school of public health college of health sciences

SCHOOL OF PUBLIC HEALTH

COLLEGE OF HEALTH SCIENCES

UNIVERSITY OF GHANA

ASSESSMENT OF KNOWLEDGE, ATTITUDES AND PRACTICES AMONG

HEALTH CARE WORKERS TOWARDS LASSA FEVER IN 5 HEALTH

FACILITIES OF FARANAH DISTRICT IN UPPER GUINEA

BY

MORY CHERIF HAIDARA

10639057

THIS DISSERTATION IS SUBMITTED TO THE UNIVERSITY OF GHANA,

LEGON IN PARTIAL FULFILMENT OF REQUIREMENTS TOWARDS THE

AWARD OF MASTER OF PUBLIC HEALTH DEGREE

MAY, 2019

University of Ghana http://ugspace.ug.edu.gh

i

DECLARATION

I do hereby declare that apart from people’s knowledge that have been duly acknowledged,

this research proposal is the result of my hard work under competent supervision

I take full responsibility for any shortcomings in this work.

…………………………………… ………………………

MORY CHERIF HAIDARA DATE

10639057


ii

CERTIFICATION

I hereby certify that this thesis was supervised in accordance with the laid down

procedures by the University.

…………………………………… ………………………

DR. ERNEST KENU DATE

(Academic Supervisor)


iii

DEDICATION

This research work is dedicated to my mother, NANSIRA MAGASSOUBA and to the

memory of my Uncle, TAHIROUN CHERIF.


iv

ACKNOWLEDGMENT

Glory be to God almighty for giving me the strength, sagacity and grace to complete my

dissertation. My sincere appreciation goes to my supervisor for his guidance, inspiration

and support. Dr. Ernest Kenu, may God reward you abundantly. My gratitude goes to

LAROCS Project for their financial support and care. I appreciate the warm reception from

the health workers at the GENERAL Hospital, ABATTOIR, BENDOU, MARCHE, AND

TIRO HEALTH CENTRES. I am very grateful for giving me the opportunity to use your

facilities for the study I am grateful for your support. To my family and friends, thank you

for being there for me. May God bless you. This research would have been impossible to

undertake without the support.


v

ABSTRACT

Introduction: Lassa fever (LF) is a zoonotic acute viral haemorrhagic fever caused by the

Lassa virus (LASV). Nosocomial infection with high case fatality rate of the disease has

been described primarily in the hospital settings in many West African countries including

Guinea. The nosocomial spread is due to the current state of the health system, leading to

poor medical practice. Hospitalized patients with LF may pose a substantial risk to health

care workers (HCWs) and to other patients (Lavergne et al., 2016). Late diagnosis and

wrong treatment are factors that can increase the likelihood of nosocomial transmission.

Therefore, it is important that health care providers working in endemic communities have

adequate knowledge on the disease, its clinical features and diagnosis (Ea, Da, Ec, Og, &

Ebhodaghe, 2013).

Objectives: The study assessed knowledge, attitudes and practices and determined factors

influencing them among health care providers working in five health facilities of Faranah

district in upper Guinea (the general hospitals, two health centres in the urban area and

another two health centres in the urban area).

Methods: A descriptive cross-sectional survey and quantitative approach was used to

collect data. Pre-coded structured questionnaire were used to conduct interviews. All health

professionals who were working in these selected health facilities were enrolled into the

study, if found eligible. Statistical analysis was done in Stata (version 14.1) Software.

Frequency distribution was done to compute proportions on good KAP, gender, religion,

educational level, and occupation. Multiple logistic regression analysis was used to assess

the strength of association between the knowledge and attitudes and each independent


vi

variable to assess the strength of association looking at the adjusted Odds Ratio (AOR)

with 95% confidence interval (CI).

Results: Sixty-three out of the 195 respondents (32.3%) had no idea what Lassa fever was.

Of the remaining one hundred and thirty-two, 67.7% (132/195) who had heard about Lassa

fever, their knowledge was accessed with a sixteen item questionnaire on knowledge

according to case definition. Nearly forty-nine percent (64/132) had good knowledge about

Lassa fever (p = 0.485; 95% CI = 0.4 – 0.6). Ninety-five percent of health professionals

(186/195) were found to have good attitude towards a suspected case of Lassa fever (p =

0.95; 95% CI = 0.91 – 0.97). With regards to practice, all health professionals had good

practices in dealing with a suspicious case of Lassa fever.

Conclusion: The study revealed a general low level of knowledge of LF disease among

the HCWs. Most of the HCWs had good attitudes and all of them had good practices

towards LF. Age and number of years of work were found to influence knowledge but not

attitudes and practices. There was not statistical significant difference in the KAP of HCWs

working in the general hospital compare to those working in the health centres. HCWs in

urban HC had better attitude compare to those in the rural ones. The Ministry of Health,

Guinea should plan more training on Lassa Fever with emphasis on other professionals as

much as medical doctors.


vii

TABLE OF CONTENTS

DECLARATION ................................................................................................................. i

CERTIFICATION .............................................................................................................. ii

DEDICATION ................................................................................................................... iii

ACKNOWLEDGMENT.................................................................................................... iv

ABSTRACT ........................................................................................................................ v

LIST OF TABLES .............................................................................................................. x

LIST OF FIGURES ........................................................................................................... xi

LIST OF ABBREVIATION ............................................................................................. xii

CHAPTER ONE ................................................................................................................. 1

INTRODUCTION .............................................................................................................. 1

1.1 Background ............................................................................................................... 1

1.1.1 Lassa Fever Burden ............................................................................................ 1

1.1.2 Lassa Virus Infection .......................................................................................... 2

1.2 Problem Statement .................................................................................................... 4

1.3 Justification of Study ................................................................................................. 6

1.4 Conceptual Framework ...................................................................................... 8

1.5 Narrative of Framework ............................................................................................ 8

1.6 Research Questions ................................................................................................... 9

1.7 Objectives ................................................................................................................ 10

General objective ....................................................................................................... 10

The specific objectives of study are .......................................................................... 10

CHAPTER TWO .............................................................................................................. 11

2.0 LITERATURE REVIEW ........................................................................................... 11

2.1 Definition ................................................................................................................ 11

2.2 Historical Account of Lassa Fever .......................................................................... 11

2.3 Properties/Strains of LASV ..................................................................................... 12

2.4 Replication of LASV ............................................................................................... 13

2.5 Epidemiology .......................................................................................................... 13

2.6 The Rodent Reservoir/Host of LASV ..................................................................... 15


viii

2.7 Transmission of LF ............................................................................................ 16

2.7.1 Rodents-To-Human .......................................................................................... 16

2.7.2 Human-to-human .............................................................................................. 17

2.8 Pathogenesis of LF .................................................................................................. 17

2.9 Amplification of LF ................................................................................................ 18

2.10 Clinical Presentations of LF .................................................................................. 18

2.11 Complications of LF ............................................................................................. 19

2.12 WHO Case Definition of LF for Epidemiological Surveillance ........................... 20

2.12.1 Clinical description ......................................................................................... 20

2.12.2 Laboratory criteria for diagnosis .................................................................... 20

2.12.3 Case classification .......................................................................................... 20

2.13 Prognostic Factors ................................................................................................. 21

2.14 Diagnosis of LF ..................................................................................................... 21

2.14.1 Laboratory investigations ............................................................................... 22

2.15 Treatment .............................................................................................................. 23

2.16 Prevention and Control.......................................................................................... 24

2.16.1 The individual prevention ............................................................................... 24

2.16.2 The community prevention ............................................................................. 24

2.16.3 Vaccine ........................................................................................................... 25

2.17 Knowledge attitude and practice on LF and other haemorrhagic fevers............... 25

CHAPTER THREE .......................................................................................................... 27

3.0 METHODOLOGY ..................................................................................................... 27

3.1 Study Design ........................................................................................................... 27

3.2 Study Area ............................................................................................................... 27

Figure 4: Map for the location of Faranah district ................................................. 28

3.2.1 The general hospital of Faranah district ...................................................... 28

3.2.2 Health centres.............................................................................................. 28

Urban health centres ........................................................................................... 29

3.3 Study Population ..................................................................................................... 29

3.4 Sampling Technique ................................................................................................ 29

3.4.1 Inclusion Criteria ........................................................................................ 29


ix

3.4.2 Exclusion Criteria ....................................................................................... 30

3.5 Study variable ..................................................................................................... 30

3.5.1 Dependent variable ..................................................................................... 30

3.5.1.1 Knowledge ................................................................................................. 30

3.5.1.2 Attitudes .................................................................................................. 30

3.5.1.3 Practices of HCWs .................................................................................. 31

3.5.2 Independent variables ................................................................................. 31

3.6 Data Collection Methods and Instruments .............................................................. 32

3.7 Data analysis ........................................................................................................... 32

3.8 Ethical consideration ............................................................................................... 33

CHAPTER FOUR ............................................................................................................. 35

4.0 RESULTS ................................................................................................................... 35

4.1 Socio-demographic characteristics of respondents ................................................. 35

4.2 Proportion of health care professionals who have good knowledge on LF ............ 36

4.3 Proportion of health care professionals with good attitude and practice ................ 37

4.4 Socio-demographic characteristics associated with knowledge ............................. 38

4.5 Factors associated with health professionals’ attitude towards LF’s suspected case

....................................................................................................................................... 41

CHAPTER FIVE .............................................................................................................. 44

5.0 DISCUSSION ............................................................................................................. 44

6.0 CONCLUSION AND RECOMMENDATION .......................................................... 49

6.1 Conclusion ............................................................................................................... 49

6.2 Recommendations ................................................................................................... 51

REFERENCES ................................................................................................................. 52

APPENDICES ..................................................................................................................... a

INFORMED CONSENT FORM ......................................................................................... a


x

LIST OF TABLES

Table 1: Independent Variable .......................................................................................... 31

Table 4.1a: Socio-demographic characteristics of respondents (n=195) .......................... 35

Table 4.1b: Socio-demographic characteristics of respondents (n=195) .......................... 36

Table 5a: Factors associated with health care workers' knowledge about Lassa Fever.... 40

Table 6a: Factors associated with health care workers' attitude towards LF's suspected

case .................................................................................................................................... 42


xi

LIST OF FIGURES

Figure 1: Conceptual framework ........................................................................................ 8

Figure 2: Lassa fever risk map in West Africa, with the higher risk located in the red

zones ................................................................................................................................. 14

