BACKGROUND: Ebola Viral disease (EVD) is caused by Ebola Virus. It is one of the Viral Haemorrhagic Fevers. It has a high fatality rate. Ebola virus belongs to the group of enveloped viruses that generally have high infection rate. This is because the lipid envelop helps them to enter easily into the host's cells. EVD can be prevented by good hygiene. This is because the lipid envelop covering of the virus can easily be destroyed by some chemical and physical agents.
AIM: This study was carried out to assess the knowledge, attitude and practice regarding Ebola viral disease prevention measures among secondary school students in Nnewi North and Nnewi South Local Government Areas in Anambra State. This study was done durig the last ebola outbreak in Nigeria.
METHODS: This was a cross sectional descriptive study carried out in 2 local government areas (Nnewi North and Nnewi South) in Anambra State, Nigeria. Multi stage sampling techniques was used. Four hundred questionnaires (200 per LGA) were included in the final analysis. A structured, pretested, self administered questionnaire was used in this study. Data was analysed using SPSS version 20.
RESULTS: Out of the 200 respondents in Nnewi North, 73(36.5%) were males and 127(63.5%) were females. In Nnewi South, 104 (52.0%) were males while 96 (48.0%) were females. In Nnewi North, 190 (55.0%) have heard of EVD, but in Nnewi South 192 (96.0%) have heard of EVD. In Nnewi North 89.5% believed that drinking salt water would cure EVD, but in Nnewi South it was 78%. In Nnewi North 95.5% practice hand washing, while 96% practice same in Nnewi South.
CONCLUSION: This study has demonstrated that almost all the students have heard of EVD. They equally had good knowledge of the preventive measures and practice them. However some misconceptions need to be corrected.
1Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria 2Department of Paediatric Surgery, University of Nigeria Teaching Hospital Ituku/Ozalla, Enugu, Nigeria 3Department of Health, Anambra State Local Government Service Commission Awka, Anambra State, Nigeria 4Department of Community Medicine, University of Portharcourt Teaching Hospital Portharcourt, Rivers State, Nigeria 5Deparment of Family Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria 6Foundation for Health and Development in Nigeria
*[email protected]
KEYWORDS
Knowledge, Attitude, practice, Ebola.
INTRODUCTION
Ebola virus is a 19kb long, non-segmented, single stranded RNA virus, which is a member of the viral family filoviridae and the causative agent of the Ebola viral disease1. Ebola viral disease is an example of a viral hemorrhagic fever. Hence the alternative name Ebola hemorrhagic fever. Viral hemorrhagic fevers are a diverse group of animal and human illnesses that may be caused by five distinct families of RNA viruses; Arenaviridae, Filoviridae, Bunyaviridae, Flaviridae and Rhabdoviridae. Other examples of viral hemorrhagic fevers are Crimean – Congo hemorrhagic fever, South American hemorrhagic fever, Dengue fever, Rift valley fever, Lassa fever and Yellow fever. All types of viral hemorrhagic fevers (VHF) are characterized by fever and bleeding disorders and all can progress to high fever, shock and death in many cases2. Before outbreaks are confirmed in areas of weak surveillance, on the local or regional levels, Ebola is often mistaken for malaria, typhoid fever, dysentery, influenza or various bacterial infections, which may be endemic to the region3. The Ebola virus causes an acute, serious illness, which is often fatal in humans. The average Ebola viral disease (EVD) case fatality rate is around 50%. However, case fatality rates have varied from 25% to 90% in past outbreaks. Ebola viral disease (EVD) first appeared in 1976 in two simultaneous outbreaks, one in Nzara (Sudan) and the other in Yambuku (Democratic Republic of Congo). The latter occurred in a village near the Ebola River, from which the disease takes its name. Five strains of the Ebola virus have been identified; Zaire, Bundibugya, Sudan, Reston and Tai forest. The Bundibugya, Zaire and Sudan Ebola Virus have been associated with large outbreaks in Africa. The virus that caused the 2014 West African outbreak belongs to the Zaire strain4,5. The most recent outbreak in West Africa (first cases noticed in March 2014) is the largest and most complex Ebola outbreak since the Ebola virus was first discovered in 19766,7. There have been more cases and deaths in this outbreak than all others combined. It has also spread between countries starting in Guinea, then spread across land borders to Sierra Leone, Liberia and Senegal and by air to Nigeria4,7. The most severely affected countries, Guinea, Sierra Leone and Liberia have very weak health systems, lacking human and infrastructural resources, Liberia and Sierra Leone having only recently emerged from long periods of conflict and instability. EVD is highly contagious owing to the fact that Ebola virus belongs to the group of enveloped viruses that generally have high infection rate. This is because the lipid envelop helps them to enter easily into the host's cells. However, the good news is that sound hygienic lifestyle with effective use of antiseptic materials can go a long way to prevent contracting the infection. The simple reason to this is that the lipid envelop covering of the virus can easily be destroyed by some chemical and physical agents (e.g. some solvents, heat, low temperature, oxidizing agents like bleach, detergents, 70% alcohol solution).
