Prevention and Control of Ebola Virus Disease in Kankan Region, Guinea
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Prevention and Control of Ebola Virus Disease in Kankan Region, Guinea AID-OFDA-G-15-00030 Final Report Start Date: December 1, 2014 Program Duration: 12 months Period of the report: December 2015 – February 2016 Helen Keller International Headquarters Contact: Country Office Contact: Jennifer Nielsen, Sr. Nutrition Advisor Bamba Foungotin Ibrahim, Country Director 352 Park Ave South, Ste 1200 HKI-Guinea New York, 10010 USA BP 6050, Conakry, Guinea Telephone: (646) 472-0321 Telephone: + 224 657 00 44 00 Fax: (212) 532-6014 E-mail:[email protected] E-mail: [email protected] • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Helen Keller International www.hki.org Introduction and overview Ebola Virus Disease (EVD) was first confirmed by the World Health Organization (WHO) in the Forest Region in March 2014, three months after the first suspected case was signaled. Initially confined to the forest area, it quickly spread to neighboring regions and districts – often transmitted during traditional burial rites in which highly contagious corpses were handled. Due to the inadequate initial response, the virus quickly crossed national borders into Liberia and Sierra Leone. An appropriate response requires interventions based on the key levers of control and treatment: identification, referral and effective treatment of cases in Ebola treatment units (ETU) and the effective training and equipment of health workers; tracing and monitoring of every person known to have had physical contact with an infected person and isolation of those who develop symptoms; safe burials; active surveillance to identify new transmission chains; and communications campaigns to raise awareness of the dangers, signs and symptoms of EVD. Community members must be enlisted to support the efforts of the health and sanitation systems. In addition, individuals who may have been infected through close contact and are being held in quarantine require care, including food and moral support, until their status is resolved. HKI aimed to contributed to the control of EVD through its expertise in capacity building and community mobilization, strengthening the capacity of health facilities and community structures to prevent the transmission of EVD and to trace contacts in the health districts of Kankan, Siguiri and Kouroussa (Kankan Region). At the health center level, HKI collaborated with the Regional Committee for the Fight against Ebola, WHO and other responders to support the training health workers serving in Kouroussa, Kankan and Siguiri on standard measures for infection prevention and control (IPC). The project supplied health centers in these three districts with protective gear, hand washing stations, chlorine, and thermo-flash devices for determining body temperature. At the community level, surveillance was strengthened through the training of vigil committees who worked under the supervision of local partners including the MOH and local government social services. These vigil committees conducted surveillance and informed authorities as quickly as possible of suspicious deaths and or suspect cases of EVD. Public places in the villages (such as markets, churches and mosques) were equipped with hand washing stations and chlorine. Counseling cards were adapted or developed to enable these volunteers to conduct public awareness campaigns in their communities. Voucher or other distribution systems ensured community members had access to soap and chlorine for disinfection. Community radio was engaged to develop and broadcast programs to raise awareness about Ebola, including precautions for safe burial and stigma reduction. The contact tracing system was strengthened by training additional agents to track down individuals who had contact with those infected with EVD, and equipping these agents with thermo- flash thermometers to monitor the health status of these potential cases during the 21-day period of observation. These contact tracing agents were equipped with smartphones connected to an interface to allow them to transmit data on their activities in real time to a central, shared server. Finally, the project worked with the local education offices to train teachers on the prevention and symptoms of EVD as well as the importance of referring cases and the risks of transmission. They will receive the counseling cards to guide their lessons. In addition to covering the originally identified districts of Kouroussa, Kankan and Siguiri, at mid- term the project added the districts of Mandiana and Kerouane. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Helen Keller International www.hki.org Table 1: Project monitoring indicators Sector 1 : Health Objective: To strengthen the capacity of health facilities and community structures to prevent the transmission of EVD and to trace contacts in the health districts of Kankan, Siguiri and Kouroussa (Kankan Sub-sec tor 1: Health system and clinical support. Indicator Target Q1 Q2 Q3 Q4 Cumulative 1 Number of health care providers trained by type (e.g., doctor, nurse, M F M F M F M F M F M F community health worker, midwife, and traditional birth attendant), 128 76 46 23 4 185 54 196 220 480 324 disaggregated by sex 2 Number of health care facilities supported and/or rehabilitated by 97 176 0 1 274 type (e.g., primary, secondary, 128 tertiary) 3 Number and percentage of health facilities submitting weekly 100% 100% 100% 100% 100% 100% surveillance reports Sub-sector 2: Community Health Education/ Behavior Change Indicator Target Q1 Q2 Q3 Q4 Cumulative 1 Numbers of CHWs trained and M F M F M F M F M F M F supported, disaggregated by sex 150 0 0 29 21 112 18 141 39 141 39 Total: Total: 0 Total: 50 Total: 130 Total: 180 Total: 180 2 Number and percentage of CHWs specifically engaged in public 0 50 180 180 180 health surveillance 150 3 Number and percentage of community members utilizing 0 0 63,864 112,887 176,751 target health education message 1. Capacity building and behavior change Capacity building Supervisor training: 30 field supervisors were trained (26 male and 4 female), 10 each in Kankan, Kouroussa and Siguiri. Their role is to supervise the community health agents in their daily activities. Community agent training: 180 community health agents (141 male and 39 female) were recruited and trained for community awareness and community education on the prevention and risk of EVD. Health agent training: Throughout the life of the project, many trainings were conducted by HKI and the Ministry of Health (MoH) on infection prevention and control (IPC) for health agents. Trainings were held at the regional hospital of Kankan, prefectural hospital, and public and private health center in the districts of Kankan, Kérouané, Kouroussa, Mandiana, and Siguiri. Initially, the project was only targeting health center managers for a two-day training session. However, a new directive from the National Committee for the Fight against EVD stated that trainings must last five days and must target all people working in health centers, including non- medical staff. Due to this new directive and the addition of two districts (Mandiana and Kouroussa) to the original three districts (Kankan, Siguiri, and Kérouané) in the project target areas, the project • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Helen Keller International www.hki.org trained a total of 1,063 health agents (513 male and 550 females) in IPC. The training covered the basic principles of prevention of infection in health facilities, the use of appropriate personal protective equipment (PPE), the management of suspected cases of EVD, the application of safe cleaning practices, and the safe disposal of hospital waste. Table 2: Number of health agent trained by site and by sex Districts Total trained Male Female Kankan 280 97 183 Kérouané 207 87 120 Kouroussa 229 145 84 Mandiana 92 24 68 Siguiri 255 160 95 TOTAL 1,063 513 550 Community awareness: Behavior Change Communication (BCC) provides stakeholders with knowledge that can influence their attitudes and practices and consequently push them to adopt behaviors that will positively impact their lifestyle. The project BCC strategy helped raise awareness of stakeholders in the target districts of symptoms, risks and prevention of EVD. 150 community health agents and teachers helped raise awareness, reaching a total of 176,751 people at the community level. Training coordinated by CNLE: In order to have certified trainers on the project team, the program deputy coordinator and program assistant participated in the training of trainers (TOT) on EVD organized by WHO in Conakry during the month of November 2015. These two project staff were then responsible for the organization and coordination of the training of over one thousand health workers. Project staff also participated in a three-day workshop in Kindia to develop operational guidelines to strengthen epidemic disease surveillance. 2. Distribution of IPC material Preventing transmission of the virus within health facilities requires application of technical procedures and use of the protective gear (PPE). During the project period, health facilities were supplied with inputs, including hand washing kits, soap,