Figure 3: Mastomys natalinsis, the reservoir of Lassa fever ............................................ 16

Figure 4: Map for the location of Faranah district ............................................................ 28

Figure 5: Proportion of health care workers who have good knowledge about Lassa fever

........................................................................................................................................... 37

Figure 6: Proportion of health care workers with good attitude ....................................... 38


xii

LIST OF ABBREVIATION

CDC Centres for disease control and prevention

EVD Ebola virus disease

KAP Knowledge Attitudes and Practices

LASV Lassa virus

LF Lassa fever

MOH Ministry of health

NGOs Non-government organizations

PCR Polymerase chain reaction

PPE Personal protective equipment

WHO World health organization


1

CHAPTER ONE

INTRODUCTION

1.1 Background

1.1.1 Lassa Fever Burden

Lassa fever (LF) is a zoonotic acute viral haemorrhagic fever caused by the Lassa virus

(LASV). It was first described in north eastern Nigeria (Lassa, in Borno state, in the

Yedseran River valley at the South end of Lake Chad) in 1969 (Ajayi et al., 2014). It is

endemic in Benin, Guinea, Liberia, Mali, Sierra Leone, and Nigeria with peaks in incidence

closely related to season. Same cases have also been reported into western countries where

LF is not endemic but was imported by returning travellers in Germany, Netherlands,

Sweden, US and UK (Ea et al., 2013). According to the World Health Organization LF

affects between 100,000 to 300,000 persons in West Africa per year and approximately

5,000 deaths (WHO, 2007). Around 80% of infected individuals are asymptomatic or have

mild symptoms while 20% progress to disease. Case fatality rate is estimated to be around

15% among those who develop severe disease. However, in 2016, the mortality rate was

reported to be above 50%. Pregnant women with LF have a high mortality rate especially

in the third trimester. Recovered LF patients may experience hearing loss as well as other

neurologic side effects (WHO, 2017). Based on prospective studies performed in four of

the most affected countries, Guinea, Sierra- Leone, Liberia, and Nigeria, Richmond and

Baglole in the year 2003, estimated that 59 million people are at risk of primary LASV

infections with an annual incidence of disease as high as 3 million and as many as 67,000

deaths per year (Lukashevich, 2012). LF affects all age-groups and gender with a seasonal

clustering around the late rainy season and dry season (Olowookere et al., 2017).


2

1.1.2 Lassa Virus Infection

Lassa fever is an acute and occasionally severe rodent- borne viral haemorrhagic fever,

with cases in humans geographically constrained to sub-Saharan West Africa (Gibb,

Moses, Redding, & Jones, 2017). LASV is an arenavirus enveloped and contains two

single-stranded RNA segments of ambience polarity encoding five proteins (N. E. Yun et

al., 2012). The natural host of LASV is the multi-mammate rat, Mastomys natalensis which

is commonly found in human households and eaten as a delicacy in several African

countries and lives in close contact with humans (Olugasa et al., 2014). LF is symptomatic

in about 20% of cases when it causes an acute illness with nonspecific symptoms such as

fever and general weakness, headache, chest pain, vomiting, diarrhoea, cough, pleural

effusion, bleeding from orifices, and in the late stages, sometimes disorientation and coma

(Olowookere et al., 2017). Deaths from LF is due to the effective reduction of circulating

volume of the blood which can cause shock, and multi-organ system failure (Shaffer et al.,

2014). Presently, there is no licensed vaccine or immunotherapy available for prevention

or treatment of this disease. The antiviral drug ribavirin has been demonstrated to reduce

fatality from 55% to 5%, but only if it is administered within 6 days after the onset of

symptoms (Branco et al., 2011). LF presents with nonspecific symptoms similar to many

other endemic illnesses in West Africa, that making it difficult to diagnose clinically;

therefore, laboratory testing is needed to confirm the diagnosis (Raabe & Koehler, 2017).

Humans contract LASV primarily through contact with excreta of its natural host.

Although uncommon, secondary transmission of LASV between humans may occur

through direct contact with infected blood or bodily secretions, such as saliva, vomit, stool,

or urine (Bausch, Hadi, Khan, & Lertora, 2010). Human infections tend to be focal with


3

periodic familial or village clusters with secondary cases due to person-to-person spread.

Infections peak between January and May – during the dry season, but cases are seen year

round (Gibb et al., 2017). In this second type of contamination nosocomial transmission

plays an important role. According to Lavergne et al., nosocomial infection with high case

fatality rate has been described primarily in the hospital settings in many West African

countries including Guinea. The nosocomial spread is due to the current state of the health

system, leading to poor medical practices. Hospitalized patients with LF may pose a

substantial risk to health care workers (HCWs) and to other patients (Lavergne et al., 2016).

This nosocomial hazard can be minimized by proper and timely infection-control

measures, careful management of infected patients, and, in some cases, administration of

prophylactic therapy to HCWs after exposure. Late diagnosis and wrong treatment are

factors that can increase the likelihood of nosocomial transmission (Ea et al., 2013). Since

no human vaccine exists and therapeutic options are limited to the broad-spectrum antiviral

ribavirin, rodent control and adjusting human behaviour are currently considered to be the

only options for LASV prevention (Mariën, Kourouma, Magassouba, Leirs, & Fichet-

Calvet, 2018). Late diagnosis and wrong treatment are factors that can increase the

likelihood of nosocomial transmission and adverse outcomes.

HCWs are potentially exposed to blood-borne pathogens through contact with infected

body parts, blood and other body fluids in the course of their work. It has been estimated

that each year, as many as three million HCWs all over the world experience percutaneous

exposure to blood-borne viruses Hepatitis C and B and HIV viruses. Apart from these

pathogens, LASV is fast gaining prominence as an emerging nosocomial transmitted


4

pathogen with significant public health impact in the West African sub region (Ekaete

Alice, Akhere, Ikponwonsa, & Grace, 2013).

Therefore, important that health care providers working in endemic communities have

adequate knowledge of the disease through its clinical presentation and its diagnosis.

Because, when these HCWs are themselves ignorant of the disease, the tendency to

misdiagnose and treat wrongly not only puts the health worker at risk, but also endangers

the lives of the close family contacts and community at large. HCWs in the endemic area

should have comprehensive information about the virus and the disease it causes.

1.2 Problem Statement

Viral haemorrhagic fevers like Lassa fever are among the most feared diseases due to their

high case fatality rates, severe clinical presentations and ease of transmission. Unlike most

viral haemorrhagic fevers, which are recognized only when outbreaks occur. LF is endemic

in West Africa, with an estimated tens of thousands of cases annually (Shaffer et al., 2014).

Since the identification of LASV, human- to-human transmission has been documented in

several nosocomial outbreaks, leading to an initial perception that the virus was both highly

contagious and virulent (Lo Iacono et al., 2015). The availability of laboratory testing has

been limited by the designation of Lassa virus as a category (Raabe & Koehler, 2017). A

pathogen by the National Institute of Allergy and Infectious Diseases (NIAID). Biosafety

level 4 (BSL-4) precautions are recommended for handling potentially infectious

specimens (Raabe & Koehler, 2017).


5

Existence of signs common to LF and other diseases such as malaria (fever, asthenia,

vomiting) which is an endemic disease, leading cause of consultation in health facilities in

Guinea (30% of consultations). It is very difficult for HCWs to identify Lassa fever’s

patient because of similarity of its signs and symptoms of another tropical diseases.

Additionally in West African towns and villages where there are no facilities for laboratory

diagnosis, most Lassa fever infections are treated as malaria (Ogbu, 2014). Therefore it is

imperative that health care workers in endemic communities are adequately sensitized on

the disease, it’s clinical features and diagnosis (Ea et al., 2013).

The difficulty of distinguishing between patients with LF and other patients suffering from

most tropical diseases due to the similarity of symptoms and clinical signs and the absence

of a diagnostic laboratory in this endemic area endanger health providers and increase the

risk of developing nosocomial infections due to LASV. Hence the need to assess the

knowledge, attitudes and practices of health providers in this community.

The reasons for choosing the city of Faranah are based on the fact that previous studies

have revealed an endemicity of LF in this city (Lukashevich et al. 2012; Klempa et al.,

2013). Between 1990 and 1992 a large epidemiological investigation into the activity of

LASV in the human populations of the Republic of Guinea was conducted by Lukashevich

et al. (2012). They sampled 25 villages, distributed in different prefectures to establish the

LASV antibody prevalence using the ELISA assay. Their results allowed to calculate the

average of seroprevalence by prefecture. Thus, the prevalence of LF in the city of Faranah

was 35% or 149/420 (Klempa et al., 2013) A second important aspect is the proven

presence of native rodents belonging to the genus Mastomys which represents both the

reservoir and the vector of LASV in some villages of Faranah. According to the study by


6

Fichet-calvet et al., (2007), LASV-positive rodents were captured in the villages of Bantu,

Gbetaya and Tangaya. The prevalence of LASV in Mastomys natalensis is12.4% (51/412)

(Fichet-calvet et al., 2007).

The Regional Hospital of Faranah which is the reference hospital of all this region and

primary health centres which have been selected for this study are health facilities where

a very large number of patients is coming for health care. Thus these health facilities could

also receive any type of LF case because they are located in an endemic LASV area. Since

the load of patients is heavier, HCWs are more likely to contract the disease and so their

knowledge, attitudes and practices are critical.

1.3 Justification of Study

This study seeks to assess Knowledge, Attitudes and Practices among health care workers

towards LF in 5 health facilities of the prefecture of Faranah in Guinea.

The reasons for this study are first of all, no studies has yet been published on of health

care personnel regarding infections (nosocomial) LF in this locality of the country.

Secondly, the level of the KAP and the quality of the attitudes and practices of the

caregivers make them most vulnerable to a disease as transmissible as LF and therefore

deserves to be evaluated and known by the authorities in charge of health in the country.

In addition to significantly enriching the medical literature, this study will provide novel

empirical evidence to support efforts of previous basic research on LF in Guinea. It will

also be of great value to health care workers, medical researchers, the Governments of

other countries in sub-Saharan Africa where this disease is endemic, as it provides general


7

overview of the problem. Finally, this study will serve as a resource for other researchers

who may want to undertake a similar study in other cities in the country or in other

countries.

The difficulty of clinically distinguishing patients with FL and other patients suffering from

most tropical diseases due to the similarity of symptoms and clinical signs and the absence

of a diagnostic laboratory in this endemic area, thus putting at risk the HCWs who work

there and increasing the risk of developing nosocomial infections due to LASV are among

other reasons for choosing this topic. Hence the need to assess the knowledge, attitudes

and practices of health providers in this community.


