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Schindell BG, Fredborg B, Kowalec K, Shaw S, Kangbai JB, Kindrachuk J. The state of mental health among Ebola virus disease survivors through a cross-sectional study in Sierra Leone. BMJ Glob Health 2024; 9:e015098. [PMID: 38782464 PMCID: PMC11116873 DOI: 10.1136/bmjgh-2024-015098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The West African Ebola virus disease (EVD) epidemic resulted in >28 000 disease cases and >11 000 fatalities. The unprecedented number of survivors from this epidemic has raised questions about the long-term mental health impacts of EVD survivorship and the capacity to meet these needs. OBJECTIVES Assess the frequency and factors associated with mental health consequences of EVD survivorship in Sierra Leone. METHODS A cross-sectional study of 595 EVD survivors and 403 close contacts (n=998) from Sierra Leone assessed via in-person survey between November 2021 and March 2022. The assessment included validated mental health screening tools (Patient Health Questionnaire-9, PTSD Checklist-5, Alcohol Use Disorders Identification Test, Drug Abuse Screening Test-20) to indicate the presence/absence of disorder. The frequency of each disorder and factors associated with each disorder were assessed. FINDINGS EVD-associated post-traumatic stress disorder (PTSD) was reported by 45.7% (n=257) of EVD survivors. Moreover, 3.9% (n=22) and 12.0% (n=67) of EVD survivors reported major depression (MD) and substance use, respectively; all mental health outcomes were higher than baseline rates in the region (PTSD: 6%-16%, MD: 1.1%, substance use: 2.2%). PTSD among EVD survivors was associated with acute EVD duration of ≥21 days (adjusted OR, AOR 2.24, 95% CI 1.16 to 4.43), 35-44 years of age (AOR 3.31, 95% CI 1.33 to 8.24; AOR 2.99, 95% CI 1.09 to 8.24) and residential mobility (AOR 4.16, 95% CI 2.35 to 7.35). CONCLUSIONS Concerningly, the levels of mental health disorders among EVD survivors in Sierra Leone remained elevated 6-8 years after recovery. CLINICAL IMPLICATIONS Results can be used to inform policy efforts and target resources to address mental health in EVD survivors.
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Affiliation(s)
- Brayden G Schindell
- Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bev Fredborg
- Psychology, The University of Winnipeg, Winnipeg, Manitoba, Canada
| | - Kaarina Kowalec
- Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Medical Epidemiology & Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Souradet Shaw
- Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Jia B Kangbai
- Public Health, Eastern Technical University of Sierra Leone, Kenema, Sierra Leone
| | - Jason Kindrachuk
- Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
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2
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Schindell BG, Kangbai JB, Shaw SY, Kindrachuk J. Stigmatization of Ebola virus disease survivors in 2022: A cross-sectional study of survivors in Sierra Leone. J Infect Public Health 2024; 17:35-43. [PMID: 37992432 DOI: 10.1016/j.jiph.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Evidence has demonstrated a high proportion of Ebola virus disease (EVD) survivors experienced stigma due to the disease. This study sought to understand the longer-term effects of stigma encountered by survivors of the 2014-2016 EVD epidemic living in Sierra Leone. METHODS This was a cross-sectional study of 595 EVD survivors and 403 close contacts (n = 998) from Sierra Leone. Assessments were conducted using a three-part survey between November 2021 to March 2022. We explored the socio-demographic factors associated with stigma experienced by EVD survivors. FINDINGS 50·6 % (n = 301) of EVD survivors reported that they continued to experience at least one aspect of stigma. Females were disproportionately affected by stigma, with 45·2 % of females reporting isolation from friends and family compared to 33·9 % of men (p = 0·005). Multivariable logistic regression models revealed those aged 40-44, living rurally, and reporting an acute infection longer than seven days was associated with EVD-related stigma at the time of survey. INTERPRETATION This study demonstrates stigma is still prevalent among people who survived EVD in 2022. It also identified socio-demographic factors associated with stigma that can be used for targeting interventions. Importantly, this highlights the continued need for EVD survivors to access mental healthcare and social support systems well after disease recovery. FUNDING This study was funded by the Canadian Institutes for Health Research (Grant no. PJT-175098. JK is funded by a Tier 2 Canada Research Chair in the Molecular Pathogenesis of Emerging and Re-Emerging Viruses. SS is funded by a Tier 2 Canada Research Chair in Program Science and Global Public Health.
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Affiliation(s)
- Brayden G Schindell
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
| | - Jia B Kangbai
- Department of Public Health, Eastern Technical University of Sierra Leone, Kenema, Sierra Leone.
| | - Souradet Y Shaw
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
| | - Jason Kindrachuk
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
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3
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Paterson A, Olliaro PL, Rojek A. Addressing stigma in infectious disease outbreaks: a crucial step in pandemic preparedness. Front Public Health 2023; 11:1303679. [PMID: 38186713 PMCID: PMC10768929 DOI: 10.3389/fpubh.2023.1303679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
There is a complex interplay between infectious disease outbreaks and the stigmatization of affected persons and communities. Outbreaks are prone to precipitating stigma due to the fear, uncertainty, moralisation, and abatement of freedoms associated with many infectious diseases. In turn, this stigma hampers outbreak control efforts. Understanding this relationship is crucial to improving coordinated outbreak response. This requires valid and reliable methods for assessing stigma towards and within impacted communities. We propose adopting a cross-outbreak model for developing the necessary assessment tools. A stigma-informed approach must then be integrated into outbreak preparedness and response efforts to safeguard public health and promote inclusivity and compassion in future outbreaks.
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Affiliation(s)
- Amy Paterson
- Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Piero L. Olliaro
- Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
| | - Amanda Rojek
- Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
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4
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Karuhije J, Nkeshimana M, Zakham F, Hewins B, Rutayisire J, Martinez GS, Kelvin D, Ndishimye P. Understanding knowledge, attitudes and practices on Ebola Virus Disease: a multi-site mixed methods survey on preparedness in Rwanda. BMC Public Health 2023; 23:2417. [PMID: 38053102 PMCID: PMC10696806 DOI: 10.1186/s12889-023-17251-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 11/16/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The overall goal of this survey was to understand the knowledge, attitudes, and practices related to the Ebola Virus Disease (EVD) in Rwanda. METHODS This mixed-method cross-sectional survey was conducted in five selected districts of Rwanda. Quantitative data were collected from 1,010 participants using Kobo Collect Software and the analysis was performed using SPSS and Python software. Qualitative data were specifically collected from 98 participants through Key Informant Interviews (KIIs) and Focus Group Discussion (FGDs). Interview transcripts were imported into NVIVO 8 for coding and subsequent analysis. RESULTS As per our quantitative findings, we report that from the 1,010 respondents, 99.6% reported having previously heard of Ebola, 97.2% believed that vaccination is important in combatting the disease and 93.3% of individuals reported a willingness to receive vaccination should one become available. Around 54% of the respondents were correct in identifying that the disease is of a viral origin which originates from wild animals (42.1%). When asked if they believed that Rwanda is at risk of an EVD outbreak, 90% of the respondents believe that the country is at risk of an EVD outbreak, and the cofactors *gender* and *whether people dwell in Rubavu/Rusizi* were found to significantly impact their perception of threat. As per our qualitative findings, the respondents mentioned that both geographical proximity and relations with the Democratic Republic of Congo place Rwanda at risk of developing an internal outbreak. Although the respondents seemed to be aware of the Ebola prevention behaviours, it was noted that some of them will require significant time before reintegrating into the community an EVD survivor, as they will first need assurance that the patient has fully recovered. Therefore, the qualitative findings reinforce what we originally reported in the quantitative approach to this study. CONCLUSION Our results show that there was high EVD-related knowledge and awareness among the general population in Rwanda. However, for strong public health awareness, preparedness, and protection, a massive investment should always be made in education about EVD with a special focus on districts neighboring countries where the disease is consistently being reported.
