CHAPTER-I

INTRODUCTION

(“Care is an absolute. Prevention is the ideal.”

-Christopher Howson)

Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever is a very

severe and often fatal illness in humans caused by Ebola virus. Ebola virus disease in humans

is caused by four of five viruses of the genus Ebolavirus. The four are Bundibugyo virus

(BDBV), Sudan virus (SUDV), Tai Forest virus (TAFV) and one simply called Ebola virus

(EBOV, formerly Zaire Ebola virus). Ebola virus disease first appeared in 1976 in 2

simultaneous outbreaks, one in what is now Nzara, South Sudan, and the other in Yambuku, a

small village in Mongala Province in northern Democratic Republic of the Congo. The latter

occurred in a village near the Ebola River, from which the disease takes its name. The virus is

usually transmitted to people from wild animals and spread across the human population

through human-to-human transmission. There is currently an overwhelming concern in India

about the spread of Ebola virus disease and the consequent health challenges and burden in

the affected regions. Ebola virus disease has a high fatality rate, and there is currently no

treatment or vaccine with proven safety and efficacy for the disease. The average EVD case

fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past

outbreaks. This makes Ebola virus disease a dreadful disease indeed.

Compared to most illnesses, Ebola hemorrhagic fever has a relatively short history.

Health care professionals discovered Ebola in 1976. There have been several Ebola

outbreaks, including the 2014-2016 "unprecedented epidemic" in Africa, which has abated.

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 Ebola virus represent an illness that should warrant a substantial paradigm shift in the

health care delivery and the public health personnel should be instrumental in making this

happen by providing adequate information to the people about the causes, symptoms, mode

of transmission, prevention and treatment of Ebola virus disease.

It is thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts.

Ebola is introduced into the human population through close contact with the blood,

secretions, organs or other bodily fluids of infected animals such as fruit bats, chimpanzees,

gorillas, monkeys, forest antelope or porcupines found ill or dead or in the rainforest.

Ebola then spreads through human-to-human transmission via direct contact (through broken

skin or mucous membranes) with:

 Blood or body fluids of a person who is sick with or has died from Ebola

 Objects that have been contaminated with body fluids (like blood, feces, vomit) from

a person sick with Ebola or the body of a person who died from Ebola

Health-care workers have frequently been infected while treating patients with

suspected or confirmed Ebola virus disease. This occurs through close contact with patients

when infection control precautions are not strictly practiced.

Burial ceremonies that involve direct contact with the body of the deceased can also

contribute in the transmission of Ebola.

Ebola virus disease is characterized by febrile severe illness, with gastrointestinal

manifestations of very high magnitude and is complicated by intravascular volume depletion,

shock, electrolyte imbalance, and finally, organ failure. The most unfortunate thing about

Ebola virus disease symptoms is that they are also easily mistaken for malaria, typhoid fever,

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dysentery, influenza, and various bacterial infections, all of which are prevalent in the Ebola

stricken regions.

Ebola virus is only transmitted by patients who are already presenting symptoms of

the disease and by direct contact with blood or body fluid of an Ebola patient. It is therefore

very crucial to equip the masses with relevant information concerning this dangerous disease.

Early supportive care with rehydration, symptomatic treatment improves survival. There is no

licensed treatment proven to neutralize the virus but a range of blood, immunological and

drug therapies are under development.

Supportive care - rehydration with oral or intravenous fluids - and treatment of specific

symptoms improves survival. There is as yet no proven treatment available for Ebola virus

disease. However, a range of potential treatments including blood products, immune therapies

and drug therapies are currently being evaluated.

In the ongoing 2018-2019 Ebola outbreak in Democratic Republic of Congo, the first-

ever multi-drug randomized control trial is being conducted to evaluate the effectiveness and

safety of drugs used in the treatment of Ebola patients under an ethical framework developed

in consultation with experts in the field and the Democratic Republic of Congo.

Good outbreak control relies on applying a package of interventions, including case

management, surveillance and contact tracing, a good laboratory service, safe burials and

social mobilization. Community engagement is key to successfully controlling outbreaks.