8

1.4 Conceptual Framework

Figure 1: Conceptual framework

1.5 Narrative of Framework

This conceptual framework shows how individual factors (professional status, number of

years of work of health staff), factors related to interventions (Ebola disease epidemic,

training seminars and Sensitization on haemorrhagic fevers) and factors related to the

health structure through the type (General Hospital or Health centre), the location (urban

or rural), the service of work (General medicine, surgery, paediatrics etc...) Could influence

the health care staff of these different sanitary structures.

Intervention factors:

Ebola epidemic

Training on Viral

Haemorraghic Fevers

KAP

Knowledge

Attitudes

Practices

Individual factors

Age

Sex

Religion

Occupation

Number of

year of work

Facility factors

Location

Type of facility

Unit of work

Nosocomial

Transmission of

LASV


9

Indeed, we assume that in a first aspect the HCWs’ KAP about LF could be influenced by

his or her professional status. In this order of thought we think that HCWs with professional

status as a doctor could have a higher level of KAP compared to other HCWs. It is also

possible that HCWs who have many years of experience have a higher level of KAP

compared to those who have less. In a second aspect of this conceptual framework, we also

assume that their KAP could also be influenced by the advent of the Ebola disease

Epidemic which occurred in the country from 2014 to 2016 in the county and with the city

of Faranah having had cases and interventions such as workshop and awareness campaigns

on Viral Haemorrhagic Fevers in general and on LF in particular.

Factors related to the health facility are factors which could directly influence the HCW’s

because we assume that a general hospital may receive more training seminars than a health

centres and urban health centres are more in a position to receive than rural ones. Otherwise

health facility factors could influence individual factors by assuming that there would be

more HCWs in urban health centres area than the rural area health centres. Which could

indirectly affect the HCWs’ KAP.

1.6 Research Questions

• What is the level of knowledge, attitudes, and practices of the health care workers

on Lassa fever in hospitals of the endemic region of Guinea?

• How does socio-demographic factors influence practices of healthcare

professionals?


10

• Is there a (statistically significant) difference between the KAP of HCWs who are

working at the Regional hospital and the KAP of those who are working in the

health centres?

• Is there a (statistically significant) difference between the KAP of HCWs who are

working in the urban health centres and those who are working in rural health

centres?

1.7 Objectives

General objective

To assess knowledge, attitudes and practices of HCWs on LF in 5 health facilities of

Faranah district in upper Guinea and determine whether KAPs differ by place of work

(Rural vs Urban or Regional vs Health Centres)

The specific objectives of study are

1. To determine the proportion of HCWs having good knowledge about LF.

2. To determine the proportion of HCWs having good attitudes and good practices in

dealing with a suspected case of L.F.

3. To identify socio-demographic factors that could influence the KAP of HCWs

working in these 5 health facilities on LF.

4. To assess whether KAP of HCWs vary by type of facility (General Hospital vs

Health centres) and place of work ( Rural vs Urban)


11

CHAPTER TWO

2.0 LITERATURE REVIEW

HCWs are potentially exposed to blood-borne pathogens through contact with infected

body parts, blood and body fluids in the course of their work. It has been estimated that

each year, as many as 3 million HCWs all over the world experience percutaneous exposure

to blood-borne viruses Hepatitis C and B and HIV viruses. Apart from these pathogens,

The public health impact of LASV in the West African sub region as an emerging

nosocomial transmitted pathogen requires significant response (Ekaete Alice et al., 2013).

2.1 Definition

Infection with LASV, a member of the Arenaviridae, results in a spectrum of illness from

unapparent infection to Lassa fever, a severe multisystem disease that often has

haemorrhagic manifestations (Robinson et al., 2016). Its initial clinical manifestations are

difficult to differentiate from those of other common febrile illnesses, such as malaria, and

a high index of clinical suspicion is required in the diagnosis (Akhuemokhan et al., 2017).

2.2 Historical Account of Lassa Fever

Lassa fever was first described in Sierra Leone in the 1950s but the virus responsible for

the disease was not identified until 1969 when two missionary nurses died in Nigeria, West

Africa, and the cause of their illness was found to be LASV, named after the town in

Nigeria where the first cases were isolated (Mccormick et al., 2017). Although LASV was

identified in 1969, records of haemorrhagic fever (HF) since the 1920s indicate this virus

had been circulating for at least 50 years (Zapata & Salvato, 2015). The nurse presumably


12

acquired infection from an obstetrical patient residing in Lassa. She died approximately

one week after the onset of symptoms. Subsequently, two more nurses that attended the

first patient contracted the disease, which was later named Lassa fever and caused the death

of one of them. Infectious virus (LASV) was isolated from all three cases (Yunusa &

Egenti, 2015).

2.3 Properties/Strains of LASV

LASV is the causative agent of LF, belongs to the family Arenaviridae. LASV is spherical

in shape and measures between 70 and 150 nm in diameter. It has a smooth surface

envelope with T-shaped spikes measuring 7–10 nm and built with glycoprotein. The

envelope encloses the genome which has helical nucleocapsid measuring between 400 and

1300 nm in length (Yunusa & Egenti, 2015). LASV can be inactivated by exposure to

ultraviolet light, gamma irradiation, or ultrasonic vibration. The effect of these physical

factors on the virus depends on the exposure time (Ogbu, 2014).

Arenaviruses are classified as segmented negative-sense RNA (nsRNA) viruses and are

phylogenetically closely related to other segmented nsRNA viruses belonging to

Bunyaviridae and Orthomyxoviridae (Nadezhda E. Yun & Walker, 2012). Its genome

consists of two segments, L (7.3 kb) and S (3.4 kb), which encode four proteins: Z (matrix),

L (polymerase), NP (nucleoprotein), and GPC, which is post-translationally cleaved into

two peptides, GP1 and GP2, that form the transmembrane glycoprotein (Andersen et al.,

2015). Arenaviruses have an 11 kb segmented genome comprised of single-stranded RNA

with ambience coding. The naked RNA is not infectious. There is considerable sequence

heterogeneity of LASVs across West Africa, with four recognized lineages three in Nigeria


13

and one in the area comprising Sierra Leone, Liberia, Guinea, and Ivory Coast (Grant,

Khan, Schieffelin, & Bausch, 2014).

2.4 Replication of LASV

Replication of Lassa fever virus forms the basis of its pathogenesis. The process starts with

adsorption of the virus on widely distributed and highly conserved cell-surface receptor

molecules. The glycoprotein of the spikes is responsible for the virus–cell interactions. The

other steps are penetration, removal of the viral envelope, and liberation of viral (Ogbu,

2014).

2.5 Epidemiology

LF accounts for an estimated 300,000 to 500,000 cases and 5000 deaths yearly in West

Africa, particularly in Sierra Leone, Nigeria, Liberia and Republic of Guinea. Serological

evidence of LF has also been found in Mali, Senegal and Central African Republic

(Ogoina, 2013). Severe and fatal disease may occur with all strains of LASV, but, other

than during the third trimester of pregnancy, in which maternal and fatal mortality are

elevated, no prognostic indicators are known that would identify, prior to disease onset

(Bausch et al., 2010).

The high seroprevelance for LASV specific antibodies in those Guinean (55%), Nigerian

(21.3%) and Sierra Leonean (52%) populations tested indicates that most infections are

mild or asymptomatic and do not require hospitalisation. This is supported by findings that

more than 80% of persons who developed antibodies have not reported recent febrile illness


14

(Mylne et al., 2015). LF is seen in both genders and all age groups (Grant et al., 2014). LF

disease is commonly found in rural communities, where the over 70% and where poverty

prevails and standards of living are low of the population resides. (Ea et al., 2013).

Figure 2: Lassa fever risk map in West Africa, with the higher risk located in the

red zones (Fichet-Calvet & Roger, 2009)

The virus has also been imported into countries where it is not endemic, for example, by

returning travellers. A few imported cases have been identified in countries outside of West

Africa endemic zone suggesting a wider distribution of LASV and challenging the current

dogma of LASV endemicity. For example, in 1980, a non-fatal case of Lassa fever was

diagnosed in The Netherlands in an aid worker stationed in Burkina Faso (ref). Nearly a


15

decade later a similar scenario unfolded in the United Kingdom (Sogoba, Feldmann, &

Safronetz, 2012).

In addition, LASV has been classified as a biosafety level 4 (BSL4) pathogen as a category

A bioweapon agent because of the potential for the spread this highly dangerous and

contagious pathogen (N. E. Yun et al., 2012).

2.6 The Rodent Reservoir/Host of LASV

After the first outbreaks reported in Nigeria and Sierra Leone in the seventies, identified

the reservoir in Sierra Leone, by isolating the virus in the multi-mammate rat, Mastomys

natalensis, a species indigenous to Africa (Fichet-Calvet, 2013). This distribution of

Mastomys in West Africa is highly variable and in some areas, 50% of domestic rodents

may be Mastomys. Since the rodents do not move far from their nest, and because LASV

is transmitted vertically in rodents, infection in local populations of rodents tends to cluster

(Ogoina, 2013).

A spatial survey of small mammals confirmed the multi-mammate rat, Mastomys

natalensis as the only reservoir host of LASV in Guinea (Fichet-calvet & Becker-ziaja,

2014). The 2-year longitudinal survey revealed that the reservoir host is more abundant

inside than outside of houses, especially during the dry season (Fichet-calvet & Becker-

ziaja, 2014).

The human disease, LF is definitely linked with the presence of Mastomys natalensis,

which is absent in coastal Guinea. In that region, only Mastomys erythroleucus (a local

species of the rat) was present and it has never been found to be infected by LASV,


16

justifying the low endemic zone described by Lukashevich et al. in 1993 (Fichet-calvet et

al., 2009).

Figure 3: Mastomys natalinsis, the reservoir of Lassa fever (Boisen et al., 2015)

2.7 Transmission of LF

There are only two 2 modes of transmission: Rodent-to-human (the primary mode) and

human-to-human (the secondary mode).

