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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 4  |  Page : 199-204

An assessment of knowledge, attitude and perceived risk of Ebola virus disease (EVD) among rural dwellers in Northern Nigeria


1 Department of Community Medicine, Ahmadu Bello University Teaching Hospital (ABUTH), Shika, Zaria; Department of Community Medicine, Kaduna State University (KASU), Kaduna, Kaduna State, Nigeria
2 Department of Community Medicine, Ahmadu Bello University Teaching Hospital (ABUTH), Shika, Zaria, Nigeria

Date of Web Publication11-Jul-2017

Correspondence Address:
Zainab K Muhammad-Idris
Department of Community Medicine, Ahmadu Bello University Teaching Hospital (ABUTH), Shika, Zaria, Kaduna State
Nigeria
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DOI: 10.4103/ssajm.ssajm_25_16

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  Abstract 

Introduction: The last Ebola virus disease (EVD) outbreak that affected countries in the West African sub-region was introduced into Nigeria on 20th July 2014. Nigeria successfully contained the epidemic in its early stages while other countries in the region have most recently attained control; however, the resurgence is still imminent. The epidemic was compounded by a high level of ignorance and misconceptions. The study, conducted in a rural community in Northern Nigeria, sought to assess their EVD knowledge, attitude and risk perception.
Subjects and Methods: The study, which is cross sectional descriptive, was conducted in Iyatawa village, a rural community in Giwa LGA, Kaduna State. Data were collected through administration of questionnaires to all the 358 household heads in the village. Scores were computed for knowledge and risk perception, and bivariate analysis was performed to find out associations among knowledge, risk perception and key socio-demographic variables with level of significance set at P < 0.05. Data were analysed using the Statistical Package for the Social Sciences version 21 software.
Results: The median age of the respondents was 35.3 years. Majority of the respondents were Hausa/Fulani (99.7%), Moslem (96.1%), married (72.1%), had no formal education (91.9%) and were subsistence farmers (45.0%). Only 43.0% had good knowledge of EVD, and 15.9% positive attitude. Majority of the respondents (83.3%) perceived their EVD risk as low. Socio-demographic characteristics were neither significantly associated with knowledge nor risk perception.
Conclusions: Comprehensive knowledge of EVD among members of Iyatawa community is fairly good; however, risk perception was low and attitude negative, thus suggesting the need to mount sensitisation and behaviour change communication interventions.

Keywords: Attitude, Ebola virus disease, knowledge, risk perception


How to cite this article:
Muhammad-Idris ZK, Ejembi CL, Abubakar AA, Bashir SS, Ahmadu L, Kera HN, Esekhaigbe C, Adagba KO. An assessment of knowledge, attitude and perceived risk of Ebola virus disease (EVD) among rural dwellers in Northern Nigeria. Sub-Saharan Afr J Med 2016;3:199-204

How to cite this URL:
Muhammad-Idris ZK, Ejembi CL, Abubakar AA, Bashir SS, Ahmadu L, Kera HN, Esekhaigbe C, Adagba KO. An assessment of knowledge, attitude and perceived risk of Ebola virus disease (EVD) among rural dwellers in Northern Nigeria. Sub-Saharan Afr J Med [serial online] 2016 [cited 2017 Dec 14];3:199-204. Available from: http://www.ssajm.org/text.asp?2016/3/4/199/210198


  Introduction Top


The Ebola virus causes an acute, serious illness, which is often fatal if untreated.[1],[2],[3] The virus was first discovered in 1976 in two concurrent outbreaks in Sudan and Democratic Republic of Congo (DRC). An original outbreak of Ebola virus disease (EVD) that begun in West Africa in December 2013[4] was the largest and most complex Ebola outbreak,[5] mainly affecting Guinea, Liberia and Sierra Leone.[6] More cases and deaths were recorded in this outbreak than all other previous outbreaks combined.[5],[6] It had also spread between countries starting in Guinea then across land borders to Sierra Leone and Liberia, by air (one traveller only) to Nigeria, and by land (one traveller) to Senegal, with the total number of countries affected by the outbreak worldwide amounting to 10.[7]

Sub-Saharan Africa, particularly the West African sub-region, was badly hit by the EVD epidemic, leaving in its trail a heightened level of panic, fear, anxiety and destruction of lives in large expanse of human settlements at the rural and urban regions. Following an outbreak reported in the last quarter of 2013 and worsened in 2014,[4],[8] Guinea, Liberia, and Sierra Leone received the worst brunt of the EVD consequences.[9],[10] As a result and by 8th August 2014, the World Health Organization (WHO) declared the Ebola epidemic in West Africa a Public Health Emergency of International Concern.[4]

The epidemic was further compounded by high levels of misconceptions due to limitations in knowledge about the disease thus creating room for stigma and discrimination leading to further deterioration in the containment measures mounted to stem the tide of the epidemic.[1] The West African epidemic, which has now been fully contained, was shown to be largely fuelled by societal misperceptions.[11] Furthermore, some members in the affected communities in these African countries continued to deny the existence of the EVD − as evidenced by their action and practice of hiding suspected cases, fleeing from affected areas, and refusing public health institutions’ package of intervention needed to address the epidemic − a situation that further fuelled the spread and impact of the epidemic among rural and urban settlements.[12],[13]

