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Moussaoui LS, Quimby M, Avancini H, Salawdi A, Skaik F, Bani Odeh R, Desrichard O, Claxton N. Situational Judgement Tests among Palestinian community members and Red Crescent volunteers to inform humanitarian action: a cross-sectional study. Arch Public Health 2024; 82:141. [PMID: 39192286 DOI: 10.1186/s13690-024-01356-8] [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: 06/05/2024] [Accepted: 08/09/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Informing humanitarian action directly from community members is recognized as critical. However, collecting community insights is also a challenge in practice. This paper reports data collected among community members and Red Crescent volunteers in the occupied Palestinian territory. The aim was to test a data collection tool, situational judgment tests (SJTs), to collect insights in the community around three themes. METHODS The SJTs covered violence prevention, road safety, and environmental pollution (waste), and were constituted of hypothetical scenarios to which respondents indicated how they would react. For each theme, the answers' pattern provides insights for humanitarian action regarding which beliefs to address. A cross-sectional survey was conducted in January and February 2023 with 656 community members, and 239 Red Crescent volunteers. RESULTS Data showed that violence is the theme for which the need is the highest among community members. Some responses varied according to the public (age, governorate, or disability level), suggesting actions could be tailored accordingly. CONCLUSIONS Despite many difficulties during data collection, this study show that the tool allowed to collect community insights, a crucial task to ensure adequate response to the challenges faced by community members and Red Crescent volunteers in occupied Palestine.
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Affiliation(s)
- L S Moussaoui
- Faculty of Psychology and Educational Sciences, Geneva University, Geneva, Switzerland.
| | - M Quimby
- Nadulpan LLC, Crestview, FL, USA
| | - H Avancini
- Swedish Red Cross Society, Stockholm, Sweden
| | - A Salawdi
- Palestine Red Crescent Society, al-Bireh (Ramallah and al-Bireh), Palestine
| | - F Skaik
- Palestine Red Crescent Society, al-Bireh (Ramallah and al-Bireh), Palestine
| | - R Bani Odeh
- Palestine Red Crescent Society, al-Bireh (Ramallah and al-Bireh), Palestine
| | - O Desrichard
- Faculty of Psychology and Educational Sciences, Geneva University, Geneva, Switzerland
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Akunzirwe R, Carter S, Simbwa BN, Wanyana MW, Ahirirwe SR, Namubiru SK, Ninsiima M, Komakech A, Ario AR, Kadobera D, Kwesiga B, Migisha R, Bulage L, Naiga HN, Zalwango JF, Agaba B, Kabami Z, Zalwango MG, King P, Kiggundu T, Kawungezi PC, Gonahasa DN, Kyamwine IB, Atuhaire I, Asio A, Elayeete S, Nsubuga EJ, Masanja V, Migamba SM, Nakamya P, Nampeera R, Kwiringira A, Choi M, Lo T, Harris JR. Time to care and factors influencing appropriate Sudan virus disease care among case patients in Uganda, September to November 2022. Int J Infect Dis 2024; 145:107073. [PMID: 38670481 DOI: 10.1016/j.ijid.2024.107073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES Early isolation and care for Ebola disease patients at Ebola Treatment Units (ETU) curb outbreak spread. We evaluated time to ETU entry and associated factors during the 2022 Sudan virus disease (SVD) outbreak in Uganda. METHODS We included persons with RT-PCR-confirmed SVD with onset September 20-November 30, 2022. We categorized days from symptom onset to ETU entry ("delays") as short (≤2), moderate (3-5), and long (≥6); the latter two were "delayed isolation." We categorized symptom onset timing as "earlier" or "later," using October 15 as a cut-off. We assessed demographics, symptom onset timing, and awareness of contact status as predictors for delayed isolation. We explored reasons for early vs late isolation using key informant interviews. RESULTS Among 118 case-patients, 25 (21%) had short, 43 (36%) moderate, and 50 (43%) long delays. Seventy-five (64%) had symptom onset later in the outbreak. Earlier symptom onset increased risk of delayed isolation (crude risk ratio = 1.8, 95% confidence interval (1.2-2.8]). Awareness of contact status and SVD symptoms, and belief that early treatment-seeking was lifesaving facilitated early care-seeking. Patients with long delays reported fear of ETUs and lack of transport as contributors. CONCLUSION Delayed isolation was common early in the outbreak. Strong contact tracing and community engagement could expedite presentation to ETUs.
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Affiliation(s)
| | - Simone Carter
- United Nations Children's Fund Public Health Emergencies, Geneva, Switzerland
| | | | | | | | | | | | - Allan Komakech
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Alex R Ario
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Benon Kwesiga
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Lilian Bulage
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Helen N Naiga
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Brian Agaba
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Zainah Kabami
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Patrick King
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | | | | | | | | | - Alice Asio
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Sarah Elayeete
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | | | | | | | - Rose Nampeera
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Mary Choi
- Centers for Disease Control and Prevention, Kampala, Uganda
| | - Terrence Lo
- Centers for Disease Control and Prevention, Kampala, Uganda
| | - Julie R Harris
- Centers for Disease Control and Prevention, Kampala, Uganda
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Enria L, Dwyer H, Marchant M, Beckmann N, Schmidt-Sane M, Conteh A, Mansaray A, N'Jai A. Political dimensions of misinformation, trust, and vaccine confidence in a digital age. BMJ 2024; 385:e079940. [PMID: 38901859 DOI: 10.1136/bmj-2024-079940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Affiliation(s)
- Luisa Enria
- London School of Hygiene and Tropical Medicine, London UK
| | - Harriet Dwyer
- London School of Hygiene and Tropical Medicine, London UK
| | - Mark Marchant
- London School of Hygiene and Tropical Medicine, London UK
| | | | | | - Abu Conteh
- Sierra Leone Urban Research Centre, Freetown, Sierra Leone
| | | | - Alhaji N'Jai
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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Biesty CP, Hemingway C, Woolgar J, Taylor K, Lawton MD, Waheed MW, Holford D, Taegtmeyer M. Community led health promotion to counter stigma and increase trust amongst priority populations: lessons from the 2022-2023 UK mpox outbreak. BMC Public Health 2024; 24:1638. [PMID: 38898512 PMCID: PMC11188168 DOI: 10.1186/s12889-024-19176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/17/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Stigma, lack of trust in authorities, and poor knowledge can prevent health-seeking behaviour, worsen physical and mental health, and undermine efforts to control transmission during disease outbreaks. These factors are particularly salient with diseases such as mpox, for which 96% of cases in the 2022-2023 UK outbreak were identified among gay, bisexual, queer and men who have sex with men (MSM). This study explored stigma and health-seeking behaviour in Liverpool through the lens of the recent mpox outbreak. METHODS Primary sources of data were interviews with national and regional key informants involved in the mpox response, and participatory workshops with priority populations. Workshop recruitment targeted Grindr users (geosocial dating/hookup app) and at risk MSM; immigrant, black and ethnic minority MSM; and male sex workers in Liverpool. Data were analysed using a deductive framework approach, building on the Health Stigma and Discrimination Framework. RESULTS Key informant interviews (n = 11) and five workshops (n = 15) were conducted. There were prevalent reports of anticipated and experienced stigma due to mpox public health messaging alongside high demand and uptake of the mpox vaccine and regular attendance at sexual health clinics. Respondents believed the limited impact of stigma on health-seeking behaviour was due to actions by the LGBTQ + community, the third sector, and local sexual health clinics. Key informants from the LGBTQ + community and primary healthcare felt their collective action to tackle mpox was undermined by central public health authorities citing under-resourcing; a reliance on goodwill; poor communication; and tokenistic engagement. Mpox communication was further challenged by a lack of evidence on disease transmission and risk. This challenge was exacerbated by the impact of the COVID-19 pandemic on the scientific community, public perceptions of infectious disease, and trust in public health authorities. CONCLUSIONS The LGBTQ + community and local sexual health clinics took crucial actions to counter stigma and support health seeking behaviour during the 2022-2023 UK mpox outbreak. Lessons from rights based and inclusive community-led approaches during outbreaks should be heeded in the UK, working towards more meaningful and timely collaboration between affected communities, primary healthcare, and regional and national public health authorities.