2.7.1 Rodents-To-Human

Inhalation of aerosolized virus

Corrupt practices by staple food producers, which involve drying cassava flour

(Garry) in the open air in the daytime and sometimes at night. This enables all

types of rat including Mastomys natalensis to contaminate the flour with their


17

excreta. Use of rat meat as a source of protein by people in some communities;

contamination of exposed food by rat faeces and urine(Lukashevich, 2012)

2.7.2 Human-to-human

Direct contact with blood, tissue secretions or excretion of infected humans through:

Needle stick or cut injuries from sharps used in LF cases - Airborne spread

Sexual contact with infected human. The virus maybe excreted in the urine of

patient for 3-9 weeks from the onset of illness. LASV can be transmitted via

semen for up to 3 months. Nosocomial transmission of LASV was well

described during the outbreaks that occasioned the discovery of the virus more

than 3 decades ago (Anderson, 2015).

Transplacental transmission from infected mother to unborn child is less frequently

reported but it is associated with poor prognosis for mother and foetus (Ogoina, 2013).

2.8 Pathogenesis of LF

After inoculation, LASV replicated first in dendritic cells and other local tissues, with

subsequent migration to regional lymph nodes and spread by lymph and blood monocytes

to a wide range of Tissues and organs occurs.

Thus, the pathogenesis of LF would mainly relate to the disruption of cellular function by

the virus. And most often patients die without significant bleeding and histopathological

lesions are generally not serious enough to explain the death (Grant et al., 2014). The level

of viremia is highly predictive of the disease outcome (Nadezhda E. Yun & Walker, 2012).

In a study involving 137 patients with LF, patients that presented with viremia < 103


18

median tissue culture infectious dose (TCID 50)/ml on the day of hospitalization had 3.7

times greater chance of survival than those admitted with higher levels of viremia.

Similarly, the probability of fatal outcome in patients with serum titters > 103 TCID50/ml

and serum levels of aspartate aminotransferase (AST) ≥ 150 international units (IU)/L was

21 times higher than that in patients not meeting either of these criteria (Nadezhda E. Yun

& Walker, 2012). The humoral response often lags, with neutralizing antibodies typically

appearing after recovery in survivors and not at all in most fatal cases (Khan et al., 2008).

2.9 Amplification of LF

LF affects all age-groups and gender with a seasonal clustering around the late rainy season

and dry season (Olowookere et al., 2017). The highest incidence appears to be in eastern

Sierra Leone, northern Liberia, southeaster Guinea, and central and southern Nigeria.

However, the risk of exposure to LASV varies significantly in a given country and often

among regions or even villages within endemic areas (Grant et al., 2014).

A detailed systematic literature review identified nine incidents of Lassa fever cases being

imported into Europe, (including one case which was in transit in London while travelling

to the U.S.) between 2000 and 2010 (Gilsdorf, Morgan, & Leitmeyer, 2012).

2.10 Clinical Presentations of LF

LF is highly variable disease with a broad range of manifestations and many degrees of

severity. There are no firm clinical predictors or pathognomonic signs. LF presents at its

early stage with symptoms and signs indistinguishable from those of other viral, bacterial

or parasitic infections common in the tropics such as malaria, typhoid and other viral


19

haemorrhagic fevers (Ea et al., 2013). Incubation periods range from 7 to 10 days, followed

by a flu-like illness that lasts 2 to 3 days, with a progressive fever, chills, malaise,

weakness, headache and myalgia in the back or the limbs (Fichet-Calvet, 2013). The

pharynx may be erythemic or even exudative, a finding which has at times led to

misdiagnosis of streptococcal pharyngitis. Gastrointestinal signs and symptoms occur early

in the course of disease and may include nausea, vomiting, epigastric and abdominal pain

and diarrhoea (Grant et al., 2014).

Clinically discernible haemorrhage is seen in fewer than 20% of cases and never in the first

few days of illness. Hematemesis, melena, haematochezia, metrorrhagia, petechiae,

epistaxis, and bleeding from the gums and venepuncture sites may develop, but

haemoptysis and haematuria are infrequent. Severe LF appears to result from an

insufficient immune response, with higher levels of viremia and lower antibody titres in

fatal cases relative to survivors (Fichet-Calvet, 2013).

2.11 Complications of LF

Clinical complications such as pleural and pericardial effusions, facial oedema, bleeding

from mucosal surfaces, and neurological manifestations occur. Capillary lesions cause

haemorrhage in the targeted organs of the stomach, small intestine, kidneys, lungs, and

brain; and among the clinical signs, sore throat, vomiting, and bleeding are highly

correlated with poor outcome, resulting in death after a mean period of 12 days after the

onset of illness (Idemyor, 2010).


20

2.12 WHO Case Definition of LF for Epidemiological Surveillance

2.12.1 Clinical description

An illness of gradual onset with one or more of the following: malaise,

fever, headache, sore throat, cough, nausea, vomiting, diarrhoea, myalgia,

chest pain, hearing loss, and

A history of contact with excreta of rodents or with a probable or confirmed

case of Lassa fever.

NB: In LF endemic regions such as Nigeria, a suspected case is defined as an illness with

onset of fever and no response to treatment of usual causes of fever in the area and at least

one of the following signs:

Bloody diarrhoea

Bleeding from gums, into skin (purpura) and into eyes

Bloody urine

2.12.2 Laboratory criteria for diagnosis

Isolation of virus (only in laboratory of biosafety level 4) from blood,

urine or throat washings or

Positive IgM serology or seroconversion (IgG antibody) in paired serum

specimens or

Demonstration of Lassa virus antigen in autopsy tissues by

immunohistochemistry or in serum by ELISA

Positive Polymerase Chain Reaction (PCR) from serum or autopsy tissues

2.12.3 Case classification

Suspected: A case compatible with the clinical description.


21

Probable: A suspected case that is epidemiologically linked to a

confirmed case.

Confirmed: A suspected case that is laboratory-confirmed.

Contact: A person having close personal contact with the patient (living

with, caring for) or a person testing the laboratory specimens of a patient in

the 3 weeks after the onset of the illness.

2.13 Prognostic Factors

Prognosis depends on how early a patient presents at the clinic and better in males who

may acquire partial immunity due to the habit of patronizing food vendors. A study done

in Nigeria, the case fatality rate in males was 23% compared to women with 44%, though

males were four times more commonly affected than females (Yunusa & Egenti, 2015).

2.14 Diagnosis of LF

The signs and symptoms of LF may be difficult to distinguish from diseases that are

common in the tropics such as severe malaria, typhoid fever, yellow fever and other viral

haemorrhagic fevers, but diagnosis can be assisted with simple laboratory support but

definitive diagnosis requires testing that is available only in highly specialized laboratories.

As the symptoms of LF are so varied and nonspecific, clinical diagnosis is often difficult

especially early in the course of infection. Hence, to make accurate diagnosis of LF, clinical

manifestation, epidemiological data, and result of laboratory findings should be taken into

consideration (Yunusa & Egenti, 2015).


22

Early events in LASV infection are complex and it has been difficult to design early

diagnostic tests. Consequently, there is no commercially available diagnostic assay for

early laboratory detection of LASV infection. Early diagnosis is important for case

classification, implementation of prevention measures, contact-tracing and treatment

initiation. LASV isolation is the ‘gold standard’ for LF diagnosis and must be done in a

high containment Biosafety Level-4 (BSL-4) facility, over several days (Zapata & Salvato,

2015).

2.14.1 Laboratory investigations

The signs and symptoms of LF may be difficult to distinguish from other common disease

in sub-Saharan Africa. Therefore, laboratory investigation is crucial in the diagnosis of

Lassa fever. Lassa fever can be diagnosed by:

Detection of the viral antigen, antibodies, or conventional virus culture.

The classical method used to detect LASV infection is inoculation of the

Vero cells with serum, cerebrospinal fluid, throat washing, pleural fluid, or

urine of the suspected individual patient. The specimen for laboratory

analysis should be collected as soon as the patient is suspected of being

infected. This conventional method is not affected by the variability of the

virus; however, the major disadvantage is the long turn- around time, which

may be days to weeks, for the result to be obtained.

One method of detection of the virus antigen is by enzyme-linked

immunosorbent assays (ELISAs) using Lassa virus–specific antibodies.

These tests are rapid and easy to perform. Also, they can be performed with


23

inactivated specimens, which is advantageous in the field if sophisticated

equipment is not available.

Indirect immunofluorescence using virus-infected cells is commonly used

in detecting IgM and IgG antibodies to LASV and preferred for the

serological diagnosis of LF. However, it has its shortcomings and is not

completely specific due to cross-reactivity among African species of

arenaviruses.

The current method of choice for early and rapid diagnosis of LASV

infection is the real-time reverse-transcription PCR. Because Lassa virus is

an RNA virus, its RNA must be reverse transcribed into complementary

DNA prior to PCR (Idemyor, 2010).

2.15 Treatment

Ribavirin the antiviral drug is effective in the treatment of LF, but only if administered

early in the course of illness. In a study of LF in Sierra Leone, West Africa, it was observed

that patients with a high risk of death who were treated for 10 days with intravenous

ribavirin, begun within the first six days after the onset of fever, had a case- fatality rate of

5% (1 of 20) (p = 0.002), while patients whose treatment began seven or more days after

the onset of fever had a case fatality rate of 26% (11 of 43) (p = 0.01). The study confirmed

the efficacy of ribavirin in the treatment of LF and that it should be used at any point in the

illness, as well as for post-exposure prophylaxis. Supportive treatment is often necessary

and includes fluid replacement, blood transfusion, and administration of paracetamol,


24

phylometadione, ringer lactate, haemocoel, quinine and broad spectrum antibiotics

(Yunusa & Egenti, 2015).

2.16 Prevention and Control

Prevention of primary transmission of LASV to humans can be achieved by avoiding

contact with Mastomys rodents, especially in endemic areas of the disease. Food should be

kept away from rodents and premises that are constantly cleaned to prevent rodents from

entering their homes. De-ratification with the use of rodenticides is also another way of

controlling the rodents and transmission of the disease. The illumination campaign against

Bush burn and the rat hunt for eating must be intensified in endemic areas. Trapping and

the use of rat poisons are effective in trying to reduce rodent populations. However, storage

of grains in modern silos will also help prevent contamination of the grain stored by

infected rodents (Ogbu, 2014).

2.16.1 The individual prevention

The affected person should be admitted to a special centre for the treatment of LF. Health

care providers and close associates of the patient should wear protective clothing, masks

and gloves (Personal Protective Equipment, PPE). Excreta from affected persons should

be properly disposed (Yunusa & Egenti, 2015).

