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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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Distribution of household disinfection kits during the 2014-2015 Ebola virus outbreak in Monrovia, Liberia: The MSF experience. PLoS Negl Trop Dis 2020; 14:e0008539. [PMID: 32956374 PMCID: PMC7529189 DOI: 10.1371/journal.pntd.0008539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 10/01/2020] [Accepted: 06/29/2020] [Indexed: 11/20/2022] Open
Abstract
During the initial phase of the 2014–2016 Ebola virus disease (EVD) outbreak in Monrovia, Liberia, all hospitals’ isolation capacities were overwhelmed by the sheer caseload. As a stop-gap measure to halt transmission, Medecins sans Frontieres (MSF) distributed household disinfection kits to those who were at high risk of EVD contamination. The kit contained chlorine and personal protective materials to be used for the care of a sick person or the handling of a dead body. This intervention was novel and controversial for MSF. This paper shed the light on this experience of distribution in Monrovia and assess if kits were properly used by recipients. Targeted distribution was conducted to those at high risk of EVD (relatives of confirmed EVD cases) and health staff. Mass distributions were also conducted to households in the most EVD affected urban districts. A health promotion strategy focused on the purpose and use of the kit was integrated into the distribution. Follow-up phone calls to recipients were conducted to enquire about the use of the kit. Overall, 65,609 kits were distributed between September and November 2014. A total of 1,386 recipients were reached by phone. A total of 60 cases of sickness and/or death occurred in households who received a kit. The majority of these (46, 10%) were in households of relatives of confirmed EVD cases. Overall, usage of the kits was documented in 56 out of 60 affected households. Out of the 1322 households that did not experience sickness and/or death after the distribution, 583 (44%) made use of elements of the kit, mainly (94%) chlorine for hand-washing. At the peak of an EVD outbreak, the distribution of household disinfection kits was feasible and kits were appropriately used by the majority of recipients. In similar circumstances in the future, the intervention should be considered. Liberia was one of the worst countries hit by the 2014–2016 Ebola Virus outbreak (EVD). All hospitals’ isolation capacity in Monrovia was stretched by the spiralling number of EVD cases. As a stop-gap measure, Medecins Sans Frontieres (MSF) distributed household disinfection kit to those who were considered at high risk of EVD transmission, including relatives of confirmed EVD cases, health staff and households in the most affected districts across Monrovia. The purpose of the kit was to care for sick person while waiting for an ambulance or handling dead body while waiting for burial team. The kit contained chlorine and personal protective materials. Health promotion strategy on the purpose and use of the kit was integrated into the distribution. Follow up with the kit recipients was done by phone to better understand the use of the kit. Overall, 65,609 kits were distributed between September and November 2014. Among 1,386 recipients reached by phone, 60 cases of sickness and/or death events occurred in households which received a kit. The majority of these were among the relatives of confirmed EVD cases. Kits’ use was documented in 56 out of 60 affected households. The distribution of household disinfection kits was feasible and kits were appropriately used by the majority of the recipients. In similar circumstances in future, the intervention should be considered.
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Impact of prophylactic vaccination strategies on Ebola virus transmission: A modeling analysis. PLoS One 2020; 15:e0230406. [PMID: 32339195 PMCID: PMC7185698 DOI: 10.1371/journal.pone.0230406] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 03/01/2020] [Indexed: 01/18/2023] Open
Abstract
Ebola epidemics constitute serious public health emergencies. Multiple vaccines are under development to prevent these epidemics and avoid the associated morbidity and mortality. Assessing the potential impact of these vaccines on morbidity and mortality of Ebola is essential for devising prevention strategies. A mean-field compartmental stochastic model was developed for this purpose and validated by simulating the 2014 Sierra Leone epidemic. We assessed the impacts of prophylactic vaccination of healthcare workers (HCW) both alone and in combination with the vaccination of the general population (entire susceptible population other than HCW). The model simulated 8,706 (95% confidence intervals [CI]: 478–21,942) cases and 3,575 (95%CI: 179–9,031) deaths in Sierra Leone, in line with WHO-reported statistics for the 2014 epidemic (8,704 cases and 3,587 deaths). Relative to this base case, the model then estimated that prophylactic vaccination of only 10% of HCW will avert 12% (95% CI: 6%-14%) of overall cases and deaths, while vaccination of 30% of HCW will avert 34% of overall cases (95% CI: 30%-64%) and deaths (95% CI: 30%-65%). Prophylactic vaccination of 1% and 5% of the general population in addition to vaccinating 30% of HCW was estimated to result in reduction in cases by 44% (95% CI: 39%-61%) and 72% (95% CI: 68%-84%) respectively, and deaths by 45% (95% CI: 40%-61%) and 74% (95% CI: 70%-85%) respectively. Prophylactic vaccination of even small proportions of HCW is estimated to significantly reduce incidence of Ebola and associated mortality. The effect is greatly enhanced by the additional vaccination even of small percentages of the general population. These findings could be used to inform the planning of prevention strategies.