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Affiliation(s)
- Colette Pang Biesty
- Department of International Public Health, Liverpool University Hospitals NHS Foundation Trust/Liverpool School of Tropical Medicine, Liverpool, UK
| | - Charlotte Hemingway
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - James Woolgar
- Public Health Department, Liverpool City Council, Liverpool, UK
| | | | | | | | - Dawn Holford
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Miriam Taegtmeyer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Lee JS, Tyler ARB, Veinot TC, Yakel E. Now Is the Time to Strengthen Government-Academic Data Infrastructures to Jump-Start Future Public Health Crisis Response. JMIR Public Health Surveill 2024; 10:e51880. [PMID: 38656780 PMCID: PMC11079773 DOI: 10.2196/51880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/24/2024] [Accepted: 03/05/2024] [Indexed: 04/26/2024] Open
Abstract
During public health crises, the significance of rapid data sharing cannot be overstated. In attempts to accelerate COVID-19 pandemic responses, discussions within society and scholarly research have focused on data sharing among health care providers, across government departments at different levels, and on an international scale. A lesser-addressed yet equally important approach to sharing data during the COVID-19 pandemic and other crises involves cross-sector collaboration between government entities and academic researchers. Specifically, this refers to dedicated projects in which a government entity shares public health data with an academic research team for data analysis to receive data insights to inform policy. In this viewpoint, we identify and outline documented data sharing challenges in the context of COVID-19 and other public health crises, as well as broader crisis scenarios encompassing natural disasters and humanitarian emergencies. We then argue that government-academic data collaborations have the potential to alleviate these challenges, which should place them at the forefront of future research attention. In particular, for researchers, data collaborations with government entities should be considered part of the social infrastructure that bolsters their research efforts toward public health crisis response. Looking ahead, we propose a shift from ad hoc, intermittent collaborations to cultivating robust and enduring partnerships. Thus, we need to move beyond viewing government-academic data interactions as 1-time sharing events. Additionally, given the scarcity of scholarly exploration in this domain, we advocate for further investigation into the real-world practices and experiences related to sharing data from government sources with researchers during public health crises.
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Affiliation(s)
- Jian-Sin Lee
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | | | - Tiffany Christine Veinot
- School of Information, University of Michigan, Ann Arbor, MI, United States
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Department of Learning Health Sciences, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Elizabeth Yakel
- School of Information, University of Michigan, Ann Arbor, MI, United States
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Johnston JS, Zhang Aluri K, Job N, Kuhnert KL, Prober C, Ward V, Skinner NA. Exploring the role of community health organizations in promoting public health during a health crisis: a qualitative study of COVID-19 responses in South Africa and Zambia. Glob Health Promot 2024; 31:65-74. [PMID: 37909401 PMCID: PMC11010546 DOI: 10.1177/17579759231205854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 09/18/2023] [Indexed: 11/03/2023]
Abstract
While the COVID-19 pandemic amplified the need for accurate and actionable health information, uncertainty and the proliferation of misinformation have contributed to significant mistrust in public health messages, especially among marginalized communities. Community health organizations can play an important role in creating trust and providing targeted health information to vulnerable groups. This qualitative study, which is focused on community health organizations supporting vulnerable populations in South Africa and Zambia, finds that during the pandemic, community health organizations expanded their roles and leveraged their established access and trust to support the communities they serve with health education and services. However, the reliance on external support limits the organizations' ability to respond in an effective and efficient manner during health crises.
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Affiliation(s)
| | | | - Nophiwe Job
- Stanford Center for Health Education, Standford University, South Africa
| | - Kira-Leigh Kuhnert
- Stanford Center for Health Education, Standford University, South Africa
| | - Charles Prober
- Stanford Center for Health Education, Stanford University, USA
- School of Medicine, Stanford University, USA
| | - Victoria Ward
- Stanford Center for Health Education, Stanford University, USA
- School of Medicine, Stanford University, USA
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Stone H, Bailey E, Wurie H, Leather AJM, Davies JI, Bolkan HA, Sevalie S, Youkee D, Parmar D. A qualitative study examining the health system's response to COVID-19 in Sierra Leone. PLoS One 2024; 19:e0294391. [PMID: 38306321 PMCID: PMC10836672 DOI: 10.1371/journal.pone.0294391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/31/2023] [Indexed: 02/04/2024] Open
Abstract
The paper examines the health system's response to COVID-19 in Sierra Leone. It aims to explore how the pandemic affected service delivery, health workers, patient access to services, leadership, and governance. It also examines to what extent the legacy of the 2013-16 Ebola outbreak influenced the COVID-19 response and public perception. Using the WHO Health System Building Blocks Framework, we conducted a qualitative study in Sierra Leone where semi-structured interviews were conducted with health workers, policymakers, and patients between Oct-Dec 2020. We applied thematic analysis using both deductive and inductive approaches. Twelve themes emerged from the analysis: nine on the WHO building blocks, two on patients' experiences, and one on Ebola. We found that routine services were impacted by enhanced infection prevention control measures. Health workers faced additional responsibilities and training needs. Communication and decision-making within facilities were reported to be coordinated and effective, although updates cascading from the national level to facilities were lacking. In contrast with previous health emergencies which were heavily influenced by international organisations, we found that the COVID-19 response was led by the national leadership. Experiences of Ebola resulted in less fear of COVID-19 and a greater understanding of public health measures. However, these measures also negatively affected patients' livelihoods and their willingness to visit facilities. We conclude, it is important to address existing challenges in the health system such as resources that affect the capacity of health systems to respond to emergencies. Prioritising the well-being of health workers and the continued provision of essential routine health services is important. The socio-economic impact of public health measures on the population needs to be considered before measures are implemented.
