Evaluation of a health systems strengthening intervention to improve Ebola Virus Disease infection prevention and control in the Democratic Republic of the Congo

Abstract

Background The Democratic Republic of Congo declared their tenth outbreak of Ebola in North Kivu in 2018, which was the second-largest in the world and took place in an active conflict zone. Transmission of Ebola occurs by direct contact with infected bodily fluids and can occur within facilities when infection prevention and control (IPC) precautions are not strictly practised. Methods To develop infection prevention and control (IPC) standards in health facilities, 45 medical students were trained and placed in 101 health facilities to mentor healthcare workers and support IPC practices between February and October 2019. A mixed-methods retrospective evaluation of quality improvement in North Kivu was conducted in October and November 2019 to capture key lessons from such a pilot IPC project. Five focus groups (N=49) and 42 key-informant interviews were conducted in addition to a secondary analysis of surveillance and programmatic data collected during the intervention. Results The intervention contributed 1.83 times (95% confidence interval, CI=1.10-3.06) to increased the likelihood of health facilities achieving an IPC score of 80% or above compared with facilities that did not receive the intervention. Overall, we found the odds of Ebola cases declining three times more likely in Butembo and Katwa (odds ratio, OR=3.00, 95% CI=1.87-5.62) relative to ten health zones in the region that were not reached by the intervention. Conclusions The results are difficult to attribute to any one type of intervention, given the number of other interventions implemented concurrently during the outbreak response. Further evaluations should be conducted to assess the cost-effectiveness of using medical students in conflict resolution and IPC, and to assess the suitability of scaling these approaches to other settings and diseases.