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Kelly JD, Barrie MB, Mesman AW, Karku S, Quiwa K, Drasher M, Schlough GW, Dierberg K, Koedoyoma S, Lindan CP, Jones JH, Chamie G, Worden L, Greenhouse B, Weiser SD, Porco TC, Rutherford GW, Richardson ET. Anatomy of a Hotspot: Chain and Seroepidemiology of Ebola Virus Transmission, Sukudu, Sierra Leone, 2015-16. J Infect Dis 2019; 217:1214-1221. [PMID: 29325149 DOI: 10.1093/infdis/jiy004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 01/06/2018] [Indexed: 01/25/2023] Open
Abstract
Studies have yet to include minimally symptomatic Ebola virus (EBOV) infections and unrecognized Ebola virus disease (EVD) in Ebola-related transmission chains and epidemiologic risk estimates. We conducted a cross-sectional, sero-epidemiological survey from October 2015 to January 2016 among 221 individuals living in quarantined households from November 2014 to February 2015 during the Ebola outbreak in the village of Sukudu, Sierra Leone. Of 48 EBOV-infected persons, 25% (95% confidence interval [CI], 14%-40%) had minimally symptomatic EBOV infections and 4% (95% CI, 1%-14%) were unrecognized EVD cases. The pattern of minimally symptomatic EBOV infections in the transmission chain was nonrandom (P < .001, permutation test). Not having lived in the same house as an EVD case was significantly associated with minimally symptomatic infection. This is the first study to investigate a chain of EBOV transmission inclusive of minimally symptomatic EBOV infections and unrecognized EVD. Our findings provide new insights into Ebola transmission dynamics and quarantine practices.
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Affiliation(s)
- J Daniel Kelly
- Department of Medicine, UCSF, San Francisco, California.,Partners in Health, Freetown, Sierra Leone
| | - Mohamed Bailor Barrie
- Partners in Health, Freetown, Sierra Leone.,Department of Global Health and Social Medicine, HMS, Boston, Massachusetts
| | | | - Sahr Karku
- Partners in Health, Freetown, Sierra Leone
| | | | | | | | | | | | - Christina P Lindan
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California
| | | | - Gabriel Chamie
- Department of HIV, ID, and Global Medicine, UCSF, San Francisco, California
| | - Lee Worden
- F.I. Proctor Foundation, UCSF, San Francisco
| | - Bryan Greenhouse
- Department of HIV, ID, and Global Medicine, UCSF, San Francisco, California
| | - Sheri D Weiser
- Department of HIV, ID, and Global Medicine, UCSF, San Francisco, California
| | - Travis C Porco
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California
| | - George W Rutherford
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California
| | - Eugene T Richardson
- Partners in Health, Freetown, Sierra Leone.,Department of Global Health and Social Medicine, HMS, Boston, Massachusetts.,Department of Anthropology, Stanford University, California.,Department of Medicine, BWH, Boston, Massachusetts
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5
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Cori A, Donnelly CA, Dorigatti I, Ferguson NM, Fraser C, Garske T, Jombart T, Nedjati-Gilani G, Nouvellet P, Riley S, Van Kerkhove MD, Mills HL, Blake IM. Key data for outbreak evaluation: building on the Ebola experience. Philos Trans R Soc Lond B Biol Sci 2017; 372:20160371. [PMID: 28396480 PMCID: PMC5394647 DOI: 10.1098/rstb.2016.0371] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2016] [Indexed: 01/15/2023] Open
Abstract
Following the detection of an infectious disease outbreak, rapid epidemiological assessment is critical for guiding an effective public health response. To understand the transmission dynamics and potential impact of an outbreak, several types of data are necessary. Here we build on experience gained in the West African Ebola epidemic and prior emerging infectious disease outbreaks to set out a checklist of data needed to: (1) quantify severity and transmissibility; (2) characterize heterogeneities in transmission and their determinants; and (3) assess the effectiveness of different interventions. We differentiate data needs into individual-level data (e.g. a detailed list of reported cases), exposure data (e.g. identifying where/how cases may have been infected) and population-level data (e.g. size/demographics of the population(s) affected and when/where interventions were implemented). A remarkable amount of individual-level and exposure data was collected during the West African Ebola epidemic, which allowed the assessment of (1) and (2). However, gaps in population-level data (particularly around which interventions were applied when and where) posed challenges to the assessment of (3). Here we highlight recurrent data issues, give practical suggestions for addressing these issues and discuss priorities for improvements in data collection in future outbreaks.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'.
