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Dong D, Abramowitz S, Matta GC, Moreno AB, Nouvet E, Stolow J, Pilbeam C, Lees S, Yeoh EK, Gobat N, Giles-Vernick T. A rapid qualitative methods assessment and reporting tool for epidemic response as the outcome of a rapid review and expert consultation. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002320. [PMID: 37889886 PMCID: PMC10610454 DOI: 10.1371/journal.pgph.0002320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/01/2023] [Indexed: 10/29/2023]
Abstract
During the first year of the COVID-19 pandemic, the Methods Sub-Group of the WHO COVID-19 Social Science Research Roadmap Working Group conducted a rapid evidence review of rapid qualitative methods (RQMs) used during epidemics. The rapid review objectives were to (1) synthesize the development, implementation, and uses of RQMs, including the data collection tools, research questions, research capacities, analytical approaches, and strategies used to speed up data collection and analysis in their specific epidemic and institutional contexts; and (2) propose a tool for assessing and reporting RQMs in epidemics emergencies. The rapid review covered published RQMs used in articles and unpublished reports produced between 2015 and 2021 in five languages (English, Mandarin, French, Portuguese, and Spanish). We searched multiple databases in these five languages between December 2020 and January 31, 2021. Sources employing "rapid" (under 6 months from conception to reporting of results) qualitative methods for research related to epidemic emergencies were included. We included 126 published and unpublished sources, which were reviewed, coded, and classified by the research team. Intercoder reliability was found to be acceptable (Krippendorff's α = 0.709). We employed thematic analysis to identify categories characterizing RQMs in epidemic emergencies. The review protocol was registered at PROSPERO (no. CRD42020223283) and Research Registry (no. reviewregistry1044). We developed an assessment and reporting tool of 13 criteria in three domains, to document RQMs used in response to epidemic emergencies. These include I. Design and Development (i. time frame, ii. Training, iii. Applicability to other populations, iv. Applicability to low resource settings, v. community engagement, vi. Available resources, vii. Ethical approvals, viii. Vulnerability, ix. Tool selection); II. Data Collection and Analysis (x. concurrent data collection and analysis, xi. Targeted populations and recruitment procedures); III. Restitution and Dissemination (xii. Restitution and dissemination of findings, xiii. Impact). Our rapid review and evaluation found a wide range of feasible and highly effective tools, analytical approaches and timely operational insights and recommendations during epidemic emergencies.
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Affiliation(s)
- Dong Dong
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Sharon Abramowitz
- Center for Global Health Science and Security, Georgetown University, Washington, D.C., United States of America
| | - Gustavo Corrêa Matta
- Department Interdisciplinary Centre for Public Health Emergencies NIESP/CEE, Center for Data Integration and Knowledge for Health, FIOCRUZ - Oswaldo Cruz Foundation, Salvador, Brazil
| | - Arlinda B. Moreno
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Elysée Nouvet
- School of Health Studies, Western University, London, Ontario, Canada
| | - Jeni Stolow
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Caitlin Pilbeam
- ANU Medical School, School of Sociology, the Australian National University, Canberra, Australia
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - EK Yeoh
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Nina Gobat
- Country Readiness Strengthening, World Health Emergencies Program, World Health Organization, Geneva, Switzerland
| | - Tamara Giles-Vernick
- Anthropology & Ecology of Disease Emergence Unit, Department of Global Health, Institut Pasteur/Université Paris Cité, Paris, France
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Vahedi L, Qushua N, Seff I, Doering M, Stoll C, Bartels SA, Stark L. Methodological and Ethical Implications of Using Remote Data Collection Tools to Measure Sexual and Reproductive Health and Gender-Based Violence Outcomes among Women and Girls in Humanitarian and Fragile Settings: A Mixed Methods Systematic Review of Peer-Reviewed Research. TRAUMA, VIOLENCE & ABUSE 2023; 24:2498-2529. [PMID: 35607868 PMCID: PMC10486180 DOI: 10.1177/15248380221097439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose: This systematic review investigates the methodological and ethical implications of using remote data collection tools to measure sexual/reproductive health (SRH) and gender-based violence (GBV) outcomes among women and