Community engagement in Ebola outbreaks in sub-Saharan Africa and implications for COVID-19 control: A scoping review

Evaluation of a decentralised model of care on case isolation and patient outcomes during the 2018-20 Ebola outbreak in the Democratic Republic of the Congo: a retrospective observational study

BACKGROUND

Partway into the 2018-20 Ebola outbreak in the Democratic Republic of the Congo (DR Congo), a new strategy of decentralised care was initiated to address delays in care seeking, improve community acceptance, and reduce the risk of Ebola virus disease (EVD) transmission through early case isolation. Unlike centralised EVD facilities (transit and treatment centres), which operated in parallel to the existing health-care system and focused exclusively on EVD, decentralised facilities were integrated into existing health-care structures with which communities were already familiar, and designed to continue providing health care for patients with other non-EVD illnesses. Here we aim to assess the strategy of decentralised care by comparing admission delays and patient outcomes among the three types of EVD facilities (decentralised, transit, and treatment).

METHODS

We performed a retrospective analysis of routinely collected data from all individuals admitted to EVD facilities (12 treatment, nine transit, and 21 decentralised facilities) at any point during the Ebola outbreak from July 27, 2018, to June 24, 2020 in DR Congo. We used multivariate mixed-effect regression to model admission delays (the number of days between symptom onset and admission to an EVD facility) and patient outcomes (survived or died), as functions of facility type at first admission and date of admission, while controlling for a variety of other covariates.

FINDINGS

Over the course of the outbreak 60 465 patients were admitted to EVD facilities, of which 2289 (3·8%) were confirmed to be EVD positive. Covariate-adjusted admission delays were somewhat higher among patients presenting to transit facilities (adjusted rate ratio 1·14 [95% CI 0·95-1·32]) or treatment facilities (1·18 [1·00-1·36]) compared with decentralised facilities. Similarly, compared with decentralised facilities, adjusted case-fatality risks were slightly higher among patients presenting to transit facilities (adjusted risk ratio 1·04 [0·82-1·26]) or treatment facilities (1·03 [0·82-1·24]).

INTERPRETATION

As was observed during the 2013-16 west Africa outbreak and the 2020 outbreak in the Equateur province of DR Congo, patients suspected of EVD that presented to decentralised facilities had modestly shorter admission delays than patients presenting to centralised facility types. Case-fatality risks were slightly lower among patients presenting to decentralised facilities; however, this finding was not statistically significant and so it is difficult to assess the generalisability.

FUNDING

Médecins Sans Frontières.

TRANSLATION

For the French translation of the abstract see Supplementary Materials section.

Barriers to community engagement during the response to an Ebola virus disease outbreak in Uganda

BACKGROUND

Uganda reported an outbreak of Ebola virus disease (EVD) in 2022. As part of the outbreak response, government and partners promoted community engagement, which seeks to involve communities in the design, implementation and evaluation of interventions to raise awareness, build trust between communities and partners and create ownership of interventions. This study, therefore, explored barriers to community engagement during the 2022-2023 EVD outbreak response in Uganda.

METHODS

This qualitative study, conducted in five districts (Kampala, Kassanda, Kyegegwa, Mubende and Wakiso), involved 25 focus group discussions among community members and community health workers (CHWs). In addition, 32 key informant interviews were conducted with staff from the Uganda Ministry of Health, district health officials, local leaders, non-governmental organisation staff and other stakeholders. Data were analysed according to the thematic approach using ATLAS.ti (V.6).

RESULTS

The main barriers to community engagement identified during the EVD outbreak response are presented under four main themes: (1) delayed consultations between partners and communities; (2) poor communication and misinformation; (3) limited support to human resources; and (4) institutional and coordination challenges. Specifically, these barriers included: limited consultation due to misbelief in community roles; delayed sociocultural discussions; stigma and delayed psychosocial interventions; misinformation, rumours and political influence; poor communication mechanisms; contradictory messages and lack of transparency; language barrier and inappropriate communication media; work overload for CHWs and other community volunteers; failure to prioritise protection of community workers; lack of compensation for CHWs and other community personnel; poor logistical management; inadequate coordination and partner operations; unfavourable institutional structures; and limited funding for emergencies.