In view of the mode of transmission, some risk factors have been recognized. These include lifestyle behaviours that can predispose (expose) someone to this virus: Handling bodily secretions of an infected individual e.g. blood, urine, saliva, sweat, seminal fluid, vaginal fluids; Attending to a person sick with the virus; Visiting hospitals or homes where Ebola patients are hospitalized; Having handshakes with an infected individual; Exchange of personal belongings e.g. clothes, eating utensils, tooth brushes of someone infected with the Ebola virus; Coming in contact with sweat of infected person; Overcrowding; Handling of bush meat with bare hands/eating poorly cooked bush meat, etc. The incubation period, is 2 to 21 days, most often this is between 4 to 10 days8,9,10. Humans are not infectious until they develop symptoms.
A study done in Sierra Leone reported high levels of awareness regarding EVD, but low comprehensive knowledge on EVD. Also the preventive practices against EVD were low and there were a lot of misconceptions regarding EVD. Furthermore, there was very high level of stigma and discrimination towards EVD victims11. This study was carried out to assess the knowledge, attitude and practice regarding Ebola viral disease prevention measures among secondary school students in Nnewi North and Nnewi South Local Government Areas in Anambra State. This study was done durig the last ebola outbreak in Nigeria.
METHODOLOGY
Nnewi North is a local government area (LGA) in Anambra state, South-east, Nigeria. Nnewi is the only town in Nnewi North LGA. There are four villages that make up the town: Otolo, Uruagu, Umudim and Nnewichi. Nnewi has a population of 391,227 according to the 2006 National population census12. Nnewi North LGA hosts 8 government owned and 48 privately owned secondary schools. Nnewi South is a Local Government Area in Anambra State, South-east Nigeria, with its headquarters at Ukpor. Other towns that make up the LGA include Ekwulumili, Amichi, Azigbo, Unubi, Ezinifite, Osumenyi, Utuh, Akwaihedi, Ogbodi and Ebenator. Its population is approximately 233,360 according to the 2006 population census13. Nnewi South hosts 17 government owned and 22 privately owned secondary schools.
Study population: The study population were secondary school students in Nnewi North and South LGAs of Anambra State.
Study Design: This was a cross-sectional descriptive study
Sample Size Determination
The minimum sample size was calculated using the formula below14;
Where;
N = minimum sample size Z = standard normal deviate at 95% confidence level (ie 1.96) P = proportion of target population estimated to have characteristic of interest;taken as 50% (0.5) q = 1 – p ( ie 1 – 0.5) d = margin of error, usually set at 5% (ie 0.05)
N =
1.962 x 0.5 x 0.50.052
= 384
• Attrition
An anticipated 10% attrition rate was assumed. Hence 10% of the calculated minimum sample size was added:
10100
x
3841
=
38.4
The final calculated sample size was 384 + 38.4 = 422. So 422 questionnaires (211 per LGA) were distributed. However only 400 questionnaires (200 per LGA), were included in data analysis.
Sampling Technique:
Multi-stage sampling technique was used:
Stage I: Simple random sampling technique was used to select three schools from each local government giving a total of six schools.
Stage II: Stratified sampling was used in selecting the respondents for the study.
Study Instrument: A Structured, self-administered questionnaire was distributed to the respondents after obtaining verbal consent from them. The questionnaire was divided into four sections. Section A contained socio-demographic data, section B: knowledge of the respondents, section C: attitude and section D: preventive measures practiced.
Data Analysis: Data obtained was analyzed using SPSS version 20, percentages were worked out and finally data was represented in tables.
