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Hafez S, Ismail SA, Zibwowa Z, Alhamshary N, Elsayed R, Dhaliwal M, Samuels F, Fakoya A. Community interventions for pandemic preparedness: A scoping review of pandemic preparedness lessons from HIV, COVID-19, and other public health emergencies of international concern. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002758. [PMID: 38709792 PMCID: PMC11073720 DOI: 10.1371/journal.pgph.0002758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/06/2024] [Indexed: 05/08/2024]
Abstract
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.
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Affiliation(s)
- Sali Hafez
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sharif A. Ismail
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zandile Zibwowa
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nadin Alhamshary
- The Nuffield Centre for International Health and Development, School of Medicine, The University of Leeds, Leeds, United Kingdom
| | - Reem Elsayed
- The University of Western Cape, Cape Town, South Africa
| | - Mandeep Dhaliwal
- HIV and Health Group, United Nations Development Program, New York, United States of America
| | - Fiona Samuels
- Centre for Public Health and Policy, Queen Mary University of London, London, United Kingdom
| | - Ade Fakoya
- Institute for Global Health, University College London, London, United Kingdom
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Martínez-Pérez GZ, Guerrero CC, Bagnol B, Sarr SC, Mbaye EHM, Diouf O, Touré EHI, Mbengue V, Ndiaye O, Nabil F. Evaluation of a Training Program on Gender Mainstreaming in Health Research Evaluation at the Senegalese National Research Ethics Committee. J Empir Res Hum Res Ethics 2024:15562646241238816. [PMID: 38497221 DOI: 10.1177/15562646241238816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Health research must be of high ethical and scientific quality and consider the needs and experiences of women, men, and nonbinary individuals. National Research Ethics Committees (RECs) are in a strategic position to impede sex- and gender-blind research. In 2020 and 2021, training programs on gender mainstreaming and sex and gender approaches in research evaluation were launched in Senegal. They were evaluated through a mixture of qualitative and quantitative methods. Knowledge acquisition was 16.67%, 8.54%, and 28.42% for the trainees of 2021, 2020, and those who attended the training in both years, respectively. Gender mainstreaming was reported as pertinent in research ethics by 74% of participants. This training is expected to catalyze gender-transformative research ethics in West Africa.
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Affiliation(s)
| | | | - Brigitte Bagnol
- Department of Anthropology, The University of Witwatersrand, Johannesburg, South Africa
| | | | - El Hadji Mamadou Mbaye
- Social Sciences Department, Institute for Health Research, Epidemiological Surveillance and Training, Dakar, Senegal
| | - Ousmane Diouf
- Ministry of Health and Social Action, Dakar, Senegal
| | | | | | - Oumy Ndiaye
- University of Cheikh Anta Diop-Dakar, Dakar, Senegal
| | - Farah Nabil
- Faculty of Health Sciences, University of Zaragoza, Zaragoza, Senegal
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Gabay G. Is it the "public" health system? The VOICE model for inclusiveness in universal (national) health systems - lessons from COVID-19. Front Public Health 2023; 11:1243943. [PMID: 38162599 PMCID: PMC10757723 DOI: 10.3389/fpubh.2023.1243943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024] Open
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Diarra T, Okeibunor J, Diallo B, Onyeneho N, Rodrigue B, N’da Konan Yao M, Yoti Z, Djingarey MH, Fall S, Gueye AS. Epidemic Response amidst Insecurity: Addressing the Ebola Virus Epidemic in the Provinces of North Kivu and Ituri. JOURNAL OF IMMUNOLOGICAL SCIENCES 2023; Suppl 3:1-10. [PMID: 38333351 PMCID: PMC7615620 DOI: 10.29245/2578-3009/2023/s3.1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
This paper examines the impact of insecurity on the management of the Ebola virus disease epidemic in the Democratic Republic of the Congo provinces of North Kivu and Ituri. In these provinces, insecurity has been one of the biggest obstacles in the response to the Ebola outbreak. When the epidemic began, these provinces were already insecure-creating unfavorable circumstances for implementing epidemic response activities. While the ninth epidemic in the Equateur province was brought under control in record time, the same was not true for the tenth epidemic in North Kivu and Ituri. Since the epidemic began, teams were organized to address all aspects of the response. These response teams conducted extensive fieldwork, including epidemiological surveillance, risk communication and community involvement, infection prevention and control, vaccination, dignified and safe burials, care at transit centers and Ebola treatment centers, and medical and psychosocial care for the recovered. They faced confrontational reactions from the communities, which jeopardized their security. The insecure state of the provinces led to the destruction and damage of infrastructure, including healthcare facilities, which affected the ability of rescue teams to access people needing care as well as the resources they needed to care for the ill. Worse yet, the insecurity took other forms, including threatening and kidnapping members of the response teams, lodging protests against the response activities in towns or health zones, committing violence against teams responsible for safe and dignified burials, instigating altercations between community members and members of the response team, and encouraging general resistance by the population. This level of insecurity interrupted or even halted response activities in some areas-sometimes for more than two weeks, decreasing the efficiency of the response teams, particularly in monitoring contacts due to the inability to access certain communities. Additionally, certain acts of protest, such as community members handling bodies as a demonstration of their opposition to safe and dignified burials, likely intensified disease spread. However, the involvement of community leaders, at least, made dialogue and negotiation possible between the response teams and community members, as such efforts led to communities contributing to the security of personnel involved in the fight against the Ebola epidemic in North Kivu and Ituri provinces.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Soce Fall
- World Health Organization, Switzerland
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Reddy M. Flattening the curve: voluntary association participation and the 2013-16 West Africa Ebola epidemic. DISASTERS 2023; 47:366-388. [PMID: 35612956 DOI: 10.1111/disa.12548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
To what extent does voluntary association participation correlate with reduced Ebola duration in districts of Guinea, Liberia, and Sierra Leone during the epidemic in West Africa in 2013-16? This study, the first cross-national quantitative analysis of Ebola outcomes across these countries, answers this question by investigating how social capital influences epidemic outcomes. Ebola virus disease struck along the borders of three countries with similar levels of human development as well as cultural practices, yet resulted in different outcomes. This study examines the role of social trust, political trust, voluntary association participation, religious organisation membership, and community meeting attendance in explaining international policy failure to reduce Ebola outcomes. Overall, in districts with a culture of raising issues and participating in voluntary and religious organisations, Ebola duration rates were lower. These findings have implications not only for health crisis response, but also for disaster response and the provision of international aid to civil society.
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Affiliation(s)
- Michelle Reddy
- Postdoctoral Fellow, Center for International Studies (CERI), Sciences Po, France
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Vaccaro C, Lenzi FR, Addonisio G, Gianfrilli D, Volkmann AM, Napier D, Giles-Vernick T. Drawing a pandemic vulnerabilities' map: The SoNAR-global Vulnerabilities Assessment digital and its output. FRONTIERS IN SOCIOLOGY 2023; 8:1127647. [PMID: 36844878 PMCID: PMC9945340 DOI: 10.3389/fsoc.2023.1127647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/09/2023] [Indexed: 06/18/2023]
Abstract
This paper describes the process, advantages and limitations of a qualitative methodology for defining and analyzing vulnerabilities during the COVID-19 pandemic. Implemented in Italy in two sites (Rome and outside Rome, in some small-medium sized municipalities in Latium) in 2021, this investigation employed a mixed digital research tool that was also used simultaneously in four other European countries. Its digital nature encompasses both processes of data collection. Among the most salient is that the pandemic catalyzed new vulnerabilities in addition to exacerbating old ones, particularly economic. Many of the vulnerabilities detected, in fact, are linked to previous situations, such as the uncertainties of labor markets, having in COVID-19 to the greatest negative effects on the most precarious workers (non-regular, part-time, and seasonal). The consequences of the pandemic are also reflected in other forms of vulnerability that appear less obvious, having exacerbated social isolation, not only out of fear of contagion, but because of the psychological challenges posed by containment measures themselves. These measures created not mere discomfort, but behavioral changes characterized by anxiety, fearfulness, and disorientation. More generally, this investigation reveals the strong influence of social determinants throughout the COVID-19 pandemic, creating new forms of vulnerability, as the effects of social, economic, and biological risk factors were compounded, in particular, among already marginalized populations.
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Affiliation(s)
| | - Francesca Romana Lenzi
- Laboratory of Psychology and Social Processes in Sport, University of Rome “Foro Italico”, Rome, Italy
| | | | - Daniele Gianfrilli
- Department of Experimental Medicine of the Sapienza University of Rome, Rome, Italy
| | - Anna Maria Volkmann
- Department of Anthropology, Science, Medicine, and Society Network, University College London, London, United Kingdom
| | - David Napier
- Department of Anthropology, Science, Medicine, and Society Network, University College London, London, United Kingdom
| | - Tamara Giles-Vernick
- Anthropology and Ecology of Disease Emergence Unit, Institut Pasteur, Paris, France
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Millimouno TM, Meessen B, Put WVD, Garcia M, Camara BS, Christou A, Delvaux T, Sidibé S, Beavogui AH, Delamou A. How has Guinea learnt from the response to outbreaks? A learning health system analysis. BMJ Glob Health 2023; 8:bmjgh-2022-010996. [PMID: 36854489 PMCID: PMC9980363 DOI: 10.1136/bmjgh-2022-010996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/23/2023] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION Learning is a key attribute of a resilient health system and, therefore, is central to health system strengthening. The main objective of this study was to analyse how Guinea's health system has learnt from the response to outbreaks between 2014 and 2021. METHODS We used a retrospective longitudinal single embedded case study design, applying the framework conceptualised by Sheikh and Abimbola for analysing learning health systems. Data were collected employing a mixed methods systematic review carried out in March 2022 and an online survey conducted in April 2022. RESULTS The 70 reports included in the evidence synthesis were about the 2014-2016 Ebola virus disease (EVD), Measles, Lassa Fever, COVID-19, 2021 EVD and Marburg virus disease. The main lessons were from 2014 to 2016 EVD and included: early community engagement in the response, social mobilisation, prioritising investment in health personnel, early involvement of anthropologists, developing health infrastructure and equipment and ensuring crisis communication. They were learnt through information (research and experts' opinions), action/practice and double-loop and were progressively incorporated in the response to future outbreaks through deliberation, single-loop, double-loop and triple-loop learning. However, advanced learning aspects (learning through action, double-loop and triple-loop) were limited within the health system. Nevertheless, the health system successfully controlled COVID-19, the 2021 EVD and Marburg virus disease. Survey respondents' commonly reported that enablers were the creation of the national agency for health security and support from development partners. Barriers included cultural and political issues and lack of funding. Common recommendations included establishing a knowledge management unit within the Ministry of Health with representatives at regional and district levels, investing in human capacities and improving the governance and management system. CONCLUSION Our study highlights the importance of learning. The health system performed well and achieved encouraging and better outbreak response outcomes over time with learning that occurred.
