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Frimpong SO, Paintsil E. Community engagement in Ebola outbreaks in sub-Saharan Africa and implications for COVID-19 control: A scoping review. Int J Infect Dis 2023; 126:182-192. [PMID: 36462575 DOI: 10.1016/j.ijid.2022.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 10/27/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES There is a paucity of scoping data on the specific roles community engagement played in preventing and managing the Ebola virus disease (EVD) outbreak in sub-Saharan Africa. We assessed the role, benefits, and mechanisms of community engagement to understand its effect on EVD case detection, survival, and mortality in sub-Saharan Africa. The implications for COVID-19 prevention and control were also highlighted. METHODS We searched for articles between 2010 and 2020 in the MEDLINE and Embase databases. The study types included were randomized trials, quasiexperimental studies, observational studies, case series, and reports. RESULTS A total of 903 records were identified for screening. A total of 216 articles met the review criteria, 103 were initially selected, and 44 were included in the final review. Our findings show that effective community involvement during the EVD outbreak depended on the survival rates, testimonials of survivors, risk perception, and the inclusion of community leaders. Community-based interventions improved knowledge and attitudes, case findings, isolation efforts, and treatment uptake. CONCLUSION Although the studies included in this review were of highly variable quality, findings from this review may provide lessons for the role of community engagement in the COVID-19 pandemic's prevention and control in sub-Saharan Africa.
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Affiliation(s)
- Shadrack Osei Frimpong
- Department of Pediatrics, Yale School of Medicine, New Haven, USA; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA.
| | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA; Department of Pharmacology, Yale School of Medicine, New Haven, USA; School of Management, Yale University, New Haven, USA
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Kayem ND, Benson C, Aye CYL, Barker S, Tome M, Kennedy S, Ariana P, Horby P. Ebola virus disease in pregnancy: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2021; 116:509-522. [PMID: 34865173 PMCID: PMC9157681 DOI: 10.1093/trstmh/trab180] [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: 04/30/2021] [Revised: 08/25/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
This review synthesises and appraises evidence on the effects of Ebola virus disease (EVD) in pregnancy. We searched bibliographic databases from dates of inception to November 2020, yielding 28 included studies. The absolute risk of maternal death associated with EVD was estimated at 67.8% (95% confidence interval [CI] 49.8 to 83.7, I2=85%, p<0.01) and the relative risk of death in pregnant women compared with non-pregnant women was estimated at 1.18 (95% CI 0.59 to 2.35, I2=31.0%, p=0.230). The absolute risk for foetal losses was estimated at 76.9% (95% CI 45.0 to 98.3, I2=96%, p<0.01) and neonatal death was 98.5% (95% CI 84.9 to 100, I2=0.0%, p=0.40). The gap analysis suggests limited or no data on the clinical course, non-fatal perinatal outcomes and EVD management in pregnant women. The review suggests that EVD has a high maternal and perinatal mortality, underscoring the urgent need for preventative and therapeutic solutions and improved screening and follow-up of pregnant women and newborns during outbreaks. There is not enough evidence to conclusively rule out pregnancy as a risk factor for mortality and there is limited evidence on the disease course, outcomes and management of EVD in pregnancy, and this supports the need for robust clinical trials and prospective studies that include pregnant women.
