Knowledge perception and belief of Ebola virus disease (EVD) among the residents of palladan, Zaria

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KNOWLEDGE, PERCEPTION AND BELIEF OF EBOLA VIRUS DISEASE
(EVD) AMONG THE RESIDENTS OF PALLADAN, ZARIA.
BY
MUSA, IKO
(U07MD1104)
A FINAL YEAR PROJECT SUBMITTED TO THE DEPARTMENT OF
COMMUNITY MEDICINE, IN PARTIAL FULFILMENT FOR THE
AWARD OF THE MBBS DEGREE BY THE AHMADU BELLO
UNIVERSITY, ZARIA.
JANUARY 2015.

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DECLARATION
I hereby declare that this project was written by me and it is the product of my research work.
All sources of my information and where applicable other writers’ view have been duly
acknowledge in form of references.
MUSA, IKO ________________________
U07MD1104 sign/date

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CERTIFICATION
I certify that this research work was carried out by MUSA IKO (U07MD1104) under my direct
supervision.
___________________ ________________________
DR. IBRAHIM DANGANA Sign/Date
(Project Supervisor)

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DEDICATION
This piece of work is dedicated to my beloved late father Mr. Musa Wundu

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ACKNOWLEDGEMENT
I return all praise, honour and glory to the Almighty God who has been my strength and fortress
all these years and who has seen me through this great work. I deeply appreciate my supervisor,
Dr Ibrahim Dangana, for his unreserved commitment, tutorship and guidance throughout this
work. May God bless you sir.
To my sweet mother, Mrs. Deborah Musa, my elder sisters (Amina Musa, Ladi Musa), my
beloved brothers (Samuel, Joshua, Rufus and Benjamin) and my beloved sisters (Amina, Ladi,
Nana, Jummai) for your support and prayers, I wouldn’t have come this far. I love you all!
To my friends: Abednego Audu, Babangida Shalli, Emmanuel S. Peter, Emmanuel Yohanna,
Shettima Isa, Emmanuel Japheth, Wankari Nggurum, My mentor and friend-Barrister Ibrahim
Wabekwa, my love Rhoda Hussaine, thanks for your patience. You are more than just friends to
me. Thanks for your contributions. Space will not permit me to mention everyone who has
contributed directly or indirectly to making this work a success, my God rewards every one of
you.

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LIST OF ABBREVIATION AND ACRONYMS
Abbreviation Definition
BEBOV Bundibugyo ebola virus
BSL-4 Biosafety level 4
CDC Centre for disease prevention and control
DRC Democratic republic of Congo
ELISA Enzyme link immunoabsorbent assay
EMRO WHO regional office for the Eastern Mediterranean
EURO WHO regional office Europe
EVD Ebola virus diseases
FOCUS 1000 Facilitating and Organizing Communities for
Sustainable Development
GP Glycoprotein
HCWs Health care workers
HSPH Harvard school of public health
IgG Immunoglobulin G
IgM Immunoglobulin M
IHR International health regulations
MVD Marburg virus disease
NHP Non-human primate
PCR Polymerase chain reaction
PHEIC Public health emergency of international, concern
PPE Personal protective equipment
RESTV Reston Ebola virus
RT-PCR Reverse transcriptase Polymerase chain reaction
SEBOV Sudan Ebola virus
TNF Tumor necrosis factor
UNICEF United
Nations Children’s Fund (UNICEF)
VHF Viral hemorrhagic fever
VP Viral structural protein
WHO World health organization
ZEBOV Zaire Ebola virus

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TABLE OF CONTENTS
Title page……………………………………………………………i
Declaration………………………………………………………….ii
Certification ..………………………………………………………iii
Dedication ……….…………………………………………………iv
Acknowledgement ………...………………………………………..v
List of acronyms and abbreviation………………………………….vi
Table of contents………………...………………………………….vii
List of tables………..………………………………………………ix
List of figures……………………………………………………….xi
Abstract ……………………………………………………...……..xii
CHAPTER ONE
Introduction………………………………………………...….1
Problem statement…………………………………………..…3
Justification for the study………………………………..…….4
Aim and objectives…………………………………….………5
CHAPTER TWO
Literature review………………………………………………6
Introduction……………………………………………………6
Epidemiology………………………………………………….7
Pathogenesis………………………………………………….13
Clinical features………………………………………………14
Diagnosis and differential diagnosis…………………………15
Management …………………………………………………17
Public knowledge of EVD and its
transmission…………………………………………………..18
Perception and belief of ebola virus disease………………....19
Prevention and control……………………………………….21

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CHAPTER THREE
Methodology………………………………………………..…………..28
Background of study area……………………………...………………..28
Study design……………………………………………………………..30
Study population…………………………………………………………30
Sampling technique….……………………………………...……………30
Sample size determination………………………………………………30
Data collection method...………………………………………………..32
Data analysis…………………………………………………………….32
Ethical considerations…………………………………………………...33
Limitations of the study…………………………………………………33
CHAPTER FOUR
Result …………………………………………………………………..35
Introduction……………………………………………………………35
Socio-Demographic Characteristics…………………………………...35
Knowledge of Ebola Virus Disease (EVD)……………………………33
Perception and Belief of Ebola Virus Disease (EVD)…………………42
Relationship Analysis………………………………………………….45
CHAPTER FIVE
Discussion……………………………………………………………..48
Conclusion …………………………………………………………….51
Recommendations …………………………………………………….51
References……………………………………………………..………53
Appendix ………………………………………………………….…..58

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LIST OF TABLES
Table 4.1: socio-demographic characteristics of the respondents ……………..35
Table 4.2: Sex distribution of respondents ……………………………………...35
Table 4.3: Marital Status of the Respondents ………………………………….35
Table 4.4: Religion of Respondents……………………………………………..36
Table 4.5: Ethnicity of the Respondents ……………………………………...36
Table 4.6: Educational Status of the respondents……………………………36
Table 4.7: Occupation of the Respondents…………………………………...37
Table 4.8: Percentage of knowledge of the cause of EVD ……………………39
Table 4.9 Percentage of knowledge of the cause of EVD ……………………..40
Table 4.10: Knowledge Regarding Cure of EVD………………………………41
Table 4.11: Prevention with Personal Protective Clothing …………………...42
Table 4.12. Number of family members respondents that drank or bathe with salt water
……………………………………………………………………………..45
Table 4.13: Cross tabulation between the highest level of education of the respondents and
those who drank or bathe with salt water ………………..45
Table 4.14: Cross tabulation of health worker’s advice and those who drank or bathe
with salt wate……………………………………………………………………….46
Table 4.15: friend’s advice and those who drank or bathe with salt water…….46

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Table 4.16: Cross tabulation of gender and those who drank or bathe with salt water
………………………………………………………………………………………..47

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LIST OF FIGURES
Figure 4.1 Percentage of the awareness of Ebola virus disease…………………38
Figure 4.2. Incubation period of Ebola virus disease……………………………38
Figure 4.3. Source of information ………………………………………………..39
Figure 4.4 Percentage of the respondents knows about mode of transmission of
EVD………………………………………………………………………..…….40
Figure 4.5. Knowledge of the symptoms of EVD……………………………….41
Figure 4.6. The perception and belief of the cause of Ebola virus disease ……..42
Figure 4.7. Perception and belief towards prevention of Ebola virus disease…..43
Figure 4.8. Behavioural change adapted toward prevention of EVD……………43
Figure 4.9. Who advised the respondent to drink or bathe with salt water……..44
Figure 4.10. Means through which respondents were advised to take or bathe with salt
water……………………………………………………………………………..44

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ABSTRACT
BACKGROUND
Ebola virus disease (EVD), previously known as Ebola haemorrhagic fever, is a serious, often
fatal illness in humans. EVD is caused by the Ebola virus, a filovirus that is thought to be
harboured by specific arboreal bat species in the affected regions. Ebola is transmitted through
direct contact with a sick person’s blood or body fluids, such as urine, saliva, faeces, vomit, and
semen. The fear and lack of correct and adequate knowledge about Ebola virus disease has led
many people to use different method of prevention which does not have a link to the disease mode
of transmission and pathogenesis
AIM
To assess the knowledge, perception and belief of Ebola virus disease among the residents of
Palladan, Zaria
METHODOLOGY
A cross sectional descriptive study was carried out among 152 residents of Palladan who are
randomly selected using multistage sampling technique. A pre-tested structured interviewer
administered questionnaire was used for data collection. Data was analysed using Statistical
Package for Social Sciences (SPSS®
) software version 21 and Microsoft®
Excel®
2013.
RESULT.
Out of 152 respondent, nearly half of the respondents were male (51%) and female (49%) who
are within the age group 18-24 years (50.7%) majority were Hausa (52.6%) Muslim (59.9%) the
respondents. Also 46.7% of the respondent had secondary education. The awareness of Ebola
virus disease is generally high: nearly everyone has heard of EVD (98%) and 74.5% believe EVD

xiii
ever exist in Nigeria where majority of the respondent heard of EVD through Television (38.8%),
and by radio (32.9%). Bats, monkey, chimpanzee, and wild animals are mostly associated with
the cause of EVD (79.7%) and (26.3%) of the respondents link the cause of EVD to a micro-
organism. Respondents with no or low level of education 2.8% and 6.3% respectively were less
likely to associate the cause of ebola virus disease to microorganism (virus). There is low
misconception that EVD could be transmitted by mosquitoes (10.1%), by air (15.4%), and (3.4%)
of the respondents believe that EVD is caused by gods, witchcraft, evildoing, or curse. There was
significant change in behaviour and practice 70% towards prevention of EVD also was positive
perception towards key prevention of Ebola virus disease where 88%, 91.9%, 79.9% of the
respondents believe in quarantine of contacts safe burial practices and wearing of protective
respectively clothing as a means of prevention respectively of EVD. There is no statistical
relationship between bathing with or drinking salt water and level of education however there is
significant statistical relationship between friend’s advice and those who drank or bathed with
salt water for the prevention of EVD during EVD outbreak in Nigeria.
CONCLUSION
Although majority of the respondents have a good knowledge and perception of the cause, means
of transmission, symptoms ways of prevention of Ebola virus disease, there is some
misconception of regarding the practice of prevention of EVD. Majority of the respondents
believe EVD had been transmitted in Nigeria. The good knowledge and perception of EVD as
well as the belief that it ever exist in Nigeria could be responsible for the significant change in
behaviour of the respondents towards EVD prevention.