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Affiliation(s)
- Tamba Mina Millimouno
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea .,Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Conakry, Guinea
| | - Bruno Meessen
- Health Systems Governance and Financing Department, World Health Organization, Geneva, Switzerland
| | - Willem Van De Put
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Marlon Garcia
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Bienvenu Salim Camara
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Aliki Christou
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Therese Delvaux
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Sidikiba Sidibé
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Conakry, Guinea
| | - Abdoul Habib Beavogui
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Alexandre Delamou
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Conakry, Guinea
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Frimpong SO, Paintsil E. Community engagement in Ebola outbreaks in sub-Saharan Africa and implications for COVID-19 control: A scoping review. Int J Infect Dis 2023; 126:182-192. [PMID: 36462575 DOI: 10.1016/j.ijid.2022.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 10/27/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES There is a paucity of scoping data on the specific roles community engagement played in preventing and managing the Ebola virus disease (EVD) outbreak in sub-Saharan Africa. We assessed the role, benefits, and mechanisms of community engagement to understand its effect on EVD case detection, survival, and mortality in sub-Saharan Africa. The implications for COVID-19 prevention and control were also highlighted. METHODS We searched for articles between 2010 and 2020 in the MEDLINE and Embase databases. The study types included were randomized trials, quasiexperimental studies, observational studies, case series, and reports. RESULTS A total of 903 records were identified for screening. A total of 216 articles met the review criteria, 103 were initially selected, and 44 were included in the final review. Our findings show that effective community involvement during the EVD outbreak depended on the survival rates, testimonials of survivors, risk perception, and the inclusion of community leaders. Community-based interventions improved knowledge and attitudes, case findings, isolation efforts, and treatment uptake. CONCLUSION Although the studies included in this review were of highly variable quality, findings from this review may provide lessons for the role of community engagement in the COVID-19 pandemic's prevention and control in sub-Saharan Africa.
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Affiliation(s)
- Shadrack Osei Frimpong
- Department of Pediatrics, Yale School of Medicine, New Haven, USA; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA.
| | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA; Department of Pharmacology, Yale School of Medicine, New Haven, USA; School of Management, Yale University, New Haven, USA
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Meagher K. Crisis Narratives and the African Paradox: African Informal Economies, COVID-19 and the Decolonization of Social Policy. DEVELOPMENT AND CHANGE 2022; 53:1200-1229. [PMID: 36718282 PMCID: PMC9877792 DOI: 10.1111/dech.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This article challenges the role of COVID-19 crisis narratives in shaping social policy choices in Africa. The COVID-19 pandemic has focused attention on Africa's vast informal economies, both as a symbol of the continent's intense vulnerability to the ravages of the pandemic, and as a puzzle in the face of the uneven and limited effects of COVID-19 across the continent. Indeed, an examination of statistical and documentary evidence reveals an inverse relationship between COVID-19 fatalities and the size of African informal economies, and a perverse relationship between best-practice COVID social protection responses and levels of COVID-19 mortality. Scrutinizing the evidence behind African COVID-19 crisis narratives raises questions about the ability of donor-led digitized social protection paradigms to address social needs in highly informalized, low-resource environments. This article highlights the role of crisis narratives as an exercise of power geared to remastering, homogenizing and reimagining African informal economies in ways that facilitate particular types of development intervention, sidelining alternative, more socially grounded policy perspectives. Through a closer examination of historical and contemporary realities in Africa's vast and varied informal economies, the article highlights the need to decolonize social policy by privileging local needs and policy perspectives over global policy agendas in the interest of transformative rather than palliative policy responses.
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Abstract
From vaccination refusal to climate change denial, antiscience views are threatening humanity. When different individuals are provided with the same piece of scientific evidence, why do some accept whereas others dismiss it? Building on various emerging data and models that have explored the psychology of being antiscience, we specify four core bases of key principles driving antiscience attitudes. These principles are grounded in decades of research on attitudes, persuasion, social influence, social identity, and information processing. They apply across diverse domains of antiscience phenomena. Specifically, antiscience attitudes are more likely to emerge when a scientific message comes from sources perceived as lacking credibility; when the recipients embrace the social membership or identity of groups with antiscience attitudes; when the scientific message itself contradicts what recipients consider true, favorable, valuable, or moral; or when there is a mismatch between the delivery of the scientific message and the epistemic style of the recipient. Politics triggers or amplifies many principles across all four bases, making it a particularly potent force in antiscience attitudes. Guided by the key principles, we describe evidence-based counteractive strategies for increasing public acceptance of science.
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Juarez JG, Carbajal E, Dickinson KL, Garcia-Luna S, Vuong N, Mutebi JP, Hemme RR, Badillo-Vargas I, Hamer GL. The unreachable doorbells of South Texas: community engagement in colonias on the US-Mexico border for mosquito control. BMC Public Health 2022; 22:1176. [PMID: 35698216 PMCID: PMC9190097 DOI: 10.1186/s12889-022-13426-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
Mosquitoes and the diseases they transmit continue to place millions of people at risk of infection around the world. Novel methods of vector control are being developed to provide public health officials with the necessary tools to prevent disease transmission and reduce local mosquito populations. However, these methods will require public acceptance for a sustainable approach and evaluations at local settings. We present our efforts in community engagement carried out in colonias of the Lower Rio Grande Valley in south Texas for mosquito surveillance, control, and ecological projects. Along the US-Mexico border the term colonia refers to impoverished communities that are usually inhabited by families of Hispanic heritage. The different engagements were carried out from September 2016 to February 2019; during this time, we had three distinct phases for community engagement. In Phase 1 we show the initial approach to the colonias in which we assessed security and willingness to participate; in Phase 2 we carried out the first recruitment procedure involving community meetings and house-to-house recruitment; and in Phase 3 we conducted a modified recruitment procedure based on community members' input. Our findings show that incorporating community members in the development of communication materials and following their suggestions for engagement allowed us to generate culturally sensitive recruitment materials and to better understand the social relationships and power dynamics within these communities. We were able to effectively reach a larger portion of the community and decrease the dropout rate of participants. Progress gained with building trust in the communities allowed us to convey participant risks and benefits of collaborating with our research projects. Community engagement should be viewed as a key component of any local vector control program as well as for any scientific research project related to vector control. Even in the face of budgetary constraints, small efforts in community engagement go a long way.
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Affiliation(s)
- Jose G Juarez
- Department of Entomology, Texas A&M University, College Station, TX, USA
| | - Ester Carbajal
- Department of Entomology, Texas A&M University, College Station, TX, USA
| | | | - Selene Garcia-Luna
- Department of Entomology, Texas A&M University, College Station, TX, USA
| | - Nga Vuong
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - John-Paul Mutebi
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Ryan R Hemme
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Dengue Branch, San Juan, PR, USA
| | | | - Gabriel L Hamer
- Department of Entomology, Texas A&M University, College Station, TX, USA.
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Burchi F, Loewe M, Malerba D, Leininger J. Disentangling the Relationship Between Social Protection and Social Cohesion: Introduction to the Special Issue. THE EUROPEAN JOURNAL OF DEVELOPMENT RESEARCH 2022; 34:1195-1215. [PMID: 35527722 PMCID: PMC9059109 DOI: 10.1057/s41287-022-00532-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 05/24/2023]
Abstract
While there is substantial evidence of the effect of social protection on poverty and vulnerability, limited research has focused on societal outcomes. This paper serves as introduction to a special issue (SI) examining the relationship between social protection and social cohesion in low- and middle-income countries. Over the last years, social cohesion has emerged as a central goal of development policy. The introduction and the papers in the SI use a common definition of social cohesion as a multi-faceted phenomenon, comprising three attributes: cooperation, trust and inclusive identity. This introductory article provides a conceptual framework linking social protection to social cohesion, shows the current empirical evidence for the bi-directional linkages, and highlights how the papers in the SI contribute to filling existing research gaps. In addition to this introduction, the SI encompasses seven papers, covering different world regions and social protection schemes, and using different quantitative and qualitative methods.
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Affiliation(s)
- Francesco Burchi
- Deutsches Institut für Entwicklungspolitik/German Development Institute (DIE), Research Programme “Transformation of Economic and Social Systems”, Tulpenfeld 6, 53113 Bonn, Germany
| | - Markus Loewe
- Deutsches Institut für Entwicklungspolitik/German Development Institute (DIE), Research Programme “Transformation of Economic and Social Systems”, Tulpenfeld 6, 53113 Bonn, Germany
| | - Daniele Malerba
- Deutsches Institut für Entwicklungspolitik/German Development Institute (DIE), Research Programme “Transformation of Economic and Social Systems”, Tulpenfeld 6, 53113 Bonn, Germany
| | - Julia Leininger
- Deutsches Institut für Entwicklungspolitik/German Development Institute (DIE), Research Programme “Transformation of Political (Dis-)order”, Tulpenfeld 6, 53113 Bonn, Germany
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Milbank C, Vira B. Wildmeat consumption and zoonotic spillover: contextualising disease emergence and policy responses. Lancet Planet Health 2022; 6:e439-e448. [PMID: 35550083 PMCID: PMC9084621 DOI: 10.1016/s2542-5196(22)00064-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/14/2022] [Accepted: 03/02/2022] [Indexed: 05/13/2023]
Abstract
Zoonotic diseases are estimated to constitute 75% of all emerging infectious diseases, of which more than 70% come from wild species. The potential threat of zoonotic spillover from the consumption of wildmeat has been the subject of policy and media attention, especially in the context of the COVID-19 pandemic; however, little is known about the actual conditions that contribute to the risk of spillover and associated disease transmission. In this Review, we compile existing evidence from available literature on the conditions of spillover associated with wildmeat consumption, including the types of wild animal and disease, modes of transmission, and the conditions in which spillover is thought to have occurred. We suggest that stronger understanding of the context of spillover from wildmeat is needed to enable more targeted and effective policy responses that reduce the risk of future pandemics of zoonotic origin. Such interventions could also lead to the avoidance of unintended adverse consequences for human communities that rely on wild produce, including wildmeat, as sources of dietary protein, fat, and micronutrients.
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Affiliation(s)
| | - Bhaskar Vira
- Department of Geography, University of Cambridge, Cambridge, UK
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Hardy A, Proctor M, MacCallum C, Shawe J, Abdalla S, Ali R, Abdalla S, Oakes G, Rosu L, Worrall E. Conditional trust: Community perceptions of drone use in malaria control in Zanzibar. TECHNOLOGY IN SOCIETY 2022; 68:101895. [PMID: 35299834 PMCID: PMC8919376 DOI: 10.1016/j.techsoc.2022.101895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The potential of drones to support public health interventions, such as malaria vector control, is beginning to be realised. Although permissions from civil aviation authorities are often needed for drone operations, the communities over which they fly tend to be ignored: How do affected communities perceive drones? Is drone deployment accepted by communities? How should communities be engaged? METHODS An initiative in Zanzibar, United Republic of Tanzania is using drones to map malarial mosqutio breeding sites for targeting larval source management interventions. A community engagement framework was developed, based on participatory research, across three communities where drones will be deployed, to map local perceptions of drone use. Costs associated with this exercise were collated. RESULTS A total of 778 participants took part in the study spanning a range of community and stakeholder groups. Overall there was a high level of acceptance and trust in drone use for public health research purposes. Despite this level of trust for drone operations this support was conditional: There was a strong desire for pre-deployment information across all stakeholder groups and regular updates of this information to be given about drone activities, as well as consent from community level governance. The cost of the perception study and resulting engagement strategy was US$24,411. CONCLUSIONS Mapping and responding to community perceptions should be a pre-requisite for drone activity in all public health applications and requires funding. The findings made in this study were used to design a community engagement plan providing a simple but effective means of building and maintaining trust and acceptability. We recommend this an essential investment.