girls in humanitarian and fragile settings. Methods: We included empirical studies of all design types that collected any self-reported primary data related to SRH/GBV using information and communication technology, in the absence of in-person interactions, from women and girls in humanitarian and fragile settings. The search was run in March 2021 without filters or limits in Ovid Medline, Embase, Web of Science, Clinicaltrials.gov, and Scopus. Quality was assessed using an adapted version of the MMAT tool. Two reviewers independently determined whether each full text source met the eligibility criteria, and conflicts were resolved through consensus. A-priori extraction fields concerned methodological rigor and ethical considerations. Results: 21 total studies were included. The majority of studies were quantitative descriptive, aiming to ascertain prevalence. Telephone interviews, online surveys, and mobile applications, SMS surveys, and online discussion forums were used as remote data collection tools. Key methodological considerations included the overuse of non-probability samples, lack of a defined sampling frame, the introduction of bias by making eligibility contingent on owning/accessing technology, and the lack of qualitative probing. Ethical consideration pertained to including persons with low literacy, participant safety, use of referral services, and the gender digital divide. Conclusion: Findings are intended to guide SRH/GBV researchers and academics in critically assessing methodological and ethical implications of using remote data collection tools to measure SRH and GBV in humanitarian and fragile settings.
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Affiliation(s)
- Luissa Vahedi
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Najat Qushua
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Ilana Seff
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Michelle Doering
- Becker Medical Library, Washington University in St. Louis, St. Louis, MO, USA
| | - Carrie Stoll
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Susan A. Bartels
- Department of Emergency Medicine, Queen’s University, Kingston ON, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Lindsay Stark
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
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Nkweleko Fankam F, Ugarte W, Akilimali P, Ewane Etah J, Åkerman E. COVID-19 pandemic hits differently: examining its consequences for women's livelihoods and healthcare access - a cross-sectional study in Kinshasa DRC. BMJ Open 2023; 13:e072869. [PMID: 37678942 PMCID: PMC10496687 DOI: 10.1136/bmjopen-2023-072869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVES The emergence of the COVID-19 pandemic led to multiple preventive actions as primary interventions to contain the spread of the virus. Globally, countries are facing enormous challenges with consequences for use of social, economic and health services. The Democratic Republic of Congo (DRC) was among the African countries implementing strict lockdown at the start of the pandemic, resulting in shortages and decreased access to services. The adverse effects of the pandemic had unpleasant consequences for the country. This study aimed to examine the association between COVID-19 pandemic-related factors, sociodemographic factors, and the need to visit healthcare facilities, including family planning services, among women aged 15-49 years in the DRC. METHODS We conducted a secondary analysis of a performance monitoring for action (PMA) cross-sectional COVID-19 phone survey in Kinshasa, DRC, which had a response rate of 74.7%. In total, 1325 randomly selected women aged 15-49 years from the Kinshasa province who had previously participated in the PMA baseline survey participated in the survey. Bivariate and multivariate logistic regressions were used to assess associations. RESULTS The COVID-19 pandemic and related factors affected 92% of women in the Kinshasa province socioeconomically. A majority were highly economically dependent on their partner or some other sources for their basic needs to be met, and even more worried about the future impact of the pandemic on their household finances. Over 50% of women did not attempt visiting a health service, with some of the top reasons being fear of being infected with COVID-19 and not being able to afford services. We found a significant association between age groups and contraceptive use. The need for and use of contraceptives was higher among women aged 25-34 years than those aged 15-24 or 35-49 years. CONCLUSION Effective social/economic support to women and girls during pandemics and in crises is essential as it can have lasting beneficial effects on many domains of their lives, including their ability to access health services and the contraceptives of their choice.