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Affiliation(s)
- Hana Stone
- King’s Centre for Global Health and Health Partnerships, Department of Population Health Sciences, School of Life Course and Population Sciences, King’s College London, London, United Kingdom
| | - Emma Bailey
- King’s Centre for Global Health and Health Partnerships, Department of Population Health Sciences, School of Life Course and Population Sciences, King’s College London, London, United Kingdom
- King’s Sierra Leone Partnership, Connaught Hospital, Freetown, Sierra Leone
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Andrew J. M. Leather
- King’s Centre for Global Health and Health Partnerships, Department of Population Health Sciences, School of Life Course and Population Sciences, King’s College London, London, United Kingdom
| | - Justine I. Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Håkon A. Bolkan
- CapaCare, Freetown, Sierra Leone
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Case Management Pillar, National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
- 34 Military Hospital, Wilberforce, Freetown, Sierra Leone
| | - Daniel Youkee
- King’s Sierra Leone Partnership, Connaught Hospital, Freetown, Sierra Leone
- Case Management Pillar, National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
| | - Divya Parmar
- King’s Centre for Global Health and Health Partnerships, Department of Population Health Sciences, School of Life Course and Population Sciences, King’s College London, London, United Kingdom
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South J, Woodall J, Stansfield J, Mapplethorpe T, Passey A, Bagnall AM. A qualitative synthesis of practice-based learning from case studies on COVID community champion programmes in England, UK. BMC Public Health 2024; 24:7. [PMID: 38166766 PMCID: PMC10759547 DOI: 10.1186/s12889-023-17470-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Community-based volunteering supports outbreak management by extending reach into at-risk communities. This paper examines the application of a 'community champions' model in England, UK, during the COVID-19 pandemic. Evidence pre-pandemic shows that community champion interventions tap into social networks to strengthen connections with disadvantaged communities. During the pandemic, the UK government set up a COVID community champions funding award scheme for local authorities to develop local programmes that addressed emerging inequalities. The study aim was to identify transferable learning on community engagement in the pandemic by undertaking a secondary qualitative synthesis of practice-based case studies of local COVID community champion programmes. METHODS A systematic staged approach for synthesis of practice-based case studies was used. In total, 16 COVID community champion case studies, which were written by practitioners involved in local programme implementation and published by the Local Government Association, were included. Case studies covered aims, programme development and delivery, examples of activities and a discussion of learning. Framework qualitative analysis methods were used to code and organise data prior to cross case analysis. The final stage produced an overarching thematic framework that best represented descriptive and interpretive themes. RESULTS The results provide an overview of common features of COVID community champion programmes and emergent learning. All local programmes aimed to reduce health inequalities by involving at-risk communities in local prevention efforts, adapting the approach to local priorities. Two levels of community engagement were volunteer mobilisation and subsequent community-based outreach activities. Elements of capacity building, such as training and creation of networks, were common. The synthesis of practice-based learning found that stronger relationships with communities were regarded as a key mechanism to support more equitable prevention strategies. Other learning themes related to champion roles, community engagement strategies and programme implementation. CONCLUSIONS By focusing on how community champion approaches were applied by local authorities in England during the COVID-19 pandemic, this study contributes to knowledge on volunteer mobilisation as a mechanism to improve public health communication and outreach. Notwithstanding the limitations of experiential evidence, the synthesis of practice-based learning highlights potentially transferable community engagement strategies for health protection and health improvement.
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Affiliation(s)
- Jane South
- School of Health, Centre for Health Promotion Research, Leeds Beckett University, Calverley Building, Portland Place, Leeds, LS1 3HE, UK.
| | - James Woodall
- School of Health, Centre for Health Promotion Research, Leeds Beckett University, Calverley Building, Portland Place, Leeds, LS1 3HE, UK
| | - Jude Stansfield
- School of Health, Centre for Health Promotion Research, Leeds Beckett University, Calverley Building, Portland Place, Leeds, LS1 3HE, UK
| | - Tom Mapplethorpe
- Corporate Strategy, Commissioning and Public Health, Kirklees Council, Huddersfield, HD1 9EL, UK
| | - Andrew Passey
- School of Health, Centre for Health Promotion Research, Leeds Beckett University, Calverley Building, Portland Place, Leeds, LS1 3HE, UK
| | - Anne-Marie Bagnall
- School of Health, Centre for Health Promotion Research, Leeds Beckett University, Calverley Building, Portland Place, Leeds, LS1 3HE, UK
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Izudi J, Bajunirwe F. Case fatality rate for Ebola disease, 1976-2022: A meta-analysis of global data. J Infect Public Health 2024; 17:25-34. [PMID: 37992431 DOI: 10.1016/j.jiph.2023.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/07/2023] [Accepted: 10/22/2023] [Indexed: 11/24/2023] Open
Abstract
An up-to-date pooled case fatality rate (CFR) for Ebola disease (EBOD) at the global level is lacking. We abstracted EBOD data from 1976 to 2022 for 16 countries and 42 outbreaks to conduct a meta-analysis. The pooled CFR was 60.6% (95% confidence interval (CI) 51.6-69.4; 95% prediction interval 12.9-99.1). Of the four ebolaviruses, Zaire virus was the most lethal (CFR = 66.6%, 95% CI 55.9-76.8), then Sudan virus (CFR=48.5%, 95% CI 38.6-58.4), Bundibugyo virus (CFR=32.8%, 95% CI 25.8-40.2) and Tai Forest virus (CFR= 0%, 95% CI 0.0-97.5). The CFR in sub-Saharan Africa was 61.3% (95% CI 52.8-69.6) and for the rest of the world was 24.5% (95% CI 0.0-67.9%). CFR declined over time but stabilized at 61.0% (95% CI, 52.0-69.0) between 2014 and 2022. Overall, the EBOD CFR is still high and heterogeneous. Accordingly, early diagnosis, early treatment if available, and supportive care are important to prevent significant morbidity and mortality.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda; Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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10
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Hampton LM, Luquero F, Costa A, Legand A, Formenty P. Ebola outbreak detection and response since 2013. THE LANCET. MICROBE 2023; 4:e661-e662. [PMID: 37354912 PMCID: PMC10469237 DOI: 10.1016/s2666-5247(23)00136-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Lee M Hampton
- Gavi, the Vaccine Alliance, Global Health Campus, Grand-Saconnex, Switzerland.
| | - Francisco Luquero
- Gavi, the Vaccine Alliance, Global Health Campus, Grand-Saconnex, Switzerland
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Mothupi M, Dasgupta J, Hosseini Jebeli SS, Stevenson J, Berdichevsky K, Vong S, Barasa E, George A. Using an intersectionality approach to transform health services for overlooked healthcare users and workers after covid-19. BMJ 2023; 381:e072243. [PMID: 37286226 DOI: 10.1136/bmj-2022-072243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Mamothena Mothupi
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | | | | - Jacqui Stevenson
- United Nations University International Institute of Global Health, Kuala Lumpur, Malaysia
| | - Karla Berdichevsky
- National Center for Gender Equity and Reproductive Health, Ministry of Health, Mexico City, Mexico
| | | | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Asha George
- Complexity and Social Change, School of Public Health, University of the Western Cape, Cape Town, South Africa
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Du LJ. The opinions of community-centered engagement and health care during and after COVID-19 pandemic. Front Psychiatry 2023; 14:1168860. [PMID: 37215659 PMCID: PMC10196059 DOI: 10.3389/fpsyt.2023.1168860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/13/2023] [Indexed: 05/24/2023] Open
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Cénat JM, Broussard C, Darius WP, Onesi O, Auguste E, El Aouame AM, Ukwu G, Khodabocus SN, Labelle PR, Dalexis RD. Social mobilization, education, and prevention of the Ebola virus disease: A scoping review. Prev Med 2023; 166:107328. [PMID: 36356934 DOI: 10.1016/j.ypmed.2022.107328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 09/05/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022]
Abstract
The Ebola Virus Disease (EVD) remains a global public health concern with multiple outbreaks over the last five years. This scoping review aimed to synthesize the current state of knowledge on awareness, education, and community mobilization programs on EVD prevention. A comprehensive search strategy was executed in October 2021 across eight databases (APA PsycInfo, CINAHL, Cochrane CENTRAL, Embase, Global Health, MEDLINE, Scopus, and Web of Science). According to the PRISMA flow diagram, out of the 4815 studies generated by the search, 33 were retained for extraction and were included in this scoping review. Findings revealed that cultural practices that increased the risk of Ebola transmission remain very prevalent, even educational and awareness campaigns. Levels of Ebola-related knowledge by community members varied widely. A large proportion of the Ebola-affected populations were not aware of modes of transmission and half were unaware of signs and symptoms. Interventions with deep community mobilization, collaboration and engagement were effective in changing cultural practices, and reducing rates of infection. Interventions in the health sector helped increase willingness to practice preventive methods and the maintenance of social distancing and patient handwashing. A majority of the population members received their information about EVD from the community and mass media (in most instances, through broadcasting stations). Community interventions with a collaborative approach are effective to prevent EVD. It is needed to build trust between communities and health care, but also to use local resources and cultural factors combined with the use of technologies of information to prevent EVD.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on Black Health, University of Ottawa, Ottawa, Ontario, Canada.