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CHAPTER ONE
1.0 INTRODUCTION
1.1 Background
Ebola virus disease (EVD), previously known as Ebola haemorrhagic fever, is a
serious, often fatal illness in humans. Ebola was first recognized in 1976 in two concurrent
outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo, near the Ebola
River, from which the disease gets its name.1
The natural reservoir host of Ebola virus is not
known. However, based on evidence and the nature of other similar viruses, researchers
believe that Ebola virus is animal-borne, with bats probably being the most likely reservoir.2,
3
EVD is caused by the Ebola virus, a filovirus that is thought to be harboured by
specific arboreal bat species in the affected regions.4
Five strains of Ebola virus, which are
genetically and antigenically distinct, have been identified over the years. These include the
Tai Forest, Reston, Sudan, Zaire and Bundibudyo viruses (Bundibudyo virus was identified
for the first time during an outbreak in Uganda in 2008).4
The latter three strains have been
associated with sizeable outbreaks in sub-Saharan Africa, with mortality rates of 30 - 90%.3
These viruses differ in geographical spread, and the Zaire Ebola virus has been associated
with the most fatal outbreaks to date.5
The 2014 outbreak of Ebola virus in West Africa is
caused by a variant of Zaire Ebolavirus with 97% sequence identity to strains isolated from
the Democratic Republic of Congo and Gabon, suggesting a parallel evolution of this virus in
the affected area as opposed to introduction from these endemic areas.4
EVD is a severe acute viral illness often characterized by the sudden onset of
fever, intense weakness, muscle pain, headache and sore throat. This is followed by
vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both
internal and external bleeding occur.1, 6
Other viral haemorrhagic fevers include dengue,

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yellow fever, Lassa and South American arena viral haemorrhagic fevers, Congo-Crimean
haemorrhagic fever, Rift Valley fever, and haemorrhagic fever with renal syndrome.7-9
Ebola is transmitted through direct contact with a sick person’s blood or body fluids,
such as urine, saliva, faeces, vomit, and semen.8
It is also spread through contact with
contaminated objects (like syringes) or infected animals. In Africa, infection has been
documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys,
forest antelope and porcupines found ill or dead in the rainforest.1, 5, 8
The incubation period
for EVD ranges from 2 to 21 days, with an average of 8-10 days.2, 5
Burial ceremonies in
which mourners have direct contact with the body of the deceased person can also play a role
in the transmission of Ebola. Men who have recovered from the disease can still transmit the
virus through their semen for up to 7 weeks after recovery from illness.5, 8
Ebola virus disease can be diagnosed definitively by enzyme-linked immunosorbent
assay (ELISA), antigen detection tests, serum neutralization test, reverse transcriptase
polymerase chain reaction (RT-PCR) assay and, virus isolation by cell culture.5, 8
Currently, there is no approved vaccine or therapy for EVD. However experimental treatment
with two new drugs, ZMapp and Nano Silver is available. Concern for a filoviral infection
must not deter an immediate assessment of treatable and more common causes of a febrile
illness among travellers, such as malaria, typhoid fever, leptospirosis, borelliosis, septicaemic
plague, tick typhus, and dysentery.7
Management is mainly supportive and containment.
Supportive management comprises fluid and electrolyte replacement, oxygen therapy,
analgesics, antibiotics and antifungals. Anticoagulants may be useful in early disease to
prevent disseminated intravascular coagulation.5, 8, 9
Outbreak control relies on applying a package of interventions, namely case
management, surveillance and contact tracing, a good laboratory service, safe burials and
social mobilisation.5
Raising awareness of risk factors for Ebola infection and protective

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measures that individuals can take is an effective way to reduce human transmission. These
preventive measures include: avoiding direct contact with blood, saliva, vomit, urine and
other bodily fluids of people with EVD or unknown illnesses; avoiding close contact with
wild animals and avoid handling wild meat; reducing the risk of human-to-human
transmission from direct or close contact with people with Ebola symptoms, particularly with
their bodily fluids.10, 11
Gloves and appropriate personal protective equipment should be worn
when taking care of ill patients at home. Regular hand washing is required after visiting
patients in hospital, as well as after taking care of patients at home; Outbreak containment
measures including prompt and safe burial of the dead, identifying people who may have
been in contact with someone infected with Ebola, monitoring the health of contacts for 21
days.5, 10
1.2 PROBLEM STATEMENT
Ebola virus disease (EVD) is one of the most feared diseases known to mankind. This is
because of the high mortality rate (up to 90%) associated with the disease, and also its
propensity for person-to-person spread through close contact with infected tissues and body
fluids of affected persons, particularly in the unprotected home-care setting and during
preparation of bodies for burial, while spread is amplified in hospitals with poor infection
control practices. Healthcare providers caring for Ebola patients and the family and friends in
close contact with Ebola patients are at the highest risk of getting sick because they may
come in contact with the blood or body fluids of sick patients.10, 12
Four West African countries (Liberia, Sierra Leone, Guinea, and Nigeria) are in the
midst of the largest Ebola outbreak the world has seen.13
The World Health Organization
(WHO) declared it an outbreak in March 2014. On August 6, 2014, the WHO, based on the

4
recommendations of its Emergency Committee, declared the current outbreak a Public Health
Emergency of International Concern (PHEIC).1, 14
On 30 September 2014, the first travel-
associated case of Ebola was reported in the United States.10, 15
An individual who travelled
from Liberia to Dallas, Texas first developed clinical findings consistent with Ebola virus
disease approximately five days after arriving in the United States.15
According to Nigeria’s Minister of Health, Professor C. O. Onyebuchi, immigration
from the countries hit by the disease has increased the threat of its spread to Nigeria. He
pointed out that apart from the cases reported in some West African countries like Liberia
and Ghana, “Ebola has been moving eastward towards Nigeria as well and we are already
facing danger from Central African Republic”.16
Three patterns of transmission have been
identified by WHO: in rural communities, facilitated by strong cultural practices and
traditional beliefs; in densely populated peri-urban communities; and cross-border
transmission. In addition, the situation is being driven by the failure to gain trust and
community support that is essential to effectively trace, monitor or isolate contacts of EVD
patients.11
Inadequate treatment facilities and insufficient human resources continue to
worsen the problems of control measures.11
1.3 JUSTIFICATION
The fear and lack of correct and adequate knowledge about Ebola virus disease has led many
people to use different method of prevention which does not have a link to the disease mode
of transmission and pathogenesis. Among such methods used by the general public include
bathing with hot-water and salt, chewing bitter kola-nut and raw onions with resultant
untoward medical consequences.8, 17
Effective prevention and control strategies have been
undermined by fear, mistrust and misinformation within affected communities, leading some
to believe that medical staff have brought the virus to the country.2, 17
This has resulted in

5
people refusing to cooperate with medical personnel, helping patients escape isolation wards,
and exhibiting hostile behaviour.2
Community perceptions, fears and reluctance to co-operate
can be especially problematic, and communication barriers must be bridged by well-designed
and understandable health messages.4
The virus has claimed more than 6,055 lives so far, and experts say a key part of fighting
the disease is to make sure people are armed with the facts.17
Locals are presumed to
subscribe to alternative disease models rooted in “traditional healing,” believe in sorcery
or the supernatural as the cause of the disease, or generally hold “misconceptions”
about its aetiology.18
Therefore, conducting this research will help in determining the
misconception about the cause, transmission and prevention of this disease.
1.5 OBJECTIVES
1.5.1 General objectives
To assess the knowledge, perception and belief of Ebola virus disease among the residents of
Palladan, Zaria
1.5.2 Specific objectives
1. To assess perception of the residents of Palladan Zaria on Ebola virus disease
2. To assess the knowledge regarding the origin, cause and transmission of Ebola virus
disease
3. To assess the knowledge of the residents of Palladan Zaria on the prevention of Ebola
virus disease
4. To determine beliefs that enhance or are detrimental to the prevention and control of
Ebola virus disease
5. To assess the practice regarding the prevention of Ebola virus disease

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CHAPTER TWO
2.0 LITERATURE REVIEW
2.1 INTRODUCTION
Ebola virus is regarded as the prototype pathogen of viral haemorrhagic fever, causing
severe disease and high case-fatality rates.19
Ebola virus, named after the river Ebola in the
Democratic Republic of Congo (formerly Zaire), with the Marburg virus belongs to the
Filoviridae family.8
Since the first documented EVD outbreak in Zaïre or the Democratic
Republic of Congo in 1976, five species of the genus Ebola virus (Filoviridae family) have
been identified from samples collected from humans and non-human primates during
outbreaks of the disease: Zaïre ebolavirus (ZEBOV), Sudan ebolavirus (SEBOV), Reston
ebolavirus (RESTV), Taï Forest ebolavirus (TEBVO) and Bundibugyo ebolavirus
(BEBOV).8
Ebola virus and Marburg virus constitute the family Filoviridae in the order of
Mononegavirales. The Ebola virus is a lipid-enveloped, nonsegmented negative sense,
single-stranded RNA filovirus. The name derives from “filum” — meaning “threadlike” in
Latin. Tissue culture-derived virions can appear as either long filamentous particles (with
branching) reaching up to 14 turn in length, or as shorter forms that can fold back upon
themselves to give '6', 'U', or circular appearances when examined by transmission electron
microscopy.4, 19
This high fatality, combined with the absence of treatment and vaccination options,
makes Ebola virus an important public health pathogen and bio-threat pathogen of category
A.20