2.16.2 The community prevention

Legislation is needed to prevent widowhood rites, traditional autopsies, bush burning and

unhygienic preparation of cassava flour and other staple foods. Animal husbandry and

fisheries should be encouraged in order to provide alternative sources of first-class proteins

for rat eaters. Regular and sustainable environmental sanitation is needed to prevent rat


25

breeding (WHO, 2012). The public should be made aware of the mode of contact of LF

and its high case fatality rate using print and electronic media. Community involvement

and participation is necessary to provide sustainable LF control. Food vendors should be

educated on the need to prevent food contamination with LF virus. Grains, flours and left-

over foods should be adequately covered to prevent contamination by rats. Rodenticides

should be used for the destruction of rats in homes, and development of LF vaccine should

be facilitated. Regular seminars should be held for health-care providers on early diagnosis

and treatment of LF, while diagnostic kits should be made available in district hospitals.

Affected people should be referred early to the special centre in order to prevent or limit

the evolution of the disease (CDC, 2004).

2.16.3 Vaccine

LASV testing is limited to Biosecurity level 4 (BSL-4) facilities, which are scarce and

inconvenient. Genetic diversity among LASV strains requires vaccine candidates to induce

a broad cross-protective immunity. Several vaccine candidates showed protection against

LF in animal models. However, only ML29 conferred sterilizing immunity with broad pre-

and post-exposure protection and no adverse events in healthy or immuno-compromised

animals (Zapata & Salvato, 2015).

2.17 Knowledge attitude and practice on LF and other haemorrhagic fevers

In a study conducted by Ea et al., (2013), less than 20% of primary care health workers

assessed, were knowledgeable of Lassa Fever disease but 97% had heard of the disease.

A study conducted to assess knowledge of Crimean-Congo fever , another haemorrhagic

fever like Lassa fever, among health professionals in Iran found that nearly 94% had an


26

idea of the disease, with just about 50% having good knowledge of the disease (Rahnarardi

et al., 2008). Another study conducted in Turkey found that over 68% of 144 primary health

workers in Turkey were found to have good knowledge of Dengue (Hidiroglu et al., 2012)

and Primary care Physicians in Singapore were found to have adequate knowledge of

Dengue fever (Lee et al., 2011).

Gloves for personal protection by majority of health workers was reported by Ea et al.,

(2013). Among nursing and midwifery students, in a study carried out in Kahramanmares,

Turkey (Ozeer et al., 2011) and among health workers in Iran ( Rahnarardi et al., 2008) it

was reported on the use of hand gloves were made, and higher than was reported in a study

carried out among healthcare personnel in Balochistan (Sheikh et al., 2004).

Hand glove is an essential component of the PPE, Standard personal protective gear for

any viral haemorrhagic fever management should include a scrub suit, gown, apron, rubber

boots, head covering, mask, eyewear, and two pairs of gloves (World Health Organisation,

1998).

In other studies, it was stated that low mention other PPE might be as a result of their

unavailability in the facility (Borchert et al., 2007; Hewlett and Hewlett, 2005) and

ignorance as to the significance of the protective gear in the prevention of infection.

In a study conducted by Ea et al., (2013), Overall knowledge of Lassa fever was poor for

51 (38.9%), and fair for 54 (41.2%) and good for 260 (19.8%). Knowledge on LF was not

significantly different across the various professions (doctors, nurses, orderlies.) at the

facility. They also reported that Sex, age and type of facility were not significantly

associated with knowledge on LF.


27

CHAPTER THREE

3.0 METHODOLOGY

3.1 Study Design

The study design was a descriptive cross-sectional survey among HCWs in 5 health

facilities of Faranah district from May –June, 2018.

3.2 Study Area

This study was carried out in Faranah district. It occupies a land mass of 12,966km2 and

has a population of 78,108 (National Institute of Statistics, Guinea 2014). Faranah is a town

in upper Guinea lying by the River Niger. This district is administratively divided into 11

sub-districts. The town is mainly inhabited by Malinké and Djallonké. Islam and

Christianity are predominant. For this study we selected the general hospital, the 2 health

centres (Abattoir and Marché) which are located in the urban area and 2 health centre

(Bendou and Tiro) located in the rural area. All of them are public health facilities.


28

Figure 4: Map for the location of Faranah district

3.2.1 The general hospital of Faranah district

The general hospital of Faranah district is located in the urban area of Faranah, not far from

the main market of this city and right in front of the Great Mosque. This hospital was built

in pre-colonial times, it has been rehabilitated several times to serve as a reference sanitary

structure for the entire Faranah region. This hospital has a capacity of 80-bed. It offers

general and specialized care services in all major clinical units, including General

Medicine, General Surgery, Paediatrics, Obstetrics and Gynaecology, Dental and Ocular

care. The total staff strength is about 80, of which there are 10 specialists and some 30

nurses.

3.2.2 Health centres

Health centres are structures that have a role in the health system to provide primary care

to the population and will use the general Hospital in need. These health centres include

the following services:

Faranah

Ngiehun

SorombaKomina

Bamba

Ouoma

Freetown

Bamako

Conakry

SIERRA

LEONE

MALI

GUINEA

A


29

Primary curative consultation

Prenatal Consultation

Family Planning

Expanded immunization Programme

Maternity

All of the health centres are public health facilities and have the same structure.

Urban health centres

In this study, we selected the 2 health centres located at Abattoir and Marche in the urban

area.

Rural health centre

Another 2 health was selected in the rural area in the sub-district of Bendou and Tiro.

3.3 Study Population

The study population included in 5 health facilities in Faranah district. The cadre of HCWs

required for the study were doctors, nurses (trained and auxiliary), laboratory technologists,

as they were directly involved in clinical patient care or specimen collection.

3.4 Sampling Technique

All of the health care providers working in these 5 public health facilities within our

period of data collection were recruited

3.4.1 Inclusion Criteria

The selection criteria for its health providers were as follows:

A full-time employee in one of the selected health facilities of Faranah district and

having worked at least one month;

Students in clinical practice of medicine and nurses;


30

Health provider who has given his informed consent.

3.4.2 Exclusion Criteria

Health workers who were absent on the day of the study were exempted and those who

did not give their consent.

3.5 Study variable

3.5.1 Dependent variable

3.5.1.1 Knowledge

The knowledge of HCWs regarding LF was knowledge acquired on its definition, signs

and symptom, the reservoir of LASV, the mode of transmission, the clinical presentation

of the infected person, the positive and differential diagnosis of LASV disease, the

measures of preventing and controlling the infection, also the case definitions. In this study,

the total score was divided into two levels for knowledge: respondents who had never heard

about LF were considered as having poor knowledge (score ≤ 50%) and good knowledge

(score > 50%).

3.5.1.2 Attitudes

The attitudes of HCWs towards LF cases were all the ways of being or postures adopted

by the care staff in the face of a suspected case of LF. For this, we asked whether the

respondent encountered a suspected case of LF in his unit of work and what his reaction

which could be was (to refer the suspected case to an isolation centre, inform health

authorities, expel the patient, and refer the suspect case to another service). For attitudes,

the total score was divided into two levels: Bad attitudes (score ≤ 50%) and Good attitudes

(score > 50%)


31

3.5.1.3 Practices of HCWs

It made possible to know the individual practices carried out by the medical staff for the

prevention and control of infections in health facilities. The question was whether the

respondents were washing their hands with water and soap or chlorine solution and wearing

basic PPE. The assessment of practices made possible to know if the respondents know the

procedure and the conditions of wearing gloves. For practices, the total score was divided

into two levels: bad practices (score ≤ 50%) and good practices (score > 50%).

3.5.2 Independent variables

Table 1: Independent Variable

Variables Operational

Definition

Scale of

Measurement

Type of Variable

Age Age at last Birthday Discrete

Numerical

Gender Male or Female Nominal

Categorical

Marital status Single, Married,

Divorced or Widowed

Nominal Categorical

Number of years of work number of years to

practice this work

Continuous

Numerical

Type of facility General hospital or

health centre

Nominal

Categorical

Training on L.F

To attend a workshop

on L.F or VHF in

general

Nominal

Categorical

Location of the facility Urban or Rural Nominal Categorical


32

3.6 Data Collection Methods and Instruments

All health providers who worked in any unit of each of the selected hospitals were

approached by the researcher. Researcher explained into detail, the study to be conducted

to get their approval to become participants. Only those who signed the consent form were

enrolled into the study. Interviews based on structured questionnaires were conducted by

the researcher with the respondents on one on one basis. The researcher was the one who

was allowed to fill the questionnaires. The questionnaire had four sections: the first part

collected data on individual factors and demography which influenced KAP; the second

section collected data on knowledge regarding LF; the third part elicited data on attitudes

of HCWs towards LF suspected or confirmed case; and the fourth part sought to find out

respondents’ practices on of prevention and control measures of infection. In this study,

the total score was divided into three levels for knowledge: respondents who had never

heard about LF were considered as having No knowledge (score = 0%); Poor knowledge

(score ≤ 50%) and Good knowledge (score > 50%). For attitudes and practices the total

score was divided into two levels: Bad attitudes and bad practices (score ≤ 50%); Good

attitudes and good practices (score > 50%).

3.7 Data analysis

Pre-coded data were entered into excel, cleaned and subsequently imported into Stata

(version15.1) Software for statistical analysis. Frequency distribution was done to compute

proportions on good KAP, gender, religion, educational level, and occupation. Mean age

and Mean of number of years of work and their respective standard deviations were

computed. Tests of significance on socio-demographic factors that influence knowledge


33

and attitudes of HCWs was done using Chi Square, with statistical significance was set at

p-values ≤ 0.05. Multiple logistic regression analysis was used to assess the strength of

association between the knowledge and attitudes and each independent variable. This was

done by first running a bivariate analysis between knowledge and attitudes and all the

independent variables (Age, Gender, marital status, Occupation, type of facility unit of

word, location of facility, donation from MOH, Availability of PPE, training on LF,

training on VHF). Independent variables with p-values ≤ 0.05 in bivariate analysis were

fitted in the final multiple logistic regression model to assess the strength of association

looking at the adjusted Odds Ratio (AOR) with 95% confidence interval (CI).

3.8 Ethical consideration

Approval of the study was obtained from Guinea Health Service Ethical Review

Committee (GHS- N: 066/CNERS/18). After this, permission was asked for from the

hospital authorities of the health facilities before data were collected. Similarly, each

respondent was asked to express consent prior to participation. Also, before participating

to the interview, each respondent was given a consent form to read and sign. Thumbprints

of those accepted to be part of the study were taken. All respondents were given assurance

that the information they provided was strictly going to be used purely for academic

purposes and nothing else and they were assured of confidentiality. Respondents were

assured that the research that come to them at any risk or cost except their precious time

that they will use to answer the questionnaire. Privacy was ensured during the data

collection since some TB patients may also be HIV patients. Questionnaires were given on


34

a one on one basis. Respondents were given the liberty to choose a place of convenience

to answer the questionnaires.