| | | | | | - Olivia Onesi
- School of Psychology, University of Ottawa, Ontario, Canada
| | | | | | - Gloria Ukwu
- School of Psychology, University of Ottawa, Ontario, Canada
| | | | | | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ontario, Canada
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Musaazi J, Namageyo-Funa A, Carter VM, Carter RJ, Lamorde M, Apondi R, Bakyaita T, Boore AL, Brown VR, Homsy J, Kigozi J, Koyuncu A, Nabaggala MS, Nakate V, Nkurunziza E, Stowell DF, Walwema R, Olowo A, Jalloh MF. Evaluation of Community Perceptions and Prevention Practices Related to Ebola Virus as Part of Outbreak Preparedness in Uganda, 2020. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00661. [PMCID: PMC9242603 DOI: 10.9745/ghsp-d-21-00661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 03/29/2022] [Indexed: 11/15/2022]
Abstract
Targeted risk communication and community engagement strategies to raise Ebola virus disease awareness and knowledge, particularly in setting where risk of infection is perceived to be low, may not be sufficient to motivate people to adopt protective behaviors and prevention practices. Introduction: During the 2018–2020 Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo, risk communication and community engagement (RCCE) were prioritized in geographic areas in Uganda considered at high risk of introduction of EVD. To inform EVD preparedness in Uganda, we evaluated community perceptions and prevention practices related to EVD in 6 districts in Uganda. Methods: In March 2020, we conducted a population-based survey in 6 purposively selected districts in Uganda using multistage cluster sampling. We examined differences between districts classified as high- versus low risk for EVD in terms of their message exposure from RCCE; risk perception; and EVD knowledge, attitudes, and prevention practices. Results: A total of 3,485 respondents were interviewed (91% response rate). EVD message exposure was more common in the high- versus low-risk districts. EVD risk perceptions were low overall but greater in the high- versus low-risk districts. Comprehensive knowledge was significantly greater in the high- versus low-risk districts (adjusted prevalence ratio [aPR] 1.61, 95% confidence interval [CI]=1.35, 1.93). Respondents' engagement in all 3 EVD prevention practices (frequent handwashing with soap, avoiding physical contact with suspected Ebola patients, and avoiding burials involving contact with a corpse) was very low (4%). However, respondents with comprehensive knowledge were more likely to engage in all 3 EVD prevention practices compared to respondents without comprehensive knowledge (aPR 1.87, 95% CI=1.08, 3.25). Conclusion: Our findings suggest that while RCCE efforts as part of EVD outbreak preparedness may have contributed to higher EVD knowledge in the targeted high-risk districts, uptake of prevention behaviors was similarly low across districts. In a non-outbreak setting, implementing targeted RCCE strategies may not be sufficient to motivate people to adopt protective behaviors in the absence of a high threshold of perceived threat such as in an active outbreak.
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Affiliation(s)
- Joseph Musaazi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Correspondence to Joseph Musaazi ()
| | - Apophia Namageyo-Funa
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Victoria M. Carter
- National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rosalind J. Carter
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mohammed Lamorde
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rose Apondi
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Amy L. Boore
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Vance R. Brown
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jaco Homsy
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Institute for Global Health Sciences, University of California San Francisco, California, USA
| | - Joanita Kigozi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Aybüke Koyuncu
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Sarah Nabaggala
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Vivian Nakate
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emmanuel Nkurunziza
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Daniel F. Stowell
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Richard Walwema
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Apollo Olowo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mohamed F. Jalloh
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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15
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Bayugo YV, Labarda M, Cruz JRB, Mier-Alpaño JD, Tiangco PMP, Oyene UE, Omoleke SA, Ulitin A, Ong A, Fajardo MS, Echavarria MI, Alger J, Mathanga D, Msiska BK, Ekwunife OI, Nwaorgu O, Abella Lizcano L, Gomez Quenguan N, Nieto Anderson CI, Beltran BY, Carcamo Rodriguez ED, Núñez ES, Nkosi-Kholimeliwa V, Mwafulirwa-Kabaghe G, Juban N. Description of global innovative methods in developing the WHO Community Engagement Package. BMJ Open 2022; 12:e063144. [PMID: 35672075 PMCID: PMC9174797 DOI: 10.1136/bmjopen-2022-063144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Development of a Community Engagement Package composed of (1) database of community engagement (CE) experiences from different contexts, (2) CE learning package of lessons and tools presented as online modules, and (3) CE workshop package for identifying CE experiences to enrich the CE database and ensure regular update of learning resources. The package aims to guide practitioners to promote local action and enhance skills for CE. SETTING AND PARTICIPANTS The packages were co-created with diverse teams from WHO, Social Innovation in Health Initiative, UNICEF, community practitioners, and other partners providing synergistic contributions and bridging existing silos. METHODS The design process of the package was anchored on CE principles. Literature search was performed using standardised search terms through global and regional databases. Interviews with CE practitioners were also conducted. RESULTS A total of 356 cases were found to fit the inclusion criteria and proceeded to data extraction and thematic analysis. Themes were organised according to rationale, key points and insights, facilitators of CE and barriers to CE. Principles and standards of CE in various contexts served as a foundation for the CE learning package. The package comprises four modules organised by major themes such as mobilising communities, strengthening health systems, CE in health emergencies and CE as a driver for health equity. CONCLUSION After pilot implementation, tools and resources were made available for training and continuous collection of novel CE lessons and experiences from diverse socio-geographical contexts.