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Affiliation(s)
- Andy Hardy
- Department of Geography and Earth Sciences, Aberystwyth University, UK
| | | | | | | | | | - Rajab Ali
- Sazani Trust, Zanzibar, United Republic of Tanzania
| | | | - Gregory Oakes
- Department of Geography and Earth Sciences, Aberystwyth University, UK
| | - Laura Rosu
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Eve Worrall
- Liverpool School of Tropical Medicine, Liverpool, UK
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15
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Leach M, MacGregor H, Ripoll S, Scoones I, Wilkinson A. Rethinking Disease Preparedness: Incertitude and the Politics of Knowledge. CRITICAL PUBLIC HEALTH 2022; 32:82-96. [PMID: 36618759 PMCID: PMC7614024 DOI: 10.1080/09581596.2021.1885628] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This paper argues for a rethinking of disease preparedness that puts incertitude and the politics of knowledge at the centre. Through examining the experiences of Ebola, Nipah, cholera and COVID-19 across multiple settings, the limitations of current approaches are highlighted. Conventional approaches assume a controllable, predictable future, which is responded to by a range of standard interventions. Such emergency preparedness planning approaches assume risk - where future outcomes can be predicted - and fail to address uncertainty, ambiguity and ignorance - where outcomes or their probabilities are unknown. Through examining the experiences of outbreak planning and response across the four cases, the paper argues for an approach that highlights the politics of knowledge, the constructions of time and space, the requirements for institutions and administrations and the challenges of ethics and justice. Embracing incertitude in disease preparedness responses therefore means making contextual social, political and cultural dimensions central.
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Affiliation(s)
- Melissa Leach
- Institute of Development Studies, University of Sussex, Brighton, UK
| | - Hayley MacGregor
- Institute of Development Studies, University of Sussex, Brighton, UK
| | - Santiago Ripoll
- Institute of Development Studies, University of Sussex, Brighton, UK
| | - Ian Scoones
- Institute of Development Studies, University of Sussex, Brighton, UK
| | - Annie Wilkinson
- Institute of Development Studies, University of Sussex, Brighton, UK
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16
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Jones J. An Ethnographic Examination of People's Reactions to State-Led COVID-19 Measures in Sierra Leone. THE EUROPEAN JOURNAL OF DEVELOPMENT RESEARCH 2022; 34:455-472. [PMID: 33551578 PMCID: PMC7849222 DOI: 10.1057/s41287-020-00358-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2020] [Indexed: 05/07/2023]
Abstract
This paper explores how individuals-defined along lines of gender, age, life experience, financial capital and profession-experience and react in nuanced ways to the impacts of state-led COVID-19 measures, in Sierra Leone. The findings are based on ethnographic data collected from Makeni city and three rural communities in Bombali District, north Sierra Leone during the outbreak of COVID-19, between 23rd March and 6th May 2020. The findings show how state-led measures-indefinite district lockdown, three-day total lockdowns and mask wearing-were experienced and responded to in myriad ways, including adapting, not complying and resisting. The diverse ways members of society experience, react and shape the effects of internationally and nationally informed health policies during a global pandemic in Sierra Leone highlight the nuances of individual experience and agency in specific socio-political contexts. These findings contribute to the emerging Social Science debate on state-society relations in the COVID-19 pandemic response.
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Affiliation(s)
- Jess Jones
- University of Makeni, Makeni, Sierra Leone
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17
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Ribeiro RM, Havik PJ, Craveiro I. The circuits of healthcare: Understanding healthcare seeking behaviour-A qualitative study with tuberculosis patients in Lisbon, Portugal. PLoS One 2021; 16:e0261688. [PMID: 34962944 PMCID: PMC8714083 DOI: 10.1371/journal.pone.0261688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Understanding health delivery service from a patient´s perspective, including factors influencing healthcare seeking behaviour, is crucial when treating diseases, particularly infectious ones, like tuberculosis. This study aims to trace and contextualise the trajectories patients pursued towards diagnosis and treatment, while discussing key factors associated with treatment delays. Tuberculosis patients' pathways may serve as indicator of the difficulties the more vulnerable sections of society experience in obtaining adequate care. METHODS We conducted 27 semi-structured interviews with tuberculosis patients attending a treatment centre in a suburban area of Lisbon. We invited nationals and migrant patients in active treatment to participate by sharing their illness experiences since the onset of symptoms until the present. The Health Belief Model was used as a reference framework to consolidate the qualitative findings. RESULTS By inductive analysis of all interviews, we categorised participants' healthcare seeking behaviour into 4 main types, related to the time participants took to actively search for healthcare (patient delay) and time the health system spent to diagnose and initiate treatment (health system delay). Each type of healthcare seeking behaviour identified (inhibited, timely, prolonged, and absent) expressed a mindset influencing the way participants sought healthcare. The emergency room was the main entry point where diagnostic care cascade was initiated. Primary Health Care was underused by participants. CONCLUSIONS The findings support that healthcare seeking behaviour is not homogeneous and influences diagnostic delays. If diagnostic delays are to be reduced, the identification of behavioural patterns should be considered when designing measures to improve health services' delivery. Healthcare professionals should be sensitised and perform continuous capacity development training to deal with patients´ needs. Inhibited and prolonged healthcare seeking behaviour contributes significantly to diagnostic delays. These behaviours should be detected and reverted. Timely responses, from patients and the healthcare system, should be promoted.
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Affiliation(s)
- Rafaela M. Ribeiro
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Philip J. Havik
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Isabel Craveiro
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
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18
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Kirk T, Green D, Allen T, Carayannis T, Bazonzi J, Ndala J, Stys P, Muzuri P, Nyenyezi A, Vlassenroot K, Nyuon ADA, Macdonald A, Owor A, Storer L, Okello J, Hopwood J, Porter H, Oryem R, Parker M, Akello G. Crisis responses, opportunity, and public authority during Covid-19's first wave in Uganda, the Democratic Republic of Congo, and South Sudan. DISASTERS 2021; 45 Suppl 1:S195-S215. [PMID: 34553404 PMCID: PMC8652749 DOI: 10.1111/disa.12513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Discussions on African responses to Covid-19 have focused on the state and its international backers. Far less is known about a wider range of public authorities, including chiefs, humanitarians, criminal gangs, and armed groups. This paper investigates how the pandemic provided opportunities for claims to and contests over power in Uganda, the Democratic Republic of the Congo, and South Sudan. Ethnographic research is used to contend that local forms of public authority can be akin to miniature sovereigns, able to interpret dictates, policies, and advice as required. Alongside coping with existing complex protracted emergencies, many try to advance their own agendas and secure benefits. Those they seek to govern, though, do not passively accept the new normal, instead often challenging those in positions of influence. This paper assesses which of these actions and reactions will have lasting effects on local notions of statehood and argues for a public authorities lens in times of crisis.
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Affiliation(s)
- Tom Kirk
- Researcher at the London School of Economics and Political ScienceUnited Kingdom
| | - Duncan Green
- Professor in Practice at the London School of Economics and Political ScienceUnited Kingdom
| | - Tim Allen
- Professor at the London School of Economics and Political ScienceUnited Kingdom
| | | | - José Bazonzi
- Researcher at the University of KinshasaDemocratic Republic of the Congo
| | - José Ndala
- Researcher at the University of GbadoliteDemocratic Republic of the Congo
| | - Patrycja Stys
- Researcher at the London School of Economics and Political ScienceUnited Kingdom
| | - Papy Muzuri
- Independent ResearcherDemocratic Republic of the Congo
| | | | | | | | - Anna Macdonald
- Assistant Professor at the University of East AngliaUnited Kingdom
| | - Arthur Owor
- Researcher at the London School of Economics and Political ScienceUnited Kingdom
- Researcher at the Centre for African ResearchUganda
| | - Liz Storer
- Researcher at the London School of Economics and Political ScienceUnited Kingdom
| | - Joseph Okello
- Researcher at the London School of Economics and Political ScienceUnited Kingdom
| | - Julian Hopwood
- Researcher at the London School of Economics and Political ScienceUnited Kingdom
| | - Holly Porter
- Assistant Professor at the University of CambridgeUnited Kingdom
| | - Robin Oryem
- Researcher at the London School of Economics and Political ScienceUnited Kingdom
| | - Melissa Parker
- Professor at the London School of Hygiene and Tropical MedicineUnited Kingdom
| | - Grace Akello
- Researcher at the London School of Economics and Political ScienceUnited Kingdom
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19
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El-Majzoub S, Narasiah L, Adrien A, Kaiser D, Rousseau C. Negotiating Safety and Wellbeing: The Collaboration Between Faith-Based Communities and Public Health During the COVID-19 Pandemic. JOURNAL OF RELIGION AND HEALTH 2021; 60:4564-4578. [PMID: 34559364 PMCID: PMC8475844 DOI: 10.1007/s10943-021-01434-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 05/27/2023]
Abstract
The COVID-19 pandemic led to lockdown measures where congregational faith-based activities were prohibited. With time, the collateral impacts of confinement emerged as priorities, and impositions had to be balanced with the collaboration of the population. In this process, faith-based organizations played a key role in encouraging their congregations to adhere to lockdown measures while fostering their mental wellbeing and resilience. This paper describes the process of establishing a collaborative negotiation among the Montreal Regional Public Health Unit, the police, and the Muslim and Jewish communities, examining the role of mediation in this context. Despite some obstacles, such as communication difficulties and decision-making limitations, the collaborative approach seems to buffer the escalation of intercommunity tension and to promote communities' commitment to physical distancing measures and should be considered in times of pandemic for a more inclusive public health approach.
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Affiliation(s)
- Salam El-Majzoub
- Department of Psychiatry, McGill University, Montreal, QC Canada
| | | | - Alix Adrien
- Department of Epidemiology, Biostatics and Occupational Health, McGill University, Montreal, QC Canada
| | - David Kaiser
- Public Health School- Department of Social and Preventative Medicine, Université de Montréal, Montreal, QC Canada
| | - Cécile Rousseau
- Division of Social and Cultural Psychiatry, McGill University, Montreal, QC Canada
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20
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Garcia AC, Beja A, Cupertino de Barros FP, Delgado AP, Ferrinho P. The Covid-19 pandemic reinforces the need for sustainable health planning. Int J Health Plann Manage 2021; 37:643-649. [PMID: 34825408 PMCID: PMC9015575 DOI: 10.1002/hpm.3389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 11/04/2021] [Indexed: 11/06/2022] Open
Abstract
The 2030 Agenda for Sustainable Development highlighted the growing attention to the adequacy of health planning models to sustainable development. A re-reading of the results of a round table debate on "sustainable planning", which took place at the 5th National Congress of Tropical Medicine (Portugal, 2019) under a participant observation strategy, framed by the findings of a "synthesis of better evidence" literature review and cross-referenced with the reflections of different authors and experts about the momentum created by the COVID-19 pandemic, underlined the challenges to sustainable health planning that have emerged and are projected beyond the current pandemic context. Variable perceptions of the term "sustainable health development", leading to the potential loss of their relevance in guiding the elaboration of policies and strategic plans, and the potential higher effectiveness of the participatory approaches of health planning in achieving sustainable health were highlighted in the debate and literature, in general and in public health emergency contexts. Those results gained new relevance during the current COVID-19 pandemic, bringing back to the forefront a reflection of the inadequate planning framework that has usually been used to understand and respond to global health challenges, despite the already existing experience, evidence and support instruments.
