Ebola viral disease (EVD) is an acute febrile illness caused by the Ebola virus, a member of the family of Filoviridae. EVD is associated with a high mortality rate in humans and non-human primates since its initial recognition in the Democratic Republic of the Congo in 1976 [
The latest outbreak which affects Guinea, Liberia, Sierra Leone, and Nigeria in West Africa is the worst in EVD history with 2127 reported cases out of which 1145 died by August 15, 2014 [
The study was conducted at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria, in the month of July, 2014. It is a 576-bedded hospital with referrals from neighbouring states such as Oyo, Ondo, Ekiti, Kogi, Kwara, and beyond.
The study population included the clinical members of staff, namely, medical doctors, nurses, pharmacists, medical laboratory technologists, community health workers (CHEW), medical records officer, and physiotherapists.
The sample size of 352 was calculated using an appropriate statistical formula for estimating the minimum sample size in descriptive health studies
The number allocated to each group of clinical staff was determined proportionately using the formula
Consenting health workers completed a pretested semistructured self-administered questionnaire that assessed participants’ general knowledge, emergency preparedness, and control and management of EVD. The questionnaires were distributed consecutively to members of each occupational group during the break period. The respondents were allowed to fill the questionnaire in their spare time at their convenience. Questionnaire information was anonymised.
Ethical approval to conduct the study was obtained from Ife Central Local Government Ethical Review Committee. Written informed consent was taken from the respondents while they were reassured of the confidentiality of the information obtained. The data collected were entered and kept in a password protected computer.
The data obtained were analysed using SPSS version 16. Simple descriptive and inferential statistics were done. Knowledge score was computed for a 41-item question on knowledge of EVD. Each item was assigned “+1” for correct knowledge and “0” for incorrect knowledge. The knowledge score was graded as good or appropriate (if respondent scored ≥ 27 points) and not good or not appropriate (if score was <27 points) using the mean score as the break-off point. Test of significance was conducted using appropriate statistical methods. Multivariate analysis was performed using logistic regression to evaluate sociodemographic variables and other variables that are independently associated with good knowledge of EVD. Adjusted odd ratio (AOR) and 95% CI were presented and used as measures of the strength of association. Significant level was put at
Four hundred completed questionnaires were analysed. The mean age (SD) of the respondents was
Sociodemographic characteristics of participants.
Variable | Frequency | % |
---|---|---|
Age group (years) | ||
20–29 | 135 | 33.8 |
30–39 | 164 | 41 |
≥40 | 101 | 25.2 |
Sex | ||
Male | 159 | 39.8 |
Female | 241 | 60.2 |
Marital status | ||
Single | 137 | 34.2 |
Married | 263 | 65.8 |
Occupation | ||
Medical doctor | 98 | 24.6 |
Nurse | 209 | 52.2 |
Pharmacist | 25 | 6.3 |
Medical laboratory technologist | 23 | 5.8 |
Community health officers | 19 | 4.7 |
Medical records officer | 17 | 4.2 |
Physiotherapist | 9 | 2.2 |
Duration of employment (years) | ||
<10 | 295 | 73.8 |
≥10 | 105 | 26.2 |
The majority 342 (85.5%) were aware of the on-going EVD outbreak in the West African subregion. Colleagues (40%) and radio (37.2%) were their major sources of information (Table
EVD awareness and source of information on the outbreak.
Variable | Frequency | % |
---|---|---|
Aware of EVD epidemic in West Africa | ||
Yes | 342 | 85.5 |
No | 58 | 14.5 |
|
||
Colleagues | 160 | 40.0 |
Radio | 149 | 37.2 |
Internet | 114 | 28.4 |
Television | 93 | 23.3 |
Newspapers | 92 | 23.1 |
Notice boards/pamphlets | 44 | 10.9 |
Only 42.3% had good knowledge of EVD (Figure
EVD knowledge of clinical variables.
Variable | Frequency | % |
---|---|---|
Ebola fever is a viral disease | ||
Yes | 373 | 93.2 |
No | 27 | 6.8 |
Incubation period last from 2 to 21 days | ||
Yes | 247 | 61.8 |
No | 153 | 38.2 |
The reservoir is usually bats | ||
Yes | 270 | 67.5 |
No | 130 | 32.5 |
Infection with the organism is usually deadly | ||
Yes | 366 | 91.5 |
No | 34 | 8.5 |
Ebola can be transmitted from person to person | ||
Yes | 351 | 87.8 |
No | 49 | 12.2 |
Ebola can be transmitted from animal to person | ||
Yes | 345 | 86.2 |
No | 55 | 13.8 |
Ebola can be transmitted from inanimate objects to person | ||
Yes | 187 | 46.8 |
No | 213 | 53.2 |
Graded score on EVD knowledge.