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Affiliation(s)
| | | | - Fathiah Zakham
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Benjamin Hewins
- Laboratory of Emerging Infectious Diseases, Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Canada
- Izaak Walton Killam (IWK) Health Center, Canadian Centre for Vaccinology (CCfV), Halifax, NS, Canada
| | | | - Gustavo Sganzerla Martinez
- Laboratory of Emerging Infectious Diseases, Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Canada
- Izaak Walton Killam (IWK) Health Center, Canadian Centre for Vaccinology (CCfV), Halifax, NS, Canada
| | - David Kelvin
- Laboratory of Emerging Infectious Diseases, Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Canada
- Izaak Walton Killam (IWK) Health Center, Canadian Centre for Vaccinology (CCfV), Halifax, NS, Canada
| | - Pacifique Ndishimye
- Laboratory of Emerging Infectious Diseases, Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Canada.
- Izaak Walton Killam (IWK) Health Center, Canadian Centre for Vaccinology (CCfV), Halifax, NS, Canada.
- African Institute for Mathematical Sciences, Kigali, Rwanda.
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5
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Juga M, Nyabadza F, Chirove F. Modelling the impact of stigmatisation of Ebola survivors on the disease transmission dynamics. Sci Rep 2023; 13:4859. [PMID: 36964196 PMCID: PMC10039084 DOI: 10.1038/s41598-023-32040-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 03/21/2023] [Indexed: 03/26/2023] Open
Abstract
Ebola virus disease (EVD) is one of the most highly stigmatised diseases in any affected country because of the disease's high infectivity and case fatality rate. Infected individuals and most especially survivors are often stigmatised by their communities for fear of contagion. We propose and analyse a mathematical model to examine the impact of stigmatisation of Ebola survivors on the disease dynamics. The model captures both the internal stigmatisation experienced by infected individuals after witnessing survivors being stigmatised and the external stigmatisation imposed on survivors by their communities. The results obtained from our analysis and simulations show that both internal and external stigma may lead to an increase in the burden of Ebola virus disease by sustaining the number of infected individuals who hide their infection and the number of unsafe burials of deceased Ebola victims. Strategies that seek to put an end to both forms of stigmatisation and promote safe burials will therefore go a long way in averting the EVD burden.
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Affiliation(s)
- M Juga
- Department of Mathematics and Applied Mathematics, University of Johannesburg, Auckland Park Campus, Johannesburg, 2006, South Africa
| | - F Nyabadza
- Department of Mathematics and Applied Mathematics, University of Johannesburg, Auckland Park Campus, Johannesburg, 2006, South Africa.
| | - F Chirove
- Department of Mathematics and Applied Mathematics, University of Johannesburg, Auckland Park Campus, Johannesburg, 2006, South Africa
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6
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Li X, Peng Z, Jiang L, Zhang P, Yang P, Yuan Z, Cheng J. Dlg1 deletion in microglia ameliorates chronic restraint stress induced mice depression-like behavior. Front Pharmacol 2023; 14:1124845. [PMID: 36909184 PMCID: PMC9992737 DOI: 10.3389/fphar.2023.1124845] [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: 12/15/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
Background: Major depression is one of the most common psychiatric disorders worldwide, inflicting suffering, significant reduction in life span, and financial burdens on families and society. Mounting evidence implicates that exposure to chronic stress can induce the dysregulation of the immune system, and the activation of brain-resident innate immune cells, microglia, leading to depression-like symptoms. However, the specific mechanisms need to be further elucidated. Method: Animal models of depression were established by chronic restraint stress (CRS), and depression-like behavior was assessed by sucrose preference test (SPT), open field test (OFT), tail suspension test (TST) and forced swimming test (FST). Microglial activation was visualized by immunofluorescent and immunohistochemical staining, and microglial morphological changes were further analyzed by skeleton analysis. The levels of inflammatory cytokines were detected by western blotting and qPCR. Result: Microglial Dlg1 knockout ameliorates CRS-induced mice depression-like behavior. In contrast to the effect of Dlg1 in the LPS-induced mouse model, Dlg1 knockout had little effect on microglial density, but significantly decreased the number of activated microglia and reversed microglia morphological changes in mice challenged with CRS. Moreover, the upregulation of inflammatory cytokines following CRS exposure was partially reversed by Dlg1 deletion. Conclusion: Our study provides the evidence that Dlg1 ablation in microglia remarkedly reverses microglial activation and depression-like behavior in mice exposed to CRS, implicating a potential target for the treatment of clinical depression.
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Affiliation(s)
- Xiaoheng Li
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Zhixin Peng
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Lingling Jiang
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China.,Hengyang Medical College, University of South China, Hengyang, Hunan, China
| | - Ping Zhang
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China.,Hengyang Medical College, University of South China, Hengyang, Hunan, China
| | - Pin Yang
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China.,School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui, China
| | - Zengqiang Yuan
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Jinbo Cheng
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China.,Center on Translational Neuroscience, College of Life and Environmental Science, Minzu University of China, Beijing, China
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7
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Davidson MC, Lu S, Barrie MB, Freeman A, Mbayoh M, Kamara M, Tsai AC, Crea T, Rutherford GW, Weiser SD, Kelly JD. A post-outbreak assessment of exposure proximity and Ebola virus disease-related stigma among community members in Kono District, Sierra Leone: A cross-sectional study. SSM - MENTAL HEALTH 2022; 2:100064. [PMID: 35449727 PMCID: PMC9017820 DOI: 10.1016/j.ssmmh.2022.100064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Based on findings from other contexts, informed by intergroup contact theory, that more contact is associated with less stigma, we hypothesized that community members with greater exposure to cases of Ebola virus disease (EVD) were less likely to report EVD-related stigma towards EVD survivors. We assessed personal stigmatizing attitudes towards Ebola survivors, which reflects personal fear and judgement, as well as perceived stigma towards EVD survivors, which reflects an individual's perception of the attitudes of the community towards a stigmatized group. Methods From September 2016 to July 2017, we conducted a cross-sectional, community-based study of EVD-related stigma among individuals who did not contract Ebola in four EVD-affected rural communities of Kono District, Sierra Leone. We identified individuals from all quarantined households and obtained a random sample of those who were unexposed. Exposed individuals either lived in a quarantined household or were reported to have been in contact with an EVD case. Our explanatory variable was proximity to an EVD case during the outbreak. Our primary outcome was stigma towards EVD survivors, measured by a 6-item adapted HIV-related stigma index validated in Zambia and South Africa, with 1 item reflecting personal stigmatizing attitudes and 5 items reflecting perceived community stigma. The 6-item EVD stigma index had good internal consistency (Cronbach's alpha=0.82). We used modified Poisson and negative binomial regression models, adjusting for potential confounders, to estimate the association between exposure proximity and EVD stigma. Results We interviewed 538 participants aged 12 to 85 years. Most (57%) had been quarantined. Over one-third (39%) reported personal stigmatizing attitudes or perceived community stigma; the most frequently endorsed item was fear and judgment towards EVD survivors. Having contact with someone with EVD was significantly associated with a lower likelihood of perceived community stigma (prevalence ratio [PR], 0.26; 95% CI, 0.13-0.54) and personal stigmatizing attitudes (PR, 0.44; 95% CI, 0.29-0.65). In contrast, being quarantined was significantly associated with a higher likelihood of perceived community stigma (PR, 3.9; 95% CI, 1.5-10.1). Conclusions In this cross-sectional study, we found evidence of an inverse relationship between EVD-related stigma and contact with an EVD case. This finding substantiates intergroup contact theory and may form the basis for anti-stigma interventions.