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Affiliation(s)
- Ana Cristina Garcia
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal.,Department of Epidemiology, National Institute of Health Doctor Ricardo Jorge, Lisbon, Portugal
| | - André Beja
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
| | | | - António Pedro Delgado
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal.,University of Cape Verde, Praia, Cape Verde
| | - Paulo Ferrinho
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
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21
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Raymond CB, Ward PR. Community-Level Experiences, Understandings, and Responses to COVID-19 in Low- and Middle-Income Countries: A Systematic Review of Qualitative and Ethnographic Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12063. [PMID: 34831831 PMCID: PMC8621360 DOI: 10.3390/ijerph182212063] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 02/02/2023]
Abstract
(1) Background: COVID-19 disruptions offer researchers insight into how pandemics are at once biological and social threats, as communities struggle to construct meaning from novel challenges to their ontological status quo. Multiple epistemes, in which public health imperatives confront and negotiate locally derived knowledge and traditions, vie for legitimacy and agency, resulting in new cultural forms. (2) Methods: To investigate the context and construction of community responses, a systematic review of qualitative literature was conducted with the aim of evaluating those insights provided by empirical, social field research in low- and middle-income countries since the onset of COVID-19. Six scholarly databases were searched for empirical, qualitative, field-based, or participatory research that was published in peer-reviewed journals between December 2019 and August 2021. (3) Results: Twenty-five studies were selected for data extraction, following critical appraisal for methodological rigor by two independent reviewers, and were then analyzed thematically. Faced with unprecedented social ruptures, restrictions in social and physical mobility, and ever-looming uncertainties of infection, financial insecurity, stigma, and loss, communities worldwide reacted in multiple and complex ways. Pervasive misinformation and fear of social rejection resulted in noncompliance with pandemic sanctions, resistance, and increased isolation, allowing the spread of the disease. The meaning of, and understandings about, COVID-19 were constructed using traditional, religious, and biomedical epistemologies, which were occasionally in conflict with each other. Innovations and adaptations, through syntheses of traditional and biomedical discourses and practice, illustrated community resilience and provided models for successful engagement to improve public health outcomes. (4) Conclusion: Local context and community engagement were indispensable considerations when enacting effective public health interventions to meet the challenges of the pandemic.
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Affiliation(s)
- Christopher B. Raymond
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia;
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22
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Rasmussen SL, Sahay S. Engaging with uncertainty: Information practices in the context of disease surveillance in Burkina Faso. INFORMATION AND ORGANIZATION 2021. [DOI: 10.1016/j.infoandorg.2021.100366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Van Bortel T, John A, Solomon S, Lombardo C, Crepaz-Keay D, McDaid S, Yap J, Weeks L, Martin S, Guo L, Seymour C, Thorpe L, Morton AD, Davidson G, Kousoulis AA. Mental health in the pandemic: a repeated cross-sectional mixed-method study protocol to investigate the mental health impacts of the coronavirus pandemic in the UK. BMJ Open 2021; 11:e046422. [PMID: 34452957 PMCID: PMC8406461 DOI: 10.1136/bmjopen-2020-046422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The WHO declared a global pandemic on 11 March 2020. Since then, the world has been firmly in the grip of the COVID-19. To date, more than 211 730 035 million confirmed cases and more than 4 430 697 million people have died. While controlling the virus and implementing vaccines are the main priorities, the population mental health impacts of the pandemic are expected to be longer term and are less obvious than the physical health ones. Lockdown restrictions, physical distancing, social isolation, as well as the loss of a loved one, working in a frontline capacity and loss of economic security may have negative effects on and increase the mental health challenges in populations around the world. There is a major demand for long-term research examining the mental health experiences and needs of people in order to design adequate policies and interventions for sustained action to respond to individual and population mental health needs both during and after the pandemic. METHODS AND ANALYSIS This repeated cross-sectional mixed-method study conducts regular self-administered representative surveys, and targeted focus groups and semi-structured interviews with adults in the UK, as well as validation of gathered evidence through citizens' juries for contextualisation (for the UK as a whole and for its four devolved nations) to ensure that emerging mental health problems are identified early on and are properly understood, and that appropriate policies and interventions are developed and implemented across the UK and within devolved contexts. STATA and NVIVO will be used to carry out quantitative and qualitative analysis, respectively. ETHICS AND DISSEMINATION Ethics approval for this study has been granted by the Cambridge Psychology Research Ethics Committee of the University of Cambridge, UK (PRE 2020.050) and by the Health and Life Sciences Research Ethics Committee of De Montfort University, UK (REF 422991). While unlikely, participants completing the self-administered surveys or participating in the virtual focus groups, semi-structured interviews and citizens' juries might experience distress triggered by questions or conversations. However, appropriate mitigating measures have been adopted and signposting to services and helplines will be available at all times. Furthermore, a dedicated member of staff will also be at hand to debrief following participation in the research and personalised thank-you notes will be sent to everyone taking part in the qualitative research.Study findings will be disseminated in scientific journals, at research conferences, local research symposia and seminars. Evidence-based open access briefings, articles and reports will be available on our study website for everyone to access. Rapid policy briefings targeting issues emerging from the data will also be disseminated to inform policy and practice. These briefings will position the findings within UK public policy and devolved nations policy and socioeconomic contexts in order to develop specific, timely policy recommendations. Additional dissemination will be done through traditional and social media. Our data will be contextualised in view of existing policies, and changes over time as-and-when policies change.
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Affiliation(s)
- Tine Van Bortel
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- School of Allied Health Sciences, De Montfort University, Leicester, UK
| | - Ann John
- Medical School, Swansea University, Swansea, UK
| | | | - Chiara Lombardo
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Mental Health Foundation, London, UK
| | | | | | - Jade Yap
- Mental Health Foundation, London, UK
| | | | - Steven Martin
- School of Allied Health Sciences, De Montfort University, Leicester, UK
| | - Lijia Guo
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | | | - Alexander D Morton
- Department of Management Science, University of Strathclyde, Glasgow, UK
| | - Gavin Davidson
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
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24
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Wamai RG, Hirsch JL, Van Damme W, Alnwick D, Bailey RC, Hodgins S, Alam U, Anyona M. What Could Explain the Lower COVID-19 Burden in Africa despite Considerable Circulation of the SARS-CoV-2 Virus? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8638. [PMID: 34444386 PMCID: PMC8391172 DOI: 10.3390/ijerph18168638] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 01/12/2023]
Abstract
The differential spread and impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing Coronavirus Disease 2019 (COVID-19), across regions is a major focus for researchers and policy makers. Africa has attracted tremendous attention, due to predictions of catastrophic impacts that have not yet materialized. Early in the pandemic, the seemingly low African case count was largely attributed to low testing and case reporting. However, there is reason to consider that many African countries attenuated the spread and impacts early on. Factors explaining low spread include early government community-wide actions, population distribution, social contacts, and ecology of human habitation. While recent data from seroprevalence studies posit more extensive circulation of the virus, continuing low COVID-19 burden may be explained by the demographic pyramid, prevalence of pre-existing conditions, trained immunity, genetics, and broader sociocultural dynamics. Though all these prongs contribute to the observed profile of COVID-19 in Africa, some provide stronger evidence than others. This review is important to expand what is known about the differential impacts of pandemics, enhancing scientific understanding and gearing appropriate public health responses. Furthermore, it highlights potential lessons to draw from Africa for global health on assumptions regarding deadly viral pandemics, given its long experience with infectious diseases.
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Affiliation(s)
- Richard G. Wamai
- Department of Cultures, Societies, and Global Studies, Northeastern University, 201 Renaissance Park, 360 Huntington Ave., Boston, MA 02115, USA;
| | - Jason L. Hirsch
- Department of Cultures, Societies, and Global Studies, Northeastern University, 201 Renaissance Park, 360 Huntington Ave., Boston, MA 02115, USA;
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, B-2000 Antwerp, Belgium;
| | - David Alnwick
- DUNDEX (Deployable U.N.-Experienced Development Experts), FX68 Belturbet, Ireland;
| | - Robert C. Bailey
- School of Public Health, University of Illinois at Chicago, Chicago, IL 60607, USA;
| | - Stephen Hodgins
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Uzma Alam
- Researcher Africa Institute for Health Policy Foundation, Nairobi 020, Kenya;
| | - Mamka Anyona
- T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA;
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25
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Saulnier DD, Blanchet K, Canila C, Cobos Muñoz D, Dal Zennaro L, de Savigny D, Durski KN, Garcia F, Grimm PY, Kwamie A, Maceira D, Marten R, Peytremann-Bridevaux I, Poroes C, Ridde V, Seematter L, Stern B, Suarez P, Teddy G, Wernli D, Wyss K, Tediosi F. A health systems resilience research agenda: moving from concept to practice. BMJ Glob Health 2021; 6:e006779. [PMID: 34353820 PMCID: PMC8344286 DOI: 10.1136/bmjgh-2021-006779] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ability of complex adaptive systems that is derived from dynamic behaviour and interactions, or as both. However, there is little congruence on the theory and the existing frameworks have not been widely used, which as diluted the research applications for health system resilience. A global group of health system researchers were convened in March 2021 to discuss and identify priorities for health system resilience research and implementation based on lessons from COVID-19 and other health emergencies. Five research priority areas were identified: (1) measuring and managing systems dynamic performance, (2) the linkages between societal resilience and health system resilience, (3) the effect of governance on the capacity for resilience, (4) creating legitimacy and (5) the influence of the private sector on health system resilience. A key to filling these research gaps will be longitudinal and comparative case studies that use cocreation and coproduction approaches that go beyond researchers to include policy-makers, practitioners and the public.
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Affiliation(s)
- Dell D Saulnier
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva and Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Carmelita Canila
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
| | - Daniel Cobos Muñoz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Livia Dal Zennaro
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Don de Savigny
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kara N Durski
- World Health Organization, Geneva, Switzerland
- Center for Emerging Infectious Diseases Policy and Research, Boston University, Boston, Massachusetts, USA
| | - Fernando Garcia
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
| | | | - Aku Kwamie
- Alliance For Health Policy and System Research, Geneva, Switzerland
| | - Daniel Maceira
- Department of Economics, University of Buenos Aires, Buenos Aires, Argentina
- Center for the Study of State and Society (CEDES), Buenos Aires, Argentina
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | | | - Camille Poroes
- Unisanté, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Valery Ridde
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France
| | - Laurence Seematter
- Unisanté, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Barbara Stern
- Center for the Study of State and Society (CEDES), Buenos Aires, Argentina
| | - Patricia Suarez
- Center for the Study of State and Society (CEDES), Buenos Aires, Argentina
| | - Gina Teddy
- Centre for Health Systems and Policy Research, Ghana Institute of Management and Public Administration, Accra, Ghana
| | - Didier Wernli
- Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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26
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Elias L, Singh A, Burgess RA. In search of 'community': a critical review of community mental health services for women in African settings. Health Policy Plan 2021; 36:205-217. [PMID: 33543248 DOI: 10.1093/heapol/czaa140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 11/14/2022] Open
Abstract
Community is deemed a central resource for the improvement of health, across disciplines, contexts and conditions. However, what is meant by this term is rarely critically explored. In Global Mental Health, considerable efforts in recent years have been directed towards scaling up 'community' approaches, with variable success, creating the need to better understand approaches to its use. Our study contributes to this need, through a critical review of studies engaging with the term 'community' in relation to women's mental health services in African settings. Our review explored 30 peer-reviewed articles from the past 15 years, which were systematically evaluated for quality of evidence. Studies were then analysed using a blend of conventional and directed content analysis to unpack perspectives on the term's use in intervention and phenomenological studies. We identified four broad categories of community: (1) place (shared geographical location or institutional affiliation), (2) practice (belongingness to a shared activity or profession), (3) symbols (meanings and experiences associated with shared community life) and (4) identity (diagnostic identity around a mental health condition). Analysis identified community of place as the most common primary focus of interest across the sample, with 80% of papers referencing this dimension. We noted that in studies where communities of practice were the focus, this was in relation to leveraging local knowledge to inform or support service delivery of intervention programmes, often designed by outsiders. Implications for future policy and mental health services research are discussed.
