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Schedwin M, Bisumba Furaha A, Elimian K, King C, Malembaka EB, Yambayamba MK, Tylleskär T, Alfvén T, Carter SE, Welo Okitayemba P, Mapatano MA, Hildenwall H. Facility capacity and provider knowledge for cholera surveillance and diarrhoea case management in cholera hotspots in the Democratic Republic of Congo - a mixed-methods study. Glob Health Action 2024; 17:2317774. [PMID: 38441883 PMCID: PMC10916892 DOI: 10.1080/16549716.2024.2317774] [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: 11/06/2023] [Accepted: 02/08/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Wider healthcare-strengthening interventions are recommended in cholera hotspots and could benefit other types of diarrhoeal diseases which contribute to greater mortality than cholera. OBJECTIVE Describe facility capacity and provider knowledge for case management of diarrhoea and cholera surveillance in cholera hotspots in the Democratic Republic of Congo (DRC) among health facilities, drug shops, and traditional health practitioners. METHODS We conducted a sequential exploratory mixed-method study, using focus group discussions, facility audits, and provider knowledge questionnaires during September and October 2022 in North Kivu and Tanganyika provinces, Eastern DRC. Content analysis was used for qualitative data. Quantitative data were summarised by facility level and healthcare provider type. Audit and knowledge scores (range 0-100) were generated. Multivariable linear regression estimated association between scores and explanatory factors. Qualitative and quantitative data were triangulated during interpretation. RESULTS Overall, 244 facilities and 308 providers were included. The mean audit score for health facilities was 51/100 (SD: 17). Private facilities had an -11.6 (95% CI, -16.7 to -6.6) lower adjusted mean score compared to public. Mean knowledge score was 59/100 (95% CI, 57 to 60) for health facility personnel, 46/100 (95% CI, 43 to 48) for drug shop vendors and 37/100 (95% CI, 34 to 39) for traditional health practitioners. Providers had particularly low knowledge concerning when to check for low blood sugar, use of nasogastric tubes, and dosing schedules. Knowledge about case definitions for cholera was similar between groups (range 41-58%) except for traditional health practitioners for the definition during an outbreak 15/73 (21%). CONCLUSIONS Increasing awareness of cholera case definitions in this context could help improve cholera surveillance and control. Increased support and supervision, especially for private providers, could help ensure facilities are equipped to provide safe care. More nuanced aspects of case management should be emphasised in provider training.
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Affiliation(s)
- Mattias Schedwin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Aurélie Bisumba Furaha
- Paediatric Department, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Kelly Elimian
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Exhale Health Foundation, Abuja, Nigeria
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Espoir Bwenge Malembaka
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Center for Tropical Diseases and Global Health, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Marc K Yambayamba
- Department of Epidemiology and Biostatistics, Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
- Section Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Thorkild Tylleskär
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Sach’s Children and Youth Hospital, Stockholm, Sweden
| | - Simone E Carter
- Public Health Emergencies, UNICEF, Kinshasa, Democratic Republic of Congo
| | - Placide Welo Okitayemba
- Programme National d’Elimination du Choléra et de lutte contre les autres Maladies Diarrhéiques, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Mala Ali Mapatano
- Department of Nutrition, Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Helena Hildenwall
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Schedwin M, Furaha AB, Hildenwall H, Elimian K, Malembaka EB, Yambayamba MK, Forsberg BC, Van Damme W, Alfvén T, Carter SE, Okitayemba PW, Mapatano MA, King C. Exploring different health care providers´ perceptions on the management of diarrhoea in cholera hotspots in the Democratic Republic of Congo: A qualitative content analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002896. [PMID: 38502678 PMCID: PMC10950234 DOI: 10.1371/journal.pgph.0002896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Abstract
Global cholera guidelines support wider healthcare system strengthening interventions, alongside vertical outbreak responses, to end cholera. Well-trained healthcare providers are essential for a resilient health system and can create synergies with childhood diarrhoea, which has higher mortality. We explored how the main provider groups for diarrhoea in cholera hotspots interact, decide on treatment, and reflect on possible limiting factors and opportunities to improve prevention and treatment. We conducted focus group discussions in September 2022 with different healthcare provider types in two urban and two rural cholera hotspots in the North Kivu and Tanganyika provinces in the Eastern Democratic Republic of Congo. Content analysis was used with the same coding applied to all providers. In total 15 focus group discussions with medical doctors (n = 3), nurses (n = 4), drug shop vendors (n = 4), and traditional health