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2.2 EPIDEMIOLOGY
The 2014 Ebola outbreak in West Africa is the largest and most complicated that the
world has ever seen.9
The disease has nevertheless remained rare since its initial description
in 1976, with no more than 2000 cases diagnosed before 2014.8
Since the latest outbreak
was first identified in the forested regions of south eastern Guinea on 1st
March 2014,
it has spread to Liberia, Sierra Leone, and Nigeria and has now been declared by the
World Health Organization as a “public health emergency of international concern”.
The filoviruses were first recognized in 1967, when the inadvertent importation of
infected monkeys from Uganda into Germany and Yugoslavia resulted in explosive outbreaks
of severe illness among vaccine plant workers who came into direct contact with the animals
by killing them, removing their kidneys, or preparing primary cell cultures for polio vaccine
production.21
Since that time, with the exception of a few accidental laboratory infections, all
cases of filoviral disease have occurred in sub-Saharan Africa. The frequency of recognized
outbreaks has been increasing since 1990.12
The current 2014 outbreak, by far the largest outbreak of Ebola virus disease ever
recorded is currently occurring in West Africa with the Zaire species of the virus.20
Although
most previous Ebola outbreaks occurred in Central Africa, this outbreak started in the West
African nation of Guinea in late 2013 and was confirmed by the World Health Organization
in March 2014.22
The initial case was a two-year-old child in Guinea, who developed fever,
vomiting, and black stools, without other evidence of haemorrhage.23
The outbreak
subsequently spread to Liberia, Sierra Leone, Nigeria, and Senegal. The case-fatality rate has
been estimated to be approximately 90 percent.9
The magnitude of the outbreak, especially in
Liberia and Sierra Leone, has probably been underestimated; this is due in part to individuals
with Ebola virus disease being cared for outside the hospital setting.21, 24
As at 3rd December

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2014, a total of 17,145 confirmed, probable, and suspected cases of Ebola virus disease
(EVD) have been reported in five affected countries (Guinea, Liberia, Mali, Sierra Leone,
and the United States of America) and three previously affected countries (Nigeria, Senegal
and Spain). Similarly, as at 5th
December 2014, there had been 6,070 deaths of individuals
from the disease.25
The outbreaks of EVD in Senegal and Nigeria were declared over on 17
October and 19 October 2014, respectively.26
Following the WHO Ebola Response Roadmap
structure, country reports fall into two categories: those with widespread and intense
transmission (Guinea, Liberia, and Sierra Leone); those with an initial case or cases, or with
localized transmission (Nigeria, Senegal, Spain, and the United States of America).25, 27
An
overview of the situation in the Democratic Republic of the Congo, where a separate,
unrelated outbreak of EVD is occurring, were also provided in the WHO Ebola Response
Roadmap structure document.25
2.2.1 Countries with Widespread and Intense Transmission
As at 5th
December 2014, A total of 17,111 confirmed, probable, and suspected cases and
6,055 deaths have been reported from EVD by the Ministries of Health of Liberia, Guinea
and Sierra Leone.25
Similarly, within this period, 622 health-care workers (HCWs) are
known to have developed EVD (106 in Guinea, 361 in Liberia, 11 in Nigeria and 138 in
Sierra Leone, 1 in Spain, 2 in Mali and 3 in the United States of America).20
The number of
HCWs that have died as a result of EVD infection were 346 (59 in Guinea, 174 in Liberia, 5
in Nigeria, 108 in Sierra Leone).25
Investigations into health-care workers (HCWs) exposures
are ongoing.
2.2.2 Countries with an Initial Case or Cases, Or with Localized Transmission
As at 5th
December 2014, five countries (Mali, Nigeria, Senegal, Spain, and the United States
of America have reported a case or cases imported from a country with widespread and

9
intense transmission. In Nigeria, there have been 20 cases and eight deaths, while in Senegal,
there has been one case.25
A total of 8 cases (7 confirmed and 1 probable), including 6 deaths (5 confirmed, 1
probable), have now been reported in Mali. All identified contacts connected with the
initial case have now completed 21 day follow-up.
In Spain, more than 42 days have now passed since the HCW infected while caring for a
patient with EVD in Madrid tested negative twice and was discharged from hospital,
therefore the outbreak in this country has now been declared over.
In the United States of America, there have been 4 cases of EVD and 1 death. One HCW in
New York and 2 HCWs in Texas have tested negative for EVD twice and have been released
from hospital. All contacts in the country have completed the 21-day follow-up period.
In Nigeria, there were 20 cases and 8 deaths. In Senegal, there was 1 case and no deaths.
However, following a successful response in both countries, the outbreaks of EVD in
Senegal and Nigeria were declared over on 17 October and 19 October 2014,
respectively.20, 25
The Ebola virus was imported into Nigeria by a late Liberian-born American, Patrick
Sawyer, who arrived Lagos on the 20th of July 2014 and died five days later after
being diagnosed with the Ebola virus at First Consultants Hospital in Obalende, Lagos
State.1, 8
The President of Nigeria, Goodluck Ebele Jonathan declared a national
emergency on Ebola and approved 1.9 billion Naira intervention fund to combat the
outbreak of the virus.28
Likewise, the Anambra State Ministry of Health on 31st
July
announced that there are concerns in the State that the disease may have infiltrated

10
the State through a corpse brought in from Liberia and deposited at Apex Mortuary in
Nkwelle Ezunaka.1
However, subsequent findings confirmed otherwise.
As at 9 October 2014, and following a retrospective review of cases, there have been
68 cases (38 confirmed,28 probable, 2 suspected) of Ebola virus disease (EVD) reported in
the Democratic Republic of the Congo, including eight among HCWs.25
In total, 49 deaths
have been reported, including eight among HCWs. 852 contacts have now completed 21-day
follow-up. All of the 269 contacts currently being monitored, were seen on 9 October, the last
date for which data has been reported. The last confirmed case was isolated on 4 October.
This outbreak is unrelated to that affecting Guinea, Liberia, Nigeria, Sierra Leone, Spain, and
the United States of America.25
Ebola virus disease has no sexual predilection, but men and women differ with respect
to the manner in which direct exposure occurs.29
Men, by the nature of their work exposure in
forest and savanna regions, may be at increased risk of acquiring a primary infection from
gathering “bush meat” (primate carcasses) for food, as well as an unknown vector or vectors.
Evidence from Africa and the Philippines is compatible with bats being a principal vector of
Ebola virus. Because women provide much of the direct care for ill family members and are
involved in the preparation of the bodies of the deceased, they may be at increased risk of
acquiring Ebola virus infection through their participation in these activities. However, men
and women who are medical healthcare providers seem to share a high and equal risk of
infection.29
Although most cases of Ebola virus infection have occurred in sub-Saharan
Africa, most patients have been black. However, no evidence exists for a specific racial
predilection.30
2.2.3 Viral Reservoirs

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The reservoir hosts of the various species of Filoviruses have not been identified. The viruses
could be maintained in small mammals, possibly rodents or bats, although wild primates
might also acquire the virus through contact with the maintenance host, there is no evidence
that they are other than accidental hosts.31
However, non-human primates have an
important role in transmitting the pathogen to human beings, because several recent
outbreaks began when hunters encountered a sick or dead animal in the forest and took it
home for consumption. Although there is serological evidence that some wild primates have
survived infection with Zaire Ebola virus, the mortality rate among great apes is high enough
to threaten their survival in some regions of Africa and could warn of a further increase in
human disease.32
Perhaps the greatest mysteries regarding the filoviruses are the identity of
their natural reservoir and the mode of transmission from the reservoir to wild apes and
humans.31
Bats have long headed the list of suspects, because they have been present in large
numbers at the sites of several filovirus outbreaks and are known to maintain other
pathogenic RNA viruses, such as rabies. Epidemiologic data have suggested a strong link
between exposure to bats and subsequent filoviral disease.19
2.2.4 Transmission
Infections with Ebola virus are acute, with is no carrier state.33
Because the natural reservoir
of the virus is unknown, the manner in which the virus first appears in a human at the start of
an outbreak has not been determined.22
However, researchers have hypothesized that the first
patient becomes infected through contact with an infected animal. Ebola is introduced into
the human population through close contact with the blood, secretions, organs or other bodily
fluids of infected animals.5
In Africa, infection has been documented through the handling of
infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill
or dead or in the rainforest.1, 5, 8

12
Person-to-person transmission occurs through direct contact of broken skin or
unprotected mucous membranes with virus-containing body fluids (e.g., blood, vomitus,
urine, faeces, semen, and probably sweat) from a person who has developed signs and
symptoms of illness.5, 8
One type of direct contact that leads to transmission is the ritual
washing of Ebola victims at funerals.31
An epidemiologic study found that family members
were only at risk of infection if they had physical contact with sick individuals or their body
fluids, or helped to prepare a corpse for burial.34
Infection apparently results from entry of
virus through breaks in the skin or the mucous membranes of the mouth or eyes.9
Even
though aerosolised filoviruses are highly infectious for non-human primates in the
laboratory, transmission patterns during epidemics indicate that the virus does not spread
naturally among human beings by the respiratory route, which suggests that it is not
efficiently aerosolised by people.19
Airborne transmission has only been reported among
healthcare workers who were exposed to aerosols generated during medical procedures.19
There is no evidence that insects have any role in disease transmission.30
Among
workers in contact with monkeys or pigs infected with Reston Ebola virus (RESTV), several
infections have been documented in people who were clinically asymptomatic. Thus, RESTV
appears less capable of causing disease in humans than other Ebola species.35
Human
infection with Ebola virus can occur through contact with wild animals (e.g., hunting,
butchering, and preparing meat from infected animals).20, 36
Other potential routes of
transmission include the following: accidental infection of workers in any Biosafety-Level-4
(BSL-4) facility where these viruses are being studied, Use of filoviruses as biological
weapons.31, 37
There is no evidence to date that filoviruses are carried by mosquitoes or other
biting arthropods.19