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Affiliation(s)
- Lauren Elias
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Aneeha Singh
- International Research and Exchanges Board (South & South East Asia Centre), 1275 K Street, NW, Suite 600 Washington, DC 20005, USA
| | - Rochelle A Burgess
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.,Research Associate, Department of Social Work, University of Johannesburg, South Africa
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Nichol AA, Bendavid E, Mutenherwa F, Patel C, Cho MK. Diverse experts' perspectives on ethical issues of using machine learning to predict HIV/AIDS risk in sub-Saharan Africa: a modified Delphi study. BMJ Open 2021; 11:e052287. [PMID: 34321310 PMCID: PMC8320245 DOI: 10.1136/bmjopen-2021-052287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/19/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To better understand diverse experts' views about the ethical implications of ongoing research funded by the National Institutes of Health that uses machine learning to predict HIV/AIDS risk in sub-Saharan Africa (SSA) based on publicly available Demographic and Health Surveys data. DESIGN Three rounds of semi-structured surveys in an online expert panel using a modified Delphi approach. PARTICIPANTS Experts in informatics, African public health and HIV/AIDS and bioethics were invited to participate. MEASURES Perceived importance of or agreement about relevance of ethical issues on 5-point unipolar Likert scales. Qualitative data analysis identified emergent themes related to ethical issues and development of an ethical framework and recommendations for open-ended questions. RESULTS Of the 35 invited experts, 22 participated in the online expert panel (63%). Emergent themes were the inclusion of African researchers in all aspects of study design, analysis and dissemination to identify and address local contextual issues, as well as engagement of communities. Experts focused on engagement with health and science professionals to address risks, benefits and communication of findings. Respondents prioritised the mitigation of stigma to research participants but recognised trade-offs between privacy and the need to disseminate findings to realise public health benefits. Strategies for responsible communication of results were suggested, including careful word choice in presentation of results and limited dissemination to need-to-know stakeholders such as public health planners. CONCLUSION Experts identified ethical issues specific to the African context and to research on sensitive, publicly available data and strategies for addressing these issues. These findings can be used to inform an ethical implementation framework with research stage-specific recommendations on how to use publicly available data for machine learning-based predictive analytics to predict HIV/AIDS risk in SSA.
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Affiliation(s)
- Ariadne A Nichol
- Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
| | - Eran Bendavid
- Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Farirai Mutenherwa
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- School of Applied Human Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Chirag Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Mildred K Cho
- Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
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Klingberg S, Adhikari B, Draper CE, Bosire EN, Tiigah P, Nyirenda D, Mukumbang FC. Engaging communities in non-communicable disease research and interventions in low- and middle-income countries: a realist review protocol. BMJ Open 2021; 11:e050632. [PMID: 34290072 PMCID: PMC8296813 DOI: 10.1136/bmjopen-2021-050632] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Engaging communities and intended beneficiaries at various stages of health research is a recommended practice. The contribution of community engagement to non-communicable disease research in low- and middle-income countries has not yet been extensively studied or synthesised. This protocol describes the steps towards generating an understanding of community engagement in the context of non-communicable disease research, prevention and health promotion using a realist review approach. A realist lens enables a rich explanatory approach to causation while capturing complexity, and an openness to multiple outcomes, including unintended consequences. The review will thus develop an understanding of community engagement without assuming that such practices result in more ethical research or effective interventions. METHODS AND ANALYSIS We propose a realist approach aiming to examine how, why, under what circumstances and for whom community engagement works or does not work. The iterative review steps include clarifying the review scope; searching for evidence; appraising studies and extracting data; synthesising evidence and drawing conclusions; and disseminating, implementing and evaluating the findings. Principles of meta-narrative review (pragmatism, pluralism, historicity, contestation, reflexivity and peer review) are employed to ensure practicable and contextualised review outputs. The proposed review will draw on theoretical and empirical literature beyond specific diseases or settings, but with a focus on informing non-communicable disease research and interventions in low- and middle-income countries. The synthesis of existing literature will be complemented by qualitative realist interviews and stakeholder consultation. Through drawing on multiple types of evidence and input from both experts and intended beneficiaries, the review will provide critical and pragmatic insights for research and community engagement in low- and middle-income countries. ETHICS AND DISSEMINATION Ethical approval has been obtained from the University of the Witwatersrand. Dissemination will include traditional academic channels, institutional communications, social media and discussions with a wide range of stakeholders.
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Affiliation(s)
- Sonja Klingberg
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Edna N Bosire
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Priscilla Tiigah
- Health Equity and Strategy Unit, Public Health England, London, UK
| | - Deborah Nyirenda
- Community Engagement and Bioethics, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi, Blantyre, Malawi
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Community engagement and vulnerability in infectious diseases: A systematic review and qualitative analysis of the literature. Soc Sci Med 2021; 284:114246. [PMID: 34311391 DOI: 10.1016/j.socscimed.2021.114246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 11/20/2022]
Abstract
The global response to infectious diseases has seen a renewed interest in the use of community engagement to support research and relief efforts. From a perspective rooted in the social sciences, the concept of vulnerability offers an especially useful analytical frame for pursuing community engagement in a variety of contexts. However, few have closely examined the concept of vulnerability in community engagement efforts, leading to a need to better understand the various theories that underline the connections between the two. This literature review searched four databases (covering a total of 537 papers), resulting in 15 studies that analyze community engagement using a framing of vulnerability, broadly defined, in the context of an infectious disease, prioritizing historical and structural context and the many ways of constituting communities. The review identified historical and structural factors such as trust in the health system, history of political marginalization, various forms of racism and discrimination, and other aspects of vulnerability that are part and parcel of the main challenges faced by communities. The review found that studies using vulnerability within community engagement share some important characteristics (e.g., focus on local history and structural factors) and identified a few theoretical avenues from the social sciences which integrate a vulnerability-informed approach in community engagement. Finally, the review proposes an approach that brings together the concepts of vulnerability and community engagement, prioritizing participation, empowerment, and intersectoral collaboration.
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30
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Fontes CM, Lipes BD, Liu J, Agans KN, Yan A, Shi P, Cruz DF, Kelly G, Luginbuhl KM, Joh DY, Foster SL, Heggestad J, Hucknall A, Mikkelsen MH, Pieper CF, Horstmeyer RW, Geisbert TW, Gunn MD, Chilkoti A. Ultrasensitive point-of-care immunoassay for secreted glycoprotein detects Ebola infection earlier than PCR. Sci Transl Med 2021; 13:13/588/eabd9696. [PMID: 33827978 DOI: 10.1126/scitranslmed.abd9696] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 03/12/2021] [Indexed: 12/23/2022]
Abstract
Ebola virus (EBOV) hemorrhagic fever outbreaks have been challenging to deter due to the lack of health care infrastructure in disease-endemic countries and a corresponding inability to diagnose and contain the disease at an early stage. EBOV vaccines and therapies have improved disease outcomes, but the advent of an affordable, easily accessed, mass-produced rapid diagnostic test (RDT) that matches the performance of more resource-intensive polymerase chain reaction (PCR) assays would be invaluable in containing future outbreaks. Here, we developed and demonstrated the performance of a new ultrasensitive point-of-care immunoassay, the EBOV D4 assay, which targets the secreted glycoprotein of EBOV. The EBOV D4 assay is 1000-fold more sensitive than the U.S. Food and Drug Administration-approved RDTs and detected EBOV infection earlier than PCR in a standard nonhuman primate model. The EBOV D4 assay is suitable for low-resource settings and may facilitate earlier detection, containment, and treatment during outbreaks of the disease.
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Affiliation(s)
- Cassio M Fontes
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Barbara D Lipes
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Jason Liu
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Krystle N Agans
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA.,Galveston National Laboratory, University of Texas Medical Branch at Galveston, Galveston, TX 77550, USA
| | - Aiwei Yan
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Patricia Shi
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Daniela F Cruz
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Garrett Kelly
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Kelli M Luginbuhl
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Daniel Y Joh
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Stephanie L Foster
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA.,Galveston National Laboratory, University of Texas Medical Branch at Galveston, Galveston, TX 77550, USA
| | - Jacob Heggestad
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Angus Hucknall
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Maiken H Mikkelsen
- Department of Electrical and Computer Engineering, Duke University, Durham, NC 27708, USA
| | - Carl F Pieper
- Departments of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA
| | - Roarke W Horstmeyer
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Thomas W Geisbert
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA.,Galveston National Laboratory, University of Texas Medical Branch at Galveston, Galveston, TX 77550, USA
| | - Michael D Gunn
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
| | - Ashutosh Chilkoti
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.
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Raftery P, Hossain M, Palmer J. An innovative and integrated model for global outbreak response and research - a case study of the UK Public Health Rapid Support Team (UK-PHRST). BMC Public Health 2021; 21:1378. [PMID: 34247621 PMCID: PMC8273030 DOI: 10.1186/s12889-021-11433-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite considerable institutional experimentation at national and international levels in response to calls for global health security reform, there is little research on organisational models that address outbreak preparedness and response. Created in the aftermath of the 2013-16 West African Ebola epidemic, the United Kingdom's Public Health Rapid Support Team (UK-PHRST) was designed to address critical gaps in outbreak response illuminated during the epidemic, while leveraging existing UK institutional strengths. The partnership between the government agency, Public Health England, and an academic consortium, led by the London School of Hygiene and Tropical Medicine, seeks to integrate outbreak response, operational research and capacity building. We explored the design, establishment and early experiences of the UK-PHRST as one of the first bodies of its kind globally, paying particular attention to governance decisions which enabled them to address their complex mission. METHODS We conducted a qualitative case study using 19 in-depth interviews with individuals knowledgeable about the team's design and implementation, review of organisational documents, and observations of meetings to analyse the UK-PHRST's creation, establishment and initial 2 years of operations. RESULTS According to key informants, adopting a triple mandate (response, research and capacity building) established the team as novel in the global epidemic response architecture. Key governance decisions recognised as vital to the model included: structuring the team as a government-academic collaboration which leveraged long-term and complementary UK investments in public health and the higher education sector; adopting a more complex, dual reporting and funding structure to maintain an ethos of institutional balance between lead organisations; supporting a multidisciplinary team of experts to respond early in outbreaks for optimal impact; prioritising and funding epidemic research to influence response policy and practice; and ensuring the team's activities reinforced the existing global health architecture. CONCLUSION The UK-PHRST aims to enhance global outbreak response using an innovative and integrated model that capitalises on institutional strengths of the partnership. Insights suggest that despite adding complexity, integrating operational research through the government-academic collaboration contributed significant advantages. This promising model could be adopted and adapted by countries seeking to build similar outbreak response and research capacities.
