Evaluation of Community Perceptions and Prevention Practices Related to Ebola Virus as Part of Outbreak Preparedness in Uganda, 2020

Joseph Musaazi; Apophia Namageyo-Funa; Victoria M. Carter; Rosalind J. Carter; Mohammed Lamorde; Rose Apondi; Tabley Bakyaita; Amy L. Boore; Vance R. Brown; Jaco Homsy; Joanita Kigozi; Aybüke Koyuncu; Maria Sarah Nabaggala; Vivian Nakate; Emmanuel Nkurunziza; Daniel F. Stowell; Richard Walwema; Apollo Olowo; Mohamed F. Jalloh

doi:10.9745/GHSP-D-21-00661

Key Findings

Individuals in Ebola virus disease (EVD) high-risk districts reported greater EVD message exposure and comprehensive knowledge compared to individuals in EVD low-risk districts.
Individuals with comprehensive knowledge of EVD were more likely to self-report frequent handwashing with soap, avoiding physical contact with suspected Ebola patients, and avoiding funerals/burials that involve physical contact with a corpse.
Rejection of EVD misconceptions was not significantly associated with self-reported EVD-related prevention practices.

Key Implications

Efforts to promote EVD comprehensive knowledge may facilitate the uptake of EVD prevention practices.
Risk communication and community engagement efforts continue to be critical for EVD preparedness and response efforts, especially in high-risk geographic areas.

ABSTRACT

Introduction:

During the 2018–2020 Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo, risk communication and community engagement (RCCE) were prioritized in geographic areas in Uganda considered at high risk of introduction of EVD. To inform EVD preparedness in Uganda, we evaluated community perceptions and prevention practices related to EVD in 6 districts in Uganda.

Methods:

In March 2020, we conducted a population-based survey in 6 purposively selected districts in Uganda using multistage cluster sampling. We examined differences between districts classified as high- versus low risk for EVD in terms of their message exposure from RCCE; risk perception; and EVD knowledge, attitudes, and prevention practices.

Results:

A total of 3,485 respondents were interviewed (91% response rate). EVD message exposure was more common in the high- versus low-risk districts. EVD risk perceptions were low overall but greater in the high- versus low-risk districts. Comprehensive knowledge was significantly greater in the high- versus low-risk districts (adjusted prevalence ratio [aPR] 1.61, 95% confidence interval [CI]=1.35, 1.93). Respondents' engagement in all 3 EVD prevention practices (frequent handwashing with soap, avoiding physical contact with suspected Ebola patients, and avoiding burials involving contact with a corpse) was very low (4%). However, respondents with comprehensive knowledge were more likely to engage in all 3 EVD prevention practices compared to respondents without comprehensive knowledge (aPR 1.87, 95% CI=1.08, 3.25).

Conclusion:

Our findings suggest that while RCCE efforts as part of EVD outbreak preparedness may have contributed to higher EVD knowledge in the targeted high-risk districts, uptake of prevention behaviors was similarly low across districts. In a non-outbreak setting, implementing targeted RCCE strategies may not be sufficient to motivate people to adopt protective behaviors in the absence of a high threshold of perceived threat such as in an active outbreak.

Footnotes

↵* Co-first authors.

Received: September 25, 2021.
Accepted: March 29, 2022.
Published: June 29, 2022.

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