35

CHAPTER FOUR

4.0 RESULTS

4.1 Socio-demographic characteristics of respondents

The results in table 4.1 below shows the socio-demographic characteristics of respondents.

The mean age of health workers was 30.4 years ± 7.7SD. The mean number of working

years of the health professional was 4.9 years ± 5.2 SD. Females were in the majority 57.4%

(112/195). Most of the health workers were married making up 64.6% (126/195) of

respondents. Muslims were the majority 80.5% (157/195). There were seventeen doctors

(8.7%), thirty-two nurses (16.4%), fifteen laboratory technologists (7.7%) and twelve

midwives (6.2%) thirty eight student professionals and other health professionals including

pharmacists, physician’s assistants, and nurse assistants constituted 41.5% of respondents

(81/195).

Table 4.1a: Socio-demographic characteristics of respondents (n=195)

Variables Frequency Percent (%)

Mean Age ± SD 30.4 ± 7.7years

Mean Number of years working ± SD 4.9 ± 5.2 years

Sex

male 83 42.6

Female 112 57.4

Marital status

Single 61 31.3

Married 126 64.6

Divorced 4 2.1

Widowed 2 1.0

co-habiting 2 1.0


36

Table 4.1b: Socio-demographic characteristics of respondents (n=195)

4.2 Proportion of health care professionals who have good knowledge on LF

Sixty three (32.3%) out of the 195 respondents had no idea what Lassa fever was. Of the

remaining one hundred and thirty two, 67.7% (132/195) who had heard about Lassa fever,

their knowledge was accessed with a sixteen item questionnaire on knowledge according

to case definition. 48.5 % (64/132) had good knowledge about Lassa fever (p = 0.485; 95%

CI = 0.4 – 0.6) as shown in figure 5.

Variables Frequency Percent (%)

Religion

Muslim 157 80.5

Christian 38 19.5

Occupation

medical doctor 17 8.7

Nurse 32 16.4

laboratory technologist 15 7.7

Midwife 12 6.2

Student 38 19.5

Other 81 41.5


37

Figure 5: Proportion of health care workers who have good knowledge about Lassa

fever

4.3 Proportion of health care professionals with good attitude and practice

In figure 6 below, Ninety five out of a hundred health professionals (186/195) were found

to have good attitude towards a suspected case of Lassa fever (p = 0.95; 95% CI = 0.91 –

0.97).

With regards to practice, all health professionals (100%) had good practices in dealing with

a suspicious case of Lassa fever.

51.5%48.5%poor knowledge

good knowledge


38

Figure 6: Proportion of health care workers with good attitude

4.4 Socio-demographic characteristics associated with knowledge

After running a bivariate analysis (chi square and simple logistic)and multiple logistic

regression to determine the association between socio-demographic characteristics and

knowledge as shown in table 5a and 5b, a number of factors showed significant association.

The mean age of health professionals who had good knowledge was significantly higher

than those with poor knowledge. In that, a one year increase in age significantly increased

the odds of having good knowledge by 15% (cOR = 1.15; 95% CI = 1.08 – 1.22).

Marital status was significantly associated with knowledge of LF amongst health

professionals. Married health professionals had 3.6 times the odds of good knowledge on

LF compared to health professionals who were single (cOR = 3.6; 95% CI = 1.7 – 7.9).

4.6%

95.4%

poor attitude

good attitude


39

This association was still significant after adjusting for other variables (aOR = 4.2; 95% CI

= 1.3 – 13.5).

Occupation was significantly associated with knowledge from a chi square test (p < 0.001).

Nurses (cOR = 0.08; 95% CI = 0.009 – 0.7), laboratory technologist (cOR = 0.06; 95% CI

= 0.005 – 0.6), student professionals (cOR = 0.03; 95% CI = 0.003 – 0.3) had significantly

lower odds on good knowledge of LF as compared to medical doctors.

A one year increase in number of working years significantly increased the odds of

knowledge on LF by 20% (cOR = 1.2; 95% CI = 1.08 – 1.3).

Type of facility, whether general hospital or health centre were significantly associated

with knowledge on LF. Logistic regression showed that health professionals who were in

health centres had significantly 70% reduction of their odds of having good knowledge on

LF as compared to health professionals in general hospital (cOR = 0.3; 95% CI = 0.2 –

0.7). This association was still significant after adjusting their odds (cOR = 0.3; 95% CI =

0.1 – 0.9).

Training of health personnel on viral haemorrhage fever (VHF) was found to be

significantly associated with health professional’s knowledge on LF in a chi square test. (p

= 0.002). Health personnel’s who had received training had significantly higher odds of

good knowledge on Lassa fever (cOR = 3.1; 95% CI = 1.5 – 6.3).


40

Table 5a: Factors associated with health care workers' knowledge about Lassa

Fever

Variables Knowledge X2 cOR(95% CI) aOR(95% CI)

good

knowledge

poor

knowledge p-value

Age (mean ± sd) 35.8 ± 8.4 28.4 ± 6.2 1.15 (1.08 - 1.22) 1.2 (1.01 - 1.4)

Sex 0.6

male 33(46.5) 38(53.5) Reference

Female 31(50.8) 30(49.2) 1.2 (0.6 - 2.4)

Marital status +0.001*

Single 14(29.8) 33(70.2) Reference

Married 48(60.8) 31(39.2) 3.6 (1.7 - 7.9) 4.2 (1.3 - 13.5)

Divorced 2(50.0) 2(50.0) 2.4 (0.3 - 18.4) 7.2 (0.3 - 163.7)

Widowed 0(0.0) 0(0.0) 1 1

co-habiting 0(0.0) 2(100.0) 1 1

Religion 0.5

Muslim 49(47.1) 55(52.9) Reference

Christian 15(53.6) 13(46.4) 1.3 (0.6 - 2.9)

Occupation <0.001*

medical doctor 15(93.8) 1(6.2) Reference

Nurse 14(53.9) 12(46.1) 0.08 (0.009 - 0.7) 1

laboratory

technologist 5(45.5) 6(54.5) 0.06 (0.005 - 0.6)

0.9 (0.007 -

101.1)

Midwife 10(83.3) 2(16.7) 0.3 (0.03 - 4.2) 1

Student 7(31.8) 15(68.2) 0.03 (0.003 - 0.3) 1

Other 13(28.9) 32(71.1) 0.03 (0.003 - 0.2) 1

Number of years

working (mean

sd) 7.6 ± 5.7 4.2 ± 3.7 1.2 (1.08 - 1.3) 1.0 (0.8 - 1.3)

Location of

facility 0.5

Urban 55(47.4) 61(52.6) Reference

Rural 9(56.3) 7(43.8) 1.4 (0.5 - 4.1)


41

Table 5b: Factors associated with health care workers' knowledge about Lassa Fever

Variables Knowledge X2 cOR(95% CI) aOR(95% CI)

good

knowledge

poor

knowledge p-value

Type of facility 0.003*

general hospital 42 (60.9) 27(39.1) Reference

health centre 22(34.9) 41(65.1) 0.3 (0.2 - 0.7) 0.3 (0.1 - 0.9)

Unit of work 0.3

internal medicine 19(43.2) 25(56.8) Reference

Surgery 7(36.8) 12(63.2) 0.8 (0.3 - 2.3) 0.8 (0.2 - 4.4)

laboratory 6(54.6) 5(45.5) 1.6 (0.4 - 5.9) 1

maternity 16(66.7) 8(33.3) 2.6 (0.9 - 7.4) 4.5 (0.7 - 29.4)

Other 16(47.1) 18(52.9) 1.2 (0.5 - 2.9) 2.9 (0.7 - 12.8)

Availability of

PPE 0.3+

always available 63(49.6) 64(50.4) Reference

not always

available 1(20.0) 4(80.0) 0.3 (0.03 - 2.3) 0.09 (0.003 - 2.9)

Trained LF

personnel 0.2+

No 58(46.8) 66(53.2) Reference

Yes 6(75.0) 2(25.0) 3.4 (0.7 - 17.6)

Trained VHF

personnel 0.002*

No 18(32.7) 37(67.3) Reference

Yes 46(59.7) 31(40.3) 3.1 (1.5 - 6.3) 1.8 (0.5 - 6.3)

*statistically significant (p<0.05) + Fisher’s exact

4.5 Factors associated with health professionals’ attitude towards LF’s suspected

case

None of the socio-demographic factors were found to be significantly associated with

health professionals’ attitude on Lassa fever. However, health workers in rural facilities

were found to be 80% reduction in their odds of having good attitude towards a suspected


42

case of Lassa fever as compared to health workers in urban facility (cOR = 0.2; 95% CI =

0.04 – 0.6). After adjusting for other variables, rural health workers had 94% significant

reduction in their odds of having good attitude towards suspected case of lassa fever (aOR

= 0.06; 95% CI = 0.01 – 0.4)

Non availability of PPE’s sometimes in facilities significantly reduced the odds of health

professionals having good attitude towards a suspected case of lassa fever (cOR = 0.2; 95%

CI= 0.03 – 0.7). After adjusting for other variables, this association was still significant

(aOR = 0.06; 95% CI = 0.01 – 0.4). These results are shown in table 6a and 6b below.

