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Baatiema L, Sanuade OA, Allen LN, Abimbola S, Hategeka C, Koram KA, Kruk