13
2.3 PATHOGENESIS
Ebola virus has a nonsegmented negative-stranded RNA genome containing 7
structural and regulatory genes.38
The Ebola genome codes for 4 virion structural proteins
(VP30, VP35, nucleoprotein, and a polymerase protein [L]) and 3 membrane-associated
proteins (VP40, glycoprotein [GP], and VP24).39
The GP gene is positioned fourth from the
3′ end of the 7 linearly arranged genes. The sGP binds to neutrophil CD16b, a neutrophil-
specific Fc g receptor III, and inhibits early neutrophil activation.33
The sGP also may be
responsible for the profound lymphopenia that characterizes Ebola infection. Thus, sGP is
believed to play pivotal roles in the ability of Ebola to prevent an early and effective host
immune response.29
Ebola virus act both directly and indirectly to disable antigen-specific immune
responses.31
Dendritic cells, which have primary responsibility for the initiation of adaptive
immune responses, are a major site of filoviral replication. In vitro studies have shown that
infected cells fail to undergo maturation and are unable to present antigens to naive
lymphocytes, potentially explaining why patients dying from Ebola virus disease do not
develop antibodies to the virus.40
Adaptive immunity is also impaired by the massive loss of
lymphocytes that accompanies lethal Ebola virus infection.4
Lymphocytes remain uninfected,
but undergo "bystander" apoptosis, presumably induced by inflammatory mediators and/or
the loss of support signals from dendritic cells. A detailed study of infected but asymptomatic
individuals revealed that they had an early (4-6 days after infection) and vigorous
immunologic response with production of interleukin (IL)–1β, IL-6, and tumour necrosis
factor (TNF), resulting in enhanced cell-mediated and humoral-mediated immunity.29
In
patients who eventually died, proinflammatory cytokines were not detected even after 2-3
days of symptomatic infection. A second, somewhat larger (120-150 kd) GP, transmembrane

14
glycoprotein, is incorporated into the Ebola virion and binds to endothelial cells but not to
neutrophils. Ebola virus is known to invade, replicate in, and destroy endothelial cells.19, 36
Destruction of endothelial surfaces is associated with disseminated intravascular coagulation,
and this may contribute to the haemorrhagic manifestations that characterize many, but not
all, Ebola infections.7, 37
Clinical infection in human and nonhuman primates is associated with rapid and
extensive viral replication in all tissues.41
Viral replication is accompanied by widespread and
severe focal necrosis. The most severe necrosis occurs in the liver, and this is associated with
the formation of Councilman-like bodies similar to those seen in yellow fever.31
In fatal
infections, the host’s tissues and blood contain large numbers of Ebola virions, and the tissues
and body fluids are highly infectious. In vitro studies have shown that infected cells fail to
undergo maturation and are unable to present antigens to naive lymphocytes, potentially
explaining why patients dying from Ebola hemorrhagic fever do not develop antibodies to the
virus.23, 35
2.4 CLINICAL FEATURES
The onset of the disease is abrupt after an incubation period of 2-21 days. The clinical
features can be divided into four main phases as follows:30
Phase A. Influenza–like syndrome: The onset is abrupt with non-specific symptoms or signs
such as high fever, headache, arthralgia, myalgia, sore throat, and malaise with nausea.
Phase B. Acute (day1–6): Persistent fever not responding to antimalarial drugs or to
antibiotics, headache, and intense fatigue, followed by diarrhoea and abdominal pain,
anorexia and vomiting.

15
Phase C. Pseudo-remission (day 7–8): During this phase the patient feels better and seeks
food. The health situation presents with some improvement. Some patients may recover
during this phase and survive from the disease.
Phase D. Aggravation (day 9): In many if not most cases, the health status gets worse.
The following symptoms may be observed also: respiratory disorders: dyspnoea, throat and
chest pain, cough, hiccups; symptoms of haemorrhagic diathesis: bloody diarrhoea,
haematemesis, conjunctival injection, gingival bleeding, nosebleeds and bleeding at the site
of injection consistent with disseminated intravascular coagulation; skin manifestations:
petaechiae (not so obvious on black skin), purpura (morbiliform skin rash); neuro-psychiatric
manifestations: prostration, delirium, confusion, coma; cardio-vascular distress and
hypovolaemic shock (death).19, 30
From these clinical manifestations it is obvious that EVD
may mimic many other tropical diseases like malaria, typhoid fever or yellow fever at the
start of the disease. In most outbreaks, recognition of the disease is delayed because
physicians are not accustomed to this new illness and the symptoms are generally non-
specific. Outside the epidemic context, it appears quite impossible to recognise the first Ebola
case in an outbreak on clinical grounds only. Suspicion of EVD is only possible later during
the aggravation phase.30
2.5 DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS
Ebola virus disease presents as a viral prodrome with a high potential for differential
diagnosis, especially early in outbreaks.7
The initial diagnosis of this syndrome is based on
clinical assessment. Therefore, proper contingency plans should be developed. Early
laboratory confirmation of suspected clinical haemorrhagic fever cases is essential to
implement appropriate control measures. In Africa, laboratory confirmation of Ebola cases
has been challenging and early recognition of the first outbreaks were severely hampered as a

16
result. Because the disease was poorly known or rare, laboratory investigations were oriented
towards the more common, endemic pathogens in the area.2
Ebola virus disease can be suspected in acute febrile patients with the symptoms
described and with a history of travel to an endemic area, if they present with fever and
constitutional symptoms. Identification might be difficult because severe and acute febrile
diseases can have a wide range of causes in areas endemic for Ebola virus, with the most
prominent being malaria and typhoid fever followed by others such as shigellosis,
meningococcal septicaemia, plague, leptospirosis, anthrax, relapsing fever, typhus, murine
typhus, yellow fever, Chikungunya fever, and fulminant viral hepatitis.2, 6, 7
Laboratory diagnosis for EVD is generally done in national and international
reference centres, which should be contacted immediately on suspicion for advice on
sampling, sample preparation, and sample transport.19
Laboratory diagnosis of Ebola virus is
achieved in two ways: measurement of host specific immune responses to infection and
detection of viral particles, or particle components in infected individuals.19
Currently, RT-
PCR and antigen detection ELISA are the primary assays to diagnose an acute infection.19, 37
Viral antigen and nucleic acid can be detected in blood from day 3 up to 7–16 days after
onset of symptoms.3
For antibody detection the most generally used assays are direct IgG and
IgM ELISAs and IgM capture ELISA. IgM antibodies can appear as early as days post onset
of symptoms and disappear between 30 and 168 days after infection and IgG-specific
antibodies develop between day 6 and 18 days after onset and persist for many years.38, 42
IgM or rising IgG titre constitutes a strong presumptive diagnosis while decreasing IgM, or
increasing IgG titres (four-fold), or both, in successive paired serum samples are highly
suggestive of a recent infection.19, 29, 31
All these assays can be done on materials that have
been rendered non-infectious. An efficient way to inactivate the virus for antigen and
antibody detection is the use of gamma irradiation from a cobalt-60 source or heat

17
inactivation.19
Similarly, the nucleic acid can be amplified by purification of the virus RNA
from materials treated with guanidinium isothiocyanate—a chemical chaotrope that denatures
the proteins of the virus and renders the sample non-infectious.3
Provision of basic on-site
diagnostics, including confounding differential diagnosis, could help with the management of
patients specifically and with an outbreak in general. The development of truly portable real-
time thermocyclers and simple serological assays appropriate for field use has made the
provision of a field diagnostic laboratory a reasonable undertaking.19, 30, 40
However, the
launch of diagnostic support in remote areas of equatorial Africa can be logistically and
technically difficult since these regions are austere environments with cultural differences
and sometimes hostile behaviour.19
2.6 MANAGEMENT
Managing Ebola patients in the African setting is a major challenge because there is no
effective antiviral drug and no specific vaccine available. Only supportive care could be
administered, to sustain cardiac and renal functions with prudent use of perfusion. Oral
rehydration was recommended but sometimes not realistic because of throat pain, vomiting
and intense fatigue.5, 8
Supportive management comprises fluid and electrolyte replacement, oxygen therapy,
analgesics, antibiotics and antifungals.20, 34
Anticoagulants may be useful in early disease to
prevent disseminated intravascular coagulation (DIC) while procoagulants in late disease to
combat it.43
However, there have been many experimental treatments available and even used
during index outbreak by the United States Government. The Nigerian Government has also
authorized the use of the same experimental serum within the country and declared it is not
unethical.8
This agent ZMapp® is serum composed of humanized antibodies against the
Ebola virus surface antigen. The two USA citizens who received this seem to show positive

18
signs of improvement. In 1999, seven out of eight victims who received serum from survivors
survived.8
Another drug, the Nano Silver did not pass the ethical test in Nigeria. Vaccines
against the Filoviruses are also at the experimental stage.1, 8
Apart from the convalescent
serum, other experimental drugs include Favipiravir which is active against RNA viruses,
Clomiphene and Toremiphene, these recognized oestrogen, receptor modulators are shown to
inhibit viral programs of Ebola virus in infected mice, but this action is thought to be
accomplished through a different pathway than the standard oestrogen pathway.19
In an Ebola outbreak in Kikwit, Congo, human convalescent blood was used for
passive immunisation to treat patients that had been infected naturally with Zaire Ebola virus;
seven out of eight patients who received blood transfusion from convalescent Ebola patients
survived.23
Such experiments, unfortunately, have not been repeated in further outbreaks
because in vitro studies showed that antibodies against Ebola had no neutralising activities.23
In addition, although monoclonal antibodies to the glycoprotein of Ebola virus showed
protective and therapeutic properties in mice, they failed to protect non-human primate
(NHP) and since Ebola virus is generally considered as a potential biological weapon, it is
urgent to develop effective antiviral drugs and vaccines.10
The ideal is to develop a candidate
vaccine able to confer interspecies cross-protection against Zaïre ebolavirus (ZEBOV),
Sudan ebolavirus (SEBOV), Bundibugyo ebolavirus (BEBOV) and unknown Ebola virus
species.19
2.7 PUBLIC KNOWLEDGE OF EVD AND ITS TRANSMISSION.
In a study conducted in Sierra Leone by Catholic Relief Services in conjunction with United
Nations Children’s Fund (UNICEF) and Facilitating and Organising Communities for
Sustainable Development (FOCUS 1000) a non-governmental organization on the public
knowledge, attitude and practice of Ebola virus disease found out that everyone in Sierra

