Kibuule Michael, Kibuule.michael@gmail.com Master of Public Health - Disaster Management. Makerere University.

1. Preparedness of Health Care Systems forPreparedness of Health Care Systems for
Ebola Outbreak in Kasese and RubiriziEbola Outbreak in Kasese and Rubirizi
Districts, Western UgandaDistricts, Western Uganda
Kibuule Michael
Makerere University College of Health Sciences-
school of Public Health

2. Background and IntroductionBackground and Introduction
 Ebola virus disease constitutes the biggest public health problem
worldwide and has occurred with increased frequency in the
last five years
 First insolated 1976 in Sub Saharan Africa. (W H O, 2014)
 First incidence of EVD in Uganda happened in Gulu district
Aug/2000- to- 01/2001, CFR of 80% (Lamunu, et al., 2004)
 Preparedness is Knowledge and other capacities developed by
individuals, communities, governments, professional response and
recovery organizations (UNISDR, 2009)
 Preparedness level of health care systems determine magnitude and
impact of EVD outbreak (WHO, 2014)
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3. Literature ReviewLiterature Review
 Health care system preparedness is optimal when it meets;
 Infrastructural-triage space,
 Rapid response teams,
 EVD committees,
 Isolation units,
 Surveillance systems,
 Case definition,
 Knowledgeable of health workers,
 Plus logistics
 Ebola virus belongs to the Filoviridae family, Species are;
Bundibugyo, Côte d’Ivoire, Reston, Sudan, and Zaire (WHO, 2014
 Incubation period of EVD is 2–21 days, and it presents with early
and late stages
 Known risk factors for EVD outbreak- Behavioral, Cultural, and
institutional, Physical contact and Poor Hand Hygiene
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4. Conceptual FrameworkConceptual Framework
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5. ObjectivesObjectives
General Objective
To assess preparedness of health care system for Ebola
outbreak response in Kasese and Rubirizi districts
Specific Objectives
To establish preparedness level of District Health Infrastructure to
respond to EVD outbreak
To determine logistical preparedness of health facilities to manage a
suspected incident of Ebola disease case in Kasese and Rubirizi
districts
To establish health care workers’ level of knowledge on
preparedness for containment of Ebola disease outbreak in Kasese
and Rubirizi districts
To determine overall level of preparedness for EVD outbreak and
response in Kasese and Rubirizi districts 6

6. MethodologyMethodology
Study Site and PopulationStudy Site and Population
Study population/Units
All Hospital level facilities, all H/CIV level facilities, selected
H/CIII facilities in Kasese district.
Doctors, Medical Clinical Officers, Nurses, laboratory technicians,
midwives and Nursing assistants 7

7. MethodologyMethodology
Study Design and Sampling ProceduresStudy Design and Sampling Procedures
 Cross-sectional study with mixed methods
 All hospitals and H/CIVs in both districts were
purposively selected
 Fifty percent H/CIIIs in each district were randomly
selected using a ballot papers
 List of H/CIIIs was obtained, ballot papers with their
names written, then randomly selected until desired
number was obtained
 Number of HCWs selected using simple random
sampling
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8. Data collection toolsData collection tools
Category of
respondents
Data collection instruments Tool
DHTs, DDMCs Key informants KI guide
Departmental heads/In-
charges
FGDs FGD guide
Health care workers Structured questionnaires Questionnaire
Facility In-charges,
hospital Administrators
Facility checklists Checklist
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9. Data Management & AnalysisData Management & Analysis
 Data was cleaned and triangulated before entry
 Data entry was done from structured questionnaire
using Epi-data
 Data was then analyzed with STATA (Version.14)
 Level of infrastructure preparedness was measured on a
14-point scale
 All “Yes” responses scored 1 and the “No” responses
score 0
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10. Data Analysis cont’Data Analysis cont’
Knowledge, a bivariate analysis was carried out using
2x2 table analysis
Social demographic characteristics as independent
variable
Independent covariates were regressed on level of
knowledge using equation of a straight line in
multivariate logistic regression
Level of knowledge as a dependent variable
Unadjusted and adjusted odds ratio was used to assess
the level of association at 0.05 significance level 13

11. Analysis cont’Analysis cont’
Qualitative analysis.
Researcher read through transcripts several times
Drew categories and clustered data among themes
Themed the categories as;-“Knowledge”, “logistics”,
“Capacity”
Summarized and displayed quotes
In-depth reading and creating meaning from data was
done
 Researcher then developed conclusions from data
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12. Factor Level
Kasese
(n=148)
Rubirizi
(n=39) p-value
N (% )148 (%)39
Gender Female 55.4%(82) 56.4%(22) 0.91
Male 44.6%(66) 43.6%(17)
Age 20-30 51.0%(75) 58.3%(21) 0.73
31-40 28.6%(42) 25.0%(9)
41 and above 20.4%(30) 16.7%(6)
Religion Catholic 29.3%(43) 51.3%(20) 0.011
Muslim 4.1%(6) 2.6%(1)
Pentecostal 0.0%(0) 2.6%(1)
Pentecostal Baptist 2.7%(4) 0.0%(0)
Protestant 54.4%(80) 28.2%(11)
Seventh day Adventist 9.5%(14) 15.4%(6)
Education level Primary level 1.4%(2) 2.6%(1) 0.72
Secondary level 6.1%(9) 2.6%(1)
Tertiary level 83.0%(122) 82.1%(32)
University 9.5%(14) 12.8%(5)
Job designation Senior Medical officer 0.0%(0) 3.2%(1) 0.097
Medical officer 4.2%(5) 0.0%(0)
Senior medical clinical officer 20.2%(24) 12.9%(4)
Senior nursing officer 3.4%(4) 3.2%(1)
Enrolled registered midwife 37.1%(56) 67.7%(21)
lab technologist 16.8%(20) 12.9%(4)
other 8.4%(10) 0.0%(0)
Nature of employment Permanent 50.3%(74) 82.1%(32) <0.001
Temporary 43.5%(64) 12.8%(5)
Volunteer 6.1%(9) 2.6%(1)
others 0.0%(0) 2.6%(1) 16
Demographic of Health Care Workers in Kasese and Rubirizi
Districts