Table 6a: Factors associated with health care workers' attitude towards LF's

suspected case

Variables Attitude COR(95% CI) AOR(95% CI)

Good attitude

n = 186

Poor attitude

n = 9

Age 0.9 (0.9 - 1.02)

Sex

male 77(92.8) 6(7.2) Reference

Female 109(97.3) 3(2.7) 2.8 (0.7 - 11.7)

Marital status

Single 57(93.4) 4(6.6) Reference

Married 121(96.0) 5(4.0) 1.7 (0.4 - 6.6)

Divorced 4(100.0) 0(0.0) 1

widowed 2(100.0) 0(0.0) 1

co-habiting 2(100.0) 0(0.0) 1

Religion

Muslim 150(95.5) 7(4.5) Reference

Christian 36(94.7) 2(5.3) 0.8 (0.2 - 4.2)


43

Table 6b: Factors associated with health care workers' attitude towards LF's suspected case

Variables Attitude COR(95% CI) AOR(95% CI)

Good attitude

n = 186

Poor attitude

n = 9

Occupation

medical doctor 17(0.0) 0(0.0) 1

Nurse 30(93.8) 2(6.3) 1.2 (0.2 - 6.3)

laboratory technologist 14(93.3) 1(6.7) 1.1 (0.1 - 10.0)

Midwife 12(100.0) 0(0.0) 1

Student 38(100.0) 0(0.0) 1

Other 75(92.6) 6(7.4) 1

Number of years

working 1.0 (0.9 - 1.2)

Location of facility

Urban 166(97.1) 5(2.9) Reference Reference

Rural 20(83.3) 4(16.7) 0.2 (0.04 - 0.6) 0.06 (0.01 - 0.4)

Type of facility

general hospital 90(96.8) 3(3.3) Reference

health centre 96(94.1) 6(5.9) 0.5 (0.1 - 2.2)

Unit of work

internal medicine 64(97.0) 2(3.0) Reference

surgery 25(100.0) 0(0.0) 1

laboratory 16(94.1) 1(5.9) 0.5 (0.04 - 5.9)

maternity 36(100.0) 0(0.0) 1

other 45(88.2) 6(11.8) 0.2 (0.04 - 1.2)

Availability of PPE

always available 173(96.7) 6(3.3) Reference Reference

not always available 13(81.3) 3(18.7) 0.2 (0.03 - 0.7) 0.06 ( 0.01 - 0.4)

Trained LF personnel

no 178(95.2) 9(4.8) Reference

yes 8(100.0) 0(0.0) 1

Trained VHF personnel

no 99(96.1) 4(3.9) Reference

yes 87(94.6) 5(5.4) 0.7 (0.2 - 2.7)


44

CHAPTER FIVE

5.0 DISCUSSION

Lassa fever is a disease of public health importance because it has the ability to cause

significant mortality and morbidity within the community, especially when outbreaks

occur, and also due to ability to spread in no time. It is therefore essential that health

workers in endemic communities such Faranah are conversant with the disease, its

manifestations, management and prevention. Maintaining a high alertness is dependent on

adequate knowledge of the disease. Patient counselling and community campaigns should

only be carried out by health workers who are adequately knowledgeable on the disease.

The greater ratio of female to male workers is an indication differential role of gender in

the health profession in Guinea, where females are more likely belong to health professions

such as nurses, auxiliaries and orderlies than males.

In this study, 32.3%, (63/195) had no idea what LF was. Of the remaining one hundred and

thirty two, 67.7% (132/195) who had heard about Lassa fever, their knowledge was

assessed with a sixteen-item questionnaire on knowledge according to case definition. 48.5

% (64/132) had good knowledge about Lassa fever (p = 0.5%; 95% CI = 0.4 – 0.6). In

another study conducted by Ea et al., (2013), less than 20% of primary care health workers

assessed, were knowledgeable of the disease, though 97% had heard of the disease. This

sharp deficit between the number of professionals who are aware of a disease and those

having in-depth knowledge is common phenomenon among health workers, which makes

it paramount that attention should not just be on creating awareness of the disease, but

ensuring that capacity building equips the health workers’ knowledge to effectively educate

to others. A study conducted to assess knowledge of Crimean-Congo fever, another


45

haemorrhagic fever like Lassa fever, among health professionals in Iran found a similar

outcome, with nearly 94% having an idea of the disease, with just about 50% having good

knowledge of the disease (Rahnarardi et al., 2008). In terms of proportions, a similar trend

has been reported by Kakade (2012) and Kongsap (2006). In contrast, over 68% of 144

primary health workers in Turkey were found to have good knowledge of Dengue

(Hidiroglu et al., 2012) and Primary care Physicians in Singapore were found to have

adequate knowledge of Dengue fever (Lee et al., 2011). The apparent higher levels of

knowledge in the latter studies may be due to the greater attention given those disease, both

by the governments of those countries and by the academia. Lassa fever in Guinea is yet to

gain the needed political commitment it deserves by government and this should be given

a major attention if even at the local government as far as Faranah District is concern. This

is because Faranah is a border town with Sierra-Leone, the second most endemic country

in West Africa after Nigeria.

In this study, all respondents were found in this study to have good practice on Prevention

and control of infections. This finding is expected due to the numerous training and

experience gathered by all professionals during the Ebola Epidemic in 2014-2016.

Prevention and control of infection programmes were organized periodically to equip

health professionals in Guinea as part of the control mechanisms to effectively deal with

the Ebola Scare at the time.

In this study, all the health professionals new the indication for using hand gloves. Gloves

for personal protection by majority of health workers was reported by Ea et al., (2013), a

similar study. Among nursing and midwifery students, in a study carried out in

Kahramanmares, Turkey (Ozeer et al., 2011) and among health workers in Iran (Rahnarardi


46

et al., 2008) similar reports on the use of hand gloves were made, and higher than was

reported in a study carried out among healthcare personnel in Balochistan (Sheikh et al.,

2004). While the hand glove is an essential component of the PPE, Standard personal

protective gear for any viral haemorrhagic fever management should include a scrub suit,

gown, apron, rubber boots, head covering, mask, eyewear, and two pairs of gloves (World

Health Organisation, 1998). All respondents, in this study, correctly selected all the above

personal protective gears as part of the component of PPE. In other studies, it was stated

that low mention other PPE might be as a result of their unavailability in the facility

(Borchert et al., 2007; Hewlett and Hewlett, 2005) and ignorance as to the significance of

the protective gear in the prevention of infection. Fortunately, that was not the case in this

study which is suggestive of availability and no ignorance of the protective gear in health

facilities in Faranah possibly due to the effective training received by the health

professional during the 2014-2016 Ebola epidemic.

In this study, socio-demographic factors found to be associated with knowledge on LF were

age, marital status, and occupation of respondents. A one year increase in age increased the

odds of having good knowledge on LF significantly. Married workers had higher odds of

having good knowledge. This findings are suggestive of the fact that older health workers

may have longer years of work experience hence their increased knowledge on the disease.

Number of working years was significantly associated with Knowledge just as occupation

in the bivariate analysis. Better knowledge was observed among doctors, since other

professions such as nurses, laboratory technologist, student professionals and other health

workers had significantly lower odd of good knowledge on LF. Similar has been reported

in other studies ( Hidiroglu et al., 2012; Ho et al. 2013; Lakhani et al., 2003; Rahnarardi et


47

al, 2008; Sheihk et al., 2004) Doctors are the leaders of the health team, with higher levels

of training and exposure. It is not surprising then that they would exhibit better knowledge.

While some may argue that it may not be necessary for other professional such as orderlies

to have much information as they are not involved in making clinical decision, this claim

may be refuted on the ground that improving their knowledge makes agents of education

on LF in their communities. This finding is in contrast with what Ea et al., (2013) reported.

They reported that Knowledge was not significantly different across the various

professions.

Type of facility, whether general hospital or health centre were significantly associated

with knowledge on Lassa fever. Health professionals who were in health centres had

significantly 70% reduction of their odds of having good knowledge on LF as compared to

health professionals in general hospital. The General hospital is in the urban area of

Faranah district and have more exposure to training programs and receives more

equipment. It serves as the main referral hospital to the other health centres within the

district and is therefore expected to have higher standards.

Training of health personnel on viral haemorrhagic fever (VHF) was found to be

significantly associated with health professional’s knowledge on Lassa fever. HCWs who

had received training had significantly higher odds of good knowledge on LF. Although

failed to remain significant after adjusting for other variables, this finding gives a policy

direction to emphasise training as an approach specifically on LF and other haemorrhagic

fevers to help improve health workers knowledge.


48


health professionals’ attitude on LF.

However, health workers in rural facilities were found to have 80% significant reduction

in their odds of having good attitude towards a suspected case of LF as compared to health

workers in urban facility.

Non availability of PPE’s sometimes in facilities significantly reduced the odds of health

professionals having good attitude towards a suspected case of LF.


49

CHAPTER SIX

6.0 CONCLUSION AND RECOMMENDATION

6.1 Conclusion

The mean age of health workers was 30.4 years. The mean number of working years of the

health professional was 4.9 years. Females were in the majority. Most of the health workers

were married. Muslims formed the majority of health professionals. There were 17 doctors

32 nurses, 15 laboratory technologists, 12 midwives, 32 student professionals and 81 other

health professionals including pharmacists, physician’s assistants, and nurse assistants and

auxiliary workers.

Sixty three out of the one hundred and ninety five respondents (32.3%) had no idea what

Lassa fever was. Of the remaining one hundred and thirty two, 67.7% (132/195) who had

heard about Lassa fever, their knowledge was assessed with a sixteen item questionnaire

on knowledge according to case definition. 48.5 % had good knowledge (scored ≥8 out of

16) about Lassa fever (p = 50%; 95% CI = 40% – 60%).

Ninety five out of 100 health professionals were found to have good attitude towards a

suspected case of Lassa fever (p = 95%; 95% CI = 91% – 97%).

With regards to practice, all health professionals (100%) had good practices in Prevention

and control of infections.

Socio-demographic factors found to be associated with knowledge on LF were age, marital

status, occupation, number of working years


50

The mean age of health professionals who had good knowledge was significantly higher

than those with poor knowledge. In that, a unit increase in age significantly increased the

odds of having good knowledge

Marital status was significantly associated with knowledge of Lassa fever amongst health

professionals. Married health professionals had 3.6 times the odds of good knowledge on

Lassa fever compared to health professionals who were single. This association was still

significant after adjusting for other variables. A unit increase in number of working years

significantly increased the odds of good knowledge on LF by 20%. Type of facility,

whether general hospital or health centre were significantly associated with knowledge on

LF. Health professionals who were in health centres had significantly 70% reduction of

their odds of having good knowledge on LF as compared to health professionals in general

hospital.


health professionals’ attitude on Lassa fever.

However, health workers in rural facilities were found to be 80% significant reduction in

their odds of having good attitude towards a suspected case of LF as compared to health

workers in urban facility Non availability of PPE’s sometimes in facilities significantly

reduced the odds of health professionals having good attitude towards a suspected case of

LF.


51

6.2 Recommendations

• Ministry of Health (MOH), Guinea should plan more training on LF with emphasis

on other professionals as much as medical doctors.

• The MOH should provide adequate supply of PPE for both urban and rural health

facilities to assure there are no shortages at the facilities

• The district health management team should provide health promotion strategies

programs on LF in rural areas with emphasis on the strategy of strengthening

community action to ensure positive KAP towards LF not only in the facility nit

also within the communities.