Ethical Consideration: Approval was obtained from the ethical review board of the Nnamdi Azikiwe University Teaching Hospital Nnewi. The consent of the School Principals was obtained as well as that of the individual respondents.
Inclusion Criteria: Eligible respondents who gave their consent.
Exclusion Criteria: Students that were not in the selected schools. Students in the selected schools but were sitting for the Senior School Certificate exam during the study. Students who did not give their consent.
RESULTS
Table 1 shows the socio-demographic characteristics of the respondents. Out of the 200 respondents in Nnewi North, 73(36.5%) were males and 127(63.5%) were females. With regards to their family size, 45(22.5%) were 2 to 4 in the family, 103(51.5%) were 5 to 7 persons while 52(26.0%) were greater than 7 in the family. Out of the 200 respondents 197(98.5%) were Ibos, 2(1.0%) were Yorubas, none was Hausa, while 1(0.5%) was from other tribes in Nigeria. Most of the respondents 199(99.5%) were Christians, none of them was Islam or Traditionalist, while 1(0.5%) practice other forms of religion. With regards to the highest educational levels of the parents of the respondents, 6(3.0%) of fathers had no formal education, 20(10.0%) had primary education, 81(40.5%) had secondary education, 93(46.5%) had tertiary education. Also 2(1.0%) of the mothers had no formal education, 20(10.0%) had primary, 82(41.2%) had secondary education, 96(48.0%) had tertiary education. Thirteen (6.5%) of the fathers were farmers, 18(9.0%) were professionals, 11(5.5%) were bankers, 109(54.5%) were traders, and 49(24.5%) of the fathers had other forms of occupation. Six (3.0%) of the mothers were farmers, 60(30.0%) were professionals, 6(3.0%) bankers, 114(57.0%) were traders and 14(7.0%) had other types of occupation.
Socio-demographic characteristics of the respondents
Variables
Nnewi North
Nnewi South
Frequency
Percentage %
Frequency
Percentage %
Student's class
JSS1
36
18.00%
35
17.50%
JSS2
32
16.00%
29
14.50%
JSS3
44
22.00%
44
22.00%
SSS1
50
25.00%
49
24.50%
SSS2
38
19.00%
43
21.50%
Total
200
100.00%
200
100.00%
Sex
Male
73
36.50%
104
52.00%
Female
127
63.50%
96
48.00%
Total
200
100.00%
200
100.00%
Family size
02-4
45
22.50%
36
18.00%
05-7
103
51.50%
106
53.00%
>7
52
26.00%
58
29.00%
Total
200
100.00%
200
100.00%
Tribe/Ethnicity
Igbo
197
98.50%
195
97.50%
Yoruba
2
1.00%
2
1.00%
Hausa
0
0.00%
1
0.50%
Others
1
0.50%
2
1.00%
Total
200
100.00%
200
100.00%
Religion
Christian
199
99.50%
194
97.00%
Islam
0
0.00%
2
1.00%
Traditionalist
0
0.00%
2
2.00%
Others
1
0.50%
0
0.00%
Total
200
100.00%
200
100.00%
Father'sHighestEducational Level
None
6
3.00%
4
2.00%
Primary
20
10.00%
39
19.50%
Secondary
81
40.50%
91
45.50%
Tertiary
93
46.50%
66
33.00%
Total
200
100.00%
200
100.00%
Mother'sHighestEducational Level
None
2
1.00%
1
0.50%
Primary
20
10.00%
28
14.00%
Secondary
82
41.00%
104
52.00%
Tertiary
96
48.00%
67
33.50%
Total
200
100.00%
200
100.00%
Father'sOccupation
Hunter
0
0.00%
2
1.00%
Farmer
13
6.50%
36
18.00%
Banker
11
5.50%
11
5.50%
Trader
109
54.50%
96
48.00%
Professional
18
9.00%
29
14.50%
Others
49
24.50%
26
13.00%
Total
200
100.00%
200
100.00%
Mother'sOccupation
Farmer
6
3.00%
23
11.50%
Banker
6
3.00%
5
2.50%
Trader
114
57.00%
118
59.00%
Professional
60
30.00%
44
22.00%
Others