practitioners (n = 4) were performed. Four categories were derived from the analysis. (i) Provider dynamics: scepticism between all cadres was prominent, whilst also acknowledging the important role all provider groups have in current case management. (ii) Choice of treatment: affordability and strong caregiver demands shaped by cultural beliefs strongly affected choice. (iii) Financial consideration on access: empathy was strong, with providers finding innovative ways to create access to treatment. Concurrently, financial incentives were important, and providers asked for this to be considered when subsiding treatment. (iv) How to improve: the current cholera outbreak response approach was appreciated however there was a strong wish for broader long-term interventions targeting root causes, particularly community access to potable water. Drug shops and traditional health practitioners should be considered for inclusion in health policies for cholera and other diarrhoeal diseases. Financial incentives for the provider to improve access to low-cost treatment and investment in access to potable water should furthermore be considered.
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Affiliation(s)
- Mattias Schedwin
- Department of Global Public Health, Stockholm, Sweden
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Aurélie Bisumba Furaha
- Paediatric Department, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Helena Hildenwall
- Department of Global Public Health, Stockholm, Sweden
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Karolinska Institutet, Intervention and Technology, Stockholm, Sweden
| | - Kelly Elimian
- Department of Global Public Health, Stockholm, Sweden
- Exhale Health Foundation, Abuja, Nigeria
| | - Espoir Bwenge Malembaka
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Tropical Diseases and Global Health, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Marc K. Yambayamba
- Vetsuisse Faculty, Section Epidemiology, University of Zurich, Zurich, Switzerland
- Department of Epidemiology and Biostatistics, Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tobias Alfvén
- Department of Global Public Health, Stockholm, Sweden
- Sach’s Children and Youth Hospital, Stockholm, Sweden
| | - Simone E. Carter
- Public Health Emergencies, UNICEF, Kinshasa, Democratic Republic of Congo
| | - Placide Welo Okitayemba
- Programme National d’Elimination du Choléra et de Lutte Contre les Autres Maladies Diarrhéiques, Kinshasa, Democratic Republic of Congo
| | - Mala Ali Mapatano
- Department of Nutrition, Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Carina King
- Department of Global Public Health, Stockholm, Sweden
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Molima CEN, Karemere H, Makali S, Bisimwa G, Macq J. Is a bio-psychosocial approach model possible at the first level of health services in the Democratic Republic of Congo? An organizational analysis of six health centers in South Kivu. BMC Health Serv Res 2023; 23:1238. [PMID: 37951897 PMCID: PMC10638814 DOI: 10.1186/s12913-023-10216-0] [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: 10/26/2022] [Accepted: 10/26/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND The health system, in the Democratic Republic of Congo, is expected to move towards a more people-centered form of healthcare provision by implementing a biopsychosocial (BPS) approach. It's then important to examine how change is possible in providing healthcare at the first line of care. This study aims to analyze the organizational capacity of health centers to implement a BPS approach in the first line of care. METHODS A mixed descriptive and analytical study was conducted from November 2017 to February 2018. Six health centers from four Health Zones (South Kivu, Democratic Republic of Congo) were selected for this study. An organizational analysis of six health centers based on 15 organizational capacities using the Context and Capabilities for Integrating Care (CCIC) as a theoretical framework was conducted. Data were collected through observation, document review, and individual interviews with key stakeholders. The annual utilization rate of curative services was analyzed using trends for the six health centers. The organizational analysis presented three categories (Basic Structures, People and values, and Key Processes). RESULT This research describes three components in the organization of health services on a biopsychosocial model (Basic Structures, People and values, and Key processes). The current functioning of health centers in South Kivu shows strengths in the Basic Structures component. The health centers have physical characteristics and resources (financial, human) capable of operating health services. Weaknesses were noted in organizational governance through sharing of patient experience, valuing patient needs in Organizational/Network Culture, and Focus on Patient Centeredness & Engagement as well as partnering with other patient care channels. CONCLUSION This study highlighted the predisposition of health centers to implement a BPS approach to their organizational capacities. The study highlights how national policies could regulate the organization of health services on the front line by relying more on the culture of teamwork in the care structures and focusing on the needs of the patients. Paying particular attention to the values of the agents and specific key processes could enable the implementation of the BPS approach at the health center level.