19
Leone has heard of Ebola and nearly everyone believes that it exists in the country (97%) and
approximately, 77% of respondents have heard of someone who survived Ebola while 53%
know the number to call to report suspected EVD cases or ask questions about the disease.44
Also a study conducted by the NOIPolls Limited in partnership with EpiAfric; an
Abuja based public health consulting firm in which 1006 respondents were interviewed in
the survey, they found out that 83% of the respondents affirmed that it spreads “by
exchange of body fluids”, whereas 7% believe it spreads “by air” while 4% each stated
that it is spread via “contact with infected bats (animal)” and “by mosquitoes”.1
In the United States, the Harvard School of Public Health (HSPH) poll found people
with less education are more likely to be concerned about an outbreak in the U.S. (less than
high school 50% vs. some college 36% vs. college graduate or more 24%). People with less
education are also more concerned they or their family will get sick with Ebola (less than
high school 37% vs. some college 22% vs. college graduate or more 14%).45
Perhaps related,
those with less education are also less likely to be following the news about the Ebola
outbreak in West Africa closely (total 63%; less than high school 57% and some college 62%
vs. college graduate or more 73%). Two-thirds of people (68%) surveyed believe Ebola
spreads “easily” (“very easily” or “somewhat easily”) from those who are sick with it.45
This
perception may contrast with Center for Disease Control and prevention, World Health
Organization, and other health experts who note that Ebola is not an airborne illness, and is
transmitted through direct contact with infected bodily fluids, infected objects, or infected
animals.
2.8 PERCEPTION AND BELIEF OF EBOLA VIRUS DISEASE
Ebola brings fear, panic and uncertainty which seem to have taken over the West
African sub-region. This fear derives mainly from paucity of factual knowledge about it,

20
reinforced by the realization that there is currently no vaccine or treatment for this fatal
illness with case fatality rate of up to 90%.8
Further concern exists about the potential for
exporting the virus from the outbreak regions to other countries, as well as the possibility of
employing the virus as a bioweapon. Such reportage has been rife in Nigeria that panic has
taken over the Nigerian society.8, 46
African customs and traditional practices are threatened.
Charlatans and spiritualist dish out unscientific and unsubstantiated remedies and claims to
cure. Unfortunately, the unsuspecting public has fallen to this in fear and panic. The most
celebrated in Nigeria was the employment of warm salt baths and salt drinks for prevention
of EVD, to which some citizens hearkened with resultant untoward medical consequences.8,
17, 47
There is no denying that the fear of EVD has threatened the social and traditional
fabric of Nigeria recently. Peoples’ psyche has been affected with attendant behavioural
modifications with regards to inter personal interactions within the society. In a
comprehensive study on indigenous responses to an Ebola outbreak, Hewlett a cultural
anthropologist, focused on the actual perception of the outbreak by the community, in
particular, specific cultural elements and local beliefs to ensure proper messages, confidence
and close cooperation of the community.23
He examined persons’ or cultures’ explanations
and predictions regarding a particular illness. Providing care and treatment for a particular
disease is often based on negotiating these different models. The data from the study showed
that: Local, national and international actions contributed to the control of the outbreak of
EVD like suspension of the following activities: Handshakes upon greeting, harmful cuts by
traditional healers, schools and public funerals.
The study clearly showed that cultural practices did indeed amplify the outbreak.
Another important finding was that local people have beliefs and practices in place that can

21
be useful to the local, national and international teams in the control of rapid epidemics such
as EVD and other viral haemorrhagic fevers. Ebola viral disease brings with it significant
amounts of fear and stigma driven by the communities belief that the outbreaks are often due
to witchcraft and wrong doings by the victims and affected families. Fear is further fuelled
when infection control techniques and restrictive practices such as quarantine and isolation
are employed to protect the public health.46, 48
2.9 PREVENTION AND CONTROL
The concepts of prevention as enunciated by Leavell and Clark49
can be approach as follows:
2.9.1 Primordial Prevention
It came from a Latin word ‘primordium’ means beginning. It means prevention at a stage,
when the risk factors have not yet developed. Primordial prevention is aimed to eliminate the
development of risk factors, it is targeted at total population or selected groups and achieved
through public health policy and health promotion.49, 50
In October 2014 California issues
quarantine policy for Ebola exposure that anyone arriving in California from an Ebola-
affected area and who has had personal contact with a person infected with the deadly virus
will be quarantined for 21 days, based on an order issued by the state's public health director.
Airline crews are trained to spot the symptoms of Ebola in passengers flying from places
where the virus is found.
2.9.2 Primary Prevention
The process of primary prevention is limited to the period before the onset of clinical
disease in an individual. Thus activities directed to prevent the occurrence of disease in
human populations fall in this category. These activities are related to health promotion and
specific protection. Primary prevention of EVD is at two levels.

22
First is to prevent the infection from entering the human population by avoiding
contact with all known vectors of the disease like fruit bats, monkeys/apes and antelopes. The
public are educated to avoid sick, dead or dying wild animals as these are potential sources of
the EVD. Fruits with holes in them should not be eaten because the hole may have been made
by bats and thus, the fruits are potentially infected.8
The second aspect is the prevention of secondary spread within the human population.
Avoidance of contact with the body fluids of infected persons is key here. Such body fluids
include blood, urine, faeces, saliva, tears, semen, vaginal fluids, sweat and breast milk of
infected persons. Dead bodies of victims are highly infectious and should be handled and
disposed of only by designated and well informed personnel who must also be well protected
with appropriate personal protective equipment (PPE). This precaution should be in place
both at home and in the hospital.8, 51
Improve health-related behaviours among at-risk and
vulnerable groups by promoting and strengthening standard infection prevention and
control practices within the community; e.g. regular hand washing, food safety, etc.15
Previously, the usefulness of an Ebola virus vaccine was disputed, because of the
disease’s rarity, little interest by industry, and the potential cost.31
Frequent outbreaks in the
past decade, several imported cases of EVD and laboratory exposures, and the potential
misuse of Ebola virus as a bio-threat agent has changed that view. Vaccine development is
part of many nations’ efforts in response to the public health threat posed by emerging or re-
emerging bio-threat pathogens such as Ebola virus. A protective vaccine would be very
valuable not only for at risk medical personnel, first responders, military personnel, and
researchers, but also for targeted vaccination in affected populations, especially during
outbreaks, for use in a so-called ring vaccination strategy. Currently, vaccine candidates to be
considered should show efficacy in at least two animal models of the disease including non-

23
human primates, the gold standard animal model for viral haemorrhagic fever caused by
several pathogens such as Ebola virus.22
Only a few vaccine platforms have passed these
requirements and are considered for further investigation and perhaps for clinical trials. These
vaccine candidates are based on recombinant technologies that use either generated
replication-deficient or attenuated replication competent platforms. Among the replication-
deficient platforms, human adenovirus-type-5 vectors have been the first successful strategies
to protect non-human primates from lethal Ebola virus challenge.19
Originally a DNA prime(glycoprotein and nucleoprotein) adenovirus
boost(glycoprotein) approach was used, which was subsequently replaced with an accelerated
approach of one immunisation with a recombinant adenovirus expressing the Zaire Ebola
virus glycoprotein 28 days before challenge.19
The approach has been further developed by
others by use of a multivalent adenovirus technology for the development of a pan
Filoviruses vaccine that provides protection against several Filoviruses species. The
adenovirus platform seems safe and robust but is weakened by pre-existing immunity in the
world population and its failure in an HIV/AIDS trial.7
The second successful approach with
replication-deficient platforms is based on Ebola virus-like particles generated by
coexpression of the viral matrix protein (VP40),nucleoprotein, and glycoprotein.32
This
approach seems to best address safety issues but might need adjuvant and still needs booster
immunisation for efficacy in non-human primates, which is not favourable for emergency
use. Other issues are associated with the costs and production of the virus-like particle (VLP)
vaccines compared with viral vector-based platforms. Reverse genetics has generated the first
new generation inactivated Ebola virus vaccine by deletion of an essential gene rendering the
resulting virus replication deficient.29
This technology allows large-scale production, but
remaining safety issues still need to be addressed for potential future use of this technology in
generation of promising vaccine candidates.

24
Generally, live attenuated viruses are more advantageous than non-replicating
vaccines because of ease of production and their potent stimulation of innate and adaptive
(humoural and cellular) immune responses. However, this idea does not seem feasible for
Ebola virus because of difficulties in ensuring the safety of live attenuated Ebola virus
strains. However, live attenuated recombinant Ebola virus vaccine vectors have been
developed on the basis of the background of less virulent viral systems such as vesicular
stomatitis virus111 and human parainfluenza virus.8
The system based on vesicular
stomatitis virus has shown tremendous efficacy in non-human primates including both
prophylactic and post exposure treatment situations.4
These potent vaccine platforms are
associated with safety issues despite having a clean record in laboratory animals including
immune-deficient animals. As with adenovirus vectors, pre-existing immunity might be an
issue with the human parainfluenza virus platform but is negligible for vesicular stomatitis
virus. Vaccine platforms of human parainfluenza and vesicular stomatitis viruses might have
potential for delivery without use of needles.37
Despite good to excellent protective efficacy
in animals, correlates and mechanisms of protection have not been well defined for most of
the vaccine candidates mentioned above. On the basis of present data, antibody responses, T-
cell proliferation, and cytotoxic-T-lymphocyte responses show that antibody and T-helper
cell memory are essential for protection, and that cell-mediated immunity, although possibly
important, is not an absolute requirement. Total antibody response is thought to be a correlate
for protection for Ebola virus vaccines. Finally, a multivalent preventive vaccine is clearly
needed to provide protection against all species of Ebola viruses, and such a vaccine will
possibly need at least three components of immune response.

