Original Article

Misconceptions about Ebola virus disease among lay people in Guinea: Lessons for community education Lonzozou Kpanakea, Komlantsè Gossoub, Paul Clay Sorumc,d,*, and Etienne Mullete a

University of Québec – TELUQ, Montréal, Canada.

b c

University of Conakry, Conakry, Guinea.

Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, USA.

d

Albany Medical Center Internal Medicine and Pediatrics, 724 Watervliet-Shaker Road, Latham, NY 12110, USA.

e

Institute of Advanced Studies (EPHE), Paris, France.

*Corresponding author.

Abstract

To characterize the perception of Ebola virus disease (EVD) in Guinea, we administered, from November 2014 to February 2015, a questionnaire to a convenience sample of 200 lay people in Conakry and a group of 8 physicians. We found widespread misconceptions among lay people, including that praying to God can protect against EVD, that traditional healers are more competent than physicians in treating EVD, that people get infected through physical proximity without contact, that the Ebola epidemic is the result of Western bioterrorism experiments, that Western medical staff disseminated the virus, and that the purpose of quarantine measures is to hasten the death of Ebola patients. Major educational interventions, sensitive to local cultural beliefs, are needed to overcome the misconceptions about Ebola in Guinea. Journal of Public Health Policy advance online publication, 11 February 2016; doi:10.1057/jphp.2016.1 Keywords: Ebola; prevention; perception; public; survey; Guinea

Introduction Since the first confirmed cases in Guinea in March 2014, the world has faced its worst outbreak of Ebola virus disease (EVD). As of 20 December 2015, there had been 28 601 confirmed, probable, or

© 2016 Macmillan Publishers Ltd. 0197-5897 Journal of Public Health Policy 1–13 www.palgrave-journals.com/jphp/

Kpanake et al

suspected cases and 11 300 reported deaths in Liberia, Sierra Leone, and Guinea (including 3804 cases and 2536 deaths in Guinea) and a handful of cases in neighboring countries and several in North America and Europe.1 The identification of a cluster of three new cases in Liberia on 19 November 2015 – after all three countries had been declared Ebolafree – points to the continued threat of Ebola in Africa. The World Health Organization (WHO) asserted in January 2015 that ‘community resistance has been a major barrier to control [the epidemic] in all three countries but took on extreme dimensions in Guinea’.2 Numerous incidents of violence against medical responders to the outbreak had been reported in Guinea, including the murder of an eight-member team; also, mobs had attacked Ebola treatment facilities.2 Even in May 2015, WHO reported that ‘community engagement has proved challenging in all 4 affected prefectures of Guinea, with several reported incidents of violence directed at field staff’.1 In addition, highrisk behaviors undermined efforts to slow the outbreak, including families hiding their sick and burning bodies in secret night-time ceremonies.2 These facts highlight the urgent need to understand, as recommended by WHO, the Guinean people’s perception of EVD.3 Such knowledge is vital to the success of efforts to prevent the spread of the disease if and when it breaks out again. The present study examined the knowledge of EVD among lay people in Guinea.

Methods Participants The second author, a Lecturer at the University of Conakry, led recruitment of participants and collection of data. His team of five research assistants, from November 2014 to February 2015, tested two groups: an unpaid convenience sample of 200 lay people living in Conakry, the capital and largest city of Guinea, and 8 physicians treating Ebola patients in Guinea. The research assistants contacted a total of 400 people during daylight hours in the main streets of all five districts of Conakry: Kaloum, Dixinn, Ratema, Matam, and Matoto. To prevent any researcher’s influence on participants’ responses (for example, through translation), the research team invited to participate only those people who could read French. On the basis of our experience in previous surveys,4,5 we determined

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© 2016 Macmillan Publishers Ltd. 0197-5897 Journal of Public Health Policy 1–13

Misconceptions about Ebola in Guinea

we needed 200 participants. To obtain this number, the team talked with 267 people able to read the questionnaire (a participation rate of 75 per cent). Their complete anonymity was guaranteed. These participants included 113 men and 87 women, aged 18–73 years (mean 29.31, standard deviation 11.76). Thirty-seven percent had not completed secondary education, 40 per cent had a secondary education degree, and 23 per cent a university degree. The physician sample consisted of four specialists in infectious diseases and four generalists (two females, six males), aged 36–60 years (mean 48), all of whom worked in Conakry University Hospital and had extensive experience treating EVD. The sample included the three physicians who had vetted the list of questions. Material The questionnaire was in French, the official language of Guinea and the language of instruction. It contained statements that covered main aspects of EVD, including modes of transmission, preventive measures, clinical aspects, treatments, and outcomes. The research team adapted some of these statements from previous questionnaires that examined the public’s knowledge of infectious diseases;4,5 we based others on public understanding of EVD during previous Ebola outbreaks in Uganda6 and Gabon.7 The resulting questionnaire contained 90 statements. To ensure that the wording used for each statement would make sense to all participants, we showed the list of statements to six passersby in Conakry (another convenience sample) who formed a focus group. They reformulated statements that they judged to be ambiguous. We presented the newly formulated statements to four additional passersby who found these statements easy to understand and made no additional suggestions. Finally, we asked three physicians in Conakry, selected because of their experience in treating EBV, to confirm that the final formulation of the statements made sense to them too. (See Tables 1 and 2 for samples; the full questionnaire is available from the corresponding author.) Each item was followed by an 11-point scale, with anchors of ‘Completely sure it is false’ (0) and ‘Completely sure it is true’ (10). The participants filled out the questionnaire by themselves with no help from the research team. The Comité National d’Éthique de la Recherche en Santé de Guinée, the Commission Recherche Ébola de Guinée, and the Ethical Review