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Affiliation(s)
- Christian Eboma Ndjangulu Molima
- École Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero N°2, Kadutu, Bukavu, Democratic Republic of Congo.
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium.
| | - Hermès Karemere
- École Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero N°2, Kadutu, Bukavu, Democratic Republic of Congo
| | - Samuel Makali
- École Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero N°2, Kadutu, Bukavu, Democratic Republic of Congo
| | - Ghislain Bisimwa
- École Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero N°2, Kadutu, Bukavu, Democratic Republic of Congo
| | - Jean Macq
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
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Zeng W, Samaha H, Yao M, Ahuka-Mundeke S, Wilkinson T, Jombart T, Baabo D, Lokonga JP, Yuma S, Mobula-Shufelt L. The cost of public health interventions to respond to the 10th Ebola outbreak in the Democratic Republic of the Congo. BMJ Glob Health 2023; 8:e012660. [PMID: 37848269 PMCID: PMC10583089 DOI: 10.1136/bmjgh-2023-012660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023] Open
Abstract
The 10th Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) drew substantial attention from the international community, which in turn invested more than US$1 billion in EVD control over two years (2018-2020). This is the first EVD outbreak to take place in a conflict area, which led to a shift in strategy from a pure public health response (PHR) to a multisectoral humanitarian response. A wide range of disease control and mitigation activities were implemented and were outlined in the five budgeted Strategic Response Plans used throughout the 26 months. This study used the budget/expenditure and output indicators for disease control and mitigation interventions compiled by the government of DRC and development and humanitarian partners to estimate unit costs of key Ebola control interventions. Of all the investment in EVD control, 68% was spent on PHR. The remaining 32% covered security, community support interventions for the PHR. The disbursement for the public health pillar was distributed as follows: (1) coordination (18.8%), (2), clinical management of EVD cases (18.4%), (3) surveillance and vaccination (15.9%), (4) infection prevention and control/WASH (13.8%) and (5) risk communication (13.7%). The unit costs of key EVD control interventions were as follows: US$66 182 for maintaining a rapid response team per month, US$4435 for contact tracing and surveillance per identified EVD case, US$1464 for EVD treatment per case, US$59.4 per EVD laboratory test, US$120.7 per vaccinated individual against EVD and US$175.0 for mental health and psychosocial support per beneficiary. The estimated unit costs of key EVD disease control interventions provide crucial information for future infectious disease control planning and budgeting, as well as prioritisation of disease control interventions.