13. BivarianteBivariante
Independent variables
Knowledge level
COR(95% CI) P-
value
AOR (95% CI) P-value
Low(n=104)
High (83)
Gender
Female 61(58.7) 43(51.8)
Male 43(41.3) 40(48.2) 1.31(0.74-2.36) 0.350 0.88(.043-1.83) 0.747
Age
20-30 48(48.0) 48(57.0)
31-40 30(30.0) 21(26.3) 0.7(0.35-1.39) 0.308 0.65(0.28-1.46) 0.295
41 and above 22(22.0) 14(16.9) 0.64(0.29-1.39) 0.256 0.33(0.11-0.91) 0.032*
Education level
Secondary level 11(10.6) 2(2.4)
Tertiary level 93(89.4) 80(97.6) 4.73(1.01-21.9) 0.047* 1 -
Job designation
Clinician 16(21.3) 18(24.0)
Nurse 59(78.7) 57(76.0) 0.85(0.39-1.84) 0.697 0.67(0.28-1.61) 0.370
Nature of employment
Permanent 58(56.3) 48(57.8)
Temporary 45(43.7) 35(42.2) 0.94(0.52-1.86) 0.835 0.60(0.28-1.28) 0.187
Religion
Christian 102(99.0) 77(92.8)
Muslim 1(1.0) 6(7.2) 7.94(0.94-67.39) 0.057 4.23(0.44-41.00) 0.21217
Significant at <0.05

14. Overall districts preparedness for 3 domainsOverall districts preparedness for 3 domains
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15. DiscussionDiscussion
Infrastructure Preparedness
Majority of HFs were not prepared infrastructure
Infrastructure assessment for PHC concluded that there were
deficiencies in infrastructure of decentralized health systems (Scholz,
et al., 2015)
Lower health facilities such as H/C IVs, IIIs missed a robust
infrastructure system
 Polgreen, et al.,Concluded that small health facilities especially
those with less than 200 beds are always less prepared compared to
the bigger facilities
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16. Discussion Cont’Discussion Cont’
Logistics preparedness cont’
PPEs weren’t observed at Health facilities implying that in case of suspected
index EVD case
Even taking highly pathogenic specimen from suspect will either take long to
be done, or person taking it will have to remove specimen without PPEs hence
making him/her ransom for a failed system
Health care workers’ knowledge level on EVD
There is low knowledge level about EVD among Health workers
In a related KAP in Nigeria, found that most health care workers had
inappropriate knowledge about EVD (Oluwookere, et al., 2015)
Very few health care workers knew that contact with clothes and beddings of
symptomatic EVD patients would be a direct mode of EVD transmission
 Precautionary measures are suboptimal
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17. ConclusionConclusion
Infrastructural preparedness
The infrastructure is system is not prepared for any Ebola outbreak
response
Logistical capacity
Health care system is not logistically prepared for outbreak
response
Level of knowledge on Ebola etiology, control and prevention
Health care workers are not prepared in terms of knowledge for
Ebola identification, detection and thence outbreak response
Overall preparedness
Overall health care system of both districts is not prepared given
that all dimensions assessed were below cut offs.
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18. RecommandationsRecommandations
Infrastructure
MoH should solicit resources and print and disseminate case definition
books, SOPs, and IEC materials and fact sheets about EVD disease to
health care workers
National stakeholders and District level should organize a multi-sectoral
approach simulation training exercise to appreciate need to be on alert at
all-times
Logistics and supply chain management
Critical logistics like; PPEs, triple package carriers for highly
pathogenic specimens and clear transportation mechanism should be
availed at all times
Knowledge on EVD etiology, prevention and control
Training should be tailored to address concerns of infection prevention
and control
Ebola biology, etiology, epidemiology and pathogenesis should be
designed for both in-service health workers and those in schools 24

19. AcknowledgementAcknowledgement
My lecturers at MUSPH
Supervisors; Mr. Abdullah Ali Halage
Dr. Sekimpi Deogratious, Dr. Innocent
Rwego
International Development Research
Centre(IDRC)-through One Health for East
and Central Africa(OHCEA)
OHCEA team
Health Care Workers in Kasese and Rubirizi25