Although the majority of participants knew that EVD is transmissible through body fluids, below half knew that the causative agent penetrates broken skin (Table
Knowledge of EVD mode of transmission.
Variable | Frequency | % |
---|---|---|
Ebola can be transmitted through saliva | ||
Yes | 274 | 68.5 |
No | 126 | 31.5 |
Ebola can be transmitted through blood | ||
Yes | 331 | 82.8 |
No | 69 | 17.2 |
Ebola can be transmitted through seminal/vagina fluid | ||
Yes | 222 | 55.5 |
No | 178 | 44.5 |
Causative agent penetrates broken skin | ||
Yes | 186 | 46.5 |
No | 214 | 53.5 |
Bodies of dead cases constitute a potential hazard | ||
Yes | 300 | 75 |
No | 100 | 25 |
Cases cease to be infectious after the acute phase of the disease | ||
Yes | 107 | 26.8 |
No | 293 | 73.2 |
Most health workers knew high grade fever (78.2%) and unexplained bleeding (73.4%) as common presentation in EVD patients while fewer health workers knew that gastrointestinal symptoms and shock (27%) could occur in these patients (Table
Knowledge of EVD clinical presentation.
EVD cases are characterized by fever >38°C | ||
Yes | 313 | 78.2 |
No | 87 | 21.8 |
Unexplained bleeding could be diagnostic | ||
Yes | 294 | 73.4 |
No | 106 | 26.6 |
Vomiting, diarrhoea, and shock are rarely observed in hospitalized patients | ||
Yes | 292 | 73.0 |
No | 108 | 27.0 |
Fever refractory to treatment and unexplained mucosal bleeding is a sign | ||
Yes | 296 | 74.0 |
No | 104 | 26.0 |
Although majority of participants knew some treatment and prevention of EVD, about three-quarter did not know that EVD has no vaccine presently (Table
EVD knowledge of treatment and prevention.
Variable | Frequency | % |
---|---|---|
|
||
Antipyretics | 343 | 85.8 |
IV fluids | 339 | 84.8 |
Corticosteroids | 212 | 53.0 |
Uses of vaccine protect from EVD infection | ||
Yes | 292 | 73.0 |
No | 108 | 27.0 |
Environmental sanitation protects from infection | ||
Yes | 350 | 87.5 |
No | 50 | 12.5 |
Safe sex protects from infection | ||
Yes | 248 | 62.0 |
No | 152 | 38.0 |
Barrier nursing protects from infection | ||
Yes | 333 | 83.2 |
No | 67 | 16.8 |
Cases can be confirmed without laboratory assistance | ||
Yes | 125 | 31.2 |
No | 275 | 68.8 |
Knowledge of EVD reporting.
Variable | Frequency | % |
---|---|---|
Critical number of cases must occur before reporting | ||
True | 174 | 43.5 |
False | 150 | 37.5 |
Not sure | 76 | 19.0 |
Suspected cases qualify for reporting | ||
True | 322 | 80.5 |
False | 20 | 5.0 |
Not sure | 58 | 14.5 |
Cases should be reported weekly for administrative efficiency | ||
True | 227 | 56.8 |
False | 67 | 16.8 |
Not sure | 106 | 26.4 |
|
||
Federal ministry of health | 290 | 72.5 |
State ministry of health | 211 | 52.8 |
Local ministry of health | 208 | 52.0 |
Risk perception and attitude to EVD.
Variable | Frequency | % |
---|---|---|
Consider self to be at risk | ||
Agree | 156 | 39.0 |
Disagree | 173 | 42.8 |
Undecided | 71 | 18.2 |
Health workers are prone to having EVD | ||
Agree | 303 | 75.8 |
Disagree | 51 | 12.7 |
Undecided | 46 | 11.5 |
It is possible to prevent EVD spread | ||
Agree | 318 | 79.5 |
Disagree | 35 | 8.7 |
Undecided | 47 | 11.8 |
There is no risk in living with EVD patient | ||
Agree | 20 | 5.0 |
Disagree | 332 | 83.0 |
Undecided | 48 | 12.0 |
Infection control policy of the hospital is inadequate | ||
Agree | 109 | 27.3 |
Disagree | 42 | 10.5 |
Undecided | 249 | 62.2 |
Medical doctors (54.1%) and nurses (42.6%) had appropriate knowledge compared to other health workers and this association was statistically significant (Table
Association between respondents’ characteristics and knowledge of EVD.