25
2.9.3 Secondary Prevention
Secondary prevention comes into play after the disease process has been initiated in
the human host. The aim of such an approach is to minimize the spread of disease and to
reduce the serious consequences. This is achieved through early diagnosis and treatment.
Early diagnosis and prompt treatment of EVD offers benefits to the affected individuals as
well as to their families and the community.50
It helps to reduce the transmission of infection
and, hence, is considered as a method of prevention. It include early diagnosis and treatment
of EVD as depicted above. Epidemiological investigation, surveillance and laboratory testing
subcommittee should be set up and train mobile epidemiological surveillance teams and
ensure that the training of the teams includes essential communication skills and in-depth
knowledge about the disease and prevention measures.52
Such teams must: Adopt a case
definition adapted to the local context of the epidemic; actively search for cases and
investigate each reported case; for each suspected, probable, or confirmed case, draw up a list
of contacts and monitor them over a period of 21 days; Publish daily epidemiological
information in the form of a situation report; After consultation with the national reference
laboratory and partners, deploy a mobile field laboratory, if required; Link up and coordinate
human and wildlife epidemic surveillance; Collect the technical data that is necessary to
declare the end of the epidemic.
2.9.4 Tertiary Prevention
Tertiary prevention acts at the stage where disease has got established in the individual. It is a
costly venture, though recent efforts at community based rehabilitation have tried to bring
down the costs. Tertiary prevention can be applied at the last two levels of prevention. These
are: Disability limitation and Rehabilitation.49
Rehabilitation is an extremely costly venture.
The aim of rehabilitation is to reintegrate the affected individual in the community by

26
optimizing his functional ability. It involves psychological, vocational and social and
educational intervention.
Comprehensive public education campaigns should be conducted to address social
stigma and exclusion of former patients and health-care workers resulting from the public’s
potentially excessive fear of contagion, contamination, or any other commonly held belief.52
Encourage activities that facilitate the social inclusion of the bereaved, orphans,
widows, and widowers as well as organizing recreational activities and encourage children’s
return to school.52
2.9.5 Control Measures
Control measures during epidemics8, 51
include:
1. Active case identification and isolation of patients from the community to prevent
continued virus spread.
2. Identifying contacts of ill or deceased persons and tracking the contacts daily for the
entire incubation period of 21 days.
3. Investigation of retrospective and current cases to document all historic and ongoing
chains of virus transmission
4. Identifying deaths in the community and using safe burial practices
5. Daily reporting of cases.
Health-care personnel must be well educated on safe infection control practices to prevent
transmission in the health-care settings with the attendant disastrous consequences. Early
recognition and identification of patients with potentiated disease is critical.
Infection prevention and control measures in the hospital5, 8, 51
should include:

27
1. Patient placement: Patients should be placed in a single room (containing a private
bathroom) with the door closed. Where available, negative pressured rooms are
recommended.
2. Health-care provider protection: Health-care providers should wear gloves (fluid
resistant or impermeable), shoe covers, eye protection (goggles, face shield), and
facemask. Additional PPE might be required in a certain situation (e.g. copious
amount of blood, other body fluids, or faeces present in the environment), including
double gloving, disposable shoe covers and leg coverings. Floors and horizontal work
surfaces should be cleaned at least once a day; Cleaning should always be carried out
from “clean” areas to “dirty” areas, in order to avoid contaminant transfer.52
3. Aerosol generating procedures: Avoid aerosol generating procedures. If performing
these procedures, PPE should include respiratory protection (N-95 filtering respirator
or higher) and the procedure should be performed in the airborne isolation room.
4. Environmental infection control: Diligent environmental cleaning and disinfection
and safe handling of potentially contaminated materials is paramount. Appropriate
disinfectants for Ebola virus and other Filoviruses 10% sodium hypochlorite (bleach)
solution, or hospital grade quaternary ammonium or phenolic products. Health-care
providers are performing environmental cleaning and disinfection should wear
recommended PPE. Clothes, beddings etc. that are not disposable by incineration are
usually soaked in boiled water and disinfectants before washing.

28
CHAPTER THREE
3.0 METHODOLOGY
3.1 BACKGROUND OF THE STUDY AREA
Zaria is a major city in Kaduna State in North-Western Nigeria, as well as being a
Local Government Area. It was one of the original seven Hausa city-states. The 2006 Census
population was 1,500,000. Zaria, initially known as Zazau, was also the capital of the Hausa
kingdom of Zazzau. However, human settlement predates the rise of Zazzau, as the region,
like some of its neighbors, had a history of sedentary Hausa settlement, with institutional but
pre-capitalist market exchange and farming.52
In the late 1450s, Islam arrived in Zaria by the
way of its sister Habe cities, Kano and Katsina. Along with Islam, trade also flourished
between the cities as traders brought camel caravans filled with salt in exchange for slaves
and grain. Between the fifteenth and sixteenth century the kingdom became a tributary state
of the Songhai Empire. In 1805 it was captured by the Fulani during the Fulani Jihad. British
forces led by Frederick Lugard took the city in 1901.52, 53
Zaria's economy is primarily based on agriculture. Staples are guinea corn and millet,
and cash crops include cotton, groundnuts and tobacco. The city is considered by some to be
a main center of Hausa agriculture. Not only is Zaria a market town for the surrounding area,
it is the home of numerous artisans, from traditional crafts like leather work, dyeing and cap
making, to tinkers, print shops and furniture makers. Zaria is also the center of a textile
industry that for over 200 years has made elaborately hand-embroidered robes that are worn
by men throughout Nigeria and West Africa.54
Zaria is situated within the Sahel savannah characterized by a tropical, continental
climate with extensive dry season (October-May), during this period, a cold weather is

29
usually experienced due to North-Easterly wind (the Harmatan) which controls the tropical
continental air mass coming in from the Sahara. Its weather prevails over most parts of the
country. Temperatures get as low as 100
at night and as high as 400
in the afternoons. In
March and April, hot but dry weather is encountered, trailed by a sweeping-in of tropical
maritime air mass from the Atlantic Ocean which displaces the North-Easterly winds.52, 53
It is located between longitude 11°04′N 7°42′E, and latitude 11.067°N 7.700°E. Area
of economic importance include farming and education, hence it can easily be referred to as
“educational town”, being home to various academic institutions like the prestigious Ahmadu
Bello University Zaria (ABU)- the largest university in Nigeria and the second largest on the
African continent. The institution is very prominent in the fields of Agriculture, Science,
Finance, Medicine and Law. Zaria is also the base for the Nigerian College of Aviation
Technology, Federal college of education, Nuhu Bamali Polytechnic, National Research
Institute for Chemical Technology and Barewa College.53
Palladan is a suburb of Zaria, and is one of the eleven district wards in Sabon Gari
Local Government Area. The population of Palladan is 26487 as of 2006 census.52
Palladan is
divided into the predominant religion is Islam with Christian minority, while the major tribe
is Hausa/Fulani. Others include Yoruba, Bajju, Kadara. The majority of the inhabitants are
businessmen and women and petty traders. They also engaged in farming smelting and
smiting of iron, pottery and dying, others include military personnel, artisans lectures and
teachers as well.53, 54

30
3.2 STUDY DESIGN
This is a cross sectional descriptive study to assess the knowledge, perception and belief of
Ebola virus disease among the residents of Palladan, Zaria.
3.3 STUDY POPULATION
The study population consist of adult male and female residents of Palladan Zaria, who are
above the age of 18 years irrespective of their gender, religion, or ethnic backgrounds and
who have been living in Palladan for at least 1year.
3.4 INCLUSION CRITERIA.
1) Adult individuals that have been residents in Palladan for at least one year.
2) All resident of Palladan above the age of 18 years
3.5 EXCLUSION CRITERIA
1) Individuals residing in Palladan for less than a year.
2) Individuals less than 18 years of age.
3) Individual who do not want to be included in the study.
3.6 SAMPLE SIZE DETERMINATION
The following formula was used to calculate the sample size,
n=
𝑧2 𝑝𝑞
𝑑2
Where n = minimum sample size
d = desired degree of precision = 0.05

31
p= proportion of individuals with good knowledge, perception and belief of Ebola
virus disease
q = complementary probability =1-p
z = standard normal deviate taken as 1.96 in correspondence to 95% confidence
interval
Where n = sample size
z = 1.96
p = 90% (proportion of respondent who indicated Ebola virus disease spread through
exchange of body fluids in a study conducted in Nigeria by the NOIPolls Limited in
collaboration with EpiAFRIC, Abuja)
q = 1-0.90
n =
1.962×0.90×(1−0.90).
0.052
n =
0.3457
0.0025
n = 138.3
n ≅ 138
Attrition rate = 10% of 138
≅ 14
The desired sample size was 152 (sum of estimated sample size and attrition rate)

32
3.7 SAMPLING TECHNIQUE
A multistage sampling technique was employed.
Stage 1. The Palladan ward was divided into 4 using main the road that passed through the
middle of the town and by another Railway that cut across the main road. The sample size
152 was then divided by 4, to obtained 38.
Stage 2. The number of houses in each quarter were numbered, out of which only 7
houses were selected from each of the quadrant using a systematic probability
sampling technique.
Stage 3. In each of the houses selected, at least 5 questionnaire were administered using
a random table balloting technique until the required sample size was obtained.
3.8 DATA COLLECTION METHOD
Data was collected using a structured interviewer administered questionnaires. The questions
were structured in such a way to reflect the objectives of the study. Sections on the
questionnaire sought to collect information on: Socio-demographic characteristics (section
A); knowledge of Ebola virus disease (section B); and perception and belief of Ebola virus
disease (section C). The questionnaire was pre-tested in Baye community that has the same
socio-demographics with the study community. Data was collected over the period of 3rd to
5th
December 2014 by the Researcher and 4 trained research assistants.