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Affiliation(s)
- Nzelle D Kayem
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Charlotte Benson
- Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, UK
| | - Christina Y L Aye
- Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, UK.,Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
| | - Sarah Barker
- Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, UK
| | - Mariana Tome
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
| | - Stephen Kennedy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
| | - Proochista Ariana
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Peter Horby
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
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Foeller ME, Carvalho Ribeiro do Valle C, Foeller TM, Oladapo OT, Roos E, Thorson AE. Pregnancy and breastfeeding in the context of Ebola: a systematic review. THE LANCET. INFECTIOUS DISEASES 2020; 20:e149-e158. [PMID: 32595045 DOI: 10.1016/s1473-3099(20)30194-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 12/31/2022]
Abstract
The outbreaks of Ebola virus between 2014 and 2020 have drawn attention to knowledge gaps related to Ebola virus disease in pregnant women. The aim of this study was to systematically evaluate available data on pregnant and lactating women with acute Ebola virus disease or following recovery. We searched MEDLINE, Embase, Cochrane Library (CENTRAL), Web of Science Core Collection, CINAHL, POPLINE, Global Health, and WHO Global Index Medicus, in addition to grey literature, for relevant articles. Studies of all types and published between database inception and Aug 19, 2019, were eligible (PROSPERO 129335). We identified 1060 records, of which 52 studies met our inclusion criteria. Overall, mortality in 274 pregnant women with Ebola virus disease was 72% (197 women died); mortality for pregnant women with Ebola virus disease were not higher than those in the general population of patients with Ebola virus disease. Nearly all women with Ebola virus disease had adverse pregnancy outcomes. Among survivors, Ebola virus RNA was detected by RT-PCR in amniotic fluid up to 32 days after maternal clearance of Ebola virus from the blood and in breastmilk 26 days after symptom onset. A risk of transmission of Ebola virus from pregnancy-related fluids and breastmilk probably exists, and precautions should be taken.
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Affiliation(s)
- Megan E Foeller
- UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HPR), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Obstetrics and Gynecology, Stanford University, Stanford, CA, USA; Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO, USA
| | | | - Timothy M Foeller
- Department of Internal Medicine, Stanford University, Stanford, CA, USA
| | - Olufemi T Oladapo
- UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HPR), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Elin Roos
- UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HPR), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna E Thorson
- UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HPR), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
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Huynh N, Baumann A, Loeb M. Reporting quality of the 2014 Ebola outbreak in Africa: A systematic analysis. PLoS One 2019; 14:e0218170. [PMID: 31237909 PMCID: PMC6592536 DOI: 10.1371/journal.pone.0218170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 05/28/2019] [Indexed: 11/18/2022] Open
Abstract
The objective of this study was to conduct a systematic analysis of the reporting quality of the Ebola Virus Disease (EVD) outbreak in West Africa from 2014-2018 using the Modified STROBE statement. We included studies on the 2014 EVD outbreak alone, limited to those on human patients in Africa. We searched the following databases (MEDLINE, EMBASE, and Web of Science) for outbreak reports published between 2014-2018. We assessed factors potentially associated with the quality of reporting. A total of 69 of 131 (53%) articles within the full-text review fulfilled our eligibility criteria and underwent the Modified STROBE assessment for analyzing the quality of reporting. The Modified STROBE scores of the included studies ranged from 11-26 points and the mean was found to be 19.54 out of 30 with a standard deviation (SD) of ± 4.30. The top three reported Modified STROBE components were descriptive characteristics of study participants, scientific background and evidence rational, and clinical significance of observations. More than 75% of the studies met a majority of the criteria in the Modified STROBE assessment tool. Information that was commonly missing included addressing potential source of bias, sensitivity analysis, further results/analysis such as risk estimates and odds ratios, presence of a flowchart, and addressing missing data. In multivariable analysis, peer-reviewed publication was the only predictor that remained significantly associated with a higher Modified STROBE score. In conclusion, the large range of Modified STROBE scores observed indicates variability in the quality of outbreak reports for EVD. The review identified strong reporting in some areas, whereas other areas are in need of improvement, in particular providing an important description of the outbreak setting and identifying any external elements (potential biases and confounding factors) that could hinder the credibility of the findings.
