Ebola Preparedness: Prevention and control knowledge and practice among health professionals in urban west Unguja

Introduction: Given the ongoing Ebola outbreak in West Africa, Zanzibar Ministry of Health has undertaken several measures to prevent Ebola infection, including training of health care professionals (HCPs) at all health facilities. However, the compliance of HCPs with infection prevention control (IPC) and general preparedness for a potential Ebola outbreak remain uncertain.

Aim: The aim of this study was to determine the level of disaster preparedness for Ebola prevention and control in terms of knowledge, practices and availability of equipment among health care professionals at the main public health facilities in Unguja, Zanzibar.

Methods: The study was based on a mixed methods approach including a questionnaire based cross-sectional survey and direct participant observation. A total 271 HCPs including Nurses, Prescribers/Doctors and Laboratory personnel working at selected health facilities (Mnazimmoja Hospital and five Primary Health Care Units (PHCUs), were enrolled in the cross-sectional survey and 45 of these were further observed for their hand washing practices, and techniques for wearing and removing gloves. In addition, a predefined checklist was used to record the availability and accessibility of personal protective equipment required for Ebola prevention.

Result: Bivariate and multivariate analyses were completed for several variables including the level of knowledge and awareness of appropriate precaution measures on Ebola as well as observed precautionary practices for different HCP classifications. The findings indicates that lack of Ebola training was strongly associated with two times more likely to have low knowledge of Ebola and three times more likely to have low awareness of precaution measures (p<0.05). Also, the age-group 20-29 of HCPs were more than twice as likely to have low knowledge of Ebola compared to all other age groups (p<0.05). Doctors and nurses displayed poor practices for infection prevention and precaution measure as compared to lab personnel (p<0.05). For hand washing, wearing and removal of gloves, HCPs generally displayed poor performance. There was availability of surgical and examination gloves at all health facilities, however there was a noticeable shortage of gowns, boots, mask and goggle.

Conclusion: This study indicates that Ebola knowledge and precaution measures of HCP at the main public health facilities in Unguja are currently at unsatisfactory levels. Infection prevention control is a basic and important topic that must be strengthened through further training of HCPs at all health facilities as well as through the provision of proper hand hygiene and personal protective equipment.