33
3.9 DATA ANALYSIS
The data collected from the study was checked for errors and then edited accordingly. It was
then entered, validated and analysed using the Statistical Package for Social Sciences
(SPSS®
) software version 21. For the descriptive aspect of the analysis, frequency
distributions were generated. For all categorical variables, means and standard deviations and
other descriptive measures were determined. Frequency tables and graphs were constructed to
represent quantitative data, while qualitative data was represented with charts by using
the software programme Microsoft®
Excel®
2013. Chi-square test was applied for comparison
of proportions and for evaluating associations of categorical variables in contingency
tables. Statistical significance was said to be achieved where p values were equal to or less than
0.05.
3.11 ETHICAL ISSUES
1) Permission was obtained from the department of community medicine, Ahmadu
Bello University Teaching Hospital to embark on the study as well as verbal
consent from the district head ‘Mai Anguwa’ of Palladan Community before
entering the community to carry out the study.
2) Verbal consent was sought and obtained from the eligible respondents after assuring
them that all information obtained would be kept confidential
3.11 LIMITATIONS OF THE STUDY
1) Due to time and financial constraints, a larger sample could not be used which could
have been a better representation of the population.

34
2) Some of the respondents did not cooperate to be questioned because according to them,
for the past few years they have not gained anything from the results of such studies.
3) Barriers to entry of males into some houses for cultural reasons also hinder effective
sampling of the population.
4) Refusal to participate in the study

35
CHAPTER FOUR
4.0 RESULT
4.1 INTRODUCTION
A total of 152 questionnaires were administered and all questionnaires were filled and
returned in Palladan community from 3rd
to 5th December, 2014. All questionnaires were
analysed and the results of the finding are shown below.
4.2 SOCIO-DEMOGRAPHIC CHARACTERISTICS
Table 4.1: Showing distribution of socio-demographic characteristics of the respondents
Age Group(years) Frequency Percent
18-24 77 50.7
25-45 40 26.3
46-64 27 17.8
>65 8 5.3
Total 152 100
Majority of the respondents were between the age group 18-24 years (50.7%)
Table 4.2: Sex distribution of respondents
Sex Frequency Percent
Male 100 65.8
Female 52 34.2
Total 152 100
Most of the respondent (65.8%) are male and 34.2% are female.
Table 4.3: Marital Status of the Respondents

36
Marital Status Frequency Percent
Married 58 38.2
Divorced 2 1.3
Widow/widower 2 1.3
Single 90 59.2
Total 152 100
38.2% of the respondents were married, while 59.2% of them were single.
Table 4.4: Religion of Respondents
Religion Frequency Percent
Islam 91 59.9
Christianity 60 39.5
Others 1 0.7
Total 152 100
Majority of the respondents (59.9%) were Muslim and 39.5% were Christian.
Table 4.5: Ethnicity of the Respondents
Ethnicity Frequency Percent
Hausa 80 52.6
Yoruba 25 16.4
Igbo 14 9.2
Others 33 21.7
Total 152 100
Majority of the respondents (52.6%) were Hausa and other tribes account for 21.7%
Table 4.6: Educational Status of the respondents

37
Educational status Frequency Percent
Quranic 13 8.6
Primary 8 5.3
Secondary 71 46.7
Tertiary 56 36.8
None 1 0.7
Others 3 2
Total 152 100
Most of the respondents (46.7%) had secondary education as their highest level of
education. 5.3% and 36.8% of them had Primary and tertiary levels of education
respectively. 0.7% had no formal education
Table 4.7: Occupation of the Respondents
Occupation Frequency Percent
Farming 4 2.6
Petty Trader 16 10.5
Artisan 8 5.3
Business 34 22.4
Civil servant 12 7.9
Student 78 51.3
Total 152 100
Majority of the respondents (51.3%) were student, 22.4% are doing business and a few
(2.6%) of them were farmers

38
4.3 KNOWLEDGE OF EBOLA VIRUS DISEASE (EVD)
Figure 4.1 Percentage of the awareness of Ebola virus disease. 98 % of the respondent
have heard of Ebola virus disease and only minority (2%) have not heard of Ebola virus
disease
Figure 4.2. Incubation period of Ebola virus disease
Majority of the respondent (64.7%) recognised 2-21 days as an incubation period of EVD
98
2
Yes No
16.7
64.7
10
3.3
5.3
10 days 2-21 days 10-15 days 5 days None of the above

39
Figure 4.3. Source of information
Majority of the respondent (38.8% and 32.9%) heard of EVD through television and radio
respectively and few (7.9%) of them heard EVD through religious institution
(Mosque/Church)
Table 4.8: Percentage of knowledge of the cause of EVD
Age group
(years)
Microorganism Bat/monkey/
chimpanzee
Evil
spirit
gods Witchcraft Evil
doing/sin
Curse
18-24 11.2 39.5 3.3 7.2 1.9 0.7 2.6
25-45 7.2 22.4 1.3 4.6 0 0.7 0
46-64 5.9 13.8 3.9 1.3 0 0.7 1.3
>65 1.9 3.3 0.7 0.7 0 1.3 0
Televisio
n
Radio
Public
announc
ement
Mosque/
Church
Moblie
phone
Internet
Newspa
per
Percentage 38.8 32.9 19.7 7.9 13.8 22.4 11.8
38.8
32.9
19.7
7.9
13.8
22.4
11.8
0
5
10
15
20
25
30
35
40
45
Percentage
Source of information on EVD

40
Table 4.9 Percentage of knowledge of the cause of EVD
Highest
level of
education
Microorganism Bat/monkey/
chimpanzee
Evil
spirit
gods Witchcraft Evil
doing/sin
Curse
Quranic 3.4 4.6 1.9 1.3 0 2.6 0.7
Primary 2.1 3.9 0.7 1.3 0.7 0 0.7
Secondary 14.7 27.6 3.3 7.9 1.3 0 0
Tertiary 18.7 40.8 3.3 3.3 0 0.7 2.6
None 2.8 0.7 0 0 0 0 0
Others 0.8 1.3 0 0 0 0 0
Figure 4.4 Percentage of the respondents knows about mode of transmission of EVD
79.1% of the respondent believe that EVD can be transmitted through the exchange of body
fluids while 9.5% believe that it can be transmitted through other means such as hand
shaking, breast milk of infected person, eating bush meat.
10.1
15.4
79.1
9.5
0
10
20
30
40
50
60
70
80
90
By mosquitoes By air By exchange of body
fluids
Others
percentage

41
Figure 4.5. Knowledge of the symptoms of EVD
Most of the respondents (60.1%) recognised fever as a symptom of EVD, 45.6% knew
gastrointestinal bleeding and 12.1% knew respiratory symptom as a manifestation of EVD.
Table 4.10: Knowledge Regarding Cure of EVD
Has cure Frequency Percent
Yes 84 56
No 66 44
Total 150 100
56% of the respondent believe EVD has cure while 44% believe otherwise
60.1
14.1
23.5
20.1
12.1
45.6
0
10
20
30
40
50
60
70
Fever Flu-like
symptoms
Haemorrhagic
rash
Eye
manifestation
Respiratory
symptoms
GIT symptoms
e.g. bleeding
Percentage

42
Table 4.11: Prevention with Personal Protective Clothing
Prevented using personal
protective clothing
Frequency Percent
Yes 86 56.4
No 66 43.6
Total 152 100
56.4% of the respondents believe EVD can be prevented using personal protective clothing.
4.4 PERCEPTION AND BELIEF OF EBOLA VIRUS DISEASE (EVD)
Figure 4.6. The perception and belief of the cause of Ebola virus disease
Majority of the respondent (79.9%) attribute bat/monkey/chimpanzees as a cause of EVD.
9.4% and 14.1% of them attribute evil spirit and gods respectively as a cause of EVD while
minority of the respondent (2%) attribute witchcraft as a cause of EVD
9.4
14.1
2 3.4 4
79.9
0
10
20
30
40
50
60
70
80
90
percentage

43
Figure 4.7. Perception and belief towards prevention of Ebola virus disease
Most of the respondent (91.9% and 88%) believe EVD can be prevented by safe burial and
quarantine of contact respectively, while 23.2% believe in drinking or bathing with salt water
as well as 21.9% believe in bitter Kola
Figure 4.8. Behavioural change adapted toward prevention of EVD
Majority of the respondent (70%) have adapted washing hand with soap and water and
minority of them (2.1%) adapted drinking traditional herbs as a change in behaviour toward
prevention of EVD. 18% of them have not change their behaviour towards prevention of
EVD.
21.9
23.2
91.9
88
20.1
0 20 40 60 80 100
Bitter kola
Drinking salt water or bathing with it
Safe burial
Quarantine of contacts
Wearing of protective clothings
70
2.1
7.3 7.3
18
0
10
20
30
40
50
60
70
80
Wash hands with
soap and water
Drink traditional
herbs
Take antibiotics Wear gloves and
protective
clothing
None
percentage
Behavioural change adapted