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Affiliation(s)
| | - William Ugarte
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Pierre Akilimali
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Junior Ewane Etah
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Eva Åkerman
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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A Global Sharing Mechanism of Resources: Modeling a Crucial Step in the Fight against Pandemics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105930. [PMID: 35627470 PMCID: PMC9141328 DOI: 10.3390/ijerph19105930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022]
Abstract
To face crises like the COVID-19 pandemic, resources such as personal protection equipment (PPE) are needed to reduce the infection rate and protect those in close contact with patients. The increasing demand for those products can, together with pandemic-related disruptions in the global supply chain, induce major local resource scarcities. During the first phase of the COVID-19 pandemic, we witnessed a reflex of ‘our people first’ in many regions. In this paper, however, we show that a cooperative sharing mechanism can substantially improve the ability to face epidemics. We present a stylized model in which communities share their resources such that each can receive them whenever a local epidemic flares up. Our main finding is that cooperative sharing can prevent local resource exhaustion and reduce the total number of infected cases. Crucially, beneficial effects of sharing are found for a large range of possible community sizes and cooperation combinations, not only for small communities being helped by large communities. Furthermore, we show that the success of sharing resources heavily depends on having a sufficiently long delay between the onsets of epidemics in different communities. These results thus urge for the pairing of a global sharing mechanism with measures to slow down the spread of infections from one community to the other. Our work uses a stylized model to convey an important and clear message to a broad public, advocating that cooperative sharing strategies in international resource crises are the most beneficial strategy for all. It stresses essential underlying principles of and contributes to designing a resilient global supply chain mechanism able to deal with future pandemics by design, rather than being subjected to the coincidental and unequal distribution of opportunities per community that we see at present.
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Polonsky JA, Bhatia S, Fraser K, Hamlet A, Skarp J, Stopard IJ, Hugonnet S, Kaiser L, Lengeler C, Blanchet K, Spiegel P. Feasibility, acceptability, and effectiveness of non-pharmaceutical interventions against infectious diseases among crisis-affected populations: a scoping review. Infect Dis Poverty 2022; 11:14. [PMID: 35090570 PMCID: PMC8796190 DOI: 10.1186/s40249-022-00935-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/03/2022] [Indexed: 12/23/2022] Open
Abstract
Background Non-pharmaceutical interventions (NPIs) are a crucial suite of measures to prevent and control infectious disease outbreaks. Despite being particularly important for crisis-affected populations and those living in informal settlements, who typically reside in overcrowded and resource limited settings with inadequate access to healthcare, guidance on NPI implementation rarely takes the specific needs of such populations into account. We therefore conducted a systematic scoping review of the published evidence to describe the landscape of research and identify evidence gaps concerning the acceptability, feasibility, and effectiveness of NPIs among crisis-affected populations and informal settlements. Methods We systematically reviewed peer-reviewed articles published between 1970 and 2020 to collate available evidence on the feasibility, acceptability, and effectiveness of NPIs in crisis-affected populations and informal settlements. We performed quality assessments of each study using a standardised questionnaire. We analysed the data to produce descriptive summaries according to a number of categories: date of publication; geographical region of intervention; typology of crisis, shelter, modes of transmission, NPI, research design; study design; and study quality. Results Our review included 158 studies published in 85 peer-reviewed articles. Most research used low quality study designs. The acceptability, feasibility, and effectiveness of NPIs was highly context dependent. In general, simple and cost-effective interventions such as community-level environmental cleaning and provision of water, sanitation and hygiene services, and distribution of items for personal protection such as insecticide-treated nets, were both highly feasible and acceptable. Logistical, financial, and human resource constraints affected both the implementation and sustainability of measures. Community engagement emerged as a strong factor contributing to the effectiveness of NPIs. Conversely, measures that involve potential restriction on personal liberty such as case isolation and patient care and burial restrictions were found to be less acceptable, despite apparent effectiveness. Conclusions Overall, the evidence base was variable, with substantial knowledge gaps which varied between settings and pathogens. Based on the current landscape, robust evidence-based guidance is not possible, and a research agenda is urgently required that focusses on these specific vulnerable populations. Although implementation of NPIs presents unique practical challenges in these settings, it is critical that such an agenda is put in place, and that the lessons learned from historical and present experiences are documented to build a firm evidence base. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-022-00935-7.