14
7.00%
10
5.00%
Total
200
100.00%
200
100.00%
Out of 200 respondents studies in Nnewi South, 104 (52.0%) were males while 96 (48.0%) were females. Thirty six (18.0%) had a family size of 2 to 4, 106 (53.0%) with a family size of 5 to 7, and 58 (29.0%) had a family size greater than 7. With regards to tribe/ethnicity, 195 (97.5%) were Ibos, 2(1.0%) were Yorubas, 1 (0.5%) was Hausa and 2 (1.0%) were from other tribes in Nigeria. Out of 200 respondents, 194 (97.0%) were Christians, 2 (1.0%) were Islam, and 4 (2.0%) practiced Traditional religion. With regards to the fathers' highest educational level, 4 (2.0%) had no formal education, 39 (19.5%) attended primary school, 91 (45.5%) had secondary education, 66(33.0%) had tertiary education. One (0.5%) of the mothers had no formal education, 28 (14.0%) went to primary school, 104 (52.0%) went to secondary school, while 67(33.5%) acquired tertiary education. With regards to the parents' occupation, majority of their fathers were traders 96 (48.0%), 36 (18.0%) were farmers, 29(14.5%) were professionals, 11 (5.5%) were bankers, 2 (1.0%) were hunters while 26 (13.0%) had other types of occupation, while 23 (11.5%) of the mothers were farmers, 44(22.0%) were professionals, 5 (2.5%) were bankers, 118 (39.0%) were traders, while 10 (5.0%) had other forms of occupation.
Knowledge of Ebola viral Disease
Nnewi North
Nnewi South
Frequency
Percentage %
Frequency
Percentage%
Have you heard of EVD before
Yes
190
95.00%
Yes
192
96.00%
No
10
5.00%
No
8
4.00%
Total
200
100.00%
Total
200
100.00%
Source of knowledge
Parents
Yes
54
27.00%
Yes
52
26.00%
No
146
73.00%
No
148
74.00%
Total
200
100.00%
Total
200
100.00%
Radio
Yes
90
45.00%
Yes
114
57.00%
No
110
55.00%
No
86
43.00%
Total
200
100.00%
Total
200
100.00%
Television
Yes
122
61.00%
Yes
95
47.50%
No
78
39.00%
No
105
52.50%
Total
200
100.00%
Total
200
100.00%
Newspaper
Yes
60
30.00%
Yes
61
30.50%
No
140
70.00%
No
139
69.50%
Total
200
100.00%
Total
200
100.00%
Church
Yes
45
22.50%
Yes
42
21.00%
No
155
77.50%
No
158
79.00%
Total
200
100.00%
Total
200
100.00%
School
Yes
53
26.50%
Yes
38
19.00%
No
147
73.50%
No
162
81.00%
Total
200
100.00%
Total
200
100.00%
Friends
Yes
55
27.50%
Yes
30
15.00%
No
145
72.50%
No
170
85.00%
Total
200
100.00%
Total
200
100.00%
Market Place
Yes
27
13.50%
Yes
21
10.50%
No
173
86.50%
No
179
89.50%
Total
200
100.00%
Total
200
100.00%
Do you believe EVD existed in
Yes
145
72.50%
Yes
154
77.00%
Nigeria
No
55
27.50%
No
46
23.00%
Total
200
100.00%
Total
200
100.00%
How can it becontracted/acquired
Eating bush meat
Yes
177
88.50%
Yes
180
90.00%
No
23
11.50%
No
20
10.00%
Total
200
100.00%
Total
200
100.00%
Sexual intercourse
Yes
170
85.00%
Yes
166
83.00%
No
30
15.00%
No
34
17.00%
Total
200
100.00%
Total
200
100.00%
Kissing
Yes
168
84.00%
Yes
154
77.00%
No
32
16.00%
No
46
23.00%
Total
200
100.00%
Total
200
100.00%
Contact with the person's blood
Yes
187
93.50%
Yes
177
88.50%
No
13
6.50%
No
23
11.50%
Total
200
100.00%
Total
200
100.00%
Contact with the person's sweat
Yes
182
91.00%
Yes
166
83.50%
No
18
9.00%
No
34
17.00%
Total
200
100.00%
Total
200
100.00%
Contact with the person's saliva
Yes
180
90.00%
Yes
161
80.50%
No
20
10.00%
No
39
19.50%
Total
200
100.00%
Total
200
100.00%
Total
200
100.00%
Total
200
100.00%
Bleeding from the nose, mouth or
Yes
121
60.50%