The EVD outbreak has now ended with the WHO declared end of Ebola transmission in Guinea on 29th December 2015, in Liberia on 14th January 2016, and in Sierra Leone on 17th March 2016, but the risk of sporadic cases (i.e., flare-ups) still remain. Seven documented flare-up clusters of cases occurred following the control of the epidemic. According to WHO on 18th March 2016, a flare-up of Ebola cases was reported in a rural village in the prefecture of Nzérékoré, Guinea. These recent outbreaks, as growing evidence has shown, appear to be related to viral persistence in some survivors for more than 18 months. Rapid and coordinated efforts were, however, instituted to control all the seven flare-ups.[14]

In Nigeria, following the successful containment of the epidemic that initially occurred in Lagos when a Liberian American citizen suffering from the disease landed in country in July 2014, the Federal Government and all other stakeholders had the Herculean task of ensuring that its millions of citizens were adequately informed and knowledgeable about the possible causes, risk of exposure, symptoms, transmission and preventive measures[15] needed to protect and prevent a resurgence of the epidemic after WHO’s certification of Nigeria as EVD-free country and its subsequent containment in all the other countries in the West African sub-region.[8],[12]

On-going vigilance, people and resources including strong surveillance and emergency response capacity are, therefore, essential and need to be maintained, while care, screening and counselling also need to be provided for all survivors to contain EVD in West Africa and even beyond.[16],[17] This is especially important as WHO recommends that countries must be on high alert and maintain strong surveillance and response systems as risk of transmission of Ebola still exists.[17]

Outbreaks of haemorrhagic fever (or EVD) also occurred in Central African countries of DRC (1995); Uganda (2000–2001 and 2012); and Republic of Congo (2003) prior to that of West Africa. Several factors such as high political will, active surveillance, strong community mobilization, efficient laboratory system, effective case management, infection prevention control, effective coordination, and shared responsibility with key development partners largely contributed to the successful and quick containment of the outbreaks and reduced the attendant stigma and discrimination that went with it in these countries. West African countries could, therefore, draw lessons from the experiences of these African countries and adapt them to their respective context in an attempt to contain the epidemic at all times and effectively control any emerging or re-emerging infectious disease that may be of future global public health significance.[1],[18],[19],[20]

It is on these premise that a study was conducted in Iyatawa village, a rural community of Giwa Local Government (LG) in Kaduna State, Nigeria to assess their knowledge, attitude and perception of EVD transmission with a view to ascertaining their understanding and level of preparedness in preventing the disease from affecting the community.


  Subjects and Methods Top


The study was conducted in Iyatawa, a rural subsistent farming community, located in Karau-Karau District, of Kadage ward in Giwa Local Government Area, Kaduna State, North West Nigeria. The population of the settlement, which is 2259, is made up of predominantly Hausa/Fulani ethnic group who are mainly Muslims. The community has a primary and a secondary school, a Primary Health Care facility and a private clinic.

As cross-sectional descriptive study was adopted, while a pre-tested, structured, interviewer-administered questionnaires were used to collect data from all 358 heads of households (HH) in Iyatawa community. The data collected covered respondents’ socio-demographic characteristics, knowledge of EVD transmission, attitudes towards measures to prevent spread of and risk perception on the disease. The data collection lasted for a period of 4 weeks, that is, from 3rd to 28th November 2014.


  Results Top


Socio-demographic characteristics of respondents

The median age of the respondents was 35.3 years. Majority of the respondents were Fulani (79.6%) closely followed by the Hausa tribe (20.1%). They were predominantly Muslims (96.1%), married (72.1%), had no formal education (91.9%) and were largely subsistence farmers (45.0%) [Table 1].
Table 1: Socio demographic characteristics of respondents (heads of household)

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Knowledge of EVD transmission

Less than a third of the respondents (29.3%) had good knowledge of EVD transmission, while 43.0% had a fair knowledge about transmission [Table 2]. More than half of respondents correctly mentioned consumption of bush meat (51.4%) as a means of transmission. Knowledge of other means of transmission is low as majority did not perceive touching dead bodies during funerals (62.8%) and contact with body fluids of infected persons (62.0%) as posing any risk to transmission of EVD. More than half of the respondents also do not know whether it is possible for EVD to spread via person-to-person (51.4%) or even by contact with bodily fluids of infected persons (52.8%) [Figure 1]. Vast majority of respondents’ source of information about EVD was the radio (98%) with very few citing village meeting (1.1%) as another source.
Table 2: Knowledge of respondents on Ebola virus disease

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Figure 1: Knowledge about risk and medium of transmission of EVD among people of Iyatawa community, November 2014

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Attitude towards EVD transmission

Majority of the respondents (84.0%) had a negative attitude towards EVD [Figure 2] - with more than a third of those with negative attitude aged between 25 and 64 years (70.7%) and having Quranic level of education (70.1%).
Figure 2: Attitude towards EVD among people of Iyatawa community, November 2014

