Health Promotion and Contact Tracing US Department of Health and Human Services Centers for Disease Control and Prevention This presentation is current as of December 2014 This presentation contains materials from ID: 931157
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Slide1
Interactions With the Community:
Health Promotion and Contact Tracing
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
This presentation is current as of December, 2014. This presentation contains materials from Centers for Disease Control and Prevention (CDC), Médecins Sans Frontières (MSF), and World Health Organization (WHO).
version 12.03.2014
Preparing Healthcare Workers to
Work in
Ebola Treatment Units (
ETUs)
in Africa
Slide2Learning Objectives
Explain the role of health promotion in Ebola outbreak management Understand the importance of appropriate health promotion messages targeted at the community about the ETUDescribe the importance of contact tracing Recognize interactions that constitute a case contact
Explain the role of healthcare workers in health promotion and contact tracing
Slide3Health Promotion
Slide4Health Promotion in an Ebola Outbreak
Health promotion is a two-way dialogue between the ETU team and the community to facilitate outbreak control that incorporates:Health educationAnthropologyPublic healthCommunicationPsychology
Community health workers, Sierra Leone
Photo provided by MSF
Slide5HP (Expatriate) Supervisor for
ETU
Health Promotion (HP) Team Organization
MSF Example from Kailahun, Sierra Leone
4 Health Promoters2 HP Outreach Workers
8 Health Promoters6 Health
P
romoters Supervising CHWs
Health promotion
Advocate for patients’ needs
Arrange visits
Burial teams
Ambulance service
Contact tracing
Disinfection teams
Health promotion
Answer questions
Address rumors, fears, concerns
Bring home survivors
Train and supervise CHWs (700+)
Alert follow-up
Contact tracing
Health
p
romotion
HP( Expatriate) Supervisor for
Community
Slide6Effective Health PromotionNeed to Understand the Population and Culture
Social structurePopulation, languages, religion, sources of income, movements and transport, social structures, communication channels, marketplaces and dates, family organizationContext of risk exposuresHealth-seeking behaviors
Funeral and burial practicesEating and living habitsPerceptions
Resistance, fear, denial, distrust, anger
Slide7Who is the Target Population for Health Promotion Messages?
Ebola Treatment Unit PatientFamily and other visitorsStaffCommunityHealthcare workers Local healers and birthing attendantsChiefs, elders, stakeholders (NGOs)
Religious leaders (pastors, imams) and teachersEverybody!!!!
Slide8Health Promotion Objectives During an Ebola Outbreak
Communicate clear, simple messages among staff, patients, and communitiesStrengthen understanding of EbolaPromote knowledge of purposes of the ETUSupport outreach activities and contact tracing
Dispel myths and fears about Ebola and
the ETU within the community
Fight stigmatization
Slide9What are the Health Promotion Messages?
Health EducationWhat is Ebola?How is it transmitted?How is it prevented?Ebola Treatment UnitWhy should people go to the ETU?
What treatment is available?How does the ETU function?How does the ETU keep the
community safe?Survivors and Negative Cases
What are the differences?Survivor being congratulated by health promotion worker, Sierra Leone Photo provided by Médecins Sans FrontièresIt is important to keep messages CLEAR and SIMPLE.
Slide10Photos to Stress Modes of Transmission
Slide11Where Does Health Promotion Take Place?
Ebola Treatment UnitCommunitySocial mobilizationOther health structuresMass media Bringing home survivorsOutreach activitiesBurial teams Disinfection teams
Ambulance serviceContact tracing
Surveillance teamsEverywhere! (hotels
, restaurants, etc.)Four survivors being escorted home by health promotion team, Sierra Leone Photo provided by MSF
Slide12How to Share Health Promotion Messages
Mass CommunicationRadioPaper pamphletsTelevisionStory tellersDance
JinglesTheatre productionsFace-to-face Communication
Health promotion staffCommunity health workers
SurvivorsMass communication and face-to-face interaction are both essentialCommunity health worker introducing Ebola survivor back into the community with a government certificate of cure, Sierra LeonePhoto provided by MSF
Slide13Benefits of Effective Health Promotion
Stops rumors and confusionCommunicate facts clearlyNew rumors arise every day from a variety of sourcesEstablishes trustSecurity for the program
Encourage ill people to come to the ETU Reduces fear
Ebola is a new disease in the areaMany deaths very quickly
Cured patient with health promotion worker, Sierra Leone Photo provided by MSF
Slide14RumorsNew Ones Arise Everyday!