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Affiliation(s)
- Wu Zeng
- Department of Global Health, Georgetown University, Washington, District of Columbia, USA
| | - Hadia Samaha
- World Bank Group, Washington, District of Columbia, USA
| | - Michel Yao
- World Health Organization, Geneva, Switzerland
| | - Steve Ahuka-Mundeke
- National Institute for Biomedical Research, Kinshasa, Congo (the Democratic Republic of the)
| | | | - Thibaut Jombart
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Dominique Baabo
- Project Implementation Unit of World Bank Health Projects, Ministry of Public Health, Hygiene and Prevention, Kinshasa, Congo (the Democratic Republic of the)
| | - Jean-Pierre Lokonga
- Project Implementation Unit of World Bank Health Projects, Ministry of Public Health, Hygiene and Prevention, Kinshasa, Congo (the Democratic Republic of the)
| | - Sylvain Yuma
- Ministry of Public Health, Hygiene and Prevention, Kinshasa, Congo (the Democratic Republic of the)
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Diarra T, Okeibunor J, Diallo B, Onyeneho N, Rodrigue B, N’da Konan Yao M, Yoti Z, Djingarey MH, Fall S, Gueye AS. Epidemic Response amidst Insecurity: Addressing the Ebola Virus Epidemic in the Provinces of North Kivu and Ituri. JOURNAL OF IMMUNOLOGICAL SCIENCES 2023; Suppl 3:1-10. [PMID: 38333351 PMCID: PMC7615620 DOI: 10.29245/2578-3009/2023/s3.1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
This paper examines the impact of insecurity on the management of the Ebola virus disease epidemic in the Democratic Republic of the Congo provinces of North Kivu and Ituri. In these provinces, insecurity has been one of the biggest obstacles in the response to the Ebola outbreak. When the epidemic began, these provinces were already insecure-creating unfavorable circumstances for implementing epidemic response activities. While the ninth epidemic in the Equateur province was brought under control in record time, the same was not true for the tenth epidemic in North Kivu and Ituri. Since the epidemic began, teams were organized to address all aspects of the response. These response teams conducted extensive fieldwork, including epidemiological surveillance, risk communication and community involvement, infection prevention and control, vaccination, dignified and safe burials, care at transit centers and Ebola treatment centers, and medical and psychosocial care for the recovered. They faced confrontational reactions from the communities, which jeopardized their security. The insecure state of the provinces led to the destruction and damage of infrastructure, including healthcare facilities, which affected the ability of rescue teams to access people needing care as well as the resources they needed to care for the ill. Worse yet, the insecurity took other forms, including threatening and kidnapping members of the response teams, lodging protests against the response activities in towns or health zones, committing violence against teams responsible for safe and dignified burials, instigating altercations between community members and members of the response team, and encouraging general resistance by the population. This level of insecurity interrupted or even halted response activities in some areas-sometimes for more than two weeks, decreasing the efficiency of the response teams, particularly in monitoring contacts due to the inability to access certain communities. Additionally, certain acts of protest, such as community members handling bodies as a demonstration of their opposition to safe and dignified burials, likely intensified disease spread. However, the involvement of community leaders, at least, made dialogue and negotiation possible between the response teams and community members, as such efforts led to communities contributing to the security of personnel involved in the fight against the Ebola epidemic in North Kivu and Ituri provinces.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Soce Fall
- World Health Organization, Switzerland
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Schots MAS, Coleman HLS, Lutwama GW, Straetemans M, Jacobs E. The impact of the COVID-19 pandemic on healthcare access and utilisation in South Sudan: a cross-sectional mixed methods study. BMC Health Serv Res 2022; 22:1559. [PMID: 36539823 PMCID: PMC9765347 DOI: 10.1186/s12913-022-08929-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Indirect effects of the COVID-19 pandemic on communities in fragile and conflict-affected settings may be severe due to reduced access and use of healthcare, as happened during the 2015 Ebola Virus Disease outbreak. Achieving a balance between short-term emergency response and addressing long-term health needs is particularly challenging in fragile and conflict-affected settings such as South Sudan, given the already significant barriers to accessing healthcare for the population. This study sought to characterise the effect of COVID-19 on healthcare access and South Sudan's healthcare response. This can inform efforts to mitigate the potential impacts of COVID-19 or other epidemiological threats, and contribute to understanding how these may be balanced for greater health system resilience in fragile contexts. METHODS We conducted a mixed methods study in three of South Sudan's states, combining data from a cross-sectional quantitative household survey with qualitative interviews and Focus Group Discussions. RESULTS Even though some fears related to COVID-19 were reported, we found these did not greatly dissuade people from seeking care and do not yield significant consequences for health system programming in South Sudan. The pillars of the response focused on risk communication and community engagement were effective in reaching communities through different channels. Respondents and participants reported behaviour changes that were in line with public health advice. We also found that the implementation of COVID-19 response activities sometimes created frictions between the national government and international health actors, and that COVID-19 caused a greater reliance on, and increased responsibility for, international donors for health planning. CONCLUSIONS Given the fact that global priorities on COVID-19 are greatly shifting, power dynamics between international health agencies and the national government may be useful to consider in further COVID-19 planning, particularly for the vaccine roll-out. South Sudan must now navigate a period of transition where COVID-19 vaccine roll-out continues and other domestic health burdens are re-prioritised.