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Charnley GEC, Yennan S, Ochu C, Kelman I, Gaythorpe KAM, Murray KA. The impact of social and environmental extremes on cholera time varying reproduction number in Nigeria. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000869. [PMID: 36962831 PMCID: PMC10022205 DOI: 10.1371/journal.pgph.0000869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/10/2022] [Indexed: 12/15/2022]
Abstract
Nigeria currently reports the second highest number of cholera cases in Africa, with numerous socioeconomic and environmental risk factors. Less investigated are the role of extreme events, despite recent work showing their potential importance. To address this gap, we used a machine learning approach to understand the risks and thresholds for cholera outbreaks and extreme events, taking into consideration pre-existing vulnerabilities. We estimated time varying reproductive number (R) from cholera incidence in Nigeria and used a machine learning approach to evaluate its association with extreme events (conflict, flood, drought) and pre-existing vulnerabilities (poverty, sanitation, healthcare). We then created a traffic-light system for cholera outbreak risk, using three hypothetical traffic-light scenarios (Red, Amber and Green) and used this to predict R. The system highlighted potential extreme events and socioeconomic thresholds for outbreaks to occur. We found that reducing poverty and increasing access to sanitation lessened vulnerability to increased cholera risk caused by extreme events (monthly conflicts and the Palmers Drought Severity Index). The main limitation is the underreporting of cholera globally and the potential number of cholera cases missed in the data used here. Increasing access to sanitation and decreasing poverty reduced the impact of extreme events in terms of cholera outbreak risk. The results here therefore add further evidence of the need for sustainable development for disaster prevention and mitigation and to improve health and quality of life.
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Affiliation(s)
- Gina E C Charnley
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Sebastian Yennan
- Surveillance and Epidemiology Department/IM Cholera, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Chinwe Ochu
- Surveillance and Epidemiology Department/IM Cholera, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Ilan Kelman
- Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
- University of Agder, Kristiansand, Norway
| | - Katy A M Gaythorpe
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Kris A Murray
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gamiba
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Baller A, Padoveze MC, Mirindi P, Hazim CE, Lotemo J, Pfaffmann J, Ndiaye A, Carter S, Chabrat MAD, Mangala S, Banzua B, Umutoni C, Niang NR, Kabego L, Ouedraogo A, Houdjo B, Mwesha D, Ousman KB, Kolwaite A, Blaney DD, Choi MJ, Pallawo R, Legand A, Park B, Formenty P, Montgomery JM, Gueye AS, Allegranzi B, Yao NKM, Fall IS. Ebola virus disease nosocomial infections in the Democratic Republic of the Congo: a descriptive study of cases during the 2018-2020 outbreak. Int J Infect Dis 2021; 115:126-133. [PMID: 34883237 PMCID: PMC8755545 DOI: 10.1016/j.ijid.2021.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 12/03/2022] Open
Abstract
Health workers were among those most affected by nosocomial Ebola virus disease (EVD) in this outbreak. Children had a higher case fatality rate compared with other patients with nosocomial EVD. Referral health facilities and privately owned health facilities had the highest number of nosocomial infections (NI). Clear case definition of NI is required to prompt transmission chain interruption.
Objectives To describe the characteristics of nosocomial cases of Ebola virus disease (EVD) in the Democratic Republic of the Congo between July 2018 and May 2020 in order to inform future interventions. Methods Nosocomial cases of EVD were identified during outbreak response surveillance, and a retrospective analysis of cases was conducted according to demographic characteristics and type of health facility (HF). Results Of 3481 cases of EVD, 579 (16.6%) were nosocomial. Of these, 332 cases occurred in women (57.3%). Patients and visitors accounted for 419 cases (72.4%), of which 79 (18.9%) were aged 6–≤18 years and 108 (25.8%) were aged ≤5 years. Health workers (HWs) accounted for the remaining 160 (27.6%) nosocomial cases. The case fatality rate (CFR) for HWs (66/160, 41.3%) was significantly lower than the CFR for patients and visitors (292/419, 69.7%) (P<0.001). The CFR was higher among cases aged 6–≤18 years (54/79, 68.4%) and ≤5 years (89/108, 82.4%). Referral HFs (>39 beds) had the highest prevalence of nosocomial EVD (148/579, 25.6%). Among HFs with at least one case of nosocomial infection, 50.0% (98/196) were privately owned. Conclusions Nurses and traditional healers should be targeted for infection prevention and control training, and supportive supervision should be provided to HFs to mitigate EVD transmission.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Berthe Banzua
- Ministry of Health, Democratic Republic of the Congo
| | | | | | | | | | | | | | | | - Amy Kolwaite