© 2016 Macmillan Publishers Ltd. 0197-5897 Journal of Public Health Policy 1–13

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Table 1: Statements about EVD with the greatest agreement between lay people and experts (Conakry, Guinea, 2015)

© 2016 Macmillan Publishers Ltd. 0197-5897 Journal of Public Health Policy 1–13

Item You can get EVD by using a bed that has been contaminated with an Ebola patient’s fluids A child can get EVD through breast-feeding Ebola infection may cause diarrhea You can get EVD by cleaning the body of a person who died from it Quarantine measures prevent transmission of EVD Ebola infection may cause a sudden high fever You can get EVD by kissing an Ebola patient You can get EVD by sharing shoes with an Ebola patient Ebola virus can be eliminated from the body by ceasing to drink alcohol Ebola infection risk may be reduced by hand washing Ebola infection may cause vomiting Ebola virus can be transmitted through anal sex You can get EVD by handling the body of a person who died from it You can get EVD by wearing an Ebola patient’s soiled clothes You can get EVD by drinking from the same glass as an Ebola patient You can get EVD by eating from the same plate as an Ebola patient You can get EVD by sharing a comb with an Ebola patient Ebola infection may cause extreme tiredness You can get EVD from direct contact through broken skin You can get EVD from saliva

Experts

M

SD

M

Δ

P

9.39 9.22 8.92 8.56 8.55 8.53 8.44 8.20 1.82 8.11 8.10 7.92 7.85 7.74 7.62 7.51 7.49 7.45 7.31 7.30

1.99 2.17 2.52 3.19 2.99 3.20 3.23 3.14 3.05 3.32 3.50 3.59 3.60 3.83 3.81 3.65 3.74 3.88 4.02 3.94

10 10 10 10 10 10 10 10 0 10 10 10 10 10 10 10 10 10 10 10

0.61 0.78 1.08 1.44 1.45 1.48 1.56 1.81 1.82 1.89 1.90 2.09 2.15 2.26 2.38 2.49 2.51 2.55 2.69 2.70

0.735 0.312 0.227 0.203 0.173 0.195 0.175 0.201 0.094 0.109 0.126 0.103 0.369 0.166 0.096 0.180 0.060 0.065 0.060 0.055

M = mean rating on the scale of 0–10; SD = standard deviation; Δ = difference between means for lay people and experts. Note: Only those items are included for which the lay people–experts differences were lower than 2.75 points and non-significant.

Kpanake et al

Lay people

Table 2: Statements about EVD with the greatest disagreement between lay people and experts (Conakry, Guinea, 2015) Lay people

The purpose of quarantine measures is to cure EVD You can get EVD by being in the same stadium bleachers (for example, for soccer) as people infected with Ebola Western medical staff disseminate Ebola virus in Africa You can get EVD by attending a place of worship You can get EVD by sitting on the same bench with an Ebola patient Ebola virus was introduced in Africa by Western scientists Praying to God protects against EVD You can get EVD by walking in the street You can get EVD from the swimming pool Providing an Ebola patient with plenty of water may be helpful All people infected by Ebola end up dying of it Treating Ebola patients in hospital does not improve their chance of survival Ebola virus may be transmitted through breathing Ebola virus may be transmitted through sneezing or coughing The Ebola epidemic is an act of punishment from God The purpose of quarantine measures is to hasten the death of Ebola patients Condom use does not prevent from EVD Ebola virus was invented by Westerners in order to exterminate African populations Sunlight worsens symptoms of EVD You can prevent EVD by eating healthy foods One month after recovery from EVD, a man cannot transmit the virus through unprotected sexual intercourse The purpose of quarantine measures is to test new drugs on people Ebola epidemic is the result of bioterrorism experiments conducted by Westerners on African populations You can get the Ebola infectious agent through mosquito bites Traditional healers are more competent to treat EVD than physicians The purpose of quarantine measures is to provide end-of-life care to Ebola patients A person infected with Ebola virus can spread the virus even if he or she is not sick The purpose of quarantine measures is to keep under surveillance Ebola patients who have malevolent intentions Taking birth-control pills can help prevent EVD Treatment of EVD at hospital can provide total recovery

M

SD

M

Δ

P

8.19 7.64 7.58 7.47 7.19 7.15 6.94 6.88 6.72 3.35 6.47 6.45 6.41 6.31 6.25 6.24 5.86 5.69 5.68 5.67 5.61 5.52 5.45 5.45 5.36 5.29 5.23 5.20 5.20 4.88

3.07 3.75 3.79 3.72 3.80 3.93 4.07 4.07 3.95 4.13 4.09 4.25 4.29 4.15 4.35 4.22 4.57 4.31 4.39 4.25 4.75 4.29 4.27 4.56 4.65 4.42 4.72 4.43 4.51 4.38

0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10

8.19 7.64 7.58 7.47 7.19 7.15 6.94 6.88 6.72 6.65 6.47 6.45 6.41 6.31 6.25 6.24 5.86 5.69 5.68 5.67 5.61 5.52 5.45 5.45 5.36 5.29 5.23 5.20 5.20 5.12

0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.002 0.001 0.001 0.001

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M = mean rating on the scale of 0–10; SD = standard deviation; Δ = difference between means for lay people and experts. Note: Only those items are included for which the lay people–experts differences were higher than 5.0 points and significant at P

Misconceptions about Ebola virus disease among lay people in Guinea: Lessons for community education.

To characterize the perception of Ebola virus disease (EVD) in Guinea, we administered, from November 2014 to February 2015, a questionnaire to a conv...
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