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Affiliation(s)
- M. A. S. Schots
- grid.11503.360000 0001 2181 1687KIT Royal Tropical Institute, Mauritskade 64, Amsterdam, 1092 AD The Netherlands
| | - H. L. S. Coleman
- grid.11503.360000 0001 2181 1687KIT Royal Tropical Institute, Mauritskade 64, Amsterdam, 1092 AD The Netherlands
| | - G. W. Lutwama
- grid.11503.360000 0001 2181 1687KIT Royal Tropical Institute, Mauritskade 64, Amsterdam, 1092 AD The Netherlands ,Health Pooled Fund, American Embassy Residency Road, Juba, South Sudan
| | - M. Straetemans
- grid.11503.360000 0001 2181 1687KIT Royal Tropical Institute, Mauritskade 64, Amsterdam, 1092 AD The Netherlands
| | - E. Jacobs
- grid.11503.360000 0001 2181 1687KIT Royal Tropical Institute, Mauritskade 64, Amsterdam, 1092 AD The Netherlands
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Ryan CS, Belizaire MRD, Nanyunja M, Olu OO, Ahmed YA, Latt A, Kol MT, Bamuleke B, Tusiime J, Nsabimbona N, Conteh I, Nyashanu S, Ramadan PO, Woldetsadik SF, Nkata JPM, Ntwari JT, Nzeyimana SD, Ouedraogo L, Batona G, Ndahindwa V, Mgamb EA, Armah M, Wamala JF, Guyo AG, Freeman AYS, Chimbaru A, Komakech I, Kuku M, Firmino WM, Saguti GE, Msemwa F, O-Tipo S, Kalubula PC, Nsenga N, Talisuna AO. Sustainable strategies for Ebola virus disease outbreak preparedness in Africa: a case study on lessons learnt in countries neighbouring the Democratic Republic of the Congo. Infect Dis Poverty 2022; 11:118. [PMID: 36461100 PMCID: PMC9716502 DOI: 10.1186/s40249-022-01040-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/02/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND From May 2018 to September 2022, the Democratic Republic of Congo (DRC) experienced seven Ebola virus disease (EVD) outbreaks within its borders. During the 10th EVD outbreak (2018-2020), the largest experienced in the DRC and the second largest and most prolonged EVD outbreak recorded globally, a WHO risk assessment identified nine countries bordering the DRC as moderate to high risk from cross border importation. These countries implemented varying levels of Ebola virus disease preparedness interventions. This case study highlights the gains and shortfalls with the Ebola virus disease preparedness interventions within the various contexts of these countries against the background of a renewed and growing commitment for global epidemic preparedness highlighted during recent World Health Assembly events. MAIN TEXT Several positive impacts from preparedness support to countries bordering the affected provinces in the DRC were identified, including development of sustained capacities which were leveraged upon to respond to the subsequent coronavirus disease 2019 (COVID-19) pandemic. Shortfalls such as lost opportunities for operationalizing cross-border regional preparedness collaboration and better integration of multidisciplinary perspectives, vertical approaches to response pillars such as surveillance, over dependence on external support and duplication of efforts especially in areas of capacity building were also identified. A recurrent theme that emerged from this case study is the propensity towards implementing short-term interventions during active Ebola virus disease outbreaks for preparedness rather than sustainable investment into strengthening systems for improved health security in alignment with IHR obligations, the Sustainable Development Goals and advocating global policy for addressing the larger structural determinants underscoring these outbreaks. CONCLUSIONS Despite several international frameworks established at the global level for emergency preparedness, a shortfall exists between global policy and practice in countries at high risk of cross border transmission from persistent Ebola virus disease outbreaks in the Democratic Republic of Congo. With renewed global health commitment for country emergency preparedness resulting from the COVID-19 pandemic and cumulating in a resolution for a pandemic preparedness treaty, the time to review and address these gaps and provide recommendations for more sustainable and integrative approaches to emergency preparedness towards achieving global health security is now.