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Affiliation(s)
- Anne Cori
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Christl A Donnelly
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Ilaria Dorigatti
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Neil M Ferguson
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Christophe Fraser
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Tini Garske
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Thibaut Jombart
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Gemma Nedjati-Gilani
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Pierre Nouvellet
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Steven Riley
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Maria D Van Kerkhove
- Centre for Global Health, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
| | - Harriet L Mills
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
- School of Veterinary Sciences, University of Bristol, Bristol BS40 5DU, UK
| | - Isobel M Blake
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
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Funk S, Ciglenecki I, Tiffany A, Gignoux E, Camacho A, Eggo RM, Kucharski AJ, Edmunds WJ, Bolongei J, Azuma P, Clement P, Alpha TS, Sterk E, Telfer B, Engel G, Parker LA, Suzuki M, Heijenberg N, Reeder B. The impact of control strategies and behavioural changes on the elimination of Ebola from Lofa County, Liberia. Philos Trans R Soc Lond B Biol Sci 2017; 372:20160302. [PMID: 28396473 PMCID: PMC5394640 DOI: 10.1098/rstb.2016.0302] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 11/12/2022] Open
Abstract
The Ebola epidemic in West Africa was stopped by an enormous concerted effort of local communities and national and international organizations. It is not clear, however, how much the public health response and behavioural changes in affected communities, respectively, contributed to ending the outbreak. Here, we analyse the epidemic in Lofa County, Liberia, lasting from March to November 2014, by reporting a comprehensive time line of events and estimating the time-varying transmission intensity using a mathematical model of Ebola transmission. Model fits to the epidemic show an alternation of peaks and troughs in transmission, consistent with highly heterogeneous spread. This is combined with an overall decline in the reproduction number of Ebola transmission from early August, coinciding with an expansion of the local Ebola treatment centre. We estimate that healthcare seeking approximately doubled over the course of the outbreak, and that isolation of those seeking healthcare reduced their reproduction number by 62% (mean estimate, 95% credible interval (CI) 59-66). Both expansion of bed availability and improved healthcare seeking contributed to ending the epidemic, highlighting the importance of community engagement alongside clinical intervention.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'.
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Affiliation(s)
- Sebastian Funk
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E, UK
| | - Iza Ciglenecki
- Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland
| | | | | | - Anton Camacho
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E, UK
| | - Rosalind M Eggo
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E, UK
| | - Adam J Kucharski
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E, UK
| | - W John Edmunds
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E, UK
| | - Josephus Bolongei
- Lofa County Health Office, Ministry of Health and Social Welfare, 7500 Voinjama, Liberia
| | - Phillip Azuma
- Lofa County Health Office, Ministry of Health and Social Welfare, 7500 Voinjama, Liberia
| | - Peter Clement
- Monrovia Country Office, World Health Organization, 1000 Monrovia, Liberia
| | - Tamba S Alpha
- Lofa County Health Office, Ministry of Health and Social Welfare, 7500 Voinjama, Liberia
| | - Esther Sterk
- Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland
| | - Barbara Telfer
- Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland
| | - Gregory Engel
- Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland
| | - Lucy Anne Parker
- Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland
- CIBER Epidemiología y Salud Pública, 28029 Madrid, Spain
- Department of Public Health, Universidad Miguel Hernández, 03202 Alicante, Spain
| | - Motoi Suzuki
- Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Nico Heijenberg
- Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland
| | - Bruce Reeder
- Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland
- College of Medicine, University of Saskatchewan, Saskatoon, Canada S7N 5E5
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Lori JR, Munro-Kramer ML, Shifman J, Amarah PNM, Williams G. Patient Satisfaction With Maternity Waiting Homes in Liberia: A Case Study During the Ebola Outbreak. J Midwifery Womens Health 2017; 62:163-171. [PMID: 28376559 DOI: 10.1111/jmwh.12600] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/26/2016] [Accepted: 11/14/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Liberia in West Africa has one of the highest maternal mortality ratios in the world (990/100,000 live births). Many women in Liberia live in rural, remote villages with little access to safe maternity services. The World Health Organization has identified maternity waiting homes (MWHs) as one strategy to minimize the barrier of distance in accessing a skilled birth attendant. However, limited data exist on satisfaction with