Abstract
In many low-income countries, volunteer health advisors (VHAs) play an important role in disseminating information, especially in rural or hard-to-reach locations. When the world’s largest outbreak of Ebola virus disease (EVD) occurred in 2014, a majority of cases were concentrated in the West African countries of Guinea, Liberia, and Sierra Leone. Twenty cases were reported in Nigeria initially and there was a need to rapidly disseminate factual information on Ebola virus. In southeast Nigeria, a group of VHAs was being used to implement the Healthy Beginning Initiative [HBI], a congregation based intervention to increase HIV testing among pregnant women and their male partners. The purpose of this study was to assess the baseline and post EVD training knowledge of VHAs during the outbreak in Nigeria. In September 2014, 59 VHAs attending a HBI training workshop in the Enugu State of Nigeria participated in an Ebola awareness training session. Participants completed a 10-item single-answer questionnaire that assessed knowledge of Ebola epidemiology, symptoms, transmission, prevention practices, treatment and survival prior to the Ebola awareness training. After the training, the VHAs repeated the questionnaire. Answers to pre and post questionnaires were analyzed using paired t-tests. Multiple linear regression was used to examine the relationship between pre and post total questionnaire scores and age, education, current location and employment. The average pre-test score was 7.3 and average post-test score was 7.8 which was a significant difference (t=-2.5, p=0.01). Prior to the training, there was a significant difference in Ebola knowledge based on the VHAs education only (p<0.01). After training, education was no longer significant for Ebola knowledge. Existing community health programs can be used as a platform to train VHAs in times of epidemics for quick dissemination of vital health information in areas lacking adequate health infrastructure and personnel.
Highlights
1.1 Ebola Virus Disease (EVD) OutbreakIn the world's largest outbreak of Ebola virus disease (EVD), there had been 20,206 cases, with 7,905 deaths as of December 31, 2014 (World Health Organization, 2015)
Nine months after the first case of Ebola was reported, confirmed cases and deaths were reported in the five West African countries of Guinea, Liberia, Sierra Leone, Senegal and Nigeria; the majority of cases were concentrated in Guinea, Liberia, and Sierra Leone (Team, 2014)
Analysis of this outbreak by the World Health Organization (WHO) found that, it was unprecedented in size, it was very similar to other Ebola epidemics in terms of incubation period, duration of illness, case fatality rate and reproduction number (Team, 2014)
Summary
In the world's largest outbreak of Ebola virus disease (EVD), there had been 20,206 cases, with 7,905 deaths as of December 31, 2014 (World Health Organization, 2015). “Social mobilizers” targeted areas surrounding EVD contacts to disperse health information and dispel false rumors, reaching about 26,000 households in total (Fasina et al, 2014) With this organized and aggressive, centralized system, Nigeria had a lower case fatality rate (45.5%) than Guinea, Liberia, and Sierra Leone and was officially declared Ebola-free on October 19, 2014. In many low-income countries with an insufficient number of trained health professionals (doctors and nurses), community or voluntary health workers play an important role in disseminating information, especially in rural or hard-to-reach locations (Lehmann & Sanders, 2007; Perry, Zulliger, & Rogers, 2014) This was evident in the 2000 outbreak of Ebola in Uganda. Community mobilization for timely information dissemination using selected village volunteers was critical in controlling the epidemic which lasted for 42 days and resulted in 224 deaths (Okware et al, 2002)
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