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Affiliation(s)
- Nina Huynh
- Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Baumann
- Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
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Nagbe T, Naiene JD, Rude JM, Mahmoud N, Kromah M, Sesay J, Chukwudi OJ, Stephen M, Talisuna A, Yahaya AA, Rajatonirina S, Fallah M, Nyenswah T, Dahn B, Gasasira A, Fall IS. The implementation of integrated disease surveillance and response in Liberia after Ebola virus disease outbreak 2015-2017. Pan Afr Med J 2019; 33:3. [PMID: 31404272 PMCID: PMC6675929 DOI: 10.11604/pamj.supp.2019.33.2.16820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/22/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Although Liberia adapted the integrated diseases surveillance and response (IDSR) in 2004 as a platform for implementation of International Health Regulation (IHR (2005)), IDSR was not actively implemented until 2015. Some innovations and best practices were observed during the implementation of IDSR in Liberia after Ebola virus disease outbreak. This paper describes the different approaches used for implementation of IDSR in Liberia from 2015 to 2017. METHODS We conducted a cross-sectional study using the findings from IDSR supervisions conducted from September to November 2017 and perused the outbreaks linelists submitted by the counties to the national level from January to December 2017 and key documents available at the national level. RESULTS In 2017, the country piloted the use of mobile phones application to store and send data from the health facilities to the national level. In addition, an electronic platform for acute flaccid paralysis (AFP) surveillance called Auto-Visual AFP Detection and Reporting (AVADAR) was piloted in Montserrado County during the first semester of 2017. The timeliness and completeness of reports submitted from the counties to national level were above the target of 80% stable despite the challenges like insufficient resources, including skilled staff. CONCLUSION IDSR is being actively implemented in Liberia since 2015. Although the country is facing the same challenges as other countries during the early stages of implementation of IDSR, the several innovations were implemented in a short time. The surveillance system reveled to be resilient, despite the challenges.
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Affiliation(s)
- Thomas Nagbe
- National Public Health Institute, Monrovia, Liberia
| | | | | | | | | | | | | | - Mary Stephen
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ambrose Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | | | | | | | | | - Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Weah VD, Doedeh JS, Wiah SQ, Nyema E, Lombeh S, Naiene J. Enhancing Ebola Virus Disease Surveillance and Prevention in Counties Without Confirmed Cases in Rural Liberia: Experiences from Sinoe County During the Flare-up in Monrovia, April to June, 2016. PLOS CURRENTS 2017; 9. [PMID: 29188127 PMCID: PMC5693337 DOI: 10.1371/currents.outbreaks.2b7f352af0866accbd7e5a82f165432a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: During the flare-ups of Ebola virus disease (EVD) in Liberia, Sinoe County reactivated the multi-sectorial EVD control strategy in order to be ready to respond to the eventual reintroduction of cases. This paper describes the impacts of the interventions implemented in Sinoe County during the last flare-up in Monrovia, from April 1 to June 9, 2016, using the resources provided during the original outbreak that ended a year ago. Methods: We conducted a descriptive study to describe the key interventions implemented in Sinoe County, the capacity available, the implications for the reactivation of the multi-sectoral EVD control strategy, and the results of the same. We also conducted a cross-sectional study to analyze the impact of the interventions on the surveillance and on infection prevention and control (IPC). Results: The attrition of the staff trained during the original outbreak was low, and most of the supplies, equipment, and infrastructure from the original outbreak remained available. With an additional USD 1755, improvements were observed in the IPC indicators of triage, which increased from a mean of 60% at the first assessment to 77% (P=0.002). Additionally, personnel/staff training improved from 78% to 89% (P=0.04). The percentage of EVD death alerts per expected deaths investigated increased from 26% to 63% (P<0.0001). Discussion: The low attrition of the trained staff and the availability of most supplies, equipment, and infrastructure made the reactivation of the multi-sectoral EVD control strategy fast and affordable. The improvement of the EVD surveillance was possibly affected by the community engagement activities, awareness and mentoring of the health workers, and improved availability of clinicians in the facilities during the flare-up. The community engagement may contribute to the report of community-based events, specifically community deaths. The mentoring of the staff during the supportive supervisions also contributed to improve the IPC indicators.
