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1 SUSTAINING PREVENTIVE MEASURES TO CONTROL EMERGENT VIRAL INFECTION IN HEALTH CARE FACILITIES. ARE WE SO ALERT TO PREEMPT FURTHER OUTBREAKS? LESSONS LEARNT FROM LASSA/EBOLA OUTBREAKS IN BENIN T.Bognon1, C.Kassa5, E.Azagba3, H.Dokponou1, S.Sesso7, R.Boton1, M.Bodéoussè4, A.Barre6, R.Mankou8, E.Zitti2, F.Nassouhouede2, E.Linssoussi2, D.Medebaho2, T.Cheho1, A.Azondekon1 Military Teaching Hospital-Cotonou 2 PRESENTATION OUTLINE INTRODUCTION OBJECTIVE METHODS RESULTS CONCLUSION 3 INTRODUCTION 1 • Benin • Neighboring of Nigeria were LF is endemic • Migration : human • Movement : animals 4 4 INTRODUCTION 2 • Risk of LF outbreaks Nov2014 2015 Dec 2016 ? Jan 2017 West Africa’s LF outbreaks overview Before 2014 • LF has become cyclical in the past two years 5 5 INTRODUCTION 3 • Community as well as health workers • 2014: death of 4 Health Workers • Jan 2016: unexplained fever within HW after care to Hemorrhagic fever case • Strength of health system for riposte? • Easy spreading !!! • During last two outbreaks: many actions!!! • WHO, UNICEF, UNFPA, Benin Government 6 6 OBJECTIVE • “I want to see your face” • Evaluating state of alert in HCC • In post epidemics for LF/Ebola as pre-emptive actions and challenges • To know get the perspectives of caregivers 7 7 METHODS 8 8 METHODS 1 • From April to Jun 2016 North • Investigated HC Centers Located in the 12 departments National, regional and districts Central Public, private and confessional Urban and rural area South 9 9 METHODS 2 • Were assessed comparing to actions taken during and after the last outbreak (LSV/Ebola) 1- Specific logistic 2- Basics hospital hygiene provided to control LF 3- knowledge on EID • Semi-structured interviews with caregivers • Direct observation of HCC environment 10 10 METHODS 3 • SPSS version 17.0: quantitative analysis A comparison between outbreaks and postepidemics periods by using Chi2(Fisher) • Contents analysis: qualitative variables 11 11 RESULTS 12 12 RESULTS 1 • 60 HCC were concerned • Levels • National(16%) • Regional (34%) • District(50%) • Types • Private and confessional(25%) • Publics (75%) 13 13 RESULTS 2 • 60 caregivers investigated Professions – Doctors 40%,Nurses 60% – Median Seniority: 10years(3-34) – None trained on LF 14 14 RESULTS 3 Specific logistic provided to control LF 15 15 RESULTS 4 Specific logistic provided to control LF X-ray % 100 90 80 70 60 50 40 30 20 10 0 64 P=0.000 7 During Outbreaks Period Functional washing devices for patients at the main entrance of HC Centers After Outbreaks Period 16 16 RESULTS 5 Specific logistic provided to control LF 100 90 80 70 60 50 40 30 20 10 0 % 89 P=0.000 9 During Outbreaks Period After Outbreaks Period Hydro alcoholic solution at Emergency Rooms or admission rooms 17 17 RESULTS 6 Specific logistic provided to control LF 72 Presence of Posters/algorithms on LF/Ebola P=0.005 14 During outbreaks Period After Outbreaks Period % 0 50 100 18 18 RESULTS 7 Basics hospital hygiene 19 19 RESULTS 8 • Basics hospital hygiene 100 % 90 80 78 70 60 50 40 P=0.002 30 20 During outbreaks period 13 10 After Outbreaks period 0 Functional water facilities at consultation room 20 20 RESULTS 9 • Basics hospital hygiene % 100 90 80 70 60 50 40 30 20 10 0 90 P=0.005 35 During outbreaks period After Outbreaks period Hand washing before/after contact with patients 21 21 RESULTS 10 Knowledge on Emerging Infectious Disease 22 22 RESULTS 11 • knowledge on Emerging Infectious disease 71 % 100 90 80 70 60 50 40 30 20 10 0 P=0.000 After Outbreaks period 5 During outbreaks period Identify LVF/Ebola suspected case 23 23 RESULTS 12 • knowledge on Emerging Infectious disease % 100 80 60 35 40 20 P=0.000 0 During Outbreaks period After Outbreaks period 0 Knowing that LF is endemic in Benin 24 24 RESULTS 13 •Zika virus • Unknown up to OG 2016 Rio 0% Asked once zika test 0% suspected zika based on symptoms 0% knew How to prevent Zika 25 25 RESULTS 14 Functional hand washing devices for patients at the main entrance of HCC: During outbreaks Period After outbreaks Period % Yes % No South 60% 40% Central 50% 50% North 80% 20% No statistical difference in findings 26 26 RESULTS 15 Hand washing before/after contact with patients During outbreaks After outbreaks Period Period % Yes % No Medical Doctor 69.2% 30.8% Nurse 70.4% 29.6% No statistical difference in findings 27 27 RESULTS 16 • Propositions from caregivers to preempt LF spreading in HCC 1. Providing logistics for basic hygiene 2. Training and supervision at levels of health system 3. Introducing EID in basics training content of health workers and schools 4. Motivating and evaluating impact HCC actions 28 28 CONCLUSION • Pre-emptive actions of LF spreading in HCC are quiet low and inadequate • Despite good knowledge of the disease • Maintain appropriate and sustain good actions • To pre-empt spreading of emerging infectious diseases such LVF/Ebola within HW • Health authorities have to mobilize resources to reinforce the health system • International as well as domestic 29 29 AKNWOLEDGEMENTS • Health workers • Collaborators • Military Teaching Hospital • Benin Ministry of health and partners • Organizers of this symposium 30 30 Thanks for your attention Merci pour votre attention “The more we are together the merrier we shall be” 31 31