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Risk perception of EVD

Of the 358 respondents interviewed in Iyatawa community, only 16.2% had a high-risk perception of EVD, agreeing that Ebola is a serious disease, which they are at risk of contracting. The vast majority (83.8%), however, believe that it is a punishment from God and thus have a low risk perception [Table 3].
Table 3: Risk perception of EVD among people of Iyatawa community, November 2014

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Relationship between socio-demographic characteristics of respondents and risk perception of EVD

There was generally low risk perception across the different age groups and also between the different sexes and in relation to educational level, where those with Quranic education have the lowest risk perception (68.9%). No statistically significant association was found between age of respondents and their perceived risk of contracting EVD (χ2 = 7.026; df = 8; P = 0.546), none between males and females and their perceived risk of acquiring EVD (χ2 = 1.503; df = 4; P = 0.826), and also between education and perceived risk of contracting EVD (χ2 = 22.971; df = 16; P = 0.115) [Table 4].
Table 4: Relationship between socio-demographic characteristics of respondents and risk perception of EVD (n = 358)

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  Discussion Top


While the Ebola virus epidemic has been contained, in view of the experience of Nigeria with the Ebola outbreak especially misconceptions, which led to wrong and sometimes fatal actions, the need to ensure all communities across the country are adequately informed to deal with potential EVD resurgence informed this study. The study sought to assess the knowledge, attitude and risk perceptions of the virus among people in a typical rural community in Northern Nigeria.

The study revealed that 72.3% of the household heads interviewed had fair or good knowledge of Ebola. However, the knowledge was not commensurate with their perceptions of risk of contracting EVD, which was very low; vast majority of respondents (83.8%) believe that EVD is a punishment from God. This finding was much higher than that from a similar study conducted in Lagos where 30% of respondents believed that it was caused by their sins and that certain churches or religious centres can cure it with born again Christians/Muslims not easily contracting the condition.[15]

The finding from this study also showed fair (43.0%) to poor (27.4%) knowledge about the disease, which can constitute a potential for stigma and discrimination that can lead to further deterioration in the containment measures needed to stem the tide of the epidemic in West Africa, which has been shown to be largely fuelled by societal misperceptions.[1],[11] This level of knowledge is equally apparent in the Lagos and US studies where about 47% of the sampled population have fair or poor knowledge of the EVD.[21],[22]

The low level of awareness of majority of the risk factors associated with the transmission of the Ebola virus may contribute to their low risk perception of either them or other members of their community contracting the disease. This is evident in the finding where even though more than half of respondents interviewed correctly agreed that consuming products from bush meat (53.1%) can lead to contracting the disease, slightly more than half of them (51.4%) did not know that the disease can be spread from person to person. Furthermore, touching dead bodies during funerals and contact with body fluids of infected persons, which are major risk factors for transmission of the virus, were not perceived as posing any risk to transmission of EVD by at least three out of five of the respondents. These findings are at variance with the findings from a study in Lagos and the United States where respondents had good knowledge of how the disease is transmitted including knowledge of transmission via non-human primates.[17],[23]

Even though 16.5% of respondents in this study did not know preventive measures of EVD, more than three quarters of them (69.6%) named hand washing as a way of prevention of EVD. This is similar to the findings from the Lagos study where high level of awareness of preventive measures such as frequent hand washing, avoiding hand-shakes, and not handling items that may have come in contact with an infected person’s blood or body fluids, were reported among others.[17]

Socio-demographic factors were significantly associated with neither knowledge nor the risk perception of EVD among people of Iyatawa community. This contrasts with a Canadian study where respondents educational and other demographic characteristics correlated with a higher perception of risk and transmissibility level with more than three-quarters of people believing that if a person is sick with Ebola, it will spread ‘easily’ to other people.[13] Previous studies have also shown that people’s knowledge about Ebola might have been affected by their educational level.[16],[17],[21] Inadequate knowledge has contributed largely to the emergence and spread of the Ebola epidemic.[22],[23],[24],[25],[26]

There are some inherent limitations to this study. Data collected solely from HH, who are predominantly male, might not be wholly representative of the knowledge, attitude and risk perceptions of the generality of people in Iyatawa community. In addition, the participants in this survey may have differing levels of education, knowledge and motivation from that of the general population (83.8% of respondents had Quranic education compared with only 1.7% who attained tertiary level).

The community has also not experienced any real threat of exposure to the EVD risk factors unlike members in affected communities of some African countries though they also still continue to deny the existence of the EVD − as evidenced by their action and practice of hiding suspected cases, fleeing from affected areas, and refusing public health institutions’ package of intervention needed to address the epidemic − a situation that further fuelled the spread and impact of the epidemic among rural and urban settlements.[12],[13] Thus, most of the responses generated from respondents in this study may, therefore, be largely academic.

Finally, we conclude that a significant proportion of the respondents in this study demonstrated fair knowledge about the EVD with majority exhibiting low risk perception on transmission of EVD to themselves and to their community. This thus requires mounting a comprehensive and sustained sensitisation and strategic behaviour change communication interventions that draw from lessons learnt from prevention and containment efforts of other African countries, targeting different interest groups with varying degrees of education particularly at the community level.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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