Raising awareness of risk factors for Ebola infection and protective measures (including

vaccination) that individuals can take is an effective way to reduce human transmission. Risk

reduction messaging should focus on several factors:

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 Reducing the risk of wildlife-to-human transmission from contact with infected fruit

bats, monkeys, apes, forest antelope or porcupines and the consumption of their raw

meat. Animals should be handled with gloves and other appropriate protective

clothing. Animal products (blood and meat) should be thoroughly cooked before

consumption.

 Reducing the risk of human-to-human transmission from direct or close contact with

people with Ebola symptoms, particularly with their bodily fluids. Gloves and

appropriate personal protective equipment should be worn when taking care of ill

patients. Regular hand washing is required after visiting patients in hospital, as well as

after taking care of patients at home.

 Outbreak containment measures, including safe and dignified burial of the dead,

identifying people who may have been in contact with someone infected with Ebola

and monitoring their health for 21 days, the importance of separating the healthy from

the sick to prevent further spread, and the importance of good hygiene and

maintaining a clean environment.

 Reducing the risk of possible sexual transmission, based on further analysis of

ongoing research and consideration by the WHO Advisory Group on the Ebola Virus

Disease Response, WHO recommends that male survivors of Ebola virus disease

practice safer sex and hygiene for 12 months from onset of symptoms or until their

semen tests negative twice for Ebola virus. Contact with body fluids should be

avoided and washing with soap and water is recommended. WHO does not

recommend isolation of male or female convalescent patients whose blood has been

tested negative for Ebola virus.

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NEED FOR THE STUDY

“Real knowledge is to know the extent of one’s ignorance” – Confucius

Ebola hemorrhagic fever first appeared in Zaire in 1976. The original outbreak was in a

village named Yambuku near the Ebola River after which the disease was named. During that

time, researchers identified the virus in person-to-person contact transmission. Of the 318

patients diagnosed with Ebola, 88% died. The second outbreak occurred in Nzara, South

Sudan, in 1976, with 151 deaths.

Once an Ebola outbreak is recognized, African officials isolate the area until the

outbreak ceases. However, in the outbreak that began in West Africa in March 2014, some of

the infected people reached larger city centers before the outbreak was recognized; this

caused further spread. The infecting Ebola virus detected during this outbreak was the Zaire

strain, the most pathogenic strain of Ebola. Health agencies are terming this outbreak as an

"unprecedented epidemic." This epidemic spread quickly in the West African countries of

Guinea and Sierra Leone. In addition, countries of Liberia, Nigeria, Senegal, Uganda, and

Mali all reported confirmed infections with Ebola. In addition, a few infections or flare-ups of

Ebola virus infection appeared in the United States, Spain, and the United Kingdom (see for

example, the case of Pauline Cafferkey, a nurse who became infected); most of the people

with Ebola in these countries either were imported infections from West Africa or were

newly spread infections from treating patients who originally became infected in Africa.

Community-based reports of morbidity, mortality, and health-seeking behaviours in four

Monrovia communities during the West African Ebola epidemic.The goal of this study was to

assess morbidity, mortality, and health-seeking behaviours during the 2014 Ebola outbreak in

Monrovia, Liberia. Researchers used a multi-stage cluster approach to recruit participants.

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Within 555 households sampled, 505 individuals were reported sick (69%) or recently sick

(38%) or deceased (7%).

In the first year after hospital discharge, mortality in Ebola survivors was five times higher

than would be expected in general Guinean population (55 deaths versus 11 deaths),

according to an observational study of 1,130 people published in The Lancet Infectious

Diseases journal. From December 8, 2015, the study followed-up 89% (1,130/1,270) of the

Guinean survivors of the 2013-16 Ebola outbreaks in West Africa and recorded 59

subsequent deaths. Survivors were followed up until September 30, 2016, and deaths up to

this time point were recorded.

Another outbreak occurred in the DRC in May 2018 in Bikoro, a small town 80 miles

from Mbandaka, with 46 reported infections and 26 deaths. Unfortunately, the large city of

Mbandaka, with over 1 million people, has recorded at least three people with Ebola. Health

officials report over 1,000 deaths due to Ebola in areas like Butembo in the Congo (DRC)

and neighboring countries in an ongoing outbreak over the last 9 months. This outbreak is

difficult to control because it is happening in a war zone where cooperation between

countries to control the outbreak is uncoordinated and even considered unwelcome.