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David D Blaney
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary J Choi
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Benjamin Park
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Meinhart M, Vahedi L, Carter SE, Poulton C, Mwanze Palaku P, Stark L. Gender-based violence and infectious disease in humanitarian settings: lessons learned from Ebola, Zika, and COVID-19 to inform syndemic policy making. Confl Health 2021; 15:84. [PMID: 34801062 PMCID: PMC8605893 DOI: 10.1186/s13031-021-00419-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The impacts of infectious disease outbreaks, epidemics, and pandemics are not gender neutral. Instead, infectious diseases and gender-based violence (GBV) mutually reinforce each other. Women and girls in humanitarian settings are disproportionately impacted as crises exacerbate gender inequality, violence, and community transmission. A syndemic model of infectious disease and GBV draws attention to their critical linkage, enabling more effective approaches to address both infectious disease transmission and GBV prevalence. MAIN BODY Implementation of infectious disease control measures have been consistently absent of critical gender considerations in humanitarian settings. We drew learnings from Ebola, Zika, and COVID-19 to highlight how women and girls living in humanitarian settings have faced bi-directional syndemic vulnerabilities between GBV and infectious disease. Our findings indicate that Ebola, Zika, and COVID-19 exacerbated GBV risk and experience of GBV increased community transmission of these infectious diseases. Moreover, we identified a failure of existing policies to address this mutually deleterious linkage. Thus, we advocate for policymakers to ask three foundational questions: (i) What are the gendered bi-directional risk pathways between infectious disease and GBV?; (ii) How can we act on the gendered risk pathways?; and, (iii) Who should be involved in designing, implementing, and evaluating gender-sensitive policies? CONCLUSION Our syndemic policy framework challenges existing thinking on a neglected issue that disproportionally impacts women and girls. By offering foundational guidance to address and thwart the syndemic of infectious disease and GBV in humanitarian settings, we endeavor to proactively and holistically address the reinforcing linkage between GBV and current or emergent infectious diseases.
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Affiliation(s)
- Melissa Meinhart
- Brown School at Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Luissa Vahedi
- Brown School at Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Simone E Carter
- UNICEF, Public Health Emergencies, Geneva Avenue de la Paix 5 - 7, 1202, Genève, Switzerland
| | | | | | - Lindsay Stark
- Brown School at Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
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Carter SE, Ahuka-Mundeke S, Pfaffmann Zambruni J, Navarro Colorado C, van Kleef E, Lissouba P, Meakin S, le Polain de Waroux O, Jombart T, Mossoko M, Bulemfu Nkakirande D, Esmail M, Earle-Richardson G, Degail MA, Umutoni C, Anoko JN, Gobat N. How to improve outbreak response: a case study of integrated outbreak analytics from Ebola in Eastern Democratic Republic of the Congo. BMJ Glob Health 2021; 6:bmjgh-2021-006736. [PMID: 34413078 PMCID: PMC8380808 DOI: 10.1136/bmjgh-2021-006736] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
The emerging field of outbreak analytics calls attention to the need for data from multiple sources to inform evidence-based decision making in managing infectious diseases outbreaks. To date, these approaches have not systematically integrated evidence from social and behavioural sciences. During the 2018–2020 Ebola outbreak in Eastern Democratic Republic of the Congo, an innovative solution to systematic and timely generation of integrated and actionable social science evidence emerged in the form of the Cellulle d’Analyse en Sciences Sociales (Social Sciences Analytics Cell) (CASS), a social science analytical cell. CASS worked closely with data scientists and epidemiologists operating under the Epidemiological Cell to produce integrated outbreak analytics (IOA), where quantitative epidemiological analyses were complemented by behavioural field studies and social science analyses to help better explain and understand drivers and barriers to outbreak dynamics. The primary activity of the CASS was to conduct operational social science analyses that were useful to decision makers. This included ensuring that research questions were relevant, driven by epidemiological data from the field, that research could be conducted rapidly (ie, often within days), that findings were regularly and systematically presented to partners and that recommendations were co-developed with response actors. The implementation of the recommendations based on CASS analytics was also monitored over time, to measure their impact on response operations. This practice paper presents the CASS logic model, developed through a field-based externally led consultation, and documents key factors contributing to the usefulness and adaption of CASS and IOA to guide replication for future outbreaks.