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Affiliation(s)
| | | | | | | | - Yahaya Ali Ahmed
- grid.463718.f0000 0004 0639 2906WHO Regional Office for Africa, Brazzaville, Congo
| | - Anderson Latt
- grid.452949.7WHO Sub-Regional Office for Africa, Dakar, Senegal
| | - Matthew Tut Kol
- grid.508167.dAfrica Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Bertrand Bamuleke
- grid.463718.f0000 0004 0639 2906WHO Country Office, Brazzaville, Congo
| | - Jayne Tusiime
- grid.463718.f0000 0004 0639 2906WHO Regional Office for Africa, Brazzaville, Congo
| | - Nadia Nsabimbona
- grid.463718.f0000 0004 0639 2906WHO Regional Office for Africa, Brazzaville, Congo
| | - Ishata Conteh
- grid.463718.f0000 0004 0639 2906WHO Regional Office for Africa, Brazzaville, Congo
| | | | - Patrick Otim Ramadan
- grid.463718.f0000 0004 0639 2906WHO Regional Office for Africa, Brazzaville, Congo
| | | | | | | | | | | | - Georges Batona
- grid.463718.f0000 0004 0639 2906WHO Country Office, Brazzaville, Congo
| | | | | | - Magdalene Armah
- grid.463718.f0000 0004 0639 2906WHO Regional Office for Africa, Brazzaville, Congo
| | | | | | | | | | | | | | | | | | | | - Shikanga O-Tipo
- grid.439056.d0000 0000 8678 0773WHO Country Office, Lusaka, Zambia
| | | | - Ngoy Nsenga
- WHO Country Office, Bangui, Central African Republic
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Flinn J, Michalek A, Bow L, Hynes NA, Philpot D, Garibaldi BT. The Use of Temperature and Pressure Data Loggers to Validate the Steam Sterilization of Category A Clinical Waste. APPLIED BIOSAFETY 2022; 27:106-115. [PMID: 36776749 PMCID: PMC9908284 DOI: 10.1089/apb.2022.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction Over the past decade, there have been outbreaks associated with high consequence infectious diseases such as Ebola virus disease, Lassa fever, and Monkeypox. The proper handling of clinical waste from patients infected with such pathogens is critical to ensure healthcare personnel and community safety. Methods Mock clinical waste bags were created to simulate four distinct waste streams: personal protective equipment (PPE), dry linens, wet linens, and solidified liquids. Pressure and temperature data loggers were buried in the middle of simulated waste loads to record time at a sterilization temperature of 132°C (270°F) to reduce sterilization time. We also validated super rapid biological indicators (BIs) by embedding standard BIs (48 h), rapid BIs (3 h), and super rapid BIs (24 min) within each load. Cycles were validated over a 2-day period, using a total of 36 simulated waste bags (6 bags each for PPE, dry linen, and wet linen, and 18 bags for solidified liquids). Results All waste bags achieved the target sterilization temperature, all BIs passed and cycle times were substantially decreased. For PPE waste processing, an estimated 15 h was saved for a 24-h period. Discussion Default factory settings are inadequate to disinfect Category A clinical waste. Reliance on autoclave temperature readings may overestimate time at goal sterilization temperature for actual waste loads. Conclusions The data provided by within bag data loggers and BIs allow for the optimization of autoclave parameters to increase throughput and enhance staff safety.
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Affiliation(s)
- Jade Flinn
- Department of Nursing and The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Andrew Michalek
- Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Lindsay Bow
- Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Noreen A. Hynes
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Donald Philpot
- Facilities Management, Johns Hopkins Health System, Baltimore, Maryland, USA
| | - Brian T. Garibaldi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Address correspondence to: Brian T. Garibaldi, Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, 1830 East Monument Street, Baltimore, MD 21205, USA.
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