Ebola and compliance with infection prevention measures in Nigeria

Abstract

An outbreak of Ebola virus in Nigeria that began in July, 2014, after a Liberian man imported the virus to the country have raised the level of compliance to infection prevention and control measures in the nation. As researchers advocating for efficient infection control in both rural and urban health-care facilities and use of safe, environmental-friendly methods to prevent infectious diseases in Nigeria, we read with interest a recent Editorial in The Lancet. The editorial emphasised the reasons why many people fear Ebola virus, and discussed the fact that if better infection control measures are in place—such as are available in medium-income or high-income countries—the long incubation period of 2–21 days of Ebola is sufficient to treat those that become ill.1The Lancet Infectious DiseasesEbola in west Africa.Lancet Infect Dis. 2014; 14: 779Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar Nigerians have never take infection prevention and control measures or environmental sanitation very seriously, despite the efforts of the government and advocates. However, amazingly with the Ebola outbreak, we have seen relatively improved compliance to WHO infection control practice guidelines of “clean care is safer care”2World Health OrganizationClean care is safer care.http://www.who.int/gpsc/en/Google Scholar (for which compliance was initially <5%) within a few weeks, because of fears about Ebola's mode of killing and the absence of a vaccine or cure for the disease. The fact that Ebola infection kills doctors and nurses treating victims of the disease, and the cases of the two American doctors who were infected despite their strict adherence to infection prevention and control measures, have forced many people to make a little effort and comply with guidelines. Raised anxieties among patients, health-care workers, and members of the community in fear of contracting the virus from each other have improved the use of handwashing techniques, not only in hospitals, but also in banks, markets, public places, and in communities, as advised by health-care workers through word of mouth, on print and social media, and in religious places. Use of ordinary soap, sanitisers, and even just ordinary water to wash hands after contact with other people has increased substantially, and more people are refusing to shake hands with strangers. Dissatisfaction with the world response to the Nigerian Ebola outbreak among many Nigerians; travel restrictions and stigmatisation of African communities abroad; an indefinite strike initiated by medical doctors in the country at the start of the outbreak; the rate at which people are dying needlessly in neighbouring Liberia, Guinea, and Sierra Leone; and reports of doctors and nurses fleeing when profusely bleeding accident victims are brought to hospitals have forced some Nigerians to go to extremes, such as following the advice of a mere rumour suggesting the use of concentrated salt solution for drinking and washing as a prevention or cure. Such misinformed control measures are not being used for a cholera outbreak that is occurring simultaneously in some areas of Nigeria. The outbreak, which has affected at least 352 people in two states within 3 months, has received less sympathy and financial support from the community and government than Ebola, but has subsided as a result of improved infection prevention and control measures in the affected communities because of fears about Ebola. In a recent survey that we did in Nigeria of 56 health-care workers and 60 members of the community (23 rural and 37 urban dwellers) about measures taken by the government to curtail the spread of Ebola, many agreed that Ebola is real and that the preventative measures are acceptable, even though some religious and cultural rights need to be forfeited. Only seven of the 60 community members interviewed have never practiced handwashing and are never cautious about touching ill people even after the outbreak. They believe that Ebola does not really exist and is merely western propaganda. We have noted improvements in actions by all the stakeholders in Nigeria listed in a call to action for adoption of the Chennai declaration in combating spread of hospital-acquired infections3Yusuf I Umar RA Adopting Chennai declaration strategies in the prevention and control of the spread of multidrug-resistant hospital-acquired bacterial infections in Nigeria: a call to action.J Glob Antimicrob Resist. 2014; 2: 203-204Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar and in strict adherence to the NICE quality standards of infection prevention and control4NICE infection prevention and control quality standards (QS61)—issued.www.nice.org.uk/guidance/qs61/resourcesDate: April, 2014Google Scholar and to WHO guidelines.2World Health OrganizationClean care is safer care.http://www.who.int/gpsc/en/Google Scholar Such improvements show that the outbreak of Ebola has successfully forced the Nigerian Government, non-governmental organisations, the media, and communities to take infection prevention and control issues seriously. We declare no competing interests.