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Affiliation(s)
| | - Meredith Labarda
- School of Health Sciences, University of the Philippines Manila, Manila, Philippines
| | | | | | | | | | | | - Allan Ulitin
- Institute of Health Policy and Development Studies - National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Alberto Ong
- Alliance for Improving Health Outcomes, Quezon City, Philippines
| | | | - Maria Isabel Echavarria
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Jackeline Alger
- Hospital Escuela, Tegucigalpa, Honduras
- Instituto de Enfermedades Infecciosas y Parasitologia Antonio Vidal, Tegucigalpa, Honduras
| | - Don Mathanga
- College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Obinna Ikechukwu Ekwunife
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Nigeria
- Social Innovation in Health Initiative (SIHI), Nnamdi Azikiwe University, Awka, Nigeria
| | - Obioma Nwaorgu
- Social Innovation in Health Initiative (SIHI), Nnamdi Azikiwe University, Awka, Nigeria
- Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Lorena Abella Lizcano
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Natalia Gomez Quenguan
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | | | | | | | - Eduardo Salomón Núñez
- Facultad de Ciencias Médicas, Universidad Católica de Honduras Nuestra Señora Reina de la Paz Facultad de Ciencias de la Salud, Tegucigalpa, Honduras
- Cirugía General, Hospital General Santa Teresa, Comayagua, Honduras
| | | | | | - Noel Juban
- Department of Clinical Epidemiology, University of the Philippines Manila, Manila, Philippines
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16
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Ravaghi H, Naidoo V, Mataria A, Khalil M. Hospitals early challenges and interventions combatting COVID-19 in the Eastern Mediterranean Region. PLoS One 2022; 17:e0268386. [PMID: 35657795 PMCID: PMC9165776 DOI: 10.1371/journal.pone.0268386] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/28/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND During rapidly evolving outbreaks, health services and essential medical care are interrupted as facilities have become overwhelmed responding to COVID-19. In the Eastern Mediterranean Region (EMR), more than half of countries are affected by emergencies, hospitals face complex challenges as they respond to humanitarian crises, maintain essential services, and fight the pandemic. While hospitals in the EMR have adapted to combat COVID-19, evidence-based and context-specific recommendations are needed to guide policymakers and hospital managers on best practices to strengthen hospitals' readiness, limit the impact of the pandemic, and create lasting hospital sector improvements towards recovery and resilience. AIM Guided by the WHO/EMR's "Hospital readiness checklist for COVID-19", this study presents the experiences of EMR hospitals in combatting COVID-19 across the 22 EMR countries, including their challenges and interventions across the checklist domains, to inform improvements to pandemic preparedness, response, policy, and practice. METHODS To collect in-depth and comprehensive information on hospital experiences, qualitative and descriptive quantitative data was collected between May-October 2020. To increase breadth of responses, this comprehensive qualitative study triangulated findings from a regional literature review with the findings of an open-ended online survey (n = 139), and virtual in-depth key informant interviews with 46 policymakers and hospital managers from 18 out of 22 EMR countries. Purposeful sampling supported by snowballing was used and continued until reaching data saturation, measures were taken to increase the trustworthiness of the results. Led by the checklist domains, qualitative data was thematically analyzed using MAXQDA. FINDINGS Hospitals faced continuously changing challenges and needed to adapt to maintain operations and provide essential services. This thematic analysis revealed major themes for the challenges and interventions utilized by hospitals for each of hospital readiness domains: Preparedness, Leadership, Operational support, logistics, supply management, Communications and Information, Human Resources, Continuity of Essential Services and Surge Capacity, Rapid Identification and Diagnosis, Isolation and Case Management, and Infection, Prevention and Control. CONCLUSION Hospitals are the backbone of COVID-19 response, and their resilience is essential for achieving universal health coverage. Multi-pronged (across each of the hospitals readiness domains) and multi-level policies are required to strengthen hospitals resilience and prepare health systems for future outbreaks and shocks.
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Affiliation(s)
- Hamid Ravaghi
- Universal Health Coverage and Health Systems Department, World Health Organization, Eastern Mediterranean Regional Office, Cairo, Egypt
| | - Vanessa Naidoo
- Division of Emergency Medicine at the University of Cape Town, Cape Town, South Africa
| | - Awad Mataria
- Universal Health Coverage and Health Systems Department, World Health Organization, Eastern Mediterranean Regional Office, Cairo, Egypt
| | - Merette Khalil
- Universal Health Coverage and Health Systems Department, World Health Organization, Eastern Mediterranean Regional Office, Cairo, Egypt
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17
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Tam WJ, Gobat N, Hemavathi D, Fisher D. Risk Communication and Community Engagement During the Migrant Worker COVID-19 Outbreak in Singapore. SCIENCE COMMUNICATION 2022; 44:240-251. [PMID: 35440864 PMCID: PMC8655121 DOI: 10.1177/10755470211061513] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In early phases of the COVID-19 pandemic in Singapore, Risk Communication and Community Engagement (RCCE) with large, diverse communities of migrant workers living in high-density accommodation was slow to develop. By August 2020, Singapore had reported 55,661 cases of COVID-19, with migrant workers comprising 94.6% of the cases. A system of RCCE among migrant worker communities in Singapore was developed to maximize synergy in RCCE. Proactive stakeholder engagement and participatory approaches with affected communities were key to effective dissemination of scientific information about COVID-19 and its prevention.
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Affiliation(s)
| | | | | | - Dale Fisher
- National University of Singapore,
Singapore
- National University Hospital, Singapore
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18
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Sserwanja Q, Mufumba I, Kamara K, Musaba MW. Rural-urban correlates of skilled birth attendance utilisation in Sierra Leone: evidence from the 2019 Sierra Leone Demographic Health Survey. BMJ Open 2022; 12:e056825. [PMID: 35351721 PMCID: PMC8961150 DOI: 10.1136/bmjopen-2021-056825] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Understanding the rural-urban context-specific correlates of skilled birth attendance (SBA) is important to designing relevant strategies and programmes. This analysis aimed to assess for the rural-urban correlates of SBA in Sierra Leone. SETTING The latest nationally representative Sierra Leone Demographic and Health Survey of 2019. PARTICIPANTS The study included a weighted sample of 7326 women aged 15-49 years. Each of them had a live birth within 5 years prior to the survey (4531 in rural areas and 2795 women in urban areas). PRIMARY AND SECONDARY OUTCOME MEASURE SBA (primary) and predictors of SBA (secondary). RESULTS SBA was higher in urban areas at 94.9% (95% CI 94.1% to 95.7%) compared with 84.2% (95% CI 83.8% to 85.9%) in rural areas. Rural women resident in the Southern, Northern and Eastern regions, with postprimary education (adjusted OR (aOR) 1.8; 95% CI 1.3 to 2.5), exposure to mass media (aOR 1.5; 95% CI 1.1 to 1.9), not having difficulties with distance to the nearest health facility (aOR 2.3; 95% CI 1.7 to 3.0) were associated with higher odds of SBA. Urban women resident in the Southern, Eastern region, with households having less than seven members (aOR 1.5; 95% CI 1.1 to 2.3), exposure to mass media (aOR 1.8; 95% CI 1.1 to 2.9) and not having difficulties with distance to the nearest health facility (aOR 1.6; 95% CI 1.1 to 2.5) were associated with higher odds of SBA. CONCLUSION Given the observed differences, improving SBA requires programmes and strategies that are context-specific.
