Health Care Worker preparedness for Ebola Virus Disease Augustina Sylverken (PhD) KCCR/KNUST

Outline Current situation Why this study Methods Results Conclusion Recommendation Take home message

Current outbreaks and emergencies in Africa WHO Regional Office for Africa, 2016 Key emergencies- Ebola, Lassa fever, Yellow fever, Meningitis, Dengue, Chikungunya etc….

Recent EVD Effect of recent epidemic: Mortality (≈ 10,000) Disruption of health systems Due to: Poor and weak health systems Unprepared and unskilled healthcare workers (HCWs) Poor understanding of disease dynamics Lack of requisite resources

WHO Ebola Situation Report, 1st July, 2015 Ebola virus disease infections in HCWs in Guinea, Liberia, and Sierra Leone Country Cases Deaths Guinea 191 96 Liberia* 378 196 Sierra Leone 305 221‡ Total 874 509 (58.3%) Data are confirmed cases and deaths only, apart from deaths in Sierra Leone, which include confirmed, probable, and suspected deaths. *Data are until 9 May. ‡Data as of 17 February. WHO Ebola Situation Report, 1st July, 2015

Ebola Virus Disease in HCWs outside the three major affected countries Cases Country Nigeria* 10 5 Senegal* Mali* 2 United States of America$ 3 United Kingdom# 1 Spain& Italy+ Total 18 7 (38.9%) *WHO, January, 2015. $CDC, 16th December, 2014. #WHO, 30th December, 2014. &WHO, 9th October, 2014. +WHO, 13th May, 2015.

And in Ghana…...No infection but......... The Africa Report, 2014 United Nations Information Centre, Accra, 2014

Training of HCWs Designation of some facilities as holding units Provision of tools and logistics Several simulation exercises by HCWs However, NO empirical data on the preparedness of Health care workers to EVD Basic knowledge? Attitudes? Preparedness? Readiness?

Aims and objectives Aim: Assess the level of preparedness, awareness and knowledge among a population of HCWs in emergency response to EVD cases in the Kumasi Metropolis of Ashanti region, Ghana. Objectives: Assess the level of preparedness in an emergency response to EVD among frontline health care workers in KMA Assess the level of awareness and knowledge of EVD in response to emergency cases among health workers at KMA Make recommendation for future training and preparedness for any epidemics in the metropolis.

Methods – Study sites * * *Study sites

‘Advanced Ebola Holding Unit’ Kumasi South Hospital ‘Advanced Ebola Holding Unit’ Suntreso Government Hospital ‘Ebola Standing Team’

Methods Study period: October-December 2015 Design: Hospital based cross sectional study Study population: Healthcare workers Sampling strategy: Purposive Training for Research Assistants on how to capture data - PDAs Attended morning meetings Informed consent Tools – Structured questionnaires on PDAs Approval: Committee on Human Publication, Research and Ethics at KNUST (CHPRE/AP/329/15)

Results - Categories N = 101

Knowledge (General) Did not know + Bacterium Doctors = 1 (0.99%) Nurses = 16 (15.84%) p = 0.247

HCWs Knowledge and Awareness Question HCW category (N, %)   MDs Nurses PA Overall (n=101) χ², p-value (n=20) (n=77) (n=4) Source of knowledge of EVD? 45.44, p>0.001 During academic training 10 (9.90) 1 (0.99) 11 (10.89) From a colleague 13 (12.87) Media 8 (7.92) 60 (59.41) 4 (3.96) 72 (71.29) Workshop 2 (1.98) Other 1(0.99) Biosafety required for EVD processing 22.65, 0.001 BSL-1 0 (0) BSL-2 BSL-3 0(0) 19 (18.81) BSL-4 9 (8.91) 63 (62.38) 76 (75.25) Biosafety required for EVD culture 20.93, 0.007 20 (19.80) Don’t know 62 (61.39) 3 (2.97) 74 (73.27) Disinfectant required for attending to EVD patient 28.52, 0.001 70% Ethanol 5 (4.95) 100% Ethanol 0.5% Sodium Hypochlorite 6 (5.94) 50% alcohol gel 50 (49.50) 18 (17.82)

HCWs Preparedness Question HCW category Total, (%) MDs Nurses PA (n=4)   Total, (%) MDs Nurses PA (n=4) Overall (n=101) χ², p-value (n=20) (n=77) Facility equipped to handle EVD cases 2.66, 0.62 Yes 4 (3.96) 21 (20.79) 1 (0.99) 26 (25.74) No 14 (13.86) 39 (38.61) 2 (1.98) 55 (54.46) I don’t know 17 (16.83) 10 (19.80) Agrees to be quarantined in case of being infected 4.69, 0.321 19 (18.81) 75 (74.26) 98 (97.03) 0 (0) Maybe Willingness to attend to an EVD patient 8.03, 0.09 9 (8.91) 36 (35.64) 45 (44.55) 6 (5.94) 25 (24.75) 35 (34.65) 5 (4.95) 16 (15.84) Adequately traininig 0.98, 0.614 8 (7.92) 69 (68.32) 92 (91.09) Confidence level in handling an EVD suspected patient 13.09, 0.11 No confidence 3 (2.97) 15 (14.85) Little confidence 10 (9.90) 13 (12.87) 24 (23.76) Confident 29 (28.71) 33 (32.67) Very confident 0 (0.99) 18 (17.82) Extremely confident 7 (6.93)

Beyond EVD…....Other EPDs

Compensation

Proposed recommendations by study participants Two key issues! Provision of logistics Training

Weakness: Small sample size Only two facilities Strengths: Empirical study to assess preparedness of HCWs to EVDs in Ghana

Key points/Take home message Our HCWs need to: Have the basic knowledge - training Well-prepared – logistics and training Enough readiness to handle any EVD/EPD emergency situation (training, logistics)

Medical Education Partnership Initiative (MEPI), Ghana Acknowledgement KNUST Medical Education Partnership Initiative (MEPI), Ghana Staff of the study hospitals Regional Health Directorate