Yes
92
46.00%
anus
No
79
39.50%
No
108
54.00%
Total
200
100.00%
Total
200
100.00%
Can EVD be treated
Yes
143
71.50%
Yes
131
65.50%
No
57
28.50%
No
69
34.50%
Total
200
100.00%
Total
200
100.00%
Knowledge of Ebola viral Disease
Nnewi North
Nnewi South
Frequency
Percentage %
Frequency
Percentage%
Contact with the person's urine
Yes
169
84.50%
Yes
148
74.00%
No
31
15.50%
No
52
26.00%
Total
200
100.00%
Total
200
100.00%
Sharing personal belonging
Yes
189
94.50%
Yes
176
88.00%
No
11
5.50%
No
24
12.00%
Total
200
100.00%
Total
200
100.00%
Having body contact with the
Yes
167
83.50%
Yes
170
85.00%
person
No
33
16.50%
No
30
15.00%
Total
200
100.00%
Total
200
100.00%
Attending burial ceremonies that
Yes
174
87.00%
Yes
170
85.00%
requires touching the body of the
No
26
13.00%
No
30
15.00%
dead suspected to have died of
Total
200
100.00%
Total
200
100.00%
Ebola
Can EVD be transmitted
Yes
61
30.50%
Yes
90
45.00%
through mosquito bite ?
No
139
69.50%
No
110
55.50%
Total
200
100.00%
Total
200
100.00%
Can EVD be transmitted
Yes
104
52.00%
Yes
139
69.50%
through the air ?
No
96
48.00%
No
61
30.50%
Total
200
100.00%
Total
200
100.00%
How can EVD be avoided ?
Avoid consumption of bush meat
Yes
190
95.00%
Yes
181
90.50%
No
10
5.00%
No
19
9.50%
Total
200
100.00%
Total
200
100.00%
Avoid close body contact and
Yes
190
95.00%
Yes
180
90.00%
contact with bodily fluids
No
10
5.00%
No
20
10.00%
Total
200
100.00%
Total
200
100.00%
Use of hand glove
Yes
186
93.00%
Yes
176
88.00%
No
14
7.00%
No
24
12.00%
Total
200
100.00%
Total
200
100.00%
Hand washing
Yes
190
95.00%
Yes
174
87.00%
No
10
5.00%
No
26
13.00%
Total
200
100.00%
Total
200
100.00%
Use hand sanitizer
Yes
189
94.50%
Yes
174
87.00%
No
11
5.50%
No
26
13.00%
Total
200
100.00%
Total
200
100.00%
Avoid burials that require
Yes
91
45.50%
Yes
120
60.00%
touching the body of the dead
No
109
54.50%
No
80
40.00%
Total
200
100.00%
Total
200
100.00%
What are the symptoms of
Ebola
Fever
Yes
87
43.50%
Yes
86
43.00%
No
113
56.50%
No
114
57.00%
Total
200
100.00%
Total
200
100.00%
Headache
Yes
61
30.50%
Yes
71
35.50%
No
139
69.50%
No
129
64.50%
Total
200
100.00%
Total
200
100.00%
Weakness
Yes
83
41.50%
Yes
75
37.50%
No
117
58.50%
No
125
62.50%
Total
200
100.00%
Total
200
100.00%
Muscle pain
Yes
43
21.50%
Yes
29
14.50%
No
157
78.50%
No
171
85.5
Total
200
100.00%
Total
200
100.00%
Vomiting
Yes
96
48.00%
Yes
76
38.00%
No
104
52.00%
No
124
62.00%
Total
200
100.00%
Total
200
100.00%
Diarrhoea
Yes
46
23.00%
Yes
31
15.50%
No
154
77.00%
No
169
84.50%
Total
200
100.00%
Total
200
100.00%
Rash
Yes
61
30.50%
Yes
49
24.50%
No
139
69.50%
No
151
75.50%
Table 2 shows the knowledge of the respondents regarding EVD. Table 2 shows that 190(55.0%) of the respondents in Nnewi North and 192(96.0%) in Nnewi South have heard of EVD, 27.0% in Nnewi North got their information from their parents, while in Nnewi South, 26.0% got the information from their parents, 45.0% (Nnewi North) and 57.0% (Nnewi South) through the radio, 61.0% (Nnewi North) and 47.5% (Nnewi South) through the television, 30% in Nnewi North and 30.5% in Nnewi South from the newspaper, 22.5% in Nnewi North and 21.0% in Nnewi South from the church, 26.5% (Nnewi North) and 19.0% (Nnewi South) from their schools, 27.5% and 15.0% of the respondents from Nnewi North and Nnewi South respectively got their