CONCLUSION

The barriers encountered in community engagement during the 2022-2023 EVD outbreak need to be addressed through strengthening guidelines and standard operating procedures, capacity building for partners and communities, as well as adequate financing to ensure Uganda is better prepared for future health emergencies.

Qualitative insights on emergency preparedness and response to marburg virus disease in Ghana: The role of risk communication and community engagement

OBJECTIVES

Faith-based healthcare providers have played pivotal roles in recent public health responses to disease outbreaks, such as Ebola, COVID-19, and Marburg Virus Disease. However, the literature on their performance remains scarce. This research therefore evaluates the risk communication and community engagement capacity of the Christian Health Association of Ghana (CHAG) during the Marburg Disease Virus outbreak in Ghana.

METHOD

Data were obtained from 15 clinical and nonclinical health workers affiliated with CHAG and the Ghana Health Service (GHS). Online interviews were conducted to assess the coordination of risk communication and community engagement during Marburg Virus outbreak in Ghana. Thematic analysis was employed for data analysis.

FINDINGS

Active engagement of national-level stakeholders, including the Ministry of Health and the Ghana Health Service, was observed. Outreach activities encompassing surveillance and contact tracing were also executed. However, resource constraints led to passive involvement of frontline workers in stakeholder meetings and risk communication activities, posing a limitation to the Risk Communication and Community Engagement (RCCE) effort.

CONCLUSION

To address health system vulnerabilities and misinformation in low-resourced countries during health emergencies, a bottom-up approach is vital. This approach will enhance the capacity of communities, professionals, NGOs, and media to counter infodemics and disinformation. Government and healthcare facility owners must ensure robust logistical and policy preparations to effectively equip healthcare facilities for future disease outbreaks.

Role of social innovations in health in the prevention and control of infectious diseases: a scoping review

BACKGROUND

The implementation of social innovations for addressing societal challenges, particularly in health, leverages community participation and technology to optimally meet social needs compared to traditional approaches. A key feature of these innovations is their ability to utilize existing capacities for contributing to resolving infectious disease outbreaks, which has attracted significant attention from health organizations. Given the potential of these innovations, this study has investigated social innovations in the prevention and control of infectious diseases as one of the major global challenges in the form of a comprehensive literature review.

METHODS

This review study examined the relevant literature from January 1, 2010 to December 31, 2022. Based on inclusion and exclusion criteria, 50 documents were retained and fully examined. The documents were analyzed by applying a thematic analysis, and important content related to the application of social innovations for the prevention and control of pandemic infectious diseases was extracted using a data collection form.

RESULTS

Five major themes concerning social innovation in the prevention and control of epidemic diseases were discerned as follows: new products, novel processes and policies, empowerment, innovative practices and behaviors, and community engagement. New products include technological products for control and management of epidemics, preventive products, diagnostic and therapeutic products. Novel processes and policies are related to reorienting and reorganizing care methods, control and monitoring policies, participatory and creative strategies. Empowerment is focused on enhancing the capabilities of health workers, community leaders, and communities. Innovative practices and behaviors involve technology-based participation and support mechanisms. Community engagement is related to awareness, consultation, community mobilization, and participation in production and support.

CONCLUSIONS

During the outbreak of infectious diseases, governments are faced with many challenges, including health, economic and social challenges. To answer these challenges, tools should be used that have the ability to answer the problem from several aspects. Social innovation as an appropriate process in response to health crises has led to new forms of relationships and empowered the communities. And to promote public health, it provides the opportunity for all members of the society to participate in crisis resolution and optimal use of resources.

Community led health promotion to counter stigma and increase trust amongst priority populations: lessons from the 2022-2023 UK mpox outbreak

BACKGROUND

Stigma, lack of trust in authorities, and poor knowledge can prevent health-seeking behaviour, worsen physical and mental health, and undermine efforts to control transmission during disease outbreaks. These factors are particularly salient with diseases such as mpox, for which 96% of cases in the 2022-2023 UK outbreak were identified among gay, bisexual, queer and men who have sex with men (MSM). This study explored stigma and health-seeking behaviour in Liverpool through the lens of the recent mpox outbreak.

METHODS

Primary sources of data were interviews with national and regional key informants involved in the mpox response, and participatory workshops with priority populations. Workshop recruitment targeted Grindr users (geosocial dating/hookup app) and at risk MSM; immigrant, black and ethnic minority MSM; and male sex workers in Liverpool. Data were analysed using a deductive framework approach, building on the Health Stigma and Discrimination Framework.