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Affiliation(s)
| | - Scott Lu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - M. Bailor Barrie
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
- Partners In Health, Freetown, Sierra Leone
| | | | | | | | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas Crea
- School of Social Work, Boston College, Boston, MA, USA
| | - George W. Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Sheri D. Weiser
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - J. Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
- F.I. Proctor Foundation, University of California, San Francisco, CA, USA
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8
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Djomaleu ML, Rogers AB, Barrie MB, Rutherford GW, Weiser SD, Kelly JD. Long-term consequences of food insecurity among Ebola virus disease-affected households after the 2013-2016 epidemic in rural communities of Kono District, Sierra Leone: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000770. [PMID: 36382340 PMCID: PMC9648537 DOI: 10.1371/journal.pgph.0000770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 09/14/2022] [Indexed: 12/03/2022]
Abstract
The 2013-2016 Ebola virus disease (EVD) epidemic caused food insecurity during and immediately following local outbreaks in Sierra Leone, but longer-term effects are less well described, particularly among households with no EVD survivors. We conducted a qualitative sub-study in July 2018 in Kono District, Sierra Leone to understand the impact of food insecurity on EVD-affected households. Using data from a community-based cohort, we compiled a list of all households, within the sampled communities in Kono District, that had at least one EVD case during the epidemic. We used purposive sampling to recruit 30 households, inclusive of 10 households with no EVD survivors, to participate in the study. The research team conducted open-ended, semi-structured interviews with the head of each household. All 30 interviews were transcribed, translated, and analyzed using comparative content analysis consistent with a grounded theory approach. Most household members were facing persistent food insecurity as direct or indirect consequences of the EVD epidemic, regardless of whether they did or did not live with EVD survivors. Three major themes emerged as drivers and/or mitigators of EVD-related food insecurity. Financial instability and physical health complications were drivers of food insecurity in the population, whereas support provided by NGOs or governmental agencies was observed as a mitigator and driver of food insecurity after its removal. Among the EVD-households reporting long-term support through jobs and educational opportunities, there was sustained mitigation of food insecurity. EVD-affected households with and without survivors continue to face food insecurity three years after the EVD epidemic. Provision of support was a mitigator of food insecurity in the short term, but its removal was a driver of food insecurity in the longer term, suggesting the need for longer-term transitional support in affected households.
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Affiliation(s)
- Manuella L. Djomaleu
- School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Abu B. Rogers
- School of Medicine, Stanford University, Stanford, California, United States of America
| | - M. Bailor Barrie
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Partners In Health, Freetown, Sierra Leone
| | - George W. Rutherford
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Sheri D. Weiser
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - J. Daniel Kelly
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Partners In Health, Freetown, Sierra Leone
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
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9
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James PB, Wardle J, Gyasi RM, Steel A, Adams J, Kabba JA, Bah AJ, Lahai M, Conteh EB. Health-related quality of life among Ebola survivors in Sierra Leone: the role of socio-demographic, health-related and psycho-social factors. Health Qual Life Outcomes 2022; 20:10. [PMID: 35033102 PMCID: PMC8761046 DOI: 10.1186/s12955-022-01916-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Evidence of how social factors affect the health-related quality of life (HRQoL) of Ebola virus disease (EVD) survivors is limited. Our study explores the association between socio-demographic, health-related and psycho-social (stigma) factors and EVD survivors' health-related quality of life (HRQoL) in Sierra Leone. Methods We conducted a nationwide cross-sectional study among 358 EVD survivors between January and August 2018. We used a multistage sampling method to recruit EVD survivors, and the RAND 36-Item Health Survey item was used to assess the HRQoL. Data were analysed using descriptive statistics and multiple linear regression. Results When comparing by each dimension in relation to their respective summary scores, role limitation physical [0.00 (50.00)] and role limitation emotional [0.00 (33.33)] were the most affected physical health and mental health domains among EVD survivors respectively. EVD survivors who were older (β = − 3.90, 95% CI − 6.47 to − 1.32, p = 0.003), had no formal education (β = − 2.80, 95% CI − 5.16 to − 0.43, p = 0.021), experienced a unit increase in the number of post-Ebola symptoms (β = − 1.08, 95% CI − 1.74 to − 0.43, p < 0.001) and experienced a unit increase in enacted stigma (β = − 2.61, 95% CI − 4.02 to − 1.20, p < 0.001) were more likely to report a decreased level of physical health. EVD survivors who experienced a unit increase in the time spent in the Ebola treatment centre (β = − 0.60, 95% CI − 0.103 to − 0.18, p = 0.006) and those who experienced a unit increase in enacted Stigma were more likely to report decreased levels of mental health (β = − 1.50, 95% CI − 2.67 to − 0.33, p = 0.012). Conclusion Sociodemographic, health-related, and psycho-social factors were significantly associated with decrease levels of HRQoL. Our findings improve our understanding of the factors that might influence the HRQoL and suggest the need for EVD survivors to be provided with a comprehensive healthcare package that caters for their physical and mental health needs.
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Affiliation(s)
- Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, 2480, Australia. .,Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, 2480, Australia.,Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, 2007, Australia
| | - Razak M Gyasi
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, 2007, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, 2007, Australia
| | - John Alimamy Kabba
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, #76 Yanta West Road, Xi'an, 710061, China
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Faculty of Basic Medical Sciences College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Institute for Global Health and Development, Queen Margaret University Edinburg, Musselburgh, Scotland, UK
| | - Michael Lahai
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Eugene B Conteh
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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10
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Boberg-Fazlic N, Ivets M, Karlsson M, Nilsson T. Disease and fertility: Evidence from the 1918-19 influenza pandemic in Sweden. ECONOMICS AND HUMAN BIOLOGY 2021; 43:101020. [PMID: 34252794 DOI: 10.1016/j.ehb.2021.101020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
What are the consequences of a severe health shock like an influenza pandemic on fertility? Using rich administrative data and a difference-in-differences approach, we evaluate fertility responses to the 1918-19 influenza pandemic in Sweden. We find evidence of a small baby boom following the end of the pandemic, but we show that this effect is second-order compared to a strong long-term negative fertility effect. Within this net fertility decline there are compositional effects: we observe a relative increase in births to married women and to better-off families. Several factors - including disruptions to the marriage market and income effects - contribute to the long-term fertility reduction. The results are consistent with studies that find a positive fertility response following natural disasters, but we show that this effect is short-lived.
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Affiliation(s)
| | | | | | - Therese Nilsson
- Lund University and Research Institute of Industrial Economics (IFN), Sweden.
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11
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Schmidt-Hellerau K, Winters M, Lyons P, Leigh B, Jalloh MB, Sengeh P, Sawaneh AB, Zeebari Z, Salazar M, Jalloh MF, Nordenstedt H. Homecare for sick family members while waiting for medical help during the 2014-2015 Ebola outbreak in Sierra Leone: a mixed methods study. BMJ Glob Health 2021; 5:bmjgh-2020-002732. [PMID: 32694222 PMCID: PMC7375393 DOI: 10.1136/bmjgh-2020-002732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/04/2020] [Accepted: 06/18/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Caring for an Ebola patient is a known risk factor for disease transmission. In Sierra Leone during the outbreak in 2014/2015, isolation of patients in specialised facilities was not always immediately available and caring for a relative at home was sometimes the only alternative. This study sought to assess population-level protective caregiving intentions, to understand how families cared for their sick and to explore perceived barriers and facilitators influencing caregiving behaviours. METHODS Data from a nationwide household survey conducted in December 2014 were used to assess intended protective behaviours if caring for a family member with suspected Ebola. Their association with socio-demographic variables, Ebola-specific knowledge and risk perception was analysed using multilevel logistic regression. To put the results into context, semi-structured interviews with caregivers were conducted in Freetown. RESULTS Ebola-specific knowledge was positively associated with the intention to avoid touching a sick person and their bodily fluids (adjusted OR (AOR) 1.29; 95% CI 1.01 to 1.54) and the intention to take multiple protective measures (AOR 1.38; 95% CI 1.16 to 1.63). Compared with residing in the mostly urban Western Area, respondents from the initial epicentre of the outbreak (Eastern Province) had increased odds to avoid touching a sick person or their body fluids (AOR 4.74; 95% CI 2.55 to 8.81) and to take more than one protective measure (AOR 2.94; 95% CI 1.37 to 6.34). However, interviews revealed that caregivers, who were mostly aware of the risk of transmission and general protective measures, felt constrained by different contextual factors. Withholding care was not seen as an option and there was a perceived lack of practical advice. CONCLUSIONS Ebola outbreak responses need to take the sociocultural reality of caregiving and the availability of resources into account, offering adapted and acceptable practical advice. The necessity to care for a loved one when no alternatives exist should not be underestimated.