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Affiliation(s)
| | - Ivan Mufumba
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- CHILD Research Laboratory, Global Health Uganda, Kampala, Uganda
| | - Kassim Kamara
- National Disease Surveillance Programme, Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area, Sierra Leone
| | - Milton W Musaba
- Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
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19
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Corbin JH, Oyene UE, Manoncourt E, Onya H, Kwamboka M, Amuyunzu-Nyamongo M, Sørensen K, Mweemba O, Barry MM, Munodawafa D, Bayugo YV, Huda Q, Moran T, Omoleke SA, Spencer-Walters D, Van den Broucke S. A health promotion approach to emergency management: effective community engagement strategies from five cases. Health Promot Int 2021; 36:i24-i38. [PMID: 34897448 PMCID: PMC8667549 DOI: 10.1093/heapro/daab152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Community engagement is crucial for controlling disease outbreak and mitigating natural and industrial disasters. The COVID-19 pandemic has reconfirmed the need to elevate community engagement to build equity, trust and sustained action in future health promotion preparedness strategies. Using the health promotion strategy of strengthening community action enhances the opportunity for better outcomes. There is, therefore, a need to improve our understanding of community engagement practices during crises, scale-up good community engagement initiatives, and improve and sustain people-centered approaches to emergency responses. This paper presents five case studies from the United States, Singapore, Sierra Leone, Kenya and South Africa that demonstrate the potential strengths that can be nurtured to build resilience in local communities to help mitigate the impact of disasters and emergencies. The case studies highlight the importance of co-developing relevant education and communication strategies, amplifying the role of community leaders, empowering community members to achieve shared goals, assessing and adapting to changing contexts, pre-planning and readiness for future emergencies and acknowledgement of historic context.
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Affiliation(s)
- J Hope Corbin
- Department of Health and Community Studies, Western Washington University, Bellingham, WA, USA
| | - Ukam Ebe Oyene
- Country Readiness Strengthening Department, WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Erma Manoncourt
- School of Global Public Health, New York University, New York, NY, USA
- Paris School of International Affairs, Sciences Po, Paris, France
| | - Hans Onya
- Department of Public Health, University of Limpopo, Sovenga, South Africa
| | | | | | | | - Oliver Mweemba
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Margaret M Barry
- World Health Organization Collaborating Centre for Health Promotion Research, School of Health Sciences, National University of Ireland, Galway, Ireland
| | - Davison Munodawafa
- Department of Community Medicine, Faculty of Medicine, Midlands State University, Gweru, Zimbabwe
- Global Health, Thammasat University, Bangkok, Thailand
| | - Yolanda V Bayugo
- Country Readiness Strengthening Department , WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Qudsia Huda
- Health Security and Preparedness Department, WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Tomas Moran
- Global Infectious Hazards Preparedness Department, WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Dayo Spencer-Walters
- Country Readiness Strengthening Department , WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Stephan Van den Broucke
- Faculté de Psychologie et des Sciences de l'Education, Institut de Recherche en Sciences Psychologiques, Université catholique de Louvain, Louvain-la-Neuve, Belgium
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20
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Bernardin A, Martínez AJ, Perez-Acle T. On the effectiveness of communication strategies as non-pharmaceutical interventions to tackle epidemics. PLoS One 2021; 16:e0257995. [PMID: 34714848 PMCID: PMC8555801 DOI: 10.1371/journal.pone.0257995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/15/2021] [Indexed: 12/02/2022] Open
Abstract
When pharmaceutical interventions are unavailable to deal with an epidemic outbreak, adequate management of communication strategies can be key to reduce the contagion risks. On the one hand, accessibility to trustworthy and timely information, whilst on the other, the adoption of preventive behaviors may be both crucial. However, despite the abundance of communication strategies, their effectiveness has been scarcely evaluated or merely circumscribed to the scrutiny of public affairs. To study the influence of communication strategies on the spreading dynamics of an infectious disease, we implemented a susceptible-exposed-infected-removed-dead (SEIRD) epidemiological model, using an agent-based approach. Agents in our systems can obtain information modulating their behavior from two sources: (i) through the local interaction with other neighboring agents and, (ii) from a central entity delivering information with a certain periodicity. In doing so, we highlight how global information delivered from a central entity can reduce the impact of an infectious disease and how informing even a small fraction of the population has a remarkable impact, when compared to not informing the population at all. Moreover, having a scheme of delivering daily messages makes a stark difference on the reduction of cases, compared to the other evaluated strategies, denoting that daily delivery of information produces the largest decrease in the number of cases. Furthermore, when the information spreading relies only on local interactions between agents, and no central entity takes actions along the dynamics, then the epidemic spreading is virtually independent of the initial amount of informed agents. On top of that, we found that local communication plays an important role in an intermediate regime where information coming from a central entity is scarce. As a whole, our results highlight the importance of proper communication strategies, both accurate and daily, to tackle epidemic outbreaks.
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Affiliation(s)
- Alejandro Bernardin
- Computational Biology Lab (DLab), Fundación Ciencia & Vida, Santiago, Chile
- Centro Interdisciplinario de Neurociencia de Valparaíso, Facultad de Ciencias, Universidad de Valparaíso, Valparaíso, Chile
| | - Alejandro J. Martínez
- Computational Biology Lab (DLab), Fundación Ciencia & Vida, Santiago, Chile
- Facultad de Ingeniería y Tecnología, Universidad San Sebastián, Santiago, Chile
- * E-mail: (AJM); (TPA)
| | - Tomas Perez-Acle
- Computational Biology Lab (DLab), Fundación Ciencia & Vida, Santiago, Chile
- Centro Interdisciplinario de Neurociencia de Valparaíso, Facultad de Ciencias, Universidad de Valparaíso, Valparaíso, Chile
- Facultad de Ingeniería y Tecnología, Universidad San Sebastián, Santiago, Chile
- * E-mail: (AJM); (TPA)
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21
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Brandt AJ, Katalenich B, Seal DW. Qualitative Review of Organizational Responses to Rumors in the 2014-2016 Ebola Virus Disease Outbreak in Liberia and Sierra Leone. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:654-667. [PMID: 34593588 PMCID: PMC8514024 DOI: 10.9745/ghsp-d-21-00203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/15/2021] [Indexed: 11/23/2022]
Abstract
Rumors and misinformation were a challenge in the 2014–2016 Ebola Virus Disease response and continue to be so in the current COVID-19 pandemic. It is important to understand previous organizational approaches to identifying and addressing rumors to refine and improve these approaches. Introduction: Rumors and misperceptions were a persistent challenge in the response to the 2014–2016 Ebola Virus Disease (EVD) outbreak in West Africa. This study aimed to document organizational approaches to identifying and addressing rumors and provide practical recommendations for future outbreaks. Methods: We conducted semistructured interviews with 34 individuals who participated in the EVD response in Liberia and/or Sierra Leone. Interviews focused on the general organizational approach and organizational response to specific rumors. Interviews were recorded and transcribed verbatim. Results: Most respondents reported that rumors were considered an organizational priority and their importance increased over time. Formal rumor identification systems using community-level reporters were described in Liberia and Sierra Leone as well as varied informal systems. A wide range of approaches was used to address rumors including Community Led Ebola Action, Community Led Total Sanitation, drama performances, Ebola Treatment Center/Unit-based approaches, radio, leveraging community leaders as an information source, and organization change. Interpersonal and community-led approaches were described most often. Staff whose professional roles did not involve rumor management reported informally addressing rumors with colleagues and beneficiaries. Rumors reflecting valid concerns with the EVD response, such as potential infection in health care facilities, were addressed through organizational change and improvement. Discussion: Interpersonal and community-led approaches were considered effective by participants and hold promise for future outbreaks. Informal systems developed at Ebola Treatment Centers/Units highlighted how these facilities may be utilized as an information hub. Professionals who interact with beneficiaries, especially local staff, are likely to address rumors informally and organizations may benefit from considering local staff an asset in rumor management. Rumors alerted responders to issues in the EVD response, but this may not be the most efficient mechanism to receive and address concerns.