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Affiliation(s)
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale, Kinshasa, The Democratic Republic of the Congo
| | | | | | - Esther van Kleef
- Public Health, Prince Leopold Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Sophie Meakin
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
| | | | | | - Mathias Mossoko
- Ministry of Health, Kinshasa, The Democratic Republic of the Congo
| | | | - Marjam Esmail
- Public Health Emergencies, UNICEF, New York, New York, USA
| | - Giulia Earle-Richardson
- National Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marie-Amelie Degail
- Health Emergencies Programme, World Health Organization, Geneve, Switzerland
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Hategeka C, Carter SE, Chenge FM, Katanga EN, Lurton G, Mayaka SMN, Mwamba DK, van Kleef E, Vanlerberghe V, Grépin KA. Impact of the COVID-19 pandemic and response on the utilisation of health services in public facilities during the first wave in Kinshasa, the Democratic Republic of the Congo. BMJ Glob Health 2021; 6:e005955. [PMID: 34315776 PMCID: PMC8318723 DOI: 10.1136/bmjgh-2021-005955] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/24/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Health service use among the public can decline during outbreaks and had been predicted among low and middle-income countries during the COVID-19 pandemic. In March 2020, the government of the Democratic Republic of the Congo (DRC) started implementing public health measures across Kinshasa, including strict lockdown measures in the Gombe health zone. METHODS Using monthly time series data from the DRC Health Management Information System (January 2018 to December 2020) and interrupted time series with mixed effects segmented Poisson regression models, we evaluated the impact of the pandemic on the use of essential health services (outpatient visits, maternal health, vaccinations, visits for common infectious diseases and non-communicable diseases) during the first wave of the pandemic in Kinshasa. Analyses were stratified by age, sex, health facility and lockdown policy (ie, Gombe vs other health zones). RESULTS Health service use dropped rapidly following the start of the pandemic and ranged from 16% for visits for hypertension to 39% for visits for diabetes. However, reductions were highly concentrated in Gombe (81% decline in outpatient visits) relative to other health zones. When the lockdown was lifted, total visits and visits for infectious diseases and non-communicable diseases increased approximately twofold. Hospitals were more affected than health centres. Overall, the use of maternal health services and vaccinations was not significantly affected. CONCLUSION The COVID-19 pandemic resulted in important reductions in health service utilisation in Kinshasa, particularly Gombe. Lifting of lockdown led to a rebound in the level of health service use but it remained lower than prepandemic levels.
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Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Faustin Mukalenge Chenge
- Faculté de Médecine, Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
- Centre de Connaissances en Santé en RD Congo, Lubumbashi, Democratic Republic of Congo
| | - Eric Nyambu Katanga
- Ministère de la Santé Publique de la République Démocratique du Congo, Kinshasa, Democratic Republic of Congo
| | | | - Serge Ma-Nitu Mayaka
- Public Health School of Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Dieudonné Kazadi Mwamba
- Public Health School of Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- Ministry of Health of Democratic Republic of Congo, Kinshasa, Democratic Republic of Congo
| | | | | | - Karen Ann Grépin
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
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11
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Earle-Richardson G, Erlach E, Walz V, Baggio O, Kurnit M, Camara CA, Craig C, Dios LR, Yee D, Soke GN, Voahary I, Prue CE. New Mixed Methods Approach for Monitoring Community Perceptions of Ebola and Response Efforts in the Democratic Republic of the Congo. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:332-343. [PMID: 34234025 PMCID: PMC8324202 DOI: 10.9745/ghsp-d-21-00144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/11/2021] [Indexed: 12/01/2022]
Abstract