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Affiliation(s)
- Philomena Raftery
- Department of Global Health & Development and Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
| | - Mazeda Hossain
- Department of Global Health & Development and Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- Centre for Women, Peace & Security, London School of Economics and Political Science, Houghton Street, London, UK
| | - Jennifer Palmer
- Department of Global Health & Development and Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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Bedson J, Jalloh MF, Pedi D, Bah S, Owen K, Oniba A, Sangarie M, Fofanah JS, Jalloh MB, Sengeh P, Skrip L, Althouse BM, Hébert-Dufresne L. Community engagement in outbreak response: lessons from the 2014-2016 Ebola outbreak in Sierra Leone. BMJ Glob Health 2021; 5:bmjgh-2019-002145. [PMID: 32830128 PMCID: PMC7445350 DOI: 10.1136/bmjgh-2019-002145] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 06/08/2020] [Accepted: 06/15/2020] [Indexed: 12/05/2022] Open
Abstract
Documentation of structured community engagement initiatives and real-time monitoring of community engagement activities during large-scale epidemics is limited. To inform such initiatives, this paper analyses the Community Led Ebola Action (CLEA) approach implemented through the Social Mobilization Action Consortium (SMAC) during the 2014–2016 Ebola epidemic in Sierra Leone. The SMAC initiative consisted of a network of 2466 community mobilisers, >6000 religious leaders and 42 local radio stations across all 14 districts of Sierra Leone. Community mobilisers were active in nearly 70% of all communities across the country using the CLEA approach to facilitate community analysis, trigger collective action planning and maintain community action plans over time. CLEA was complemented by interactive radio programming and intensified religious leader engagement. Community mobilisers trained in the CLEA approach used participatory methods, comprised of an initial community ‘triggering’ event, action plan development and weekly follow-ups to monitor progress on identified action items. Mobilisers collected operational and behavioural data on a weekly basis as part of CLEA. We conducted a retrospective analysis of >50 000 weekly reports from approximately 12 000 communities from December 2014 to September 2015. The data showed that 100% of the communities that were engaged had one or more action plans in place. Out of the 63 110 cumulative action points monitored by community mobilisers, 92% were marked as ‘in-progress’ (85%) or ‘achieved’ (7%) within 9 months. A qualitative examination of action points revealed that the in-progress status was indicative of the long-term sustainability of most action points (eg, continuous monitoring of visitors into the community) versus one-off action items that were marked as achieved (eg, initial installation of handwashing station). Analysis of behavioural outcomes of the intervention indicate an increase over time in the fraction of reported safe burials and fraction of reported cases referred for medical care within 24 hours of symptom onset in the communities that were engaged. Through CLEA, we have demonstrated how large-scale, coordinated community engagement interventions can be achieved and monitored in real-time during future Ebola epidemics and other similar epidemics. The SMAC initiative provides a practical model for the design, implementation and monitoring of community engagement, integration and coordination of community engagement interventions with other health emergency response pillars, and adaptive strategies for large-scale community-based operational data collection.
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Affiliation(s)
- Jamie Bedson
- Restless Development Sierra Leone, Freetown, Sierra Leone.,Consultant to the Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | | | - Danielle Pedi
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Saiku Bah
- Restless Development Sierra Leone, Freetown, Sierra Leone
| | | | | | | | | | | | | | - Laura Skrip
- Epidemiology, Institute for Disease Modeling, Bellevue, Washington, USA
| | - Benjamin M Althouse
- Epidemiology, Institute for Disease Modeling, Bellevue, Washington, USA .,Information School, University of Washington, Seattle, Washington, USA.,Biology, New Mexico State University, Las Cruces, NM, United States
| | - Laurent Hébert-Dufresne
- Vermont Complex Systems Center, University of Vermont, Burlington, Vermont, USA.,Computer Science, University of Vermont, Burlington, Vermont, USA
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Kola L, Kohrt BA, Hanlon C, Naslund JA, Sikander S, Balaji M, Benjet C, Cheung EYL, Eaton J, Gonsalves P, Hailemariam M, Luitel NP, Machado DB, Misganaw E, Omigbodun O, Roberts T, Salisbury TT, Shidhaye R, Sunkel C, Ugo V, van Rensburg AJ, Gureje O, Pathare S, Saxena S, Thornicroft G, Patel V. COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health. Lancet Psychiatry 2021; 8:535-550. [PMID: 33639109 PMCID: PMC9764935 DOI: 10.1016/s2215-0366(21)00025-0] [Citation(s) in RCA: 332] [Impact Index Per Article: 110.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/30/2022]
Abstract
Most of the global population live in low-income and middle-income countries (LMICs), which have historically received a small fraction of global resources for mental health. The COVID-19 pandemic has spread rapidly in many of these countries. This Review examines the mental health implications of the COVID-19 pandemic in LMICs in four parts. First, we review the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders. Second, we assess the responses in different countries, noting the swift and diverse responses to address mental health in some countries, particularly through the development of national COVID-19 response plans for mental health services, implementation of WHO guidance, and deployment of digital platforms, signifying a welcome recognition of the salience of mental health. Third, we consider the opportunity that the pandemic presents to reimagine global mental health, especially through shifting the balance of power from high-income countries to LMICs and from narrow biomedical approaches to community-oriented psychosocial perspectives, in setting priorities for interventions and research. Finally, we present a vision for the concept of building back better the mental health systems in LMICs with a focus on key strategies; notably, fully integrating mental health in plans for universal health coverage, enhancing access to psychosocial interventions through task sharing, leveraging digital technologies for various mental health tasks, eliminating coercion in mental health care, and addressing the needs of neglected populations, such as children and people with substance use disorders. Our recommendations are relevant for the mental health of populations and functioning of health systems in not only LMICs but also high-income countries impacted by the COVID-19 pandemic, with wide disparities in quality of and access to mental health care.
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Affiliation(s)
- Lola Kola
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria; BRiTE Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Charlotte Hanlon
- Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Siham Sikander
- Global Health Department, Health Services Academy, Islamabad, Pakistan; Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | | | - Corina Benjet
- Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Eliza Yee Lai Cheung
- The Reference Centre for Psychosocial Support, International Federation of the Red Cross and Red Crescent, Hong Kong Special Administrative Region, China; The Red Cross of the Hong Kong Special Administrative Region of China, Hong Kong Special Administrative Region, China
| | - Julian Eaton
- CBM Global and Centre for Global Mental Health, London, UK
| | - Pattie Gonsalves
- Wellcome-DBT India Alliance, Sangath, New Delhi, India; School of Psychology, University of Sussex, Brighton, UK
| | - Maji Hailemariam
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | | | - Daiane B Machado
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Centre for Data and Knowledge Integration for Health, CIDACS-FIOCRUZ, Bahia, Brazil
| | - Eleni Misganaw
- Mental Health Service Users Association Ethiopia, Addis Ababa, Ethiopia; Global Mental Health Peer Network, Pretoria, South Africa
| | - Olayinka Omigbodun
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria; Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tessa Roberts
- Centre for Society and Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; WHO Collaborating Centre for Research and Training in Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Charlene Sunkel
- Global Mental Health Peer Network, Johannesburg, South Africa
| | - Victor Ugo
- Mentally Aware Nigeria Initiative, Lagos, Nigeria; United for Global Mental Health, London, UK
| | - André Janse van Rensburg
- Centre for Rural Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Centre for Health Systems Research and Development, Faculty of Humanities, University of the Free State, Bloemfontein, South Africa
| | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Shekhar Saxena
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Graham Thornicroft
- Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Implementation Science, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Wellcome-DBT India Alliance, Sangath, New Delhi, India
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Chiam AL, Cheng NWI, Larson H. Community engagement for outbreak preparedness and response in high-income settings: A systematic review. Glob Public Health 2021; 17:1113-1135. [PMID: 33938368 DOI: 10.1080/17441692.2021.1919734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND This review aims to (i) identify and critique existing methods of community engagement for outbreak preparedness and response in high-income settings, and (ii) understand community members' experiences of community engagement, and their views and concerns towards pandemic planning/response. METHODS Following the PRISMA guidelines, a systematic review was conducted by searching Medline, Embase, PubMed, Global Health, CINAHL Plus and Scopus for publications from 2004 to June 2019. Potential literature was screened using explicit inclusion and exclusion criteria. Included studies were appraised using the Critical Appraisal Skills Programme Qualitative Research checklist. Those using deliberative approaches were appraised using additional criteria for judging deliberation quality. Thematic synthesis was then conducted. RESULTS Primary studies employed participatory research approaches, deliberative forums, interviews/focus groups to engage community members on pandemic planning/response with varying degrees of involvement and methodological rigour. This review indicates such endeavours must take into account instrumental and relational considerations: socioeconomic pressures; agency and capacity; diversity and divergent views; educate, communicate and engage; trust and transparency. CONCLUSION Community engagement for pandemic planning/response requires clear methods, processes and who 'community' constitutes. Instrumental and relational considerations must be addressed concurrently in pandemic planning/response to enhance preparedness for public health emergencies.
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Affiliation(s)
| | | | - Heidi Larson
- London School of Hygiene & Tropical Medicine, London, UK
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Knowledge, Attitudes, and Practices (KAP) Regarding the COVID-19 Outbreak in Côte d'Ivoire: Understanding the Non-Compliance of Populations with Non-Pharmaceutical Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094757. [PMID: 33946980 PMCID: PMC8124153 DOI: 10.3390/ijerph18094757] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 12/24/2022]
Abstract
At the beginning of the COVID-19 outbreak, preventive measures seemed the most appropriate method to control its spread. We assessed the knowledge, attitudes, and practices of the Ivorian public regarding preventive measures, conducting a hybrid survey across the country. Participants were invited to complete a questionnaire online, by phone, or face-to-face. Chi-squared, Fisher’s exact, and Kruskal–Wallis tests were used to compare the frequency of responses regarding compliance with preventive measures. Data were validated for 564 individuals. Over one-third of respondents believed that COVID-19 was related to non-natural causes. Though the disease was perceived as severe, respondents did not consider it to be highly infectious. Overall, 35.6% of respondents fully trust health officials in the management of the pandemic, and 34.6% trusted them moderately. Individuals who believed COVID-19 was a disease caused by a pathogen and the well-educated were likely to comply with preventive measures. About 70% of respondents stated that their daily expenses had increased due to preventive measures. The study concludes that beyond unfavorable socioeconomic conditions, the level of knowledge regarding COVID-19 and trust in the government/health system are more likely to influence compliance with preventive measures such as self-reporting, physical distancing, the use of face masks, and eventually the acceptability of vaccines.
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Mayhew SH, Kyamusugulwa PM, Kihangi Bindu K, Richards P, Kiyungu C, Balabanova D. Responding to the 2018-2020 Ebola Virus Outbreak in the Democratic Republic of the Congo: Rethinking Humanitarian Approaches. Risk Manag Healthc Policy 2021; 14:1731-1747. [PMID: 33953623 PMCID: PMC8092619 DOI: 10.2147/rmhp.s219295] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/20/2021] [Indexed: 11/23/2022] Open
Abstract
The Democratic Republic of Congo (DRC) presents a challenging context in which to respond to public health crises. Its 2018-2020 Ebola outbreak was the second largest in history. Lessons were known from the previous West African outbreak. Chief among these was the recognition that local action and involvement are key to establishing effective epidemic-response. It remains unclear whether and how this was achieved in DRC's Ebola response. Additionally, there is a lack of scholarship on how to build resilience (the ability to adapt or transform under pressure) in crisis-response. In this article, we critically review literature to examine evidence on whether and how communities were involved, trust built, and resilience strengthened through adaptation or transformation of DRC's 2018-2020 Ebola response measures. Overall, we found limited evidence that the response adapted to engage and involve local actors and institutions or respond to locally expressed concerns. When adaptations occurred, they were shaped by national and international actors rather than enabling local actors to develop locally trusted initiatives. Communities were "engaged" to understand their perceptions but were not involved in decision-making or shaping responses. Few studies documented how trust was built or analyzed power dynamics between different groups in DRC. Yet, both these elements appear to be critical in building effective, resilient responses. These failures occurred because there was no willingness by the national government or international agencies to concede decision-making power to local people. Emergency humanitarian response is entrenched in highly medicalized, military style command and control approaches which have no space for decentralizing decision-making to "non-experts". To transform humanitarian responses, international responders can no longer be regarded as "experts" who own the knowledge and control the response. To successfully tackle future humanitarian crises requires a transformation of international humanitarian and emergency response systems such that they are led, or shaped, through inclusive, equitable collaboration with local actors.