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Affiliation(s)
- Vera Darling Weah
- Health Promotion Division, Ministry of Health and Social Welfare, Monrovia, Liberia
| | - John S Doedeh
- County Health Team, Ministry of Health and Social Welfare, Greenville City, Sinoe County, Liberia
| | - Samson Q Wiah
- County Health Team, Ministry of Health and Social Welfare, Greenville City, Sinoe County, Liberia
| | - Emmanuel Nyema
- World Health Organization, Greenville City, Sinoe County, Liberia
| | - Siafa Lombeh
- World Health Organization, Greenville City, Sinoe County, Liberia
| | - Jeremias Naiene
- World Health Organization, Greenville City, Sinoe County, Liberia
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Kovacic V, Tirados I, Esterhuizen J, Mangwiro CTN, Lehane MJ, Torr SJ, Smith H. We Remember… Elders' Memories and Perceptions of Sleeping Sickness Control Interventions in West Nile, Uganda. PLoS Negl Trop Dis 2016; 10:e0004745. [PMID: 27253367 PMCID: PMC4890773 DOI: 10.1371/journal.pntd.0004745] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/05/2016] [Indexed: 11/18/2022] Open
Abstract
The traditional role of African elders and their connection with the community make them important stakeholders in community-based disease control programmes. We explored elders’ memories related to interventions against sleeping sickness to assess whether or not past interventions created any trauma which might hamper future control operations. Using a qualitative research framework, we conducted and analysed twenty-four in-depth interviews with Lugbara elders from north-western Uganda. Participants were selected from the villages inside and outside known historical sleeping sickness foci. Elders’ memories ranged from examinations of lymph nodes conducted in colonial times to more recent active screening and treatment campaigns. Some negative memories dating from the 1990s were associated with diagnostic procedures, treatment duration and treatment side effects, and were combined with memories of negative impacts related to sleeping sickness epidemics particularly in HAT foci. More positive observations from the recent treatment campaigns were reported, especially improvements in treatment. Sleeping sickness interventions in our research area did not create any permanent traumatic memories, but memories remained flexible and open to change. This study however identified that details related to medical procedures can remain captured in a community’s collective memory for decades. We recommend more emphasis on communication between disease control programme planners and communities using detailed and transparent information distribution, which is not one directional but rather a dialogue between both parties. African elders are recognized by their communities as important traditional leaders. This role gives them an influential position, which is commonly overlooked by disease control programmes. We focused on sleeping sickness a disease which has a long history of control interventions in our study location in north-western Uganda. We interviewed elders to explore their memories of past interventions. This is important because negative perceptions of past interventions could influence how communities perceive control programmes today. Interviewed elders described sleeping sickness control interventions dating from the 1960s and more recent interventions from 1990s. Invasive diagnostic procedures, toxic side effects of treatment and long hospitalization were remembered from the later interventions. Despite these negative experiences, elders, however, observed recent improvements in treatment and had no negative perceptions of sleeping sickness control programmes. We conclude that community experience with control programmes remains in memories for decades, and we recommend the involvement of elders in planning of these interventions. This would be particularly beneficial because they are aware of the historical contexts of disease control in their environment, have insights into socio-cultural aspects of their communities and may serve as spokespersons between beneficiary community and programme implementers.
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Affiliation(s)
- Vanja Kovacic
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail: ;
| | - Inaki Tirados
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Johan Esterhuizen
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Clement T. N. Mangwiro
- Department of Animal Science, Bindura University of Science Education, Bindura, Zimbabwe
| | - Michael J. Lehane
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Stephen J. Torr
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Helen Smith
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Leblebicioglu H, Sunbul M, Bodur H, Ozaras R. Discharge criteria for Crimean-Congo haemorrhagic fever in endemic areas. J Infect 2016; 72:500-1. [PMID: 26828701 DOI: 10.1016/j.jinf.2016.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 01/20/2016] [Accepted: 01/24/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Hakan Leblebicioglu
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey.
| | - Mustafa Sunbul
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey.
| | - Hurrem Bodur
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Research and Training Hospital, Ankara, Turkey.
| | - Resat Ozaras
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey.
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