RESULTS

Key informant interviews (n = 11) and five workshops (n = 15) were conducted. There were prevalent reports of anticipated and experienced stigma due to mpox public health messaging alongside high demand and uptake of the mpox vaccine and regular attendance at sexual health clinics. Respondents believed the limited impact of stigma on health-seeking behaviour was due to actions by the LGBTQ + community, the third sector, and local sexual health clinics. Key informants from the LGBTQ + community and primary healthcare felt their collective action to tackle mpox was undermined by central public health authorities citing under-resourcing; a reliance on goodwill; poor communication; and tokenistic engagement. Mpox communication was further challenged by a lack of evidence on disease transmission and risk. This challenge was exacerbated by the impact of the COVID-19 pandemic on the scientific community, public perceptions of infectious disease, and trust in public health authorities.

CONCLUSIONS

The LGBTQ + community and local sexual health clinics took crucial actions to counter stigma and support health seeking behaviour during the 2022-2023 UK mpox outbreak. Lessons from rights based and inclusive community-led approaches during outbreaks should be heeded in the UK, working towards more meaningful and timely collaboration between affected communities, primary healthcare, and regional and national public health authorities.

Community interventions for pandemic preparedness: A scoping review of pandemic preparedness lessons from HIV, COVID-19, and other public health emergencies of international concern

Community action is broadly recognised as central to comprehensive and effective system responses to pandemics. However, there is uncertainty about how and where communities can be best supported to bolster long-term resilience and preparedness. We applied a typology of community interventions (Community Informing, Consulting, Involving, Collaborating or Empowering-or CICICE) to cover the diverse range of interventions identified across the literature and used this to structure a scoping review addressing three linked topics: (i) how CICICE interventions have been understood and applied in the literature on epidemic and pandemic preparedness; (ii) the spectrum of interventions that have been implemented to strengthen CICICE and (iii) what evidence is available on their effectiveness in influencing preparedness for current and future emergencies. We drew on peer-reviewed and grey literature from the HIV (from 2000) and COVID-19 pandemics and recent public health emergencies of international concern (from 2008), identified through systematic searches in MEDLINE, Scopus, the Cochrane Collaboration database, supplemented by keyword-structured searches in GoogleScholar and websites of relevant global health organisations. Following screening and extraction, key themes were identified using a combined inductive/deductive approach. 130 papers met the criteria for inclusion. Interventions for preparedness were identified across the spectrum of CICICE. Most work on COVID-19 focused on informing and consulting rather than capacity building and empowerment. The literature on HIV was more likely to report interventions emphasising human rights perspectives and empowerment. There was little robust evidence on the role of CICICE interventions in building preparedness. Evidence of effect was most robust for multi-component interventions for HIV prevention and control. Much of the reporting focused on intermediate outcomes, including measures of health service utilisation. We put forward a series of recommendations to help address evidence shortfalls, including clarifying definitions, organising and stratifying interventions by several parameters and strengthening evaluation methods for CICICE.

Development and validation of a French questionnaire that assesses knowledge, attitude, and practices toward Marburg diseases in sub-Saharan African countries

OBJECTIVES

Marburg virus, previously referred to as Marburg hemorrhagic fever, is a highly severe and frequently fatal illness that affects humans. This study aimed to develop and validate a French questionnaire to assess knowledge, attitude, and practice toward Marburg virus disease (FKAP-MVD).

STUDY DESIGN

An anonymous online survey was used, which was distributed through various platforms and emails. Data were collected from Burkina Faso, Guinea, the Democratic Republic of Congo, and Senegal.

METHODS

To conduct the study, an anonymous online survey was used, which was distributed through various platforms such as Facebook, Twitter, WhatsApp, and emails. The survey was uploaded onto a Google form to facilitate data collection. Data were collected from Burkina Faso, Guinea, the Democratic Republic of Congo, and Senegal.