Variable | Knowledge |
|
|
|
---|---|---|---|---|
Appropriate | Not appropriate | |||
Age (years) | ||||
20–29 | 58 (43.0) | 77 (57.0) | 5.720 | 0.057 |
30–39 | 78 (47.6) | 86 (52.4) | ||
≥40 | 33 (32.7) | 68 (67.3) | ||
Sex | ||||
Male | 70 (44.0) | 89 (56.0) | 0.341 | 0.559 |
Female | 99 (41.1) | 142 (58.9) | ||
Marital status | ||||
Currently married | 111 (42.2) | 152 (57.8) | 0.001 | 0.980 |
Not currently married | 58 (42.3) | 79 (57.7) | ||
Occupation | ||||
Medical doctor | 53 (54.1) | 45 (45.9) | 12.291 | 0.002 |
Nurse | 89 (42.6) | 120 (57.4) | ||
Other health workers | 27 (29.0) | 66 (71.0) | ||
Duration of employment (years) | ||||
<10 | 132 (44.7) | 163 (55.3) | 2.869 | 0.090 |
≥10 | 37 (35.2) | 68 (64.8) |
The only predictor of good/appropriate knowledge was participants’ occupation (Table
Binary logistic regression of respondents’ characteristics and EVD knowledge.
Variable | AOR | 95% CI |
|
---|---|---|---|
Occupation | |||
Medical doctor | 2.879 | 1.582–5.239 | 0.001 |
Nurse | 1.813 | 1.072–3.065 | 0.026 |
Other health workers (ref.) | 1 |
This study assessed the knowledge, attitude, and practice of health workers in a tertiary hospital in the south-western part of Nigeria towards EVD. The health workers that participated included medical doctors, nurses, pharmacists, medical laboratory technologists, medical record officers, physiotherapists, and community health workers. All these health workers come into contact with patients or their body fluids in the work place. Hence this baseline study determines their preparedness towards EVD. Most participants were young, were females, were married, and had practised less than 10 years. This implies that the participants still had more years to work and hence the necessity to remain healthy in order to perform their health care duties. Also, these health workers could be a source of spread of this life threatening infection to coworkers, their families, and community.
Although most respondents were aware of the EVD epidemic in the West African subregion, some were not aware. This is not acceptable as every health worker should be aware to ensure necessary precautions are taken to reduce the ongoing epidemic and control it whenever such spreads to the facility. This will ensure early diagnosis, management, control, and reporting of such cases to appropriate authority whenever they occur. Colleagues and radio were identified by the participants as their major sources of information. This shows the importance of peers and media in information management. Studies in Nigeria and elsewhere had reported the radio as a valid means of spreading current information to hospital workers as well as the general populace [
Over half of the respondents had poor knowledge of EVD. This is probably because as at the time this study commenced, no case was reported in Nigeria. EVD was seen by most respondents as too far away to be a problem. However, this perception about a dangerous infectious disease such as EVD could result in uncontrollable epidemics; hence attitudinal change will be necessary if this must be averted. The World Health Organization had reported several cases of EVD outside the epidemic zone with Nigeria reporting its first case on July 20, 2014 [
Most participants felt that the infection control policy of the hospital was inadequate to protect health workers against EVD. This implies that the hospital authorities must do all that is required to develop a policy targeting EVD.
Occupation was found to be the only predictor of EVD knowledge with medical doctors and nurses having better knowledge more than other health workers. This reflects the training undergone by these groups of workers and the need to strengthen the capacity of other health workers with adequate knowledge of preventing, diagnosing, and managing EVD cases. All health workers need continuous education on EVD. Also, the training should focus on the concept of universal precautions, which must be observed by every health care worker while interacting with every patient [
This baseline study is limited by its cross-sectional design and the fact that some respondents could have given socially acceptable answers to some questions. However, this study will serve as a guide for planning and implementing interventions targeted at controlling possible epidemics in the study area.
In conclusion, most health workers had inappropriate knowledge about EVD; hence continuous medical education focusing on the concept of universal precautions should target all health workers. Also, an infection control policy targeting EVD is urgently required and emergency preparedness towards possible EVD epidemic is necessary.
The authors declare that they had no competing interests.
The authors are grateful to the management of Obafemi Awolowo University Teaching Hospitals and health workers that participated in this study. The authors thank Mr. Anthony Adejuwon for editing this paper.