44
Figure 4.9. Who advised the respondent to drink or bathe with salt water
Majority of the respondent (34.1%) were advised by a family member to drink or bathe with
salt water
Figure 4.10. Means through which respondents were advised to take or bathe with salt
water. Most of the respondent (39.3%) were advised through phone call and a minority
(2.2%) through a third party
3.7
20.9
34.1
5.2
0
5
10
15
20
25
30
35
40
Health worker A friend A family member Others
percentage
Source of advice on salt bathe and water as means of EVD
prevention
39.3
9
11.9
2.2
3.8
Phone call Text message Face to face instruction Through a third party Others

45
Table 4.12. Number of family members respondents that drank or bathe with salt water
family members that drank or bathe with salt water Frequent Percentage
1 2 1.8
2 14 12.8
3 18 16.5
More than three 75 68.8
Total 109 100
Most of the family (68.8%) members that drank or bathe with salt water are more than three
4.5 RELATIONSHIP ANALYSIS
Table 4.13: Cross tabulation between the highest level of education of the respondents
and those who drank or bathe with salt water
Highest Level of education Drank or bathe with salt
water
Total
Yes No
Quranic 6 7 13
Primary 4 4 8
Secondary 31 25 56
Tertiary 40 31 71
None 0 1 1
Others 2 1 3
Total 83 69 152
χ2= 1.921 df = 5 α level of significance = 0.05
Comment: The chi-square analysis above shows that there is no relationship between
highest level of education and salt water drinking

46
Table 4.14: Cross tabulation of health worker’s advice and those who drank or bathe
with salt water
Health worker’s advice drank or bathe with salt water Total
Yes No
Yes 4 1 5
No 79 68 147
Total 83 69 152
Comment: The chi-square analysis above shows that there is no relationship between health
worker’s advice and salt water drinking
Table 4.15: friend’s advice and those who drank or bathe with salt water
Friend’s advice Drank or bathe with salt water Total
Yes No
Yes 28 0 28
No 55 69 124
Total 83 69 152
Comment: The chi-square analysis above shows that there is significant relationship between
friend’s advice and salt water drinking.

47
Table 4.16: Cross tabulation of gender and those who drank or bathe with salt water
Gender drank or bathe with salt water Total
Yes No
Male 48 52 100
Female 35 17 52
Total 83 69 152
Comment: The chi-square analysis above shows that there is relationship between Gender
and salt water drinking.

48
CHAPTER FIVE
5.1 Discussion
The study was conducted among the residents of Palladan, Zaria. It assessed the
knowledge, perception and belief of Ebola virus disease. Out of 152 questionnaires
administered, 152 were returned and was subsequently analyzed. Response rate was therefore
100%. Out of the 152 respondents, 100 are male and female constitute the remaining 52
respondents with male to female ratio of 2:1. This is a slightly higher male to female
proportion compared to a study done by EpiAfric®
-Polling Analytical Databank Strategies
(an NGO based in Abuja) in 2014, were the proportion was almost equal with 51% and 49%
respectively.1
Majority of the respondents were within the age group 18-24 years (50.7%),
and most of the respondents were Muslim (59.9%) and with Hausa accounting for most of the
respondents (52.6%) followed by Igbo tribe (9.2%) and other tribes (21.7%)
Majority of the respondents (46.7%) had secondary education, followed by Tertiary
level of education (36.8%), 8.6% of the respondents had Quranic education, (5.3%) had
Primary education, while four of them (2.7%) had no form of formal education. Half (51.3%)
of the respondents were students; followed by business men/women (22 .4%); petty traders
(10.5%). The lowest represented occupation in the research was farming (2.6%), this is
contrary to that found by the earlier quoted study1
in which a slight majority of the
respondents were self-employed (23%), followed by business men/women (18%), and their
lowest was religious leader/missionary (1%).
Concerning the awareness of EVD, almost everyone has heard of EVD (98%) and
74.5% believe EVD had been in Nigeria. This is similar to that found in a study, among 1,007
United State (U.S) adults by the Pew Research Centre56
where 98% have heard at least a little
about the current outbreak of the virus and nearly half of Americans (49%) were tracking news

49
about Ebola very closely, while in Nigeria, 97% are aware of EVD as found in the study by
EpiAfric. However, a study in Sierra Leone by Catholic Relief Services in conjunction with
UNICEF and FOCUS 1000, found out that everyone (100%) is aware of EVD and 97% of the
respondent surveyed belief EVD exist in Sierra Leone. 44
Majority of the respondent heard of
EVD through Television (38.8%), followed by radio (32.9%), internet (22.4%) then public
announcement (19.7%), and least (7.9%) in religious venues such as mosques and churches.
Similarly, the source of information is similar to that found in Sierra Leone with radio being
by far the primary channel of receiving information on EVD (88%), followed by television
(21%).44
Regarding the cause of EVD, bats, monkey, chimpanzee, and wild animals are mostly
associated with the cause of EVD (79.7%) and (26.3%) of the respondents link the cause of
EVD to a micro-organism. Respondents with no or low level of education 2.8% and 6.3%
respectively were less likely to associate the cause of Ebola virus disease to microorganism
(virus) as compared to those with secondary (14.7%) or higher level of education (tertiary)
18.7% . Less than (3.4%) of the respondents believe that EVD is caused by gods, witchcraft,
evil-doing, or curse. This is less than that found by in a study in the U.S by the Harvard school
of public health in which they found two-third of the respondents (68%) attributed the cause
of EVD to microorganism (virus).45
Misconception that EVD could be transmitted by mosquitoes was found among 10.1%
of the respondents and by air in 15.4% of them as compared to 7% found in the former in the
Nigerian study by EpiAfric. However, a high misconception (30%) that EVD can be caught
through mosquitoes and another 30% by air was found in a study by Oxfam in Guinea 2014.1,55
There is however good knowledge on the transmission of EVD through exchange of body
fluids (79.1%) similar to the study in Nigeria by EpiAfric 2014 in which 83% of the

50
respondents believe EVD spreads through exchange of body fluids while 43% was found in
Sierra Leone by CRS/UNICEF/FOCUS 1000.1, 44
Knowledge of correct incubation period of 2-21 days was found in majority of the
study subjects (64.7%) as well as correct knowledge of the symptoms of EVD where two-third
(60.1%) and a third (45.6%) of the respondent knew fever and gastrointestinal bleeding as a
symptoms of EVD respectively. 12.1% of the respondents believe respiratory symptoms
(cough, breathlessness) could be a presentation of EVD, this is similar to that found in a study
in Washington 2014, out of 1204 respondents, 65% knew the incubation period of EVD and
69% knew fever and gastrointestinal bleeding as a symptoms of EVD.57
Despite half (53.3%) of the respondents drank salt water to prevent themselves from
EVD during the Ebola outbreak in Nigeria 2014, only less than one quarter believe that they
can protect themselves from Ebola by drinking salt water or bathing with it or eating biter
kola; such believe is lower compared to that found in Sierra Leone in which they found 40%
of respondents believe bathing with salt and hot water can prevent EVD and 1 in 5 believe that
spiritual healers can successfully treat the disease.43
Further Chi-square analysis at 5 degree of
freedom and level of significance-p value of 0.05 showed that there is no relationship between
bathing with or drinking salt water and level of education. This is contrary to what was found
in a study44
to assess knowledge, attitude and practice relating to EVD prevention and medical
care in Sera Leone, where they found out that such belief is higher in both the educated in
urban and rural areas.
There is significant change in behaviour and practice towards prevention of EVD in
which 70% wash hands with soap and water upon hearing Ebola outbreak in Nigeria. However,
18% of the respondents have not changed their behaviour. This is lower than that found in the
Sierra Leonean study44
where nearly everyone (95%) reported some behaviour change and
92% in Guinea in the study by Oxfam 2014.4, 56

51
Generally, there are positive perception towards key prevention of Ebola virus disease
such that 88% of the respondents agree that they can prevent Ebola by quarantine of contacts,
91.9% agree that they can prevent the disease by safe burial practices; and 79.9% agree
prevention should include wearing of protective clothing. This is contrary to that found in
Guinea in study by Start Fund Project in 2014, which demonstrated that 67% of 2,050
respondents did not know any method of preventing Ebola and 47% did not even believe Ebola
existed and, 88% said it was a way for the government and non-governmental organisation
(NGOs) to make money.56
Chi-square analysis (x2
=28.533 with p value of 0.05 and 1 degree of freedom) of the
relationship between friend’s advice and those who drank or bathed with salt water for the
prevention of EVD showed that there is significant relationship. Similarly, although 2.6% of
those that drank or bathe with salt water were advised by a health worker, there is no
relationship between health worker’s advice and bathing with salt water for the prevention of
EVD as analyzed by chi-square (x=1.345, p value=0.05, df=1).
5.2 CONCLUSION
Although majority of the respondents have a good knowledge and perception of the cause,
means of transmission, symptoms ways of prevention of Ebola virus disease, there is some
misconception of regarding the practice of prevention of EVD. Majority of the respondents
believe EVD had been transmitted in Nigeria. The good knowledge and perception of EVD as
well as the belief that it ever exist in Nigeria could be responsible for the significant change in
behaviour of the respondents towards EVD prevention.
5.3 RECOMMENDATIONS

52
The Kaduna state government in collaboration with the federal ministry of health should create
policies and programmes to:
 Address misconception about the disease and clearly spell out mode of transmission in
the local languages
 Develop clear messages in local languages on protective practices through health talks
and programmes on mass media.
 Should set up strategies towards educating Palladan community to maximally use
television and radio as it is the preferred channel with the widest geographic reach and
effectively use television medium to tell survivor stories and create a hopeful narrative
stories;
 Support inter-personal engagement at grassroots level in order to improve community
response and ownership of the social mobilization efforts;
Health workers in collaboration with the ministry of health of Kaduna state to
 Ensure that key information on Ebola is communicated directly by health professional.
 Qualitative research using the explanatory model should be funded and undertaken to
evaluate population/communities’ belief and perception of the causes and control of
EVD, as well as the attendant cultural threats. Such research will generate ideas that
will aid in better EVD control.

53
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