National survey of Ebola-related knowledge, attitudes and practices before the outbreak

peak in Sierra Leone: August 2014, conducted interviews with 1413 randomly selected

respondents from 9 out of 14 districts in Sierra Leone using multistage cluster sampling. All

respondents were aware of Ebola. When asked unprompted, 60% of respondents could

correctly cite fever, diarrhoea and vomiting as signs/symptoms of Ebola. A majority of

respondents knew that avoiding infected blood and bodily fluids (87%) and contact with an

infected corpse (85%) could prevent Ebola. However, there were also widespread

misconceptions such as the belief that Ebola can be prevented by washing with salt and hot

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water (41%). Almost everyone interviewed (95%) expressed at least one discriminatory

attitude towards Ebola survivors. Unprompted, self-reported actions taken to avoid Ebola

infection included hand washing with soap (66%) and avoiding physical contact with

patients with suspected Ebola (40%).

The prognosis of Ebola hemorrhagic fever is often poor; the death rate of this disease

ranges from 25%-100%, and those who survive may experience the complications. However,

early diagnosis and treatment of Ebola may greatly increase the patient's chance for survival.

Unfortunately, this disease has been mainly located in countries where medical care is often

difficult to obtain, especially in rural areas of Africa. Statistics available on the ongoing

2014-2016 outbreak of Ebola are summarized below:

Total suspected, probable, and confirmed infections worldwide equal 28,616 and total

deaths equal 11,310 for a death rate or death toll of approximately 41%. An occasional new

infection (at a low level) and deaths of current patients are unlikely to change these numbers

substantially as the epidemic outbreak has ended according to the CDC. Fortunately, this

epidemic of 2014-2016 did not become a pandemic but did show how rapidly a relatively rare

disease like Ebola can rapidly infect a large number of individuals in this modern-day

society. The globalized world has not only provided a passage for people to cross borders but

has also created a corridor for diseases to travel at rapid speeds. With a steady rise in the

number of non-communicable diseases, as well as infectious disease threats, it has become

urgent for us to build more resilient universal health care systems that prioritize prevention

along with containment of such diseases.

India, which had so far remained unscathed from the virus, has diagnosed a fresh case of

it after an Indian resident’s semen sample showed traces of Ebola virus. In the year 2014 a 26

year old man who returned from Liberia (West Africa) was kept in isolation at Delhi’s

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Airport Health Organization Quarantine Centre as his semen sample tested positive for traces

of Ebola virus. WHO declared Ebola Virus Disease as a public health emergency of

international concern, under the International Health Regulations, IHR (2005) on 8 August

2014 and hence every country needs to raise the level of vigilance on the deadly virus. India

too should be on alert. There are thousands of Indians who are working in Ebola infected

areas in Africa. If they return to their homeland – India – then chances of spreading of the

virus is there due to dense population and poor sanitation in India. The reason being almost

45000 Indians live in Ebola-affected African countries and there is every chance that visiting

Indians can bring it home. In India, steps have been taken by the health ministry to deal with

this deadly virus, if at all it gets detected here. Adequate awareness has been advocated to

curb and control the outbreak. This present study, therefore, sets out to assess the

effectiveness of planned teaching programme in enhancing knowledge about Ebola virus

disease among adults.

STATEMENT OF PROBLEM

“A pre-experimental study to assess the effectiveness of planned teaching programme on

knowledge regarding Ebola virus disease among young adults residing at selected community

area of Bhilai (C.G).”

OBJECTIVES

1. To assess the pre-test & post-test level of knowledge regarding Ebola virus disease

among young adults at selected community area of Bhilai (C.G).

2. To assess the effectiveness of planned teaching programme on knowledge regarding

Ebola virus disease among young adults.

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3. To find out the association between pre-test knowledge score regarding Ebola virus

disease among young adults with their selected socio demographic variables.

OPERATIONAL DEFINITIONS

1. Assess: - It is the way to determine the level of knowledge regarding the Ebola among

young adults.

2. Effectiveness: - It is defined as a significant increase in the level of knowledge

regarding Ebola virus disease among young adults which is measured from the

difference in pre-test and post-test level of knowledge.

3. Knowledge: - It refers to the correct responses received from young adults on

structured interview schedule regarding Ebola virus disease.

4. Planned teaching programme: - In this study it refers to strategy which has been

validated by experts in order to impart knowledge regarding Ebola virus disease.