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Affiliation(s)
| | - Maike Winters
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Padraig Lyons
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Bailah Leigh
- Department of Community Medicine, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Western Area, Sierra Leone
| | - Mohammad B Jalloh
- Office of the Chief Executive Officer, FOCUS 1000, Freetown, Sierra Leone
| | - Paul Sengeh
- Research and Evaluation, FOCUS 1000, Freetown, Sierra Leone
| | | | - Zangin Zeebari
- Jönköping International Business School, Jönköping University, Jonkoping, Sweden
| | - Mariano Salazar
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Mohamed F Jalloh
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.,Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Helena Nordenstedt
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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12
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Muller AE, Himmels JPW, Van de Velde S. Instruments to measure fear of COVID-19: a diagnostic systematic review. BMC Med Res Methodol 2021; 21:82. [PMID: 33892631 PMCID: PMC8064424 DOI: 10.1186/s12874-021-01262-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/31/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has become a source of fear across the world. Measuring the level or significance of fear in different populations may help identify populations and areas in need of public health and education campaigns. We were interested in diagnostic tests developed to assess or diagnose COVID-19-related fear or phobia. METHODS We performed a systematic review of studies that examined instruments diagnosing or assessing fear or phobia of COVID-19 (PROSPERO registration: CRD42020197100). We utilized the Norwegian Institute of Public Health's Live map of covid-19 evidence, a database of pre-screened and pre-categorized studies. The Live map of covid-19 evidence identified references published since 1 December 2019 in MEDLINE, Embase, and the Centers for Disease Control and Prevention. Following biweekly searches, two researchers independently categorized all studies according to topic (seven main topics, 52 subordinate topics), population (41 available groups), study design, and publication type. For this review, we assessed for eligibility all studies that had been categorized to the topic "Experiences and perceptions, consequences; social, political, economic aspects" as of 25 September 2020, in addition to hand-searching included studies' reference lists. We meta-analyzed correlation coefficients of fear scores to the most common reference tests (self-reports of anxiety, depression, and stress), and reported additional concurrent validity to other reference tests such as specific phobias. We assessed study quality using the QUADAS-2 for the minority of studies that presented diagnostic accuracy statistics. RESULTS We found 18 studies that validated fear instruments. Fifteen validated the Fear of COVID-19 scale (FCV-19S). We found no studies that proposed a diagnosis of fear of COVID-19 or a threshold of significant/clinical versus non-significant/subclinical fear. Study quality was low, with the most common potential biases related to sampling strategy and un-blinded data analysis. The FSV-19S total score correlated strongly with severe phobia (r = 0.703, 95%CI 0.634-0.761) in one study, and moderately with anxiety in a meta-analysis. CONCLUSIONS The accuracy of the FSV-19S needs to be measured further using fear-related reference instruments, and future studies need to provide cut-off scores and normative values. Further evaluation of the remaining three instruments is required.
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Affiliation(s)
| | | | - Stijn Van de Velde
- Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213, Oslo, Norway
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13
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Ouanes S, Al-Amin H, Hussein NB, Khan F, Al Shahrani A, David P, Wali AB, Thapur M, Karim MA, Al Maslamani M, Al-Ansari Z, Ghuloum S. Physical and Psychosocial Well-Being of Hospitalized and Non-Hospitalized Patients With COVID-19 Compared to the General Population in Qatar. Front Psychiatry 2021; 12:792058. [PMID: 34966311 PMCID: PMC8710676 DOI: 10.3389/fpsyt.2021.792058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/22/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Many studies have shown a high prevalence of depression, anxiety, and stress symptoms in COVID-19 patients and the general population. However, very few studies directly examined the potential impact on the health-related quality of life (HRQoL), and none compared HRQoL in COVID-19 patients to the general population amid the pandemic. Methods: We carried out a cross-sectional study comparing HRQoL (as measured using the RAND Short Form 36 or SF-36 Health Survey) in randomly selected individuals from three different groups: hospitalized COVID-19 patients, quarantined COVID-19 patients, and controls from the general population in Qatar. We constructed a multivariate analysis of covariance (MANCOVA) to compare the SF-36 scores between the three groups and control for various covariates. Results: Our sample consisted of 141 COVID-19 inpatients, 99 COVID-19 quarantined patients, and 285 healthy controls. Surprisingly, we found that HRQoL was higher in COVID-19 hospitalized than in COVID-19 non-hospitalized patients than in controls. The main components where COVID-patients scored higher than controls were physical functioning and role limitations due to emotional problems. In COVID-19 patients, the female gender, older age, and past psychiatric history were associated with lower HRQoL. Conclusions: It seems that COVID-19 patient's HRQoL might be better than expected. Our results can be explained by social support from family and friends, easy access to mental health screening and care, and a possible change of perspectives after recovery from COVID-19, resulting in psychological growth and enhanced resilience.
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Affiliation(s)
- Sami Ouanes
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Hassen Al-Amin
- Weill Cornell Medicine, Psychiatry Department, Doha, Qatar
| | | | - Faisal Khan
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | | | - Premalatha David
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Amel Baker Wali
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Maliha Thapur
- Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Suhaila Ghuloum
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
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14
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Bah AJ, James PB, Bah N, Sesay AB, Sevalie S, Kanu JS. Prevalence of anxiety, depression and post-traumatic stress disorder among Ebola survivors in northern Sierra Leone: a cross-sectional study. BMC Public Health 2020; 20:1391. [PMID: 32917162 PMCID: PMC7485189 DOI: 10.1186/s12889-020-09507-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background There is limited data available on the long-term mental health impact of Ebola virus disease (EVD) on survivors despite the disease experience of survivors meeting the criteria of a traumatic event as defined in the Diagnostic and Statistical Manual of Mental Disorders version IV (DSM IV). This study aimed to assess the prevalence and predictive factors of anxiety, depression and posttraumatic stress disorder among EVD survivors, approximately 2 years after discharge from the Ebola treatment centre (ETC). Methods We conducted a cross-sectional study between May and August 2017 among 197 adults Ebola survivors in Bombali district, Northern Sierra Leone. We collected information about demographics, mental health status and possible predictive factors. The HAD scale was used to measure anxiety and depression. PTSD was measured using the PTSD-checklist (PCL). Chi-square test or Fisher exact two-tailed tests were used to test for associations and the multiple logistic regressions model to determine factors that were independently associated with the outcome variables. Results The mean anxiety, depression and PTSD scores were (5.0 ± 3.9), (7.1 ± 3.8) and (39.5 ± 6.4) respectively. Based on cut-off scores, the prevalence of anxiety (HADs score ≥ 8), depression (HADs score ≥ 8) and PTSD (PCL ≥ 45) among Ebola survivors were (n = 49, 24.9%), (n = 93, 47.2%) and (n = 43, 21.8%) respectively. Older Ebola survivors (≥30 years) were more likely to show symptoms of depression (AOR = 8.5, 95% CI: 2.68–27.01, p = 0.001) and anxiety (AOR = 3.04; 95%CI: 1.2–7.7, p = 0.019) compared to younger ones (< 30 years). In addition, Ebola survivors who experienced a decreased level of exercise post-ETC discharge were more likely to show symptoms of depression (AOR = 2.63; 95%CI: 1.25–5.54, p = 0.011) and anxiety (AOR = 3.60; 95%CI: 1.33–9.72, p = 0.012) compared to those whose exercise remained the same post-ETC discharge. Conclusion Our findings show that anxiety, depression and PTSD are common among the Ebola survivors in Bombali district, Northern Sierra Leone, and that underscores the need to diagnose and manage mental health morbidities among Ebola survivors long after their recovery from Ebola virus disease. Cognitive Behaviour Therapy (CBT) and Interpersonal Therapy (IPT) need to be explored as part of overall mental healthcare package interventions.