information from their friends and 13.5% (Nnewi North) and 10.5% (Nnewi South) from the market place. On the other hand, majority of the respondents 72.5% and 77.0% from Nnewi North and Nnewi South respectively believed EVD existed in Nigeria. With regards to how EVD can be contracted or acquired, 88.5% in Nnewi North believed it can be acquired through eating bush meat while in Nnewi South 90.0% believed it can be acquired through eating bush meat; 88.0% (Nnewi North) and 83.0% (Nnewi South) through sexual intercourse; 84.0% (Nnewi North) and 77.0% (Nnewi South) through kissing; 93.5% in Nnewi North and 88.5% in Nnewi South through blood; 91.0% and 83.0% through sweat from Nnewi North and South respectively; 90.0% (Nnewi North) and 80.5% (Nnewi South) through saliva; 84.5% (Nnewi North) and 74.0% (Nnewi South) through urine; 94.5% (Nnewi North) and 88.0% (Nnewi South) through sharing of personal belongings; 83.5% (Nnewi North) and 85.0% (Nnewi South) through body contact while 87.0% (Nnewi North) and 85.0% (Nnewi South) through attending burial ceremonies that require touching the body of the dead suspected to have died of Ebola. Sixty one (30.5%) of the respondents in Nnewi North and 45.0% in Nnewi South believed EVD can be transmitted through mosquito bite while 52.0% from Nnewi North and 62.5% in Nnewi South believed it can be transmitted through the air.
Regarding how EVD can be prevented, 95.0% (Nnewi North) and 90.0% (Nnewi South) believed EVD can be prevented by avoiding consumption of bush meat, 95.0% (Nnewi North) and 90.5% (Nnewi South) by avoiding close body contact and contact with bodily fluids, 93.0% and 88.0% of the respondents from Nnewi North and South respectively by the use of hand gloves, 95.0% (Nnewi North) and 87.0% (Nnewi South) by hand washing, 94.5% (Nnewi North) and 87.0% (Nnewi South) by use of hand sanitizers while 45.5% from Nnewi North and 40.0% from Nnewi South by avoiding burial ceremonies. With regards to knowledge of symptoms of EVD, majority of the respondents have good knowledge of the symptoms; fever 45.5% (Nnewi North) and 43.0% (Nnewi South), weakness 41.5% and 35.5% Nnewi North and South respectively, muscle pain 21.5% and 14.5% respectively, vomiting 48.0% (Nnewi North) and 38.0% (Nnewi South), diarrhoea 23.0% (Nnewi North) and 15.5% (Nnewi South), rashes 30.5% and 24.5% respectively, and bleeding from the nose, mouth or anus 60.5% and 46.0% from Nnewi North and South respectively. Concerning treatment, 71.5% and 65.5% of the respondents from Nnewi North and South respectively believed EVD can be treated.
Attitude towards prevention of EVD
Variables
Nnewi North
Nnewi South
Frequency
Percentage %
Frequency
Percentage %
If you had any of the symptom
Yes
19
9.50%
Yes
37
18.50%
above, would you keep it secret?
No
181
90.50%
No
163
81.50%
Total
200
100.00%
Total
200
100.00%
Would you allow someone who had
Yes
74
37.00%
Yes
64
32.00%
recovered from the disease to sit
No
126
63.00%
No
136
68.00%
beside you on the seat in the class?
Total
200
100.00%
Total
200
100.00%
Would you allow someone who had
Yes
81
40.50%
Yes
73
36.50%
recovered from the disease into
No
119
59.50%
No
127
63.50%
your house?
Total
200
100.00%
Total
200
100.00%
If somebody you know had thedisease, where would you directthe person for treatment?