The Red Cross community feedback system enabled rapid collection and analysis of extensive verbal feedback during an Ebola outbreak in eastern DRC. Using this information, Ebola response leaders adapted strategies to address community concerns. In an epidemic, community feedback is critical to ensure that response strategies are accepted and appropriate. Background: Efforts to contain the spread of Ebola in the eastern Democratic Republic of the Congo (DRC) during the 2018–2020 epidemic faced challenges in gaining community trust and participation. This affected implementation of community alerts, early isolation, contact tracing, vaccination, and safe and dignified burials. To quickly understand community perspectives and improve community engagement, collaborators from the DRC Red Cross, the International Federation of the Red Cross, and the U.S. Centers for Disease Control and Prevention explored a new method of collecting, coding, and quickly analyzing community feedback. Methods: Over 800 DRC Red Cross local volunteers recorded unstructured, free-text questions and comments from community members during community Ebola awareness activities. Comments were coded and analyzed using a text-coding system developed by the collaborators. Coded comments were then aggregated and qualitatively grouped into major themes, and time trends were examined. Results: Communities reported a lack of information about the outbreak and the response, as well as concerns about the Ebola vaccination program and health care quality. Some doubted that Ebola was real. The response used the feedback to revise some community engagement approaches. For example, 2 procedural changes that were followed by drops in negative community responses were: using transparent body bags, which allayed fears that bodies or organs were being stolen, and widening the eligibility criteria for Ebola vaccination, which addressed concerns that selectively vaccinating individuals within Ebola-affected communities was unfair. Discussion: This system is unique in that unstructured feedback collected by local volunteers in the course of their work was rapidly coded, analyzed, and given to health authorities for use in making course corrections throughout the response. It provides a platform for local voices to be heard throughout an emergency response and provides a mechanism for assessing the effects of program adjustments on community sentiments.
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Affiliation(s)
| | - Eva Erlach
- International Federation of the Red Cross and Red Crescent Societies, Geneva, Switzerland
| | - Vivienne Walz
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ombretta Baggio
- International Federation of the Red Cross and Red Crescent Societies, Geneva, Switzerland
| | - Molly Kurnit
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Christina Craig
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lucia Robles Dios
- International Federation of the Red Cross and Red Crescent Societies, Geneva, Switzerland
| | - Daiva Yee
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Ialijaona Voahary
- International Federation of the Red Cross and Red Crescent Societies, Geneva, Switzerland
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12
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Hrynick TA, Ripoll Lorenzo S, Carter SE. COVID-19 response: mitigating negative impacts on other areas of health. BMJ Glob Health 2021; 6:bmjgh-2020-004110. [PMID: 33858832 PMCID: PMC8053814 DOI: 10.1136/bmjgh-2020-004110] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 12/17/2022] Open
Abstract
‘Vertical’ responses focused primarily on preventing and containing COVID-19 have been implemented in countries around the world with negative consequences for other health services, people’s access to and use of them, and associated health outcomes, especially in low-income and middle-income countries (LMICs). ‘Lockdowns’ and restrictive measures, especially, have complicated service provision and access, and disrupted key supply chains. Such interventions, alongside more traditional public health measures, interact with baseline health, health system, and social and economic vulnerabilities in LMICs to compound negative impacts. This analysis, based on a rapid evidence assessment by the Social Science in Humanitarian Action Platform in mid-2020, highlights the drivers and evidence of these impacts, emphasises the additional vulnerabilities experienced by marginalised social groups, and provides insight for governments, agencies, organisations and communities to implement more proportionate, appropriate, comprehensive and socially just responses that address COVID-19 in the context of and alongside other disease burdens. In the short term, there is an urgent need to monitor and mitigate impacts of pandemic responses on health service provision, access and use, including through embedding COVID-19 response within integrated health systems approaches. These efforts should also feed into longer-term strategies to strengthen health systems, expand universal healthcare coverage and attend to the social determinants of health—commitments, both existing and new—which governments, donors and international agencies must make and be held accountable to. Crucially, affected communities must be empowered to play a central role in identifying health priorities, allocating resources, and designing and delivering services.
