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

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

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

4. 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

5. 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

6. 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, $CDC, 16th December, #WHO, 30th December, 2014.
&WHO, 9th October, WHO, 13th May, 2015.

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

8. 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?

9. 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.

10. Methods – Study sites * *
*Study sites

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

12. 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)

13. Results - Categories
N = 101

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

15. 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)

16. 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)

17. Beyond EVD…....Other EPDs

18. Compensation

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

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

21. 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)

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