5. Ebola virus disease: An infectious or fatal disease marked by fever and severe

internal bleeding, spread through contact with infected body.

6. Young adults: - Adults who are residing in selected community areas between the

age of (18-35) years

7. Community: Urban community of Utai.

NULL HYPOTHESIS

(Ho): There will be no significant difference in pre-test and post-test knowledge scores

regarding Ebola virus disease among young adults.

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HYPOTHESIS

H1: There will significant difference in pre-test and post-test knowledge scores regarding

Ebola virus disease among young adults.

H2: There will be significant association between pre-test knowledge scores among young

adults with their selected socio demographic variables.

DELIMITATIONS

 The study is delimited to only young adults aged between 18-35 years of selected

community area of Bhilai (C.G.)

 Cost and time factors necessarily limited to 40 samples.

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CONCEPTUAL FRAMEWORK BASED ON IMOGENE KING

OF GOAL ATTAINMENT THEORY

Imogene King earned a diploma in nursing from St. Johns hospital of nursing in

St. Louise in 1945. She then worked as an office nurse, school nurse, staff nurse and private

duty nurse to support herself while studying for a baccalaureate degree. In 1948 she received

a bachelor of science in nursing education from St. Louise University. From 1947 to 1958

King worked as an instructor in medical surgical nursing and then as an assistant director at

St. Louise University and a doctor of education degree from teachers college, Columbia

University, New York in 1961. King was awarded an honorary PhD from southern Illinois

University in1980.

OPEN SYSTEM FRAMEWORK

The purpose of the conceptual framework is to organize concept that represent

essential knowledge that ought to be used by many disciplines and to construct theories from

the framework and test them from the perspective of nursing as a discipline.

Nursing phenomena are organized within three dynamic interacting system.

 Personal system

 Interpersonal system

 Social system

PERSONAL SYSTEM

Each individual is a personal system the relevant concept are perception, self-

growth, body image, space, learning and time.

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INTERPERSONAL SYSTEM

Interpersonal system is formed by human being interacting. Two interacting

individuals form a dyad; three form a triad, and four or more form small or large groups. As

the numbers of interacting individuals increase so does the complexity of interaction. The

relevant concept for interpersonal system is interaction, communications, transactions role

and stress. The concepts from the personal system are also used in understanding interaction.

SOCIAL SYSTEM

A social system is defined as “an organized boundary system of social roles, behavior

and practices developed to maintain values and the mechanism to regulate the practice and

rules.”

THEORY OF GOAL ATTAINMENT

The major components of the theory of goal attainment are stated in her (King’s)

interpersonal system in which two people who are usually stranger comes together in a health

care system to help and be helped to maintain a state of health that permits functioning in

roles. The present study aims at assessing the effectiveness of planned teaching programme

for subjects to enhance their knowledge regarding Ebola virus disease. The conceptual

framework of present study based on Imogene King theory of goal attainment model.

DEFINITION OF TERM USED IN THE MODEL

INTERACTION

It is defined as a process of perception and communication between person and

environment and between person and person represented by verbal and non-verbal behaviors

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that are goal-directed. In this study it refers to the plan to reinforce knowledge of subjects

regarding Ebola virus disease by using planned teaching programme.

PERCEPTION

Each person representation of reality. The elements of perception are the importing of

energy from the environment and organizing it by information, transformation, energy,

processing, and information, storing information and exploring information in the form of

overt behaviors. In this study refers to the inadequate knowledge of subjects regarding Ebola

virus disease.

COMMUNICATION

As a process whereby information given from one person to another either directly

in face to face. In this study refers to the investigator developed and introduce planned

teaching programme for young adults on Ebola virus disease.

TRANSACTION

Observable behaviors of human being interacting with that environment. Transaction

represent the valuation component of human interactions and involve bargaining, negotiating

and social exchange. In this study it refers to the post-test to assess the knowledge using

knowledge questionnaire scoring as-

 Poor knowledge : - 0 to 10 mark (0% to 33.33%).

 Average knowledge : - 11 to 20 mark (36.66% to 66.66%).

 Good knowledge : - 21 to 30 mark (70% to 100%).

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SUMMARY

This chapter deals with introduction to the problem, need of the study, statement of

the problem, objectives, hypothesis, operational definition, conceptual framework and

summary.

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