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Affiliation(s)
- Susannah H Mayhew
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Patrick Milabyo Kyamusugulwa
- Bukavu Medical University College/Institut Supérieur des Techniques Médicales de Bukavu (ISTM-Bukavu), Bukavu, Eastern Democratic Republic of Congo
| | - Kennedy Kihangi Bindu
- Centre de Recherche sur la Démocratie et le Développement en Afrique (CREDDA), Université Libre des Pays des Grands Lacs, Goma, Democratic Republic of Congo
| | - Paul Richards
- School of Environmental Sciences, Njala University, Freetown, Sierra Leone
| | - Cyrille Kiyungu
- Hygiene, State Administration, Kikwit, Democratic Republic of Congo
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Vanderslott S, Van Ryneveld M, Marchant M, Lees S, Nolna SK, Marsh V. How can community engagement in health research be strengthened for infectious disease outbreaks in Sub-Saharan Africa? A scoping review of the literature. BMC Public Health 2021; 21:633. [PMID: 33794820 PMCID: PMC8012744 DOI: 10.1186/s12889-021-10348-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/27/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Community engagement (CE) is a well-established practical and scholarly field, recognised as core to the science and ethics of health research, for which researchers and practitioners have increasingly asked questions about desired standards and evaluation. In infectious disease outbreak contexts, questions may be more complex. However, it is unclear what body of knowledge has been developed for CE specifically as it applies to emerging infectious diseases. This scoping review seeks to describe (1) How CE has been conceptualised and understood; and (2) What conclusions have research teams reached on the effectiveness of CE in these settings, including challenges and facilitators. METHODS We used a scoping review framework by Arksey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005) to structure our review. We conducted a brainstorming session and initial trial search to inform the protocol, search terms, and strategy. Three researchers discussed, developed and applied agreed screening tools and selection criteria to the final search results. Five researchers used the screening tools to screen abstracts and full text for inclusion by consensus. Additional publications were sought from references of retrieved publications and an expert call for literature. We analysed and reported emerging themes qualitatively. RESULTS We included 59 papers from a total of 722 articles derived from our trial and final literature searches, as well as a process of "citation chasing" and an expert call for grey literature. The core material related exclusively to health research trials during the 2014-2016 West Africa Ebola outbreak. We synthesized reports on components of effectiveness of CE to identify and propose three themes as essential elements of effective CE. CONCLUSIONS While there is a large volume of literature documenting CE activities in infectious disease research settings generally, there are few accounts of effectiveness dimensions of CE. Our review proposes three themes to facilitate the effectiveness of CE initiatives as essential elements of CE activities in infectious diseases studies: (1) Communication towards building collaborative relationships; (2) Producing contextual knowledge; and (3) Learning lessons over time. As there were relatively few in-depth accounts of CE from our literature review, documentation and accounts of CE used in health research should be prioritised.
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Affiliation(s)
- Samantha Vanderslott
- Oxford Vaccine Group & Oxford Martin School, University of Oxford, 34 Broad St, Oxford, OX1 2BD, UK.
| | - Manya Van Ryneveld
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, Republic of South Africa
| | - Mark Marchant
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Sylvie Kwedi Nolna
- Department of Public Health, University of Yaounde I, Rue Melen, Yaounde, Cameroon
| | - Vicki Marsh
- KEMRI Wellcome Trust Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, NDM, Oxford University, Oxford, UK
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
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Fadul N, Hussein ME, Fadul AA. Re-opening Sudan: the Balance Between Maintaining Daily Living and Avoiding the Next Peak of COVID-19. CURRENT TROPICAL MEDICINE REPORTS 2021; 8:231-237. [PMID: 33816059 PMCID: PMC8006878 DOI: 10.1007/s40475-021-00237-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Abstract
Purpose of the Review To describe the intersectionality of healthcare and economy, and potential solutions to prevent the next peak of COVID-19 in Sudan. Recent Findings Sudan has recently emerged from a 30-year dictatorship to face the COVID-19 pandemic in the midst of the worst economic crisis. Disease control measures that have been used in developed countries have been difficult to implement in Sudan due to economic, social, and structural challenges. There is a need for integration of data into the disease response plan and for community engagement to help with mitigation efforts. Youth-led community organizations were critical in the success of the Sudanese revolution. Their formal involvement in contact tracing and community awareness campaigns can be beneficial. Summary The COVID-19 pandemic has brought to the surface many of the challenges facing the healthcare system in Sudan. Culturally tailored interventions are needed to prevent the next peak of COVID-19 in the country.
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Affiliation(s)
- Nada Fadul
- Specialty Care Clinic, Division of Infectious Diseases, University of Nebraska Medical Center, 988106 Nebraska Medical Center, Omaha, NE 68198-8106 USA
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Applying a One Health Approach in Global Health and Medicine: Enhancing Involvement of Medical Schools and Global Health Centers. Ann Glob Health 2021; 87:30. [PMID: 33816135 PMCID: PMC7996453 DOI: 10.5334/aogh.2647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Multidisciplinary and multisectoral approaches such as One Health and related concepts (e.g., Planetary Health, EcoHealth) offer opportunities for synergistic expertise to address complex health threats. The connections between humans, animals, and the environment necessitate collaboration among sectors to comprehensively understand and reduce risks and consequences on health and wellbeing. One Health approaches are increasingly emphasized for national and international plans and strategies related to zoonotic diseases, food safety, antimicrobial resistance, and climate change, but to date, the possible applications in clinical practice and benefits impacting human health are largely missing. Methods: In 2018 the “Application of the One Health Approach to Global Health Centers” conference held at the Albert Einstein College of Medicine convened experts involved in One Health policy and practice. The conference examined issues relevant to One Health approaches, sharing examples of challenges and successes to guide application to medical school curricula and clinical practice for human health. This paper presents a synthesis of conference proceedings, framed around objectives identified from presentations and audience feedback. Findings and Recommendations: The following objectives provide opportunities for One Health involvement and benefits for medical schools and global health centers by: 1) Improving One Health resource sharing in global health and medical education; 2) Creating pathways for information flow in clinical medicine and global health practice; 3) Developing innovative partnerships for improved health sector outcomes; and 4) Informing and empowering health through public outreach. These objectives can leverage existing resources to deliver value to additional settings and stakeholders through resource efficiency, more holistic and effective service delivery, and greater ability to manage determinants of poor health status. We encourage medical and global health educators, practitioners, and students to explore entry points where One Health can add value to their work from local to global scale.
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Enria L, Waterlow N, Rogers NT, Brindle H, Lal S, Eggo RM, Lees S, Roberts CH. Trust and transparency in times of crisis: Results from an online survey during the first wave (April 2020) of the COVID-19 epidemic in the UK. PLoS One 2021; 16:e0239247. [PMID: 33591985 PMCID: PMC7886216 DOI: 10.1371/journal.pone.0239247] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background The success of a government’s COVID-19 control strategy relies on public trust and broad acceptance of response measures. We investigated public perceptions of the UK government’s COVID-19 response, focusing on the relationship between trust and perceived transparency, during the first wave (April 2020) of the COVID-19 pandemic in the United Kingdom. Methods Anonymous survey data were collected (2020-04-06 to 2020-04-22) from 9,322 respondents, aged 20+ using an online questionnaire shared primarily through Facebook. We took an embedded-mixed-methods approach to data analysis. Missing data were imputed via multiple imputation. Binomial & multinomial logistic regression were used to detect associations between demographic characteristics and perceptions or opinions of the UK government’s response to COVID-19. Structural topic modelling (STM), qualitative thematic coding of sub-sets of responses were then used to perform a thematic analysis of topics that were of interest to key demographic groups. Results Most respondents (95.1%) supported government enforcement of behaviour change. While 52.1% of respondents thought the government was making good decisions, differences were apparent across demographic groups, for example respondents from Scotland had lower odds of responding positively than respondents in London. Higher educational levels saw decreasing odds of having a positive opinion of the government response and decreasing household income associated with decreasing positive opinion. Of respondents who thought the government was not making good decisions 60% believed the economy was being prioritised over people and their health. Positive views on government decision-making were associated with positive views on government transparency about the COVID-19 response. Qualitative analysis about perceptions of government transparency highlighted five key themes: (1) the justification of opacity due to the condition of crisis, (2) generalised mistrust of politics, (3) concerns about the role of scientific evidence, (4) quality of government communication and (5) questions about political decision-making processes. Conclusion Our study suggests that trust is not homogenous across communities, and that generalised mistrust, concerns about the transparent use and communication of evidence and insights into decision-making processes can affect perceptions of the government’s pandemic response. We recommend targeted community engagement, tailored to the experiences of different groups and a new focus on accountability and openness around how decisions are made in the response to the UK COVID-19 pandemic.
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Affiliation(s)
- Luisa Enria
- Department of Global Health and Development, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Naomi Waterlow
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Public Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nina Trivedy Rogers
- UCL Research Department of Epidemiology & Public Health, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Hannah Brindle
- Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sham Lal
- Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rosalind M. Eggo
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Public Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Shelley Lees
- Department of Global Health and Development, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chrissy h. Roberts
- Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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Turk E, Durrance-Bagale A, Han E, Bell S, Rajan S, Lota MMM, Ochu C, Porras ML, Mishra P, Frumence G, McKee M, Legido-Quigley H. International experiences with co-production and people centredness offer lessons for covid-19 responses. BMJ 2021; 372:m4752. [PMID: 33593813 PMCID: PMC7879267 DOI: 10.1136/bmj.m4752] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Eva Turk
- Science Centre Health and Technology, University of South-Eastern Norway, Drammen, Norway
- University of Maribor, Faculty of Medicine, Maribor, Slovenia
| | | | - Emeline Han
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Sadie Bell
- London School of Hygiene and Tropical Medicine, London, UK
| | - Selina Rajan
- London School of Hygiene and Tropical Medicine, London, UK
| | - Maria Margarita M Lota
- Department of Medical Microbiology, College of Public Health, University of the Philippines, SEAMEO TROPMED Regional Center for PUBLIC Health, Hospital Administration, Environmental and Occupational Health, Manila, Philippines
| | - Chinwe Ochu
- Prevention, Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | - Gasto Frumence
- School of Public Health and Social Sciences, Department of Development Studies, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Helena Legido-Quigley
- London School of Hygiene and Tropical Medicine, London, UK
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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Leach M, MacGregor H, Scoones I, Wilkinson A. Post-pandemic transformations: How and why COVID-19 requires us to rethink development. WORLD DEVELOPMENT 2021; 138:105233. [PMID: 33100478 PMCID: PMC7566764 DOI: 10.1016/j.worlddev.2020.105233] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
COVID-19 is proving to be the long awaited 'big one': a pandemic capable of bringing societies and economies to their knees. There is an urgent need to examine how COVID-19 - as a health and development crisis - unfolded the way it did it and to consider possibilities for post-pandemic transformations and for rethinking development more broadly. Drawing on over a decade of research on epidemics, we argue that the origins, unfolding and effects of the COVID-19 pandemic require analysis that addresses both structural political-economic conditions alongside far less ordered, 'unruly' processes reflecting complexity, uncertainty, contingency and context-specificity. This structural-unruly duality in the conditions and processes of pandemic emergence, progression and impact provides a lens to view three key challenge areas. The first is how scientific advice and evidence are used in policy, when conditions are rigidly 'locked in' to established power relations and yet so uncertain. Second is how economies function, with the COVID-19 crisis having revealed the limits of a conventional model of economic growth. The third concerns how new forms of politics can become the basis of reshaped citizen-state relations in confronting a pandemic, such as those around mutual solidarity and care. COVID-19 demonstrates that we face an uncertain future, where anticipation of and resilience to major shocks must become the core problematic of development studies and practice. Where mainstream approaches to development have been top down, rigid and orientated towards narrowly-defined economic goals, post-COVID-19 development must have a radically transformative, egalitarian and inclusive knowledge and politics at its core.