MWHs or maternal health care in Liberia. METHODS This mixed-methods case study examines women's satisfaction with their stay at a MWH and compares utilization rates before and during the Ebola outbreak. From 2012 to 2014, 650 women who stayed at one of 6 MWHs in rural Liberia during the perinatal or postnatal period were surveyed. Additionally, 60 semi-structured interviews were conducted with traditional providers, skilled birth attendants, and women utilizing the MWHs. Quantitative analyses assessed satisfaction rates before and during the Ebola outbreak. Content analysis of semi-structured interviews supplemented the quantitative data and provided a lens into the elements of satisfaction with the MWHs. RESULTS The majority of women who utilized the MWHs stated they would suggest the MWH to a friend or relative who was pregnant (99.5%), and nearly all would utilize the home again (98.8%). Although satisfaction with the MWHs significantly decreased during the Ebola outbreak (P < .001), participants were satisfied overall with the MWHs. Content analysis identified areas of satisfaction that encompassed the themes of restful and supportive environment as well as areas for improvement such as lacking necessary resources and loneliness. DISCUSSION This case study demonstrated that women using MWHs in Bong County, Liberia are generally satisfied with their experience and plan to use an MWH again during future pregnancies to access a skilled birth attendant for birth. Women are also willing to encourage family and friends to use MWHs.
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"Ebola kills generations": Qualitative discussions with Liberian healthcare providers. Midwifery 2016; 45:44-49. [PMID: 27998827 DOI: 10.1016/j.midw.2016.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 12/04/2016] [Accepted: 12/08/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE the purpose of this study was to explore healthcare providers' perceptions and reactions to the Ebola Virus Disease (EVD) epidemic. DESIGN a descriptive, qualitative study design was employed. Focus groups were conducted with Liberian healthcare providers who participated in care of patients with EVD. SETTING the study was conducted in Bong County, Liberia (population: 333,000), which was severely affected, with over 650 reported cases and close to 200 deaths by the end of 2015. PARTICIPANTS the total sample of 58 participants, included 11 nurses, ten traditional birth attendants (TBAs), four midwives, 28 general community health volunteers, three physician assistants, one community member and one pharmacy dispenser. MEASUREMENTS AND FINDINGS five core themes related to changes in healthcare practices and interactions since the EVD outbreak were identified based on the results of the focus groups; fear, stigma, resource constraints, lack of knowledge and training, and shifting cultural practices. KEY CONCLUSIONS this work represents a preliminary understanding of Liberian healthcare workers reactions to the EVD epidemic, and highlights the significant issues they faced as they attempted to care for patients and protect themselves. IMPLICATIONS FOR PRACTICE while the EVD epidemic has been declared over, preparedness activities for future disease outbreaks must continue. This study can inform future healthcare policy initiatives as well as preparedness activities targeted towards healthcare workers in low resource settings.
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Tuite AR, Fisman DN. The IDEA model: A single equation approach to the Ebola forecasting challenge. Epidemics 2016; 22:71-77. [PMID: 27717616 DOI: 10.1016/j.epidem.2016.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/23/2016] [Accepted: 09/25/2016] [Indexed: 11/28/2022] Open
Abstract
Mathematical modeling is increasingly accepted as a tool that can inform disease control policy in the face of emerging infectious diseases, such as the 2014-2015 West African Ebola epidemic, but little is known about the relative performance of alternate forecasting approaches. The RAPIDD Ebola Forecasting Challenge (REFC) tested the ability of eight mathematical models to generate useful forecasts in the face of simulated Ebola outbreaks. We used a simple, phenomenological single-equation model (the "IDEA" model), which relies only on case counts, in the REFC. Model fits were performed using a maximum likelihood approach. We found that the model performed reasonably well relative to other more complex approaches, with performance metrics ranked on average 4th or 5th among participating models. IDEA appeared better suited to long- than short-term forecasts, and could be fit using nothing but reported case counts. Several limitations were identified, including difficulty in identifying epidemic peak (even retrospectively), unrealistically precise confidence intervals, and difficulty interpolating daily case counts when using a model scaled to epidemic generation time. More realistic confidence intervals were generated when case counts were assumed to follow a negative binomial, rather than Poisson, distribution. Nonetheless, IDEA represents a simple phenomenological model, easily implemented in widely available software packages that could be used by frontline public health personnel to generate forecasts with accuracy that approximates that which is achieved using more complex methodologies.
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Affiliation(s)
| | - David N Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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