Prayer house
Yes
29
14.50%
Yes
20
10.00%
No
171
85.50%
No
180
90.00%
Total
200
100.00%
Total
200
100.00%
Treat the person at home
Yes
0
0.00%
Yes
3
1.50%
No
200
100.00%
No
197
98.50%
Total
200
100.00%
Total
200
100.00%
Chemist
Yes
0
0.00%
Yes
3
1.50%
No
200
100.00%
No
197
98.50%
Total
200
100.00%
Total
200
100.00%
Traditional doctor
Yes
5
2.50%
Yes
5
2.50%
No
195
97.50%
No
195
97.50%
Total
200
100.00%
Total
200
100.00%
Hospital
Yes
167
83.50%
Yes
166
83.00%
No
33
16.50%
No
34
17.00%
Total
200
100.00%
Total
200
100.00%
Do you believe drinking salt water
Yes
21
10.50%
Yes
44
22.00%
could prevent or cure EVD disease?
No
179
89.50%
No
156
78.00%
Total
200
100.00%
Total
200
100.00%
Do you believe bathing salt water
Yes
17
8.50%
Yes
41
20.50%
could prevent or cure Ebola disease?
No
183
91.50%
No
159
79.50%
Total
200
100.00%
Total
200
100.00%
Do you usually set traps in the
Yes
49
24.50%
Yes
64
32.00%
bush to catch bush meat?
No
151
75.50%
No
136
68.00%
Total
200
100.00%
Total
200
100.00%
If yes, do you still set traps afteryou heard the news about Ebola?
Yes
26
13.00%
Yes
31
15.50%
No
174
87.00%
No
169
84.50%
Total
200
100.00%
Total
200
100.00%
Do you like eating bush meat?
Yes
100
50.00%
Yes
106
53.00%
No
100
50.00%
No
94
47.00%
Total
200
100.00%
Total
200
100.00%
If yes, do you still eat bush meat
Yes
30
15.00%
Yes
31
15.50%
after you heard the news about Ebola?
No
170
85.00%
No
169
84.50%
Total
200
100.00%
Total
200
100.00%
Do you still shake hands with your
Yes
76
38.00%
Yes
36
18.00%
friends after you heard the Ebola news?
No
124
62.00%
No
164
82.00%
Total
200
100.00%
Total
200
100.00%
Out of 200 respondents in Nnewi North, 9.5% would keep it secret if he or she had any of the symptoms of EVD, while out of the 200 respondents in Nnewi South, 18.5% would keep it secret. In Nnewi North 37.0% of the respondents would seat close to a person who recovered from EVD, while only 32.0% would do same in Nnewi South.
Practices toward prevention of EVD
Practices towards prevention of EVD
Nnewi North
Nnewi South
Frequency
Percentage %
Frequency
Percentage %
Do you practice hand
Yes
191
95.50%
Yes
192
96.00%
washing with water and
No
9
4.50%
No
8
4.00%
soap?
Total
200
100.00%
Total
200
100.00%
Do the school provide the
Yes
182
91.00%
Yes
186
93.00%
students with facilities for
No
18
9.00%
No
14
7.00%
hand washing?
Total
200
100.00%
Total
200
100.00%
Did you stop attending
Yes
71
35.50%
Yes
79
39.50%
burial ceremonies?
No
129
64.50%
No
121
60.50%
Total
200
100.00%
Total
200
100.00%
Do you use hand sanitizer?
Yes
163
81.50%
Yes
161
80.50%
No
37
18.50%
No
39
19.50%
Total
200
100.00%
Total
200
100.00%
Do you bath with salt water
Yes
45
22.50%
Yes
58
29.00%
No
155
77.50%
No
142
71.00%
Total
200
100.00%
Total
200
100.00%
Do you drink salt water?
Yes
29
14.50%
Yes
56
28.00%
No
171
85.50%
No
144
72.00%
Total
200
100.00%
Total
200
100.00%
Do you use nose mask to
Yes
64
32.00%
Yes
91
45.50%
prevent Ebola?
No
136
68.00%
No
109
54.50%
Total
200
100.00%
Total
200
100.00%
Do you wear hand gloves to
Yes
101
50.50%
Yes
136
68
prevent Ebola?
No
99
49.50%
No
64
32.00%
Total
200
100.00%
Total
200
100.00%
No
155
77.50%
No
142
71.00%
Total
200
100.00%
Total
200
100.00%
Do you drink salt water?
