Knowledge, Attitudes, and Practices Related to Ebola Virus Disease at the End of a National Epidemic — Guinea, August 2015
Authors: Mohamed F. Jalloh, Susan J. Robinson, Jamaica Corker, Wenshu Li, Kathleen Irwin, Alpha M. Barry, Paulyne Ngalame Ntuba, Alpha A. Diallo, Mohammad B. Jalloh, James Nyuma, Musa Sellu, Amanda VanSteelandt, Megan Ramsden, LaRee Tracy, Pratima L. Raghunathan, John T. Redd, Lise Martel, Barbara Marston, Rebecca Bunnell
Journal: MMWR Morbidity and Mortality Weekly Report (2017)

† A form of systematic random sampling that helps minimize survey administration cost and time by avoiding prior listing of all households in the enumeration area by beginning the process at a certain geographic point and following a specified path to select households to interview.https://unstats.un.org/unsd/demographic/meetings/egm/Sampling_1203/docs/no_2.pdf.in the Forest Guinea region, but transmission persisted in the Maritime Guinea region (8).Various control measures were implemented, including case investigation and contact tracing, health communication about prevention practices, and specialized treatment units and burial teams to manage persons and corpses affected by Ebola.The assessment employed a cross-sectional design using a multistage cluster sampling procedure.The 2014 Guinea Census List of Enumeration Areas served as the sampling frame for the random selection of 150 clusters across all eight administrative regions, which were grouped by the four natural regions of Guinea.Within each administrative region, prefectures were randomly sampled from among two strata defined by high (≥95) or low (<95) cumulative counts of confirmed cases that had been reported to the national Ebola surveillance system by May 2015.The sample was further stratified to include both urban and rural subprefectures.Districts within each subprefecture were randomly selected, and 20 households were selected from each cluster using a form of systematic random sampling known as the random walk method.† In each selected household, two interviews were conducted; the first was with the head of household, and the second was with a randomly selected woman aged ≥25 years or a person of either sex aged 15-24 years.Interviews were conducted by locally trained data collectors using a free open-source set of tools to manage mobile data collection (https://opendatakit. org), installed on mobile devices.Data were analyzed using statistical software.For each record, weighted estimates adjusted for the probability of participant selection were calculated by applying a factor based on population size of the participant's administrative region; 95% confidence intervals were generated for overall and regional data.Data collection teams approached 6,699 persons, 6,273 (94%) of whom (from 3,137 households) consented to initiate the assessment.Among these, 5,733 (91%) persons who reported that they had heard of Ebola before the survey were asked questions for up to 60 minutes about Ebola through * https://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html.Health communication and social mobilization efforts to improve the public's knowledge, attitudes, and practices (KAP) regarding Ebola virus disease (Ebola) were important in controlling the 2014-2016 Ebola epidemic in Guinea (1), which resulted in 3,814 reported Ebola cases and 2,544 deaths.*Most Ebola cases in Guinea resulted from the washing and touching of persons and corpses infected with Ebola without adequate infection control precautions at home, at funerals, and in health facilities (2,3).As the 18-month epidemic waned in August 2015, Ebola KAP were assessed in a survey among residents of Guinea recruited through multistage cluster sampling procedures in the nation's eight administrative regions (Boké, Conakry, Faranah, Kankan, Kindia, Labé, Mamou, and Nzérékoré).Nearly all participants (92%) were aware of Ebola prevention measures, but 27% believed that Ebola could be transmitted by ambient air, and 49% believed they could protect themselves from Ebola by avoiding mosquito bites.Of the participants, 95% reported taking actions to avoid getting Ebola, especially more frequent handwashing (93%).Nearly all participants (91%) indicated they would send relatives with suspected Ebola to Ebola treatment centers, and 89% said they would engage special Ebola burial teams to remove corpses with suspected Ebola from homes.Of the participants, 66% said they would prefer to observe an Ebola-affected corpse from a safe distance at burials rather than practice traditional funeral rites involving corpse contact.The findings were used to guide the ongoing epidemic response and recovery efforts, including health communication, social mobilization, and planning, to prevent and respond to future outbreaks or sporadic cases of Ebola.Ebola-related KAP assessments were conducted in Sierra Leone (4), Liberia (5), Nigeria (6), and in one region in Guinea (7) during Ebola epidemics in 2014-2015.To learn more about Ebola-related KAP in Guinea as the nation's epidemic waned following more than a year of Ebola education and prevention activities, several organizations conducted an Ebola KAP assessment across all administrative regions in August 2015.At that time, cumulative case counts varied substantially across the four natural regions of Guinea (Forest Guinea, Maritime Guinea, Middle Guinea, and Upper Guinea) (Figure ); previously intense transmission had been controlled