.9%). More than half (58.1%) of the respondents had tertiary education and 50.2% were mainly traders, unemployed, students or housewives which had the highest number of respondents.

ciBabatunde Olowookere 910706002


The study also revealed that majority of the respondents have moderate knowledge of

thesigns of EVD (94%), spread of EVD (69.3%), signs of illness (50.0%), likely wise 78.5%

of the respondents affirmed that to prevent contracting EVD by regular hand washing with

soap and water, 59.5% of the respondentsstated that not touching persons with suspected

EVD infection, 55.0% mentioned regular use of hand sanitizer while 3.8% of the respondents

do not know how to prevent contacting EVD.

The findings above is not in tandem with the report of International Federation of Red cross

andRed Crescent Societies stating that Liberian citizens have limited knowledge regarding

the mode of transmission of the Ebola virus.92

Likewise, the survey established that knowledge across all domains shows that of the 390

respondents, 6.2% possessed satisfactory knowledge in all three domains. 15%, 24.5%, 2.9%

and 13.1% possessed satisfactory knowledge in signs and symptoms, preventive measures

and mode of spread and level of preparedness.

There was a significantassociationsignificant association of residents’knowledgeresidents’

knowledge on educational status andoccupationand occupation (p-value: 0.000 and 0.001).

This study found out that the higher the educational status and occupation the more

satisfactory knowledge of EVD. This favors the argument that income and education are

positively associated with disaster preparedness.93 Education in particular is a key tool to

promote disaster preparedness because highly educated individuals have better economic

resources to undertake preparedness actions and because education may influence cognitive

elements and shape how individuals perceived and received and assess risks, and how they

ciiBabatunde Olowookere 910706002


process risk- minimizing information.94Likewise, earlier research has found that highly

educated individuals in Indonesia are reported to cope better with the post-tsunami phase of

the disaster, especially over the long run.95

However, there was statistically significant relationship between occupation and attitude and

perception (p-value: 0.001). This study found out that socio-economic status of residents such

as occupation enhanced positive attitude and perception.

There was also a statistically significant association between occupation and level of

preparedness (p-value: 0.072). This also shows that high level of preparedness of residents is

determined by their occupation. The empirical evidence on the relationship between the

preparedness level and the income has been adequately established.8787 8784

There was a statistically significant association between educational status and practices

(p=0.000) and occupation and practices (0.066). This implies that educational level and

professionalism enhanced positive practices in EVD prevention and mode of spread.

The commendation by World Health Organization and other nations on thecontainmentthe

containment of EVD outbreak in Nigeria was corroborated by respondents (52.4%) who

believed that government is doing enough to contain the EVD outbreak.8479 This also

translated to respondents high level of preparedness level and practices such as regular hand

ciiiBabatunde Olowookere 910706002


wash with soap and water and use of hand sanitizers to prevent the spread of highly infectious

diseases.

Preparedness is a function of availability of resources, satisfactory knowledge, positive

attitude and standard practices/protocols. It envisages entire health system from physician’s

preparedness, hospital preparedness, laboratory and diagnostics preparedness to the public

health preparedness.

civBabatunde Olowookere 910706002


CONCLUSION

Findings from this study indicates that majority of the respondents have adequate knowledge

of causes, spread and prevention of EVD in the study areas. There is positive attitude towards

prevention of EVD resurgence in the three LGAs surveyed. The result demonstrates a high

degree of preparedness level against the resurgence of Ebola Virus Disease in the three (3)

LGAs of Lagos State. Majority of the respondents who had heard about Ebola accepted that

Ebola was real and could not identify the most common things.

Given that being affected by Ebola is a truly life changing experience with far reaching

consequences on both survivors and caregivers, appropriate interventions are needed to

improve the preparedness level against the resurgence of the disease.

The results demonstrate a high degree of preparedness levelagainstlevel against the

reemergence of Ebola Virus Disease in the three (3) LGAs of Lagos State. Majority of the

respondents who had heard about Ebola accepted that Ebola was real and could identify the

most common signs

Survey result reveals gaps on respondent’s knowledge in not participating in burial rites of a

person that dies of Ebola disease. Targeted public health messages are is required to raise the

knowledge level of the citizenry. , correct misconception and should be widely disseminated,

with radio and television as media of choice.

Furthermore,large Furthermore, a large numbers of respondents (from the study area) are now

acquainted with relevant steps to take in preventing the outbreak and consequent spread of

cvBabatunde Olowookere 910706002


EVD thus signifying an . This is an indication of improved level of awareness in the fight

against the disease. in tandem with positive practices regarding EVD.

Overwhelming agreement with intended behaviors such as isolation of those with symptoms,

early treatment and safe burial shows a new and emerging consensus akin to public health

recommendations. Perhaps Tthe most striking finding is the high degree of community

involvement in containing the scourge and the widespread effort at reaching out to family,

friends, and neighbors to imbibe the culture.

cviBabatunde Olowookere 910706002


RECOMMENDATIONS

The recommendations that will be cited here are in line with the findings of this study and

should be implemented by policy makers in the health sector. They are as follows:

1. The Government should increase awareness of the disease so as to reduce the

misconception especially amongst the people with low level of education as this also

affects their understanding of the disease.

2. In the practice towards EVD, the public should ensures good practice such as ensuring

high level of personal hygiene, good environmental sanitation, avoids eating bush

meats, practice safe sex, avoids pets especially monkeys, ensure good burial

procedure, wear protective clothing and help disseminate the information on Ebola.

3. Standard protocols should be developed and enforced by the Federal Ministry of

Health and state Ministries y of Health to ensure best practices at Primary Health Care

facilities. uniformity of practice at primary care facilities.

4. Majority of respondents in this study learnt about EVD from mass media sources,

health institutions from community level to federal level should device means of

transmitting reliable health information to staff.

5. Hand sanitizers should be provided freely for the populace.

cviiBabatunde Olowookere 910706002


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Figure 41: Overview of Ebola virus pathogenesis

Government & Nonprofit

RESIDENTS PREPAREDNESS LEVEL AGAINST EBOLA VIRUS DISEASE RESURGENNCE: A SURVEY IN THREE LOCAL GOVERNMENT AREAS IN LAGOS STATE