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Affiliation(s)
- Amelia J Brandt
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.,Center for Salud/Health & Opportunities for Latinos, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bonnie Katalenich
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - David W Seal
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
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22
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A review and agenda for integrated disease models including social and behavioural factors. Nat Hum Behav 2021; 5:834-846. [PMID: 34183799 DOI: 10.1038/s41562-021-01136-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 05/14/2021] [Indexed: 02/05/2023]
Abstract
Social and behavioural factors are critical to the emergence, spread and containment of human disease, and are key determinants of the course, duration and outcomes of disease outbreaks. Recent epidemics of Ebola in West Africa and coronavirus disease 2019 (COVID-19) globally have reinforced the importance of developing infectious disease models that better integrate social and behavioural dynamics and theories. Meanwhile, the growth in capacity, coordination and prioritization of social science research and of risk communication and community engagement (RCCE) practice within the current pandemic response provides an opportunity for collaboration among epidemiological modellers, social scientists and RCCE practitioners towards a mutually beneficial research and practice agenda. Here, we provide a review of the current modelling methodologies and describe the challenges and opportunities for integrating them with social science research and RCCE practice. Finally, we set out an agenda for advancing transdisciplinary collaboration for integrated disease modelling and for more robust policy and practice for reducing disease transmission.
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23
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Jalloh MF, Sengeh P, James N, Bah S, Jalloh MB, Owen K, Pratt SA, Oniba A, Sangarie M, Sesay S, Bedson J. Integrated digital system for community engagement and community-based surveillance during the 2014-2016 Ebola outbreak in Sierra Leone: lessons for future health emergencies. BMJ Glob Health 2021; 5:bmjgh-2020-003936. [PMID: 33355270 PMCID: PMC7757454 DOI: 10.1136/bmjgh-2020-003936] [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: 09/09/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 11/04/2022] Open
Abstract
Community engagement and community-based surveillance are essential components of responding to infectious disease outbreaks, but real-time data reporting remains a challenge. In the 2014-2016 Ebola outbreak in Sierra Leone, the Social Mobilisation Action Consortium was formed to scale-up structured, data-driven community engagement. The consortium became operational across all 14 districts and supported an expansive network of 2500 community mobilisers, 6000 faith leaders and 42 partner radio stations. The benefit of a more agile digital reporting system became apparent within few months of implementing paper-based reporting given the need to rapidly use the data to inform the fast-evolving epidemic. In this paper, we aim to document the design, deployment and implementation of a digital reporting system used in six high transmission districts. We highlight lessons learnt from our experience in scaling up the digital reporting system during an unprecedented public health crisis. The lessons learnt from our experience in Sierra Leone have important implications for designing and implementing similar digital reporting systems for community engagement and community-based surveillance during public health emergencies.
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Affiliation(s)
- Mohamed F Jalloh
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden .,Focus 1000, Freetown, Sierra Leone
| | | | | | - Saiku Bah
- Restless Development Sierra Leone, Freetown, Sierra Leone
| | | | | | | | | | | | - Samuel Sesay
- Health Education Division, Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area, Sierra Leone
| | - Jamie Bedson
- Restless Development Sierra Leone, Freetown, Sierra Leone
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24
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Jalloh MF, Kinsman J, Conteh J, Kaiser R, Jambai A, Ekström AM, Bunnell RE, Nordenstedt H. Barriers and facilitators to reporting deaths following Ebola surveillance in Sierra Leone: implications for sustainable mortality surveillance based on an exploratory qualitative assessment. BMJ Open 2021; 11:e042976. [PMID: 33986045 PMCID: PMC8126305 DOI: 10.1136/bmjopen-2020-042976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To understand the barriers contributing to the more than threefold decline in the number of deaths (of all causes) reported to a national toll free telephone line (1-1-7) after the 2014-2016 Ebola outbreak ended in Sierra Leone and explore opportunities for improving routine death reporting as part of a nationwide mortality surveillance system. DESIGN An exploratory qualitative assessment comprising 32 in-depth interviews (16 in Kenema district and 16 in Western Area). All interviews were audio-recorded, transcribed and analysed using qualitative content analysis to identify themes. SETTING Participants were selected from urban and rural communities in two districts that experienced varying levels of Ebola cases during the outbreak. All interviews were conducted in August 2017 in the post-Ebola-outbreak context in Sierra Leone when the Sierra Leone Ministry of Health and Sanitation was continuing to mandate reporting of all deaths. PARTICIPANTS Family members of deceased persons whose deaths were not reported to the 1-1-7 system. RESULTS Death reporting barriers were driven by the lack of awareness to report all deaths, lack of services linked to reporting, negative experiences from the Ebola outbreak including prohibition of traditional burial rituals, perception that inevitable deaths do not need to be reported and situations where prompt burials may be needed. Facilitators of future willingness to report deaths were largely influenced by the perceived communicability and severity of the disease, unexplained circumstances of the death that need investigation and the potential to leverage existing death notification practices through local leaders. CONCLUSIONS Social mobilisation and risk communication efforts are needed to help the public understand the importance and benefits of sustained and ongoing death reporting after an Ebola outbreak. Localised practices for informal death notification through community leaders could be integrated into the formal reporting system to capture community-based deaths that may otherwise be missed.
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Affiliation(s)
- Mohamed F Jalloh
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John Kinsman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Reinhard Kaiser
- Sierra Leone Country Office, U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Amara Jambai
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Rebecca E Bunnell
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Helena Nordenstedt
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Šehović AB, Govender K. Addressing COVID-19 vulnerabilities: How do we achieve global health security in an inequitable world. Glob Public Health 2021; 16:1198-1208. [PMID: 33870859 DOI: 10.1080/17441692.2021.1916056] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The spread of the serve acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, [WHO. (2019). Naming the coronavirus disease (COVID-19) and the virus that causes it. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it] and is responsible for the COVID-19 pandemic is another in a long line of Coronavirus outbreak - and unlikely to be the last. More than a year into the pandemic, SARS-CoV-2 has exposed the dangerous hollowness of a global commitment to global health security. Global health security (GHS) has no uncontested definition, and despite ample pandemic warnings (HIV, H1N1, SARS, MERS-CoV, Ebola, Zika) the world, remains woefully unprepared for an adequate pandemic response; its lack of preparation the predicable result of inattention to equity and with it global health security. The first section of this paper lays out the particular challenges of COVID-19 for less well-resourced countries. The second part discusses the inequities being perpetuated and accentuated in the development and distribution of COVID-19 vaccines. The third section discusses ways to address these global inequities and its related complexities. We conclude by restating some of the key priorities for achieving GHS.