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Affiliation(s)
- Abdulai Jawo Bah
- Faculty of Basic Medical Sciences College of Medicine and Allied Health Sciences University of Sierra Leone, Freetown, Sierra Leone.,Institute for Global Health and Development, Queen Margaret University Edinburg, Musselburgh, Scotland, UK.,Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Peter Bai James
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone. .,Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
| | - Nuhu Bah
- Directorate of Drugs and Medical Supplies Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Amara Bangali Sesay
- Directorate of Drugs and Medical Supplies Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Joseph Sam Kanu
- Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown, Sierra Leone
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15
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Alva S, Davis N, Stan L, Pivato I, Sanderson J. Conducting mixed-methods research with Ebola survivors in a complex setting in Sierra Leone. BMC Public Health 2020; 20:1346. [PMID: 32883281 PMCID: PMC7470604 DOI: 10.1186/s12889-020-09469-9] [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: 03/31/2020] [Accepted: 08/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In late 2015, the Sierra Leone government established the Comprehensive Program for Ebola Survivors (CPES) to improve the well-being of 3466 registered Ebola virus disease (EVD) survivors. This case analysis outlines the challenges of conducting research studies on the health situation of these EVD survivors in a complicated, post-Ebola context. It outlines strategies to address these challenges without compromising research quality. The mixed-methods study sought to determine EVD survivors' access to health services offered through CPES, their health and disability status, and psychosocial and mental health issues faced. Qualitative data from survivors and stakeholders at multiple levels complemented and contextualized the survey results to help understand the unique health and associated socioeconomic challenges that EVD survivors face, which could be applied to other crisis settings. Study findings indicated that CPES had lasting impacts on Sierra Leone's health system, enabling it to respond to EVD survivors, who increasingly accessed health services and showed lower levels of disability after receiving care. DISCUSSION Understanding the health service needs of this specialized population in a country with an overloaded health system after the Ebola epidemic makes this research study important and timely. The study faced several challenges, including working in a low-resource and low-capacity setting marked by constantly changing priorities and activities of CPES donors and implementers. Further, the study aimed to measure sensitive topics, such as mental health and disability, with standardized tools that required careful contextualization for accurate reporting of findings. Strategies to overcome these challenges included utilizing a mixed-methods approach to contextualize and validate survey results. The study also enabled capacity building of local research teams to ensure that they could follow lines of inquiry and navigate the complex post-Ebola context. CONCLUSIONS Flexibility is paramount when conducting high-quality research for representative and useful results. Timely research and ongoing sharing of the findings with stakeholders is critical to ensure that they benefit study subjects. Furthermore, in such settings, there is a need to balance engagement of stakeholders with maintaining independence and impartiality in the research design and subsequent data produced.
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16
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Secor A, Macauley R, Stan L, Kagone M, Sidikiba S, Sow S, Aronovich D, Litvin K, Davis N, Alva S, Sanderson J. Mental health among Ebola survivors in Liberia, Sierra Leone and Guinea: results from a cross-sectional study. BMJ Open 2020; 10:e035217. [PMID: 32461296 PMCID: PMC7259862 DOI: 10.1136/bmjopen-2019-035217] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To describe the prevalence and correlates of depression and anxiety among adult Ebola virus disease (EVD) survivors in Liberia, Sierra Leone and Guinea. DESIGN Cross-sectional. SETTING One-on-one surveys were conducted in EVD-affected communities in Liberia, Sierra Leone and Guinea in early 2018. PARTICIPANTS 1495 adult EVD survivors (726 male, 769 female). PRIMARY AND SECONDARY OUTCOME MEASURES Patient Health Questionnaire-9 (PHQ-9) depression scores and Generalised Anxiety Disorder-7 (GAD-7) scores. RESULTS Prevalence and severity of depression and anxiety varied across the three countries. Sierra Leone had the highest prevalence of depression, with 22.0% of participants meeting the criteria for a tentative diagnosis of depression, compared with 20.2% in Liberia and 13.0% in Guinea. Sierra Leone also showed the highest prevalence of anxiety, with 10.7% of participants meeting criteria for generalized anxiety disorder (GAD-7 score ≥10), compared with 9.9% in Liberia and 4.2% in Guinea. Between one-third and one-half of respondents reported little interest or pleasure in doing things in the previous 2 weeks (range: 47.0% in Liberia to 37.6% in Sierra Leone), and more than 1 in 10 respondents reported ideation of self-harm or suicide (range: 19.4% in Sierra Leone to 10.4% in Guinea). Higher depression and anxiety scores were statistically significantly associated with each other and with experiences of health facility-based stigma in all three countries. Other associations between mental health scores and respondent characteristics varied across countries. CONCLUSIONS Our results indicate that both depression and anxiety are common among EVD survivors in Liberia, Sierra Leone and Guinea, but that there is country-level heterogeneity in prevalence, severity and correlates of these conditions. All three countries should work to make mental health services available for survivors, and governments and organisations should consider the intersection between EVD-related stigma and mental health when designing programmes and training healthcare providers.
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Affiliation(s)
- Andrew Secor
- JSI Research and Training Institute Inc, Monrovia, Liberia
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Rose Macauley
- JSI Research and Training Institute Inc, Monrovia, Liberia
| | - Laurentiu Stan
- JSI Research and Training Institute Inc, Freetown, Sierra Leone
| | - Meba Kagone
- JSI Research and Training Institute Inc, Conakry, Guinea
| | | | - Sadou Sow
- JSI Research and Training Institute Inc, Conakry, Guinea
| | - Dana Aronovich
- JSI Research and Training Institute Inc, Arlington, Virginia, USA
| | - Kate Litvin
- JSI Research and Training Institute Inc, Arlington, Virginia, USA
| | - Nikki Davis
- JSI Research and Training Institute Inc, Arlington, Virginia, USA
| | - Soumya Alva
- JSI Research and Training Institute Inc, Arlington, Virginia, USA
| | - Jeff Sanderson
- JSI Research and Training Institute Inc, Arlington, Virginia, USA
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17
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James PB, Wardle J, Steel A, Adams J. Ebola survivors' healthcare-seeking experiences and preferences of conventional, complementary and traditional medicine use: A qualitative exploratory study in Sierra Leone. Complement Ther Clin Pract 2020; 39:101127. [PMID: 32379665 DOI: 10.1016/j.ctcp.2020.101127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND and Purpose: This study explores Ebola survivors' healthcare-seeking experiences within the context of Sierra Leone's free healthcare initiative (FHCI) and comprehensive package for Ebola survivors (CPES) program while also exploring the enablers and barriers to their use of informal healthcare. MATERIALS AND METHODS We employed an inductive, exploratory qualitative approach using focus group discussion with 41 adults Ebola survivors in the four administrative regions of Sierra Leone. RESULTS Biomedical care was the first choice of treatment option for most survivors immediately following post-ETC discharge. Survivors' healthcare-seeking experience varies before and after their inclusion into FHCI and the establishment of the CPES program. Personal and health system factors influenced survivors' decision to seek multiple healthcare approaches, especially T&CM. CONCLUSION Our findings suggest the determinants of Ebola survivors' healthcare-seeking experiences should be considered when developing and implementing programs aimed at improving the current health status of Ebola survivors in Sierra Leone.
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Affiliation(s)
- Peter Bai James
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Sydney, Australia; Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone.
