Principal Investigators: Lara Ho, IRC & Ruwan Ratnayake
This study used a participatory mixed methods approach to evaluate the processes that health workers take in adhering to standard precautions, after being trained and supplied with materials, in order to ensure the strict adherence that is necessary to prevent Ebola infection.
The aim was to develop strategies to improve adherence to standard precautions through the assessment of knowledge, risk perception, self-efficacy, and barriers and enablers for standard precautions in primary health facilities. It also enabled better understanding of the perspectives of health facility staff and health committees on the use of personal protective equipment.
It was important to understand the experience of front line health workers with IPC in the context of Ebola and to see how we could improve practices. Our approach was participatory: the health workers would identify the problems and issues, and we would work with them to come up with solutions depending on what the baseline results showed— for example, a solution might be to increase health worker engagement with community members or it might be to rearrange layout of the health centre.
Many of these front line health workers had no knowledge of Ebola before the epidemic, but they remained dedicated to continuing to provide health services despite huge challenges—including facing stigma from many people in their communities. The IPC training provided by the MoHSW and the Ebola Response Consortium was crucial in that it gave them conﬁdence, knowledge, and supplies that they didn’t have before to carry out their work in the most difﬁcult of situations.
The research has helped understanding of the levels of knowledge, risk perceptions, barriers, and enablers of adherence to standard precautions for health care workers who were provided with basic equipment and training on IPC for Ebola control in Kenema District, Sierra Leone. The publications produced as a result of the study also outline what strategies health facility staff can use to improve adherence to standard precautions
Healthcare workers’ (HCW) level of knowledge about Ebola and IPC evolved dramatically over the course of the Ebola epidemic. HCW felt at greater risk than the general population because of their work at health facilities where Ebola patients might present, although the eventual provision of IPC supplies and training greatly increased their confidence and sense of being protected.
One main finding was a widespread, acute feeling of stigmatisation and isolation among primary health care workers. They were stigmatised and ostracised at work and at home, by friends, family members, fellow health professionals, and the broader community. As a result, health care workers described experiencing a profound sense of loss, loneliness, anxiety, isolation, and sadness, along with the disruption of their lives at work, in communities and at home. The workers interviewed during the research expressed continued commitment to their work despite these challenges.
During recovery from this epidemic and in future ones, the research recommended responders and donors to:
Stopping Ebola at the Frontlines: Infection Prevention and Control in Sierra LeoneView
Participatory behavioural change to reinforce infection prevention and control for Ebola virus disease in Sierra LeoneView
In August 2014, the Ebola Outbreak in West Africa was declared an International Health Emergency by WHO and within a couple of weeks ELRHA launched a rapid-response call for research to combat the crisis. The UK Department for International Development (DFID), the Wellcome Trust and ELRHA opened a special funding window through the Research for Health in Humanitarian Crises (R2HC) programme.
The aim of this emergency call was both to produce robust research findings that could contribute to the effectiveness of the response to the current outbreak and help to draw lessons for future outbreaks of Ebola and other communicable diseases. The projects funded will strengthen the evidence base for the Ebola response in topics ranging from diagnostics to anthropology, surveillance and disease control.
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