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Affiliation(s)
| | - Kaymarlin Govender
- College of Law and Management Sciences, University of KwaZulu-Natal, Durban, South Africa
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26
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Erlach E, Nichol B, Reader S, Baggio O. Using Community Feedback to Guide the COVID-19 Response in Sub-Saharan Africa: Red Cross and Red Crescent Approach and Lessons Learned from Ebola. Health Secur 2021; 19:13-20. [PMID: 33497272 PMCID: PMC9195486 DOI: 10.1089/hs.2020.0195] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Risk communication and community engagement are critical elements of epidemic response. Despite progress made in this area, few examples of regional feedback mechanisms in Africa provide information on community concerns and perceptions in real time. To enable humanitarian responders to move beyond disseminating messages, work in partnership with communities, listen to their ideas, identify community-led solutions, and support implementation of solutions systems need to be in place for documenting, analyzing, and acting on community feedback. This article describes how the International Federation of Red Cross and Red Crescent Societies and its national societies in sub-Saharan Africa have worked to establish and strengthen systems to ensure local intelligence and community insights inform operational decision making. As part of the COVID-19 response, a system was set up to collect, compile, and analyze unstructured community feedback from across the region. We describe how this system was set up based on a system piloted in the response to Ebola in the Democratic Republic of the Congo, which tools were adapted and shared across the region, and how the information gathered was used to shape and adapt the response of the Red Cross and Red Crescent Societies and the broader humanitarian response.
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Affiliation(s)
- Eva Erlach
- Eva Erlach, Mag.a iur, is Community Engagement and Accountability (CEA) Delegate and Bronwyn Nichol, MPH, is Community Epidemic and Pandemic Preparedness Delegate, Health and Care Unit; both at the International Federation of Red Cross and Red Crescent Societies (IFRC), Africa Regional Office, Nairobi, Kenya. Sharon Reader, MA, is a Norwegian Capacity (Norwegian Refugee Council) CEA Global Advisor and freelance consultant (previously IFRC Africa CEA Senior Advisor), Glasgow, Scotland. Ombretta Baggio, MA, is Senior Advisor, Community Engagement and Accountability, IFRC, Geneva, Switzerland
| | - Bronwyn Nichol
- Eva Erlach, Mag.a iur, is Community Engagement and Accountability (CEA) Delegate and Bronwyn Nichol, MPH, is Community Epidemic and Pandemic Preparedness Delegate, Health and Care Unit; both at the International Federation of Red Cross and Red Crescent Societies (IFRC), Africa Regional Office, Nairobi, Kenya. Sharon Reader, MA, is a Norwegian Capacity (Norwegian Refugee Council) CEA Global Advisor and freelance consultant (previously IFRC Africa CEA Senior Advisor), Glasgow, Scotland. Ombretta Baggio, MA, is Senior Advisor, Community Engagement and Accountability, IFRC, Geneva, Switzerland
| | - Sharon Reader
- Eva Erlach, Mag.a iur, is Community Engagement and Accountability (CEA) Delegate and Bronwyn Nichol, MPH, is Community Epidemic and Pandemic Preparedness Delegate, Health and Care Unit; both at the International Federation of Red Cross and Red Crescent Societies (IFRC), Africa Regional Office, Nairobi, Kenya. Sharon Reader, MA, is a Norwegian Capacity (Norwegian Refugee Council) CEA Global Advisor and freelance consultant (previously IFRC Africa CEA Senior Advisor), Glasgow, Scotland. Ombretta Baggio, MA, is Senior Advisor, Community Engagement and Accountability, IFRC, Geneva, Switzerland
| | - Ombretta Baggio
- Eva Erlach, Mag.a iur, is Community Engagement and Accountability (CEA) Delegate and Bronwyn Nichol, MPH, is Community Epidemic and Pandemic Preparedness Delegate, Health and Care Unit; both at the International Federation of Red Cross and Red Crescent Societies (IFRC), Africa Regional Office, Nairobi, Kenya. Sharon Reader, MA, is a Norwegian Capacity (Norwegian Refugee Council) CEA Global Advisor and freelance consultant (previously IFRC Africa CEA Senior Advisor), Glasgow, Scotland. Ombretta Baggio, MA, is Senior Advisor, Community Engagement and Accountability, IFRC, Geneva, Switzerland
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27
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Jalloh MF, Nur AA, Nur SA, Winters M, Bedson J, Pedi D, Prybylski D, Namageyo-Funa A, Hageman KM, Baker BJ, Jalloh MB, Eng E, Nordenstedt H, Hakim AJ. Behaviour adoption approaches during public health emergencies: implications for the COVID-19 pandemic and beyond. BMJ Glob Health 2021; 6:e004450. [PMID: 33514594 PMCID: PMC7849902 DOI: 10.1136/bmjgh-2020-004450] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/29/2022] Open
Abstract
Human behaviour will continue to play an important role as the world grapples with public health threats. In this paper, we draw from the emerging evidence on behaviour adoption during diverse public health emergencies to develop a framework that contextualises behaviour adoption vis-à-vis a combination of top-down, intermediary and bottom-up approaches. Using the COVID-19 pandemic as a case study, we operationalise the contextual framework to demonstrate how these three approaches differ in terms of their implementation, underlying drivers of action, enforcement, reach and uptake. We illustrate how blended strategies that include all three approaches can help accelerate and sustain protective behaviours that will remain important even when safe and effective vaccines become more widely available. As the world grapples with the COVID-19 pandemic and prepares to respond to (re)emerging public health threats, our contextual framework can inform the design, implementation, tracking and evaluation of comprehensive public health and social measures during health emergencies.
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Affiliation(s)
- Mohamed F Jalloh
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aasli A Nur
- Department of Sociology, University of Washington, Seattle, Washington, USA
| | - Sophia A Nur
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maike Winters
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jamie Bedson
- Independent Consultant, Seattle, Washington, USA
| | - Danielle Pedi
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Dimitri Prybylski
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Apophia Namageyo-Funa
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathy M Hageman
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brian J Baker
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Eugenia Eng
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Helena Nordenstedt
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Avi J Hakim
- CDC COVID-19 Response Team, Atlanta, Georgia, USA
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28
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Graffigna G, Bosio C, Savarese M, Barello M, Barello S. "#I-Am-Engaged": Conceptualization and First Implementation of a Multi-Actor Participatory, Co-designed Social Media Campaign to Raise Italians Citizens' Engagement in Preventing the Spread of COVID-19 Virus. Front Psychol 2020; 11:567101. [PMID: 33250811 PMCID: PMC7674954 DOI: 10.3389/fpsyg.2020.567101] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/25/2020] [Indexed: 01/29/2023] Open
Abstract
The COVID-19 pandemic forced health authorities around the world to introduce public health measures to contain the risks of contagion. This greatly impacted on citizens' quality of life, often raising concerns and reactance. There is an ongoing urgent need to promote and sustain behavioral changes and adherence to preventive measures. Based on the theoretical framework of the Patient Health Engagement Model and a participatory co-design process, a social media campaign aimed at improving citizens' health engagement toward behavioral change for preventing the spread of COVID-19 was promoted in Italy in the early months of the pandemic. In this paper, we describe the methodological process adopted to develop the campaign, its characteristics, and the first results-in terms of audience reach and engagement in its early implementation. The discussion of this grounded-up and citizen-centered approach to social campaign development highlights key ways of promoting learning, engaging citizens, and supporting their participation in the co-production of educational interventions for behavioral change toward preventive actions.
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Affiliation(s)
- Guendalina Graffigna
- EngageMinds HUB – Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Faculty of Agricultural, Nutrition and Environmental Sciences, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Caterina Bosio
- EngageMinds HUB – Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Mariarosaria Savarese
- EngageMinds HUB – Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Faculty of Agricultural, Nutrition and Environmental Sciences, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Marina Barello
- EngageMinds HUB – Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Serena Barello
- EngageMinds HUB – Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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