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Affiliation(s)
- Melissa Leach
- Institute of Development Studies at the University of Sussex, UK
| | - Hayley MacGregor
- Institute of Development Studies at the University of Sussex, UK
| | - Ian Scoones
- Institute of Development Studies at the University of Sussex, UK
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Schmidt-Sane M, Nielsen J, Chikombero M, Lubowa D, Lwanga M, Gamusi J, Kabanda R, Kaawa-Mafigiri D. Gendered care at the margins: Ebola, gender, and caregiving practices in Uganda's border districts. Glob Public Health 2021; 17:899-911. [PMID: 33517846 DOI: 10.1080/17441692.2021.1879895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In July 2019, Ebola in the Democratic Republic of Congo (DRC) was declared a public health emergency of international concern and neighbouring countries were put on high alert. This paper examines the intersections of gender, caregiving, and livelihood practices in Uganda's border districts that emerged as key factors to consider in preparedness and response. This paper is based on an anthropological study of the Ebola context among Bantu cultures. We report on data from focus group discussions and key informant interviews with various sectors of the community. The study identified intersecting themes reported here: (1) women as primary caregivers in this context; and (2) women as providers, often in occupations that increase vulnerability to Ebola. Findings demonstrate the role that women play inside and outside the home as caregivers of the sick and during burials, and intersections with livelihood-seeking strategies. Because women's caregiving is largely unpaid, women face a double burden of work as they seek other livelihood strategies that sometimes increase vulnerability to Ebola. Epidemic response should address these intersections and the context-specific vulnerabilities of caregivers; it should also be localised and community-centred and able to attend to the cultural as well as the economic needs of a community.
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Affiliation(s)
- Megan Schmidt-Sane
- Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA.,Center for Social Science Research on AIDS, Makerere University School of Social Sciences, Kampala, Uganda
| | - Jannie Nielsen
- Center for Social Science Research on AIDS, Makerere University School of Social Sciences, Kampala, Uganda
| | | | | | | | | | | | - David Kaawa-Mafigiri
- Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA.,Center for Social Science Research on AIDS, Makerere University School of Social Sciences, Kampala, Uganda
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Osborne J, Paget J, Napier D, Giles-Vernick T, Kutalek R, Rodyna R, Ahmed SM, Dückers M. Addressing vulnerabilities in communities facing infectious disease threats: A need for social science-driven assessments. J Glob Health 2021; 11:03003. [PMID: 33604031 PMCID: PMC7872718 DOI: 10.7189/jogh.11.03003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jacob Osborne
- Nivel - Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - John Paget
- Nivel - Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - David Napier
- Department of Anthropology, Science, Medicine, and Society Network, University College London, London, UK
| | - Tamara Giles-Vernick
- Anthropology and Ecology of Disease Emergence Unit, Institut Pasteur, 75015 Paris, France
| | - Ruth Kutalek
- Department of Social and Preventative Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Roman Rodyna
- Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Syed Masud Ahmed
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Michel Dückers
- Nivel - Netherlands Institute for Health Services Research, Utrecht, the Netherlands.,ARQ National Psychotrauma Centre, Diemen, the Netherlands.,Faculty of Social and Behavioural Science, University of Groningen, Groningen, the Netherlands
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The Unlikely Saviour: Portugal's National Health System and the Initial Impact of the COVID-19 Pandemic? ACTA ACUST UNITED AC 2020; 63:291-297. [PMID: 33288975 PMCID: PMC7710772 DOI: 10.1057/s41301-020-00268-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
What is the impact of COVID-19 on Portugal’s Serviço Nacional de Saúde (SNS), the country’s national health service? The story, still unfolding, has all the elements of a recipe for disaster: one of the most elderly populations in the world; a weakened SNS, the result of a litany of policies and interventions by the ‘Troika’ (the European Commission, the European Central Bank and the International Monetary Fund); a health care delivery system focused on non-communicable diseases and long-term care; the growing public distrust in public services, compared to private, hotel-like health care facilities. We are aware that these are still the early days of the epidemic, yet it is safe to say that algorithmic scenarios of doom and gloom have so far been averted. In the past six months of the pandemic, the level of trust of the Portuguese population in the SNS and its health personnel has significantly improved, while the government has started to provide additional funding and to work for the expansion of the public system. At the very inception of the pandemic, private hospitals practically closed their doors to COVID-19 patients. Unexpectedly a new disease, COVID-19, by definition the foe of any health system, has granted the opportunity for a rare consensus amongst different key political and/or corporate actors in a long-called-for reform of the SNS. Social science and humanities, with their analytical tools and theoretical-conceptual frameworks, are mandatory in providing well-funded answers to such riddles and better grasping the reasons for the twist and turns.
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Romha G, Girmay W. Knowledge, attitude and practice towards anthrax in northern Ethiopia: a mixed approach study. BMC Infect Dis 2020; 20:814. [PMID: 33167885 PMCID: PMC7653774 DOI: 10.1186/s12879-020-05544-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anthrax is the second most highly prioritized zoonotic disease in Ethiopia due to its negative impact at the household level, causing disease and production losses in livestock and severe disease in humans. This study seeks to assess the knowledge of, attitudes towards, and practices addressing (KAPs) anthrax in the communities of Eastern Tigray, Northern Ethiopia. METHODS A cross-sectional survey was conducted concurrently with focus group discussions (FGDs) and key informant interviews (KIIs) between May 2019 and April 2020. A total of 862 respondents participated in the questionnaire survey. Of these, 800 were local community members while 62 were professionals working at health service institutions. In addition, qualitative data were collected using six FGDs and 11 KIIs. RESULTS Sixty-two percent (496/800) of the community respondents said that they were aware of anthrax while 38% (304/800) of them did not. Only 9.3% (74/800) of the respondents reported that the causative agent of anthrax is germs/microbial. About 56.5% (35/62) of professional respondents said that it is bacterial. More than 60% (64.1%, 513/800) of the respondents did not know that whether the disease was zoonotic or not. Regarding clinical signs, 26.3 (210/800) and 36.8% (294/800) of the respondents could identify at least one in animals and humans, respectively, while 21.3 (170/800) and 20.1% (161/800) knew one or more transmission routes in animals and humans, respectively. Moreover, 43.4% (347/800) and 45.6% (365/800) of the respondents mentioned one or more control/prevention method(s) in animals and humans, respectively. Regarding qualitative results, some of the participants knew the disease (in animals) by their local names: Lalish and Tafia (splenomegaly), and Gulbus (abdominal cramps and shivering). Some reported that anthrax was exclusively a human disease while others recognized its zoonotic potential after the clinical signs in both animals and humans were listed. CONCLUSION The KAP of the participants regarding anthrax was low. There was no consistent understanding of the disease among the participants. The study also revealed that the participants did not receive consistent, adequate, and continuous education regarding the disease.
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Affiliation(s)
- Gebremedhin Romha
- Department of Veterinary Public Health and Food Safety, College of Veterinary Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Weldemelak Girmay
- Department of Veterinary Public Health and Food Safety, College of Veterinary Sciences, Mekelle University, Mekelle, Ethiopia
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Lees S, Enria L. Comparative ethnographies of medical research: materiality, social relations, citizenship and hope in Tanzania and Sierra Leone. Int Health 2020; 12:575-583. [PMID: 33165554 PMCID: PMC7650898 DOI: 10.1093/inthealth/ihaa071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/30/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022] Open
Abstract
In this paper we bring together ethnographic research carried out during two clinical prevention trials to explore identities, relations and political imaginations that were brought to life by these different technologies. We highlight the ways in which critical anthropological engagement in clinical trials can help us radically reconsider the parameters and standards of medical research. In the paper we analyse the very different circumstances that made these two trials possible, highlighting the different temporalities and politics of HIV and Ebola as epidemics. We then describe four themes revealed by ethnographic research with participants and their communities but mediated by the specific sociopolitical contexts in which the trials were taking place. In both countries we found materiality and notions of exchange to be important to participants’ understanding of the value of medical research and their role within it. These dynamics were governed through social relations and moral economies that also underpinned challenges to Western notions of research ethics. The clinical trials offered a language to express both disaffection and disillusionment with the political status quo (often through rumours and anxieties) while at the same time setting the foundations for alternative visions of citizenship. Attached to these were expressions of ‘uncertainty and hope’ steeped in locally distinctive notions of destiny and expectations of the future.
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Affiliation(s)
- Shelley Lees
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Luisa Enria
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Enria L. Unsettled authority and humanitarian practice: reflections on local Iegitimacy from Sierra Leone’s borderlands. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/13600818.2020.1828325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Luisa Enria
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Optimizing Pandemic Preparedness and Response Through Health Information Systems: Lessons Learned From Ebola to COVID-19. Disaster Med Public Health Prep 2020; 16:333-340. [PMID: 33004102 PMCID: PMC7642496 DOI: 10.1017/dmp.2020.361] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Strengthening health systems and maintaining essential service delivery during health emergencies response is critical for early detection and diagnosis, prompt treatment, and effective control of pandemics, including the novel coronavirus disease 2019 (COVID-19). Health information systems (HIS) developed during recent Ebola outbreaks in West Africa and the Democratic Republic of the Congo (DRC) provided opportunities to collect, analyze, and distribute data to inform both day-to-day and long-term policy decisions on outbreak preparedness. As COVID-19 continues to sweep across the globe, HIS and related technological advancements remain vital for effective and sustained data sharing, contact tracing, mapping and monitoring, community risk sensitization and engagement, preventive education, and timely preparedness and response activities. In reviewing literature of how HIS could have further supported mitigation of these Ebola outbreaks and the ongoing COVID-19 pandemic, 3 key areas were identified: governance and coordination, health systems infrastructure and resources, and community engagement. In this concept study, we outline scalable HIS lessons from recent Ebola outbreaks and early COVID-19 responses along these 3 domains, synthesizing recommendations to offer clear, evidence-based approaches on how to leverage HIS to strengthen the current pandemic response and foster community health systems resilience moving forward.
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Community response to the Ebola outbreak: Contribution of community-based organisations and community leaders in four health districts in Guinea. Glob Public Health 2020; 15:1767-1777. [PMID: 32673146 DOI: 10.1080/17441692.2020.1789194] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The major challenges in controlling the Ebola Virus Disease (EVD) outbreak in Guinea were contact tracing, referral of suspected cases, secure burial and mistrust in the context of a weak health system. Community involvement and uptake of key interventions were very low, contributing to the spread of the epidemic. A community engagement project, using community based organisations (CBOs) and community leaders, was implemented in four affected health districts in rural Guinea. This paper reports on the contribution of the CBOs and community leaders in controlling the EVD outbreak. Base-, mid- and end - line assessments were conducted using a mixed methods approach. In total, 422 CBOs members, 50 community leaders and 40 village birth attendants were engaged in social mobilisation, awareness raising, reaching 154,310 people and leading to the end of reluctance and mistrust. Thus, 95 suspected cases were referred to health facilities, contact tracing and secure burial increased from 88.0% to 96.6% and from 67% to 95.4%, respectively, and institutional deliveries increased from 637 to 806. Involvement of CBOs and community leaders against the EVD outbreak is an effective resource that should also be considered to better respond to possible large-scale epidemic threats in a fragile health system context.
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