Yes
29
14.50%
Yes
56
28.00%
No
171
85.50%
No
144
72.00%
Total
200
100.00%
Total
200
100.00%
Do you use nose mask to
Yes
64
32.00%
Yes
91
45.50%
prevent Ebola?
No
136
68.00%
No
109
54.50%
Total
200
100.00%
Total
200
100.00%
Do you wear hand gloves to
Yes
101
50.50%
Yes
136
68
prevent Ebola?
No
99
49.50%
No
64
32.00%
Total
200
100.00%
Total
200
100.00%
In Nnewi North, 95.5% of the respondents and in Nnewi South 96.0% practice hand washing with soap and water. Ninety one percent of the respondents in Nnewi North agreed the school provided facilities for hand washing while in Nnewi South, 93.0% admitted the school provided them with facilities for hand washing.
DISCUSSION
On the knowledge of Ebola viral disease, the study shows that nearly all the respondents; 190 (95.0%) in Nnewi North and 192 (96.0%) in Nnewi South have heard of Ebola viral disease. Also, majority of the respondents, 145 (72.5%) from Nnewi North and 154 (77.0%) from Nnewi South believed Ebola existed in Nigeria. This is similar to the findings of studies done in Sierra Leone15,16 which reported that nearly every Sierra Leonean has heard about Ebola. With regards to the knowledge of preventive measures against the disease, 190 (95.0%) respondents from Nnewi North and 180 (90.5%) respondents from Nnewi South agreed EVD can be prevented by avoiding close body contacts and contact with bodily fluids. Such level of knowledge of prevention of EVD by avoiding contact with cases was also reported in Sierra Leone. However, in contrast to the situation in Sierra Leone where 85% of the respondents agreed with the statement that one can protect oneself by avoiding funeral or burial rituals that require handling the body of someone who died of Ebola, only 45.5% (Nnewi North) and 40% (Nnewi South) agreed with the statement in this study. On the misconception about transmission of Ebola viral disease, some respondents (30.5% in Nnewi North and 40.0% in Nnewi South) agreed EVD can be transmitted through mosquito bite. This shows that among the respondents some are yet to get the appropriate knowledge about EVD transmission.
On the attitude towards prevention of EVD, only very few of the respondents 9.5% (Nnewi North) and 18.5% (Nnewi South) would keep it secret if he or she had any of the symptoms of EVD, while 59.5% of respondents in Nnewi North and 63.5% in Nnewi South would not allow someone who had recovered from the disease into their homes. Also in Nnewi North and Nnewi South respectively, 37.0% and 32.0% of the respondents would seat close to a person who recovered from the disease. Furthermore, None of the respondents in Nnewi North would treat an EVD case at home, while 1.5% of the respondents in Nnewi South would treat an EVD case at home. In Guinea 33% of the respondents claimed they would treat the symptoms at home for at least 3-4 weeks6. Among the 200 respondents in Nnewi North 8.5% believed that bathing with salt water could prevent EVD but in Nnewi South 20.5% believed bathing with salt water could prevent or cure Ebola disease. A higher percentage (42%) was reported in Sierra leone.15 Bathing with salt water and drinking of salt water was wrongly propagated in Nigeria during the ebola outbreak. There were even cases of death from drinking salt water in Nigeria during the ebola outbreak. A great number of the respondents 95.5% and 96.0% from Nnewi North and Nnewi South respectively practice handwashing with soap and water. This is higher than the rate in Sierra Leone where 70% of respondents practice handwashing with soap and water in order to help prevent EVD.15 These high levels of practice of handwashing could be explained by the massive promotion of hand washing by the government and agencies during the outbreak of EVD in the country, which was also the period this study was conducted.
In conclusion, this study has demonstrated that almost all the students have heard of Ebola viral disease and knew it existed in Nigeria. A good number of them knew various modes of transmission and spread of the disease. They equally had good knowledge of the preventive measures and practice them. However a good number of them still believe dead bodies could not be a source of the infection, that EVD can be transmitted through mosquito bites and that bathing with salt water would prevent Ebola.
Based on these findings we recommend continued awareness campaigns on EVD and its preventive measures. We also recommend continuous periodic training of teachers on EVD so that they will transfer the knowledge to the students.
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