52

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https://doi.org/10.2217/fvl.15.1


a

APPENDICES

INFORMED CONSENT FORM

Title: ASSESSMENT OF KNOWLEDGE, ATTITUDES AND PRACTICES

AMONG HEALTH CARE WORKERS TOWORDS LASSA FEVER IN 5

HEALTH FACITIES OF FARANAH DISTRICT IN UPPER GUINEA

Principal Investigator: MORY CHERIF HAIDARA

Address: SCHOOL OF PUBLIC HEALTH

DEPARTMENT OF EPIDEMIOLOGY

AND DISEASE CONTROL

UNIVERSITY OF GHANA, LEGON

Contact: 0551896623/ [email protected]

My name is Mory Cherif Haidara. I am a graduate student of University of Ghana School

of Public Health undertaking a research on assessment of knowledge, attitudes and

practices among health care workers in 5 health facilities of Faranah district. The

study seeks to find out the level of knowledge, attitudes and practices of health care workers

on Lasa fever and which sociodemographic factors could influence them. Participants are

required to share their experiences on Lassa fever by responding to questions.

Personal information that will lead to identification of participants will not be included in

the questionnaire. Questionnaire clients will respond to will be anonymous (will not

bear names of participants) so you will not be identified. You are free to be part of the

study and decide to leave at any point you want. However, be assured that your privacy

and confidentiality will be respected. Be assured that the research come at no risk and no

cost except the precious time that they will used to fill the questionnaire. You can choose

a place of convenience to answer the questions.


b

VOLUNTEER AGREEMENT

The above document describing the benefits, risks and procedures for the research title

“assessment of knowledge, attitudes and practices among health care workers in

health facilities of Faranah district” has been explained to me.

I have read all of the above, asked questions, received answers regarding participation

in this study, and am willing to give consent to participate in this study as a volunteer.

I certify that the nature and purpose in this research have been duly explained to

the above individual.

Date Name and Signature of Person Who Obtained Consent


c

University of Ghana

School of Public Health

Department of Epidemiology and Disease Control

I am Mory Cherif Haidara. I am a Master of Public health (MPH) student at the Department

of Epidemiology and Disease Control, University of Ghana, Legon, conducting a study

entitled: Assessment of knowledge, attitudes and practices towards Lassa fever among

health care workers in 5 health faculties in Faranah prefecture in Guinea as part of the

requirement for the award of a Master of Public health (MPH) degree. I would be very

grateful if you could spare some few minutes to answer the questions below to the best of

your ability. Please be assures that your responses are completely confidential and would

be used solely for academic purposes. Your cooperation is fully appreciated. Thank you.

Please CIRCLE the appropriate answers or provide information where necessary or write

the figure of the correct answer in the followed column.

N°00…

QUESTIONS CODING CATEGORIES SKIP

TO

COD

ES

SECTION A: SOCIO-DEMOGRAPHIC CHARACTERISTICS

1 Sex Male…………………………..….1

Female……………………...……2

SEX

2 Age (State your last

birthday age in year)

……………………………………

AGE

3 Marital status

Single ……………………….…….1

Married……………….…………...2

Divorced ………………….……....3

Widowed …………………………4

Co-habiting……………………….5

MSTA

4 Religion

Muslim……………………………..1

Christian…………………………....2

Other……………………………….3

RLG


d

5 Occupation

Medical doctor …..………….…..1

Nurse …………..………….…….2

Laboratory

technologist/Scientist….………...3

Midwife………………..…….…..4

Student………………………..…5

Other..............................................6

DSGT

6 How long have you been

working in this health

facility?

NOYW

Facility factors

7 Location of the facility Urban…………………………….1

Rural………….……………….....2

LOF

8 Type of facility General hospital………………...1

Health centre…………………....2

TOF

9

Unit of work

Internal medicine………………..1

Surgery………………………….2

Laboratory………………………3

Maternity………………………..4

Other…………………………….5

UOW

Intervention factors

10 Does your facility receive

PPE from the MoH or

NGOs as donations?

Yes..................................................1

Non.................................................2

DON

11 What can you say about

the Availability of PPE?

Always available………;………....1

Not always available………..…….2

AVAIL

12 Have you received a

training on LF?

Yes..................................................1

Non.................................................2

FART

13 Have you received a

training on viral

haemorrhagic fevers like

Ebola virus disease since

you have been working in

this facility?

Yes..................................................1

Non.................................................2

TRAN

Section B: Knowledge

14 Have you heard about

Lassa fever before?

Yes..................................................1

Non.................................................2

HALF

15 If yes by which mean? In school..........................................1

During your medical practices........2

By media.........................................3

IBWM


e

Never................................................

4

16 Which type of disease is

Lassa fever?

Haemorrhagic fever........................1

Chronic disease..............................2

Do not know ..................................3

WTD

17 In which country the

LASV has been

discovered?

Nigeria............................................1

Congo (Zaïre)..................................2

Do not know...................................3

WCD

18 what is the causal agent

Bacterium…..……………………1

Virus………………….……….....2

Do not know ……………...……..3

DOCA

19 To which family LASV

belongs?

Arenaviridae ……………......…….1

Filoviridae……...............……........2

Do not know....................................3

WFB

20 What are the incubation

period of LF?

2 à 21 jours…......……………….1

2 à 10 jours………….………......2

Do not know.......…..……………3

IPLF

21 what is the natural host of

the causal agent

Rodent...........……………………1

Monkey ……...………………….2

Do not know ………...…………..3

HOST

Please check all correct answers

22 What are the pathways of

Lassa Fever

transmissions?

Mosquito bites already

contaminated□

Consumption of bush meat□

Direct contact with liquids

biological contamination without

appropriate protective material □;

Direct contact with

contaminated patient's clothing or

linen □;

Airway □;

Consuming infected food by rodent

urine and faeces □;

Consuming rodent’s meat □

Correct answer................................1

Wrong answer.................................2

Do not know....................................3

PLFT

23 Knowledge of LF

symptoms and signs:

Fever □; Diarrhea □;

Vomiting □; polyuria □; Asthenia □;

Skin rash □;

Palpitation □; Bleeding □; Dyspnea

□; agitation □;

Myalgia □; Headache □; Abdominal

LFSS


f

pain □ ;

Constipation □; Slimming □;

clubbing □;

Nervousness □; Cramps □;

Dizziness □

Correct answer................................1

Wrong answer.................................2

Do not know...................................3

24 With what diseases do we

do differential diagnosis

of the LF?

Malaria□; Typhoid fever □;

EVD□; Marburg fever □; Yellow

fever □ ; Cholera □; Diabetes □;

Meningitis □;

Correct answer................................1

Wrong answer.................................2

Do not know...................................3

DDLF

25 What are the elements of

difference between

malaria and LF?

Brutal Fever □; Headache □; Fever

□; Haemorrhage □; Fatigue □;

Vomiting □; GE □; TDR □; TR-

PCR □;

Correct answer................................1

Wrong answer.................................2

Do not know...................................3

EOD

26 What are the tests to

make the positive

laboratory diagnosis of

the LF?

Virus culture □; ELISA □

IFA IgM □; IFA IgG □; PCR □

Correct answer................................1

Wrong answer.................................2

Do not know...................................3

PLD

27

Do you know the definition of LF suspicious case?

1= Yes □ 2 = No □

If yes say

it.........................................................................................

Correct answer........................................................................1

Wrong answer.........................................................................2

Do not know............................................................................3

DFSC

28

Do you know the definition of LF confirmed case?

1= Yes □ 2= No □

If yes say

it............................................................................................

Correct answer...........................................................................1

Wrong answer............................................................................2

Do not know..............................................................................3

DFCC1



g

SECTION C: Attitudes

32 Does LF is part of the

diseases under epidemic

surveillance in your

facility?

Yes………………………………1

No……………………………….2

DUES

33 Have you been involved

in a case management of

LF patient in the past?

Yes………………………………1

No……………………………….2

LFCM

34 Will you refuse to treat a

suspected LF patient with

adequate PPE in order to

protect yourself?

Yes…………………....……………1

No……………………....………….2

RTLF1

35 Will you refuse to treat a

suspected LF patient

without adequate PPE in

order to protect yourself?

Yes…………………....…...………1

No……………………....………….2

2 RTLF2

36 Would you like to get

more information about

LF?

Yes………………………....………1

No………….....……………....…….2

MINFO


29 What are the preventive

measures?

Health education □

Adequate hand washing □

Use of dedicated equipment for each

patient □

Personal Protective equipment □

Isolation of confirmed case □

Rodent elimination □

Correct answer................................1

Wrong answer.................................2

Do not know....................................3

PRME

30

Is there a specific treatment against LF?

Yes………………………….……1

No………………………….…….2

Do not know..................................3

If yes which antiviral is used for the treatment?

Correct answer................................1

Wrong answer.................................2

DFDIA

31 Is there a vaccine to

prevent LF?

No……………………………….1

Yes………………………………2

Do not know..................................3

PSDIA


h

37 If you have a suspicious

LF case which reaction

would you adopt?

Notify hospital authorities □;

Inform the head of your unit □;

Refer the patient to another unit or

hospital □; Treat the patient □;

Sack the patient □

Correct answer................................1

Wrong answer.................................2

Do not know....................................3

SLFC

SECTION D: Practices

38 What are the products

used for hand wash?

Water only □; Water + soap; 5% □;

chlorinated water; Alcoholic hydro □;

Gel; Chlorinated water at 0.05% □;

Alcohol at 90 ° □;

Correct answer................................1

Wrong answer.................................2

Do not know....................................3

PHW

39 What are the indications

of hand washing?

Before any direct contact with a

patient □;

Immediately after removing gloves □;

Before handling an invasive device □;

After touching any biological fluid □;

After touching any object in the

patient’s environment □;

After any direct contact with the

patient □;

Correct answer................................1

Wrong answer.................................2

Do not know.....................................3

INHW

40 What are the components

of personal protective

equipment PPE?

Face Shield □; Blouse □; Bonnet □;

Glove □; Flap □; Boots □;

Correct answer................................1

Wrong answer.................................2

CPPE

41 What are the indications

of gloves using?

Before touching a patient □;

Before hand washing □;

Before touching biological fluids □;

Before touching any object in the

patient’s environment □;

Correct asnswer................................1

Wrong answer.................................2

Do not know....................................3

INGU


school of public health college of health sciences

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