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Affiliation(s)
- Tabitha A Hrynick
- Health and Nutrition Cluster, Institute of Development Studies, Brighton, UK
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13
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Bardosh KL, de Vries DH, Abramowitz S, Thorlie A, Cremers L, Kinsman J, Stellmach D. Integrating the social sciences in epidemic preparedness and response: A strategic framework to strengthen capacities and improve Global Health security. Global Health 2020; 16:120. [PMID: 33380341 PMCID: PMC7772799 DOI: 10.1186/s12992-020-00652-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The importance of integrating the social sciences in epidemic preparedness and response has become a common feature of infectious disease policy and practice debates. However to date, this integration remains inadequate, fragmented and under-funded, with limited reach and small initial investments. Based on data collected prior to the COVID-19 pandemic, in this paper we analysed the variety of knowledge, infrastructure and funding gaps that hinder the full integration of the social sciences in epidemics and present a strategic framework for addressing them. METHODS Senior social scientists with expertise in public health emergencies facilitated expert deliberations, and conducted 75 key informant interviews, a consultation with 20 expert social scientists from Africa, Asia and Europe, 2 focus groups and a literature review of 128 identified high-priority peer reviewed articles. We also analysed 56 interviews from the Ebola 100 project, collected just after the West African Ebola epidemic. Analysis was conducted on gaps and recommendations. These were inductively classified according to various themes during two group prioritization exercises. The project was conducted between February and May 2019. Findings from the report were used to inform strategic prioritization of global investments in social science capacities for health emergencies. FINDINGS Our analysis consolidated 12 knowledge and infrastructure gaps and 38 recommendations from an initial list of 600 gaps and 220 recommendations. In developing our framework, we clustered these into three areas: 1) Recommendations to improve core social science response capacities, including investments in: human resources within response agencies; the creation of social science data analysis capacities at field and global level; mechanisms for operationalizing knowledge; and a set of rapid deployment infrastructures; 2) Recommendations to strengthen applied and basic social sciences, including the need to: better define the social science agenda and core competencies; support innovative interdisciplinary science; make concerted investments in developing field ready tools and building the evidence-base; and develop codes of conduct; and 3) Recommendations for a supportive social science ecosystem, including: the essential foundational investments in institutional development; training and capacity building; awareness-raising activities with allied disciplines; and lastly, support for a community of practice. INTERPRETATION Comprehensively integrating social science into the epidemic preparedness and response architecture demands multifaceted investments on par with allied disciplines, such as epidemiology and virology. Building core capacities and competencies should occur at multiple levels, grounded in country-led capacity building. Social science should not be a parallel system, nor should it be "siloed" into risk communication and community engagement. Rather, it should be integrated across existing systems and networks, and deploy interdisciplinary knowledge "transversally" across all preparedness and response sectors and pillars. Future work should update this framework to account for the impact of the COVID-19 pandemic on the institutional landscape.
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Affiliation(s)
- Kevin Louis Bardosh
- Center for One Health Research, School of Public Health, University of Washington, Box 357230, Seattle, WA, 98195-7230, USA.
| | - Daniel H de Vries
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105, BP, Amsterdam, the Netherlands
| | | | | | - Lianne Cremers
- Amsterdam University Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - John Kinsman
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Darryl Stellmach
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Edward Ford Building (A27) Fisher Road, Sydney, NSW, 2006, Australia
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14
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Stark L, Meinhart M, Vahedi L, Carter SE, Roesch E, Scott Moncrieff I, Mwanze Palaku P, Rossi F, Poulton C. The syndemic of COVID-19 and gender-based violence in humanitarian settings: leveraging lessons from Ebola in the Democratic Republic of Congo. BMJ Glob Health 2020; 5:bmjgh-2020-004194. [PMID: 33208316 PMCID: PMC7677331 DOI: 10.1136/bmjgh-2020-004194] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 01/01/2023] Open
Affiliation(s)
- Lindsay Stark
- Brown School at Washington University in St Louis, St Louis, Missouri, USA
| | - Melissa Meinhart
- Brown School at Washington University in St Louis, St Louis, Missouri, USA
| | - Luissa Vahedi
- Brown School at Washington University in St Louis, St Louis, Missouri, USA
| | | | | | | | | | - Flore Rossi
- UNICEF, Kinshasa, Democratic Republic of Congo
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