Abstract
Today, there are dozens of deadly diseases in the world, but the Ebola virus disease (alternatively “EVD” or “Ebola”) is among the most virulent and lethal. Although intensive research is underway, there is no cure currently available for Ebola and the death toll attributable to this disease continues to increase. To date, there have been nearly 30,000 cases of Ebola infections that caused more than 11,000 deaths, primarily in West Africa, but the disease has the potential to spread worldwide unless first responders, emergency management managers and the health care community take aggressive steps to identify infections and contain outbreaks. The main purpose of this study is to provide a systematic and critical review of the relevant juried, scholarly and governmental literature about the Ebola virus disease to create an awareness manual that is targeted at educating Nigerian citizens concerning this disease. A secondary purpose of this study is to identify gaps in the existing literature concerning optimal strategies for responding to Ebola outbreaks in order to recommend further areas of study.

An effective preparedness strategy for future Ebola Virus Disease outbreak in Nigeria: Public Awareness Approach

Chapter One: Introduction

Statement of the problem

In spite of increasingly aggressive efforts to identify a cure for the Ebola virus disease (Preston, 2014), outbreaks continue to occur, including an ongoing one in the Democratic Republic of the Congo (which has proven to be the most difficult to manage to date), each with the potential of escalating into a worldwide pandemic (Brown, 2015). Therefore, national and local emergency managers must develop a comprehensive understanding of the etiology of this disease, its course and what steps should be taken in response to confirmed cases in order to contain outbreaks when they occur and to educate citizens to prevent the spread of rumors that can further exacerbate the virulence and lethality of the Ebola disease virus (Allam, 2014).

Purpose of the study

The overarching purpose of this study was to provide a systematic and critical review of the relevant peer-reviewed, scholarly and governmental literature concerning Ebola in order to develop an awareness manual for educating the Nigerian citizen on Ebola virus disease. A secondary purpose of this study was to identify any gaps in the current body of scholarship concerning optimal strategies for responding to Ebola outbreaks in order to recommend further areas of study.

Significance of the problem

Unlike many other deadly diseases that continue to plague humankind, Ebola is in a category almost by itself in terms of its lethality. Indeed, Ebola infections typically kill between 25% and 90% of its victims, and it is not surprising that the public generally reacts to even the mention of this disease with dread and terror (Ebola outbreak, 2019). The largest outbreak of Ebola occurred in West Africa during the period between 2014 and 2016, but the second-largest outbreak is still ongoing in the Democratic Republic of Congo despite efforts on the part of the international health care community to contain it (Ebola, 2019). In fact, the outbreak in the Democratic Republic of Congo was all the more noteworthy because the country had a comprehensive preparedness plan already in place (Hancock,2019).

While many countries of the world remain directly unaffected by Ebola, the potential for this deadly disease to spread beyond the borders of the African continent are pronounced, especially due to the ease with which people can travel long distances today (Hood, 2015). Moreover, the Ebola disease virus has been shown to be able to cross national borders with relative ease, and its impact on the nations of Africa has been severe. For instance, according to the U.S. Centers for Disease Control and Prevention (CDC)< “A total of 28,616 cases of EVD and 11,310 deaths were reported in Guinea, Liberia, and Sierra Leone. There were an additional 36 cases and 15 deaths that occurred when the outbreak spread outside of these three countries” (Ebola outbreak, 2019). The fear and dread that are associated with Ebola are due in large part to the fact that there is no cure for the disease and misinformation and rumors abound concerning its effects (Ebola, 2019), a troubling situation that directly relates to the rationale in support of this study as described below.

Rationale of the study

Developing effective responses to the Ebola virus disease requires a series of multifaceted interventions, and all are essential for containing outbreaks of the disease (Ebola, 2019). The elements of effective responses include isolating infected victims, providing them with the best palliative care possible and identifying any new victims and repeating these interventions (Ebola, 2019). Other elements of effective responses to Ebola include the prevention of further infections by the disease by performing safe but respectful burials of deceased victims, and ensuring that affected health care facilities, ambulances and victims’ homes are decontaminated (Ebola, 2019).

While these steps can help contain an outbreak, they do not stop them from occurring in the first place. Therefore, while the search for a cure for the Ebola virus disease continue, it is vitally important for national and local emergency management teams to formulate effective response interventions to minimize the transmission of the disease, including educating citizens concerning the Ebola disease virus to prevent the spread of misinformation that could adversely affect the ability of emergency managers to achieve this objective.

Chapter Two: Review of the Relevant Literature

Chapter Introduction

This chapter provides a review of the relevant literature concerning the Ebola virus disease, including transmission methods, symptoms, diagnosis, and current treatment strategies. In addition, this chapter provides an analysis concerning ways to identify optimal emergency management strategies for Ebola outbreaks in Nigeria.

Overview of the Ebola virus disease

Cause of the Ebola virus disease

The Ebola virus disease is caused by an infection from a host of viruses that are included in the genus, Ebolavirus: Ebola virus and the species, Zaire ebolavirus (What is Ebola virus disease?, 2019). One of the more challenging aspects of Ebola is its virulence which facilitates transmission from person to person...…to occur, but also due to misunderstandings and misinformation about how the disease is spread and the risk the disease represents to them personally. To its credit, the Nigerian government, in collaboration with the World Health Organization, took immediate steps to not only effectively contain this potential outbreak, but to provide accurate information to citizens concerning warning signs of the disease and what steps they should take if they believed they were infected.

The Nigerian government launched a house-to-house information campaign and communicated with the public through local radio stations in the dialects spoken in various regions of the country (Successful Ebola responses in Nigeria, Senegal and Mali, 2016). In addition, existing resources that were being used for polio surveillance including global positioning systems for mapping purposes were adapted to focus on the Ebola disease. Moreover, the country’s political leadership also established isolation facilities and a fully equipped emergency operations center to coordinate the work by specially trained health care staff for diagnosing the disease.

This was no small undertaking by any measure, but the successful outcome of the Nigerian’s government’s intervention in this situation made it clear that providing all citizens with the information they needed during this crisis was just as important as the medical services that were provided by community health workers to victims. In fact, the Nigerian government achieved 100% contact tracing in Lagos during this episode (Successful Ebola responses in Nigeria, Senegal and Mali, 2016). Given the profound constraints that were involved, this was a remarkable achievement, but it would not have been possible without community health care workers.

The 2014 incident clearly underscored the need for a cadre of well trained and knowledgeable community health care workers who can “take the message about Ebola to the streets.” For example, according to Shuaib and Gunnala (2014), community health workers in Nigeria played an essential role in containing the Ebola virus disease. In this regard, Shuaib and Gunnala (2014) report that specially trained community health workers “worked with community leaders, going house to house to provide important information about Ebola and searching for active cases and contacts, and they helped local religious leaders to expand their education and outreach strategies, especially in efforts to reduce transmission during funerals and burials” (p. 867).

Beyond the foregoing measures, community health workers in Nigeria also served other important roles such as data collection for aggregation, providing citizens with information concerning culturally appropriate protective practices, and essentially helped prevent a full-blown Ebola outbreak. This achievement was all the more noteworthy given Nigeria’s large population and dense urban areas which could have made the outbreak far worse than that experienced in West African countries (Perry & Dhillon, 2016). In sum, then, Nigeria mounted an immediate response, including a high-profile community information campaign, to the first case of Ebola identified in 2014 that proved highly effective in reducing public anxiety and improving the ability of the nation’s network of responders to deliver the medical services that were needed in a timely fashion.