Chopping limbs, draining blood, stealing organsStaff bring Ebola to the communityChlorine causes cancerIf everyone bathes in warm
salt water between 2 and 3am, Ebola will go awayPrayer alone will make Ebola go away
Ebola is finishedEbola does not existEbola is HIVMSF throws people into the
burn pitsEbola is a way for the government to kill different tribesMSF kills patients with EbolaEbola comes from waterMSF is going to spray entire villagesPatients will be forced to go to the ETUThere is no food or water at the ETU
Slide15Educating the Community
A health promotion talk in a village, Sierra Leone
Photo provided by MSF
Slide16Lessons Learned: General
Avoid terms like “isolation unit” or “camp” Keep messages clear and simpleDo not focus on messages that are irrelevant or of minor importanceIt is very easy for people to get caught up in details and miss the main pointBalance negative messages with positive messages “Ebola is very deadly, BUT many people survive”
Slide17Lessons Learned: Inside the ETU
Use see-through fences (strive for visibility)Provide area for visitors near the high-risk zoneProvide opportunities for religious servicesProvide mental health servicesTake care of families of patients who dieMake morgue visibleProvide area for grieving
Give 24 hours to view body, to provide time for items to be placed inside body bag, and to say prayers
Slide18Patient with Ebola holding picture of his wife and child. All three survived.
Photo provided by MSF, Sierra Leone
Slide19Contact Tracing
Slide20What is Contact Tracing?
Identify all contacts of every Ebola caseInterviews with patient, family, healthcare workers, and othersContact: Anyone who had exposure to a person with Ebola (dead or alive) over the past 21 daysDirect contact = needlestick
, splash to mucous membranes, or touching any infected body fluids or a corpse without correctly wearing personal protective equipment (PPE), or living with and caring for a person showing symptoms of EbolaClose contact
= being within three feet of a person with Ebola for a prolonged time without wearing PPE (e.g. , same household or worksite)Risk level:
*high risk *some risk *low riskFollow all high, some, and low risk contacts daily until 21 days after last contacthttp://www.cdc.gov/vhf/ebola/exposure/risk-factors-when-evaluating-person-for-exposure.html
Slide21Contact Tracing is Key to Ebola Outbreak Control
If you can quickly identify and isolate
this patient
You can prevent these people from getting sick
Slide22Contact Tracing and the Healthcare Worker
Contact tracing is:Conducted by public health workers as part of the epidemiologic component of the responseNot done by healthcare workers who are caring for patientsHealthcare workers need to understand contact tracing to:Facilitate the processReport observed deficiencies in contact tracing to epidemiologists
Slide23Contact Tracing: The Visit
Visit all contacts daily for 21 days after last interaction with confirmed case (alive or dead) to see if the contact remains wellContact tracing can pose a risk of infection
Contact or the contact’s household members may be illAlways maintain interpersonal distance of >1 meter (3 feet)
to reduce risk of infectionDo not enter homesPPE generally not used during contact tracing
If contact has fever or is unwell, call for safe transportation to the ETU
Slide24Contact Tracing: Outcomes
If contact has fever or is ill: safely transport to the ETUIf contact remains well for 21 days: monitoring endsIf contact is absent: report
to epidemiologists—finding and visiting this contact is a priority for
the next dayIf contact is not traceable for several days
Search diligently for contact Continue tracing contact until found; important to try to account for the contact even after 21 days have passedMany times, a contact flees due to fear. In these cases, the team should proceed with caution
Slide25Contact Tracing in t
he Field
Contact tracing team,
Kailahun
district, Sierra LeonePhoto provided by MSF
Slide26Community outreach team going to a village,
Kailahun
district, Sierra Leone
Photo provided by MSF
Slide27All direct and close contacts
will be monitored for 21 days
Slide28When Patients with Ebola are Not Hospitalized
Ideally, to control the epidemic, all patients with Ebola are hospitalized in ETUsIsolation prevents spreadTreatment
improves chances of survivalHowever, some patients with Ebola
are not admittedSome patients refuse admission—admission is not compulsory
Some ETUs are full and have to turn away patientsWhat can be done?If a patient refuses admission, do your best to change his or her mindIf the ETU is full, know the plan and recommendations for patients returning homeOther strategies for caring for patients with Ebola are under active discussion
Slide29Home-based Support and Risk Reduction for
Patients Who Refuse ETU AdmissionExample from MSFIf patient remains at home, he or she should be looked after by ONE designated caregiverEducate patient and caregiver About routes of transmission
How to protect caregiver and other people in the homeAbout basic supportive treatment (e.g., painkillers, fever control, oral antibiotics, antimalarials
, ORS)Give caregiver protective equipment and disinfection materials along with appropriate trainingNotify the ETU contact tracing infrastructure
Slide30Summary
Health promotion and contact tracing are essential elements of outbreak controlThey are conducted by health promoters, community health workers, epidemiologists, and other public health workers Healthcare workers’ roles in health promotion and contact tracing
Support clear communication about Ebola, ETUs, safety measuresFacilitate contact tracing where possible
Report observed deficiencies in contact tracing to epidemiologists
Slide31U.S. Department of Health and Human Services
Centers for Disease Control and Preventionhttp://www.cdc.gov/vhf/ebola