RESULTS

Of the total sample of 510 participants, 60.0% were male, their mean age was 28.41 ± 6.32 years, 38.0% were married, 86.6% resided in urban areas and 64.1% had a university education. The questionnaire had good internal consistency; Cronbach's alpha was 0.87. The correlation between knowledge and attitude was 0.002, the correlation between knowledge and practice was 0.204, and the correlation between practice and attitude was relatively weak and negative at -0.060. This indicates the divergent validity of the questionnaire. The KMO value of 0.91 indicates a high level of adequacy, suggesting that the data are suitable for factor analysis. The Bartlett test of Sphericity yielded an approximate χ2 value of 4016.890 with 300 degrees of freedom and a P-value of 0.0001. The confirmatory factor analysis revealed 25 questions in three domains. The normed chi-square value is 1.224. The goodness of Fit Index (GFI) is 0.902, the Comparative Fit Index (CFI) is 0.982, the Root Mean Square Error of Approximation (RMSEA) is 0.033, and the Root Mean Square Residual (RMR) is 0.062. These values indicate a good fit of the model to the data.

CONCLUSIONS

In general, the developed questionnaire has significant potential to inform public health initiatives and interventions related to MVD.

Exploring the perspectives and practices of humanitarian actors towards the Participation Revolution in humanitarian digital health responses: a qualitative study

BACKGROUND

As crises escalate worldwide, there is an increasing demand for innovative solutions to enhance humanitarian outcomes. Within this landscape, digital health tools have emerged as promising solutions to tackle certain health challenges. The integration of digital health tools within the international humanitarian system provides an opportunity to reflect upon the system's paternalistic tendencies, driven largely by Global North organisations, that perpetuate existing inequities in the Global South, where the majority of crises occur. The Participation Revolution, a fundamental pillar of the Localisation Agenda, seeks to address these inequities by advocating for greater participation from crisis-affected people in response efforts. Despite being widely accepted as a best practice; a gap remains between the rhetoric and practice of participation in humanitarian response efforts. This study explores the extent and nature of participatory action within contemporary humanitarian digital health projects, highlighting participatory barriers and tensions and offering potential solutions to bridge the participation gap to enhance transformative change in humanitarian response efforts.

METHODS

Sixteen qualitative interviews were conducted with humanitarian health practitioners and experts to retrospectively explored participatory practices within their digital health projects. The interviews were structured and analysed according to the Localisation Performance Measurement Framework's participation indicators and thematically, following the Framework Method. The study was guided by the COREQ checklist for quality reporting.

RESULTS

Varied participatory formats, including focus groups and interviews, demonstrated modest progress towards participation indicators. However, the extent of influence and power held by crisis-affected people during participation remained limited in terms of breadth and depth. Participatory barriers emerged under four key themes: project processes, health evidence, technology infrastructure and the crisis context. Lessons for leveraging participatory digital health humanitarian interventions were conducting thorough pre-project assessments and maintaining engagement with crisis-affected populations throughout and after humanitarian action.

CONCLUSION

The emerging barriers were instrumental in shaping the limited participatory reality and have implications: Failing to engage crisis-affected people risks perpetuating inequalities and causing harm. To advance the Participation Revolution for humanitarian digital health response efforts, the major participatory barriers should be addressed to improve humanitarian efficiency and digital health efficacy and uphold the rights of crisis-affected people.

Responses to Hospital Restrictions on Family Visits during the COVID-19 Epidemic in Mali and France

Few studies have focused on the presence of families in the hospital in the context of an epidemic. The present study aims to contribute to filling this gap by answering the following question: How did professionals, patients and their families cope with more or less drastic restrictions to family visits and presence during the COVID-19 pandemic in a French and a Malian hospital during the COVID-19 pandemic? Data were collected during the first two waves of the pandemic through 111 semi-structured interviews (France = 55, Mali = 56). Most of the interviews were conducted with staff (n = 103), but also with families in the case of Mali (n = 8). The investigators also conducted 150 days of field observations, 44 in France and 106 in Mali. Thematic analysis was applied using an inductive approach. Interviews were content analyzed to identify passages in the interviews that were relevant to these different themes. The study highlighted the difficulty for the medical-clinical system to provide appropriate responses to the many emotional needs of patients in a pandemic context. Families in France benefited from a support service to reduce stress, while in Mali, no initiative was taken in this sense. In both countries, families often used the telephone as an alternative means of communicating with relatives. The results showed that in the two contexts, the presence and involvement of the families contributed to a better response to the patients' psycho-affective demands and thus promoted resilience in this field.