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Sydney, Australia; National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, 2480, Australia
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Sydney, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Sydney, Australia
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18
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James PB, Wardle J, Steel A, Adams J. An assessment of Ebola-related stigma and its association with informal healthcare utilisation among Ebola survivors in Sierra Leone: a cross-sectional study. BMC Public Health 2020; 20:182. [PMID: 32020858 PMCID: PMC7001224 DOI: 10.1186/s12889-020-8279-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We examined the magnitude and correlates of Ebola virus disease (EVD)-related stigma among EVD survivors in Sierra Leone since their return to their communities. In addition, we determined whether EVD-related stigma is a predictor of informal health care use among EVD survivors. METHODS We conducted a cross-sectional study among 358 EVD survivors in five districts across all four geographic regions (Western Area, Northern Province, Eastern Province and Southern Province) of Sierra Leone. Ebola-related stigma was measured by adapting the validated HIV related stigma for people living with HIV/AIDS instrument. We also measured traditional and complementary medicine (T&CM) use (as a measure of informal healthcare use). Data were analysed using descriptive statistics and regression analysis. RESULTS EVD survivors report higher levels of internalised stigma (0.92 ± 0.77) compared to total enacted stigma (0.71 ± 0.61). Social isolation (0.96 ± 0.88) was the highest reported enacted stigma subscale. Ebola survivors who identified as Christians [AOR = 2.51, 95%CI: 1.15-5.49, p = 0.021], who perceived their health to be fair/poor [AOR = 2.58, 95%CI: 1.39-4.77. p = 0.003] and who reside in the northern region of Sierra Leone [AOR = 2.80, 95%CI: 1.29-6.07, p = 0.009] were more likely to experience internalised stigma. Verbal abuse [AOR = 1.95, 95%CI: 1.09-3.49, p = 0.025] and healthcare neglect [AOR = 2.35, 95%CI: 1.37-4.02, p = 0.002] were independent predictors of T&CM use among EVD survivors. CONCLUSION Our findings suggest EVD-related stigma (internalised and enacted) is prevalent among EVD survivors since their return to their communities. Religiosity, perceived health status and region were identified as independent predictors of internalised stigma. Verbal abuse and healthcare neglect predict informal healthcare use. EVD survivor-centred and community-driven anti-stigma programs are needed to promote EVD survivors' recovery and community re-integration.
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Affiliation(s)
- Peter Bai James
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007 Australia
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Jonathan Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007 Australia
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007 Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007 Australia
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James PB, Wardle J, Steel A, Adams J. Post-Ebola psychosocial experiences and coping mechanisms among Ebola survivors: a systematic review. Trop Med Int Health 2019; 24:671-691. [PMID: 30843627 DOI: 10.1111/tmi.13226] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE A myriad of physical and psychosocial sequelae have been reported among Ebola survivors from previous Ebola virus disease (EVD) outbreaks, including the most recent in West Africa. This review examines the various forms of psychological distress experienced by EVD survivors, family and community reactions to EVD survivors and EVD survivors' coping mechanisms. METHODS We conducted a literature search of original articles employing Medline (Ovid), PubMed, Web of Science, Scopus, CINAHL, EBSCO host academic search complete, PsycINFO (EBSCO) and Embase databases. RESULTS Our search identified 1890 articles of which 24 met our inclusion criteria. Various forms of psychological distress were prevalent among EVD survivors including depression, anxiety, anger, grief, guilt, flashbacks, sadness, worthlessness, substance addiction, suicidal tendencies and self-stigmatisation. Family and community responses to EVD survivors ranged from acceptance to rejection, isolation, stigmatisation and discrimination. EVD survivors' coping strategies included engagement with religious faith, EVD survivors associations and involvement in EVD prevention and control interventions. CONCLUSION Psychological distress, including that resulting from family and community stigma and discrimination, appears common among EVD survivors. Community-based mental health and psychosocial interventions integrated within a broader package of care for EVD survivors that also recognises the physical health challenges are required. Well-designed longitudinal studies can provide clear insights on the nature and trajectory of the psychosocial issues currently experienced by EVD survivors.
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Affiliation(s)
- P B James
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - J Wardle
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - A Steel
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - J Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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20
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Kelly JD, Weiser SD, Wilson B, Cooper JB, Glayweon M, Sneller MC, Drew C, Steward WT, Reilly C, Johnson K, Fallah MP. Ebola virus disease-related stigma among survivors declined in Liberia over an 18-month, post-outbreak period: An observational cohort study. PLoS Negl Trop Dis 2019; 13:e0007185. [PMID: 30811388 PMCID: PMC6411197 DOI: 10.1371/journal.pntd.0007185] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 03/11/2019] [Accepted: 01/23/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND While qualitative assessments of Ebola virus disease (EVD)-related stigma have been undertaken among survivors and the general public, quantitative tools and assessment targeting survivors have been lacking. METHODS AND FINDINGS Beginning in June 2015, EVD survivors from seven Liberian counties, where most of the country's EVD cases occurred, were eligible to enroll in a longitudinal cohort. Seven stigma questions were adapted from the People Living with HIV Stigma Index and asked to EVD survivors over the age of 12 at initial visit (median 358 days post-EVD) and 18 months later. Primary outcome was a 7-item EVD-related stigma index. Explanatory variables included age, gender, educational level, pregnancy status, post-EVD hospitalization, referred to medical care and EVD source. Proportional odds logistic regression models and generalized linear mixed-effects models were used to assess stigma at initial visit and over time. The stigma questions were administered to 859 EVD survivors at initial visit and 741 (86%) survivors at follow-up. While 63% of survivors reported any stigma at initial visit, only 5% reported any stigma at follow-up. Over the 18-month period, there was a significant decrease in stigma among EVD survivors (Adjusted Odds Ratio [AOR], 0.02; 95% Confidence Interval [CI], 0.01-0.04). At initial visit, having primary, junior high or vocational education, and being referred to medical care was associated with higher odds of stigma (educational level: AOR, 1.82; 95%CI, 1.27-2.62; referred: AOR, 1.50; 95%CI, 1.16-1.94). Compared to ages of 20-29, those who had ages of 12-19 or 50+ experienced lower odds of stigma (12-19: AOR, 0.32; 95%CI, 0.21-0.48; 50+: AOR, 0.58 95%CI, 0.37-0.91). CONCLUSIONS Our data suggest that EVD-related stigma was much lower more than a year after active Ebola transmission ended in Liberia. Among survivors who screened negative for stigma, additional probing may be considered based on age, education, and referral to care.
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Affiliation(s)
- J. Daniel Kelly
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
- U.S. Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | - Sheri D. Weiser
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Barthalomew Wilson
- U.S. Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | - Joseph B. Cooper
- U.S. Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | - Meekie Glayweon
- U.S. Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | - Michael C. Sneller
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States of America
| | - Clara Drew
- U.S. Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, United States of America
| | - Wayne T. Steward
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Cavan Reilly
- U.S. Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, United States of America
| | - Kumblytee Johnson
- U.S. Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | - Mosoka P. Fallah
- U.S. Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
- National Institute of Public Health, Ministry of Health, Monrovia, Liberia
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21
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Strong AE, Schwartz DA. Effects of the West African Ebola Epidemic on Health Care of Pregnant Women: Stigmatization With and Without Infection. ACTA ACUST UNITED AC 2019. [PMCID: PMC7123537 DOI: 10.1007/978-3-319-97637-2_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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22
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O’Leary A, Jalloh MF, Neria Y. Fear and culture: contextualising mental health impact of the 2014-2016 Ebola epidemic in West Africa. BMJ Glob Health 2018; 3:e000924. [PMID: 29989048 PMCID: PMC6035506 DOI: 10.1136/bmjgh-2018-000924] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/01/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ann O’Leary
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Mohamed F Jalloh
- Division of Global Health Protection, Centers for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
- Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden
| | - Yuval Neria
- Departments of Psychiatry and Epidemiology, Columbia University Medical Center, New York City, New York, USA
- New York State Psychiatric Institute, New York City, New York, USA
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23
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Nuriddin A, Jalloh MF, Meyer E, Bunnell R, Bio FA, Jalloh MB, Sengeh P, Hageman KM, Carroll DD, Conteh L, Morgan O. Trust, fear, stigma and disruptions: community perceptions and experiences during periods of low but ongoing transmission of Ebola virus disease in Sierra Leone, 2015. BMJ Glob Health 2018; 3:e000410. [PMID: 29629189 PMCID: PMC5884263 DOI: 10.1136/bmjgh-2017-000410] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 11/06/2022] Open
Abstract
Social mobilisation and risk communication were essential to the 2014–2015 West African Ebola response. By March 2015, >8500 Ebola cases and 3370 Ebola deaths were confirmed in Sierra Leone. Response efforts were focused on ‘getting to zero and staying at zero’. A critical component of this plan was to deepen and sustain community engagement. Several national quantitative studies conducted during this time revealed Ebola knowledge, personal prevention practices and traditional burial procedures improved as the outbreak waned, but healthcare system challenges were also noted. Few qualitative studies have examined these combined factors, along with survivor stigma during periods of ongoing transmission. To obtain an in-depth understanding of people’s perceptions, attitudes and behaviours associated with Ebola transmission risks, 27 focus groups were conducted between April and May 2015 with adult Sierra Leonean community members on: trust in the healthcare system, interactions with Ebola survivors, impact of Ebola on lives and livelihood, and barriers and facilitators to ending the outbreak. Participants perceived that as healthcare practices and facilities improved, so did community trust. Resource management remained a noted concern. Perceptions of survivors ranged from sympathy and empathy to fear and stigmatisation. Barriers included persistent denial of ongoing Ebola transmission, secret burials and movement across porous borders. Facilitators included personal protective actions, consistent messaging and the inclusion of women and survivors in the response. Understanding community experiences during the devastating Ebola epidemic provides practical lessons for engaging similar communities in risk communication and social mobilisation during future outbreaks and public health emergencies.
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Affiliation(s)
- Azizeh Nuriddin
- Program Performance and Evaluation Office, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mohamed F Jalloh
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Erika Meyer
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rebecca Bunnell
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Franklin A Bio
- Research and Evaluation, FOCUS 1000, Freetown, Sierra Leone
| | | | - Paul Sengeh
- Research and Evaluation, FOCUS 1000, Freetown, Sierra Leone
| | - Kathy M Hageman
- Epidemiology and Strategic Information Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dianna D Carroll
- National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lansana Conteh
- Health Education Division, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Oliver Morgan
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
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24
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Jalloh MF, Sengeh P, Monasch R, Jalloh MB, DeLuca N, Dyson M, Golfa S, Sakurai Y, Conteh L, Sesay S, Brown V, Li W, Mermin J, Bunnell R. National survey of Ebola-related knowledge, attitudes and practices before the outbreak peak in Sierra Leone: August 2014. BMJ Glob Health 2017; 2:e000285. [PMID: 29259820 PMCID: PMC5728302 DOI: 10.1136/bmjgh-2017-000285] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 05/16/2017] [Accepted: 05/17/2017] [Indexed: 11/07/2022] Open
Abstract
Background The 2014–2015 Ebola epidemic in West Africa was the largest ever to occur. In the early phases, little was known about public knowledge, attitudes and practices (KAP) relating to Ebola virus disease (Ebola). Data were needed to develop evidence-driven strategies to address gaps in knowledge and practice. Methods In August 2014, we conducted interviews with 1413 randomly selected respondents from 9 out of 14 districts in Sierra Leone using multistage cluster sampling. Where suitable, Ebola-related KAP questions were adapted from other internationally validated questionnaires related to infectious diseases. Results All respondents were aware of Ebola. When asked unprompted, 60% of respondents could correctly cite fever, diarrhoea and vomiting as signs/symptoms of Ebola. A majority of respondents knew that avoiding infected blood and bodily fluids (87%) and contact with an infected corpse (85%) could prevent Ebola. However, there were also widespread misconceptions such as the belief that Ebola can be prevented by washing with salt and hot water (41%). Almost everyone interviewed (95%) expressed at least one discriminatory attitude towards Ebola survivors. Unprompted, self-reported actions taken to avoid Ebola infection included handwashing with soap (66%) and avoiding physical contact with patients with suspected Ebola (40%). Conclusion Three months into the 2014 Ebola outbreak in Sierra Leone, our findings suggest there was high awareness of the disease but misconceptions and discriminatory attitudes toward survivors remained common. These findings directly informed the development of a national social mobilisation strategy and demonstrated the importance of KAP assessment early in an epidemic.
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Affiliation(s)
- Mohamed F Jalloh
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Research and Evaluation Department, FOCUS 1000, Freetown, Western Area, Sierra Leone.,Public Health Sciences Department, Karolinska Institutet, Stockholm, Sweden
| | - Paul Sengeh
- Research and Evaluation Department, FOCUS 1000, Freetown, Western Area, Sierra Leone
| | - Roeland Monasch
- Sierra Leone Country Office, UNICEF, Freetown, Western Area, Sierra Leone
| | - Mohammad B Jalloh
- Office of the Chief Executive Officer, FOCUS 1000, Freetown, Western Area, Sierra Leone
| | - Nickolas DeLuca
- Division of HIV/AIDS Prevention, Prevention Communication Branch, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith Dyson
- Sierra Leone Country Office, Catholic Relief Services, Freetown, Western Area, Sierra Leone
| | - Sheku Golfa
- Sierra Leone Country Office, UNICEF, Freetown, Western Area, Sierra Leone
| | - Yukiko Sakurai
- Sierra Leone Country Office, UNICEF, Freetown, Western Area, Sierra Leone
| | - Lansana Conteh
- Health Education Division, Ministry of Health and Sanitation, Freetown, Western Area, Sierra Leone
| | - Samuel Sesay
- Health Education Division, Ministry of Health and Sanitation, Freetown, Western Area, Sierra Leone
| | - Vance Brown
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wenshu Li
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan Mermin
- Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rebecca Bunnell
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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25
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Richardson ET, Kelly JD, Sesay O, Drasher MD, Desai IK, Frankfurter R, Farmer PE, Barrie MB. The symbolic violence of 'outbreak': A mixed methods, quasi-experimental impact evaluation of social protection on Ebola survivor wellbeing. Soc Sci Med 2017; 195:77-82. [PMID: 29156248 PMCID: PMC5919219 DOI: 10.1016/j.socscimed.2017.11.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/07/2017] [Accepted: 11/10/2017] [Indexed: 01/24/2023]
Abstract
Despite over 28,000 reported cases of Ebola virus disease (EVD) in the 2013-16 outbreak in West Africa, we are only beginning to trace the complex biosocial processes that have promoted its spread. Important questions remain, including the effects on survivors of clinical sequelae, loss of family and livelihood, and other psychological and social trauma. Another poorly understood question is what effect social protection and job creation programs have had on survivors' wellbeing. Several clinical and social protection programs have been developed to respond to the needs of EVD survivors; however, little in the way of impact evaluation has taken place. We enrolled 200 randomly selected EVD survivors from Port Loko, Kenema, and Kailahun districts in Sierra Leone and stratified them based on the amount of instrumental social protection received post-discharge from an Ebola Treatment Unit. We then conducted a survey and in-depth interviews to assess participants' wellbeing and food security. Social protection categories II-IV (moderate to extensive) were each significantly associated with ∼15-22% higher wellbeing scores compared to minimal social protection (p < 0.001). Only social protection category IV (extensive) was significantly associated with being food secure (adjusted odds ratio 6.11; 95% confidence interval, 2.85-13.10) when compared to minimal social protection. Qualitative themes included having a sense of purpose during the crisis (work and fellowship helped survivors cope); using cash transfers to invest in business; the value of literacy and life-skills classes; loss of breadwinners (survivors with jobs were able to take over that role); and combating the consequences of stigma. We conclude that, for EVD survivors, short-term social protection during the vulnerable period post-discharge can pay dividends two years later. Based on the empiric evidence presented, we discuss how terms such as "outbreak" and "epidemic" do symbolic violence by creating the illusion that social suffering ends when transmission of a pathogen ceases.
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Affiliation(s)
- Eugene T Richardson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Partners in Health, Sierra Leone; Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA.
| | - J Daniel Kelly
- Partners in Health, Sierra Leone; UCSF School of Medicine, San Francisco, USA
| | - Osman Sesay
- Partners in Health, Sierra Leone; Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA
| | | | - Ishaan K Desai
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | | | - Paul E Farmer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Partners in Health, Sierra Leone; Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA
| | - Mohamed Bailor Barrie
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Partners in Health, Sierra Leone
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26
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Affiliation(s)
- Sharon Abramowitz
- Department of Anthropology, Rutgers University, Brookline, Massachusetts 02445
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27
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Kondé MK, Diop MK, Curtis MY, Barry A, Kouyaté S, Ghilardi L, Kouyaté S, Diallo AM, Magassouba N, Quick I, Keïta M, Carroll MW, Jansa J, Subissi L. Sex practices and awareness of Ebola virus disease among male survivors and their partners in Guinea. BMJ Glob Health 2017; 2:e000412. [PMID: 29018586 PMCID: PMC5623339 DOI: 10.1136/bmjgh-2017-000412] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 02/01/2023] Open
Abstract
Introduction Towards the end of the 2013–2016 West African outbreak, sexually-transmitted Ebola virus re-emerged from Ebola virus disease (EVD) survivors in all three hardest hit countries. We explore sex practices and awareness of the risk of Ebola virus transmission among EVD survivors and their partners. Methods In this cross-sectional study, we recruited a convenience sample of study participants aged >15 years who were male EVD survivors, their sexual partners and a comparison group. We administered a questionnaire to all respondents, estimated self-reported sexual practices and risk awareness and conducted in-depth interviews. Results We recruited 234 EVD survivors, 256 sexual partners of survivors and 65 individuals in the comparison group from five prefectures in Guinea. The prevalence of safe sexual behaviour (regular condom use or sexual abstinence >12 months) and regular condom use in EVD survivors was 38% (95% CI 31% to 44%) and 21% (95% CI 16% to 27%), respectively. Among partners, these prevalences were lower (11%, 95% CI 7% to 15% and 9%, 95% CI 5% to 12%, respectively). EVD survivors were more than five times as likely to engage in safe sexual behaviour compared with the comparison group (aOR 5.59, 95% CI 2.36 to 13.2). One-hundred and thirty one EVD survivors (57%) and 94 partners (37%) were aware of the risk of Ebola virus re-emergence associated with having unsafe sex. Partners who reported not being informed by their husband/boyfriend (EVD survivor) were more likely to be unaware of this risk (aOR 20.5, 95% CI 8.92 to 47.4). Conclusions We disclose here a need to improve knowledge of the disease and close the gap between knowledge and practice found in EVD survivors and their partners. Current and future survivors’ follow-up programmes should include partners and be more effective at communicating sex-related risks. Community-level fears and attitudes that enable stigmatisation should be addressed. Safe sex interventions targeting EVD survivors and their partners should be prioritised.
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Affiliation(s)
- Mandy Kader Kondé
- Department of Public Health, Universite Gamal Abdel Nasser de Conakry, Conakry, Guinea.,Fondation Santé et Développement durable, FOSAD-CEFORPAG, Conakry, Guinea
| | - Moustapha Keita Diop
- Laboratoire d'analyse socio-anthropologique de Guinée (LASAG), Université Général Lansana Conté de Sonfonia-Conakry, Conakry, Guinea
| | - Marie Yvonne Curtis
- Laboratoire d'analyse socio-anthropologique de Guinée (LASAG), Université Général Lansana Conté de Sonfonia-Conakry, Conakry, Guinea
| | - Abdoulaye Barry
- Fondation Santé et Développement durable, FOSAD-CEFORPAG, Conakry, Guinea
| | - Saidou Kouyaté
- Fondation Santé et Développement durable, FOSAD-CEFORPAG, Conakry, Guinea
| | - Ludovica Ghilardi
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Sékou Kouyaté
- Laboratoire d'analyse socio-anthropologique de Guinée (LASAG), Université Général Lansana Conté de Sonfonia-Conakry, Conakry, Guinea
| | - Aissatou Malal Diallo
- Laboratoire d'analyse socio-anthropologique de Guinée (LASAG), Université Général Lansana Conté de Sonfonia-Conakry, Conakry, Guinea
| | - N'faly Magassouba
- Laboratoire des Fièvres Hémorragiques en Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Isadora Quick
- Institut thématique multi-organismes I3M (Immunologie, Inflammation,Infectiologie et microbiologie), Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Mory Keïta
- WHO Country office, World Health Organization, Conakry, Guinea
| | - Miles W Carroll
- Microbiology services, Public Health England, London, London, UK.,University of Southampton, South General Hospital, Southampton, UK
| | - Josep Jansa
- Section of Epidemic Intelligence and Response, European Centre for Disease Prevention and Control, Stockholm, Stockholms Län, Sweden
| | - Lorenzo Subissi
- Section of Epidemic Intelligence and Response, European Centre for Disease Prevention and Control, Stockholm, Stockholms Län, Sweden.,Global Outbreak Alert and Response Network, World Health Organization, Geneva, Switzerland
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Ajayi NA, Ojide CK, Ajayi IA, Ukwaja KN. Evaluation of clinicians' reporting proficiency and their risk perceptions of Ebola virus disease in Ebonyi State, Nigeria. Germs 2017; 7:140-148. [PMID: 28932714 DOI: 10.18683/germs.2017.1119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Ebola virus disease (EVD) is a highly contagious infection with a high case fatality rate. Thus, there is a crucial need for early detection and reporting of any individual suspected to have EVD in order to facilitate containment strategies. The aim of our study was to evaluate clinicians' reporting proficiency and their risk perceptions of EVD in Ebonyi State, Nigeria. METHODS We performed a descriptive cross-sectional study conducted among clinicians. Consenting clinicians completed a structured questionnaire on the reporting of and their risk perceptions about EVD. Predictors of reporting proficiency and risk perceptions of EVD were identified using multivariable logistic regression analysis. RESULTS A total of 398 clinicians completed the survey, 312 (78.4%) were male. The average duration of the respondent's clinical practice was 5.0, 8.0, and 8.9 years for those working in primary, secondary and tertiary hospitals, respectively. The overall mean±SD knowledge score for proficiency in reporting was 4.4±0.6 (out of a maximum of 5), and 380 (95.5%) of the respondents had a good knowledge of the modalities of reporting suspected EVD cases. The overall mean±SD risk perception score was 5.6±1.2 (out of a maximum of 10) and only 202 (50.8%) of the respondents had accurate risk estimates towards EVD control. Only male sex was a predictor of accurate risk perception of EVD (aOR 1.7, 95%CI: 1.1-2.9). CONCLUSION There was a high level of knowledge of reporting modalities regarding EVD among the clinicians; however, only approximately half of them had accurate risk perception towards EVD. The gaps identified should inform post-EVD control strategies.
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Affiliation(s)
- Nnennaya Anthony Ajayi
- MBBS, Department of Internal Medicine, Federal Teaching Hospital, PMB 102, Abakaliki, Ebonyi State, Nigeria
| | - Chiedozie Kingsley Ojide
- MBBS, MSc, Department of Medical Microbiology, Federal Teaching Hospital, PMB 102, Abakaliki, Ebonyi State, Nigeria
| | - Immanuel Anthony Ajayi
- MBBS, Department of Internal Medicine, Federal Teaching Hospital, PMB 102, Abakaliki, Ebonyi State, Nigeria
| | - Kingsley Nnanna Ukwaja
- MBBS, MSc, Department of Internal Medicine, Federal Teaching Hospital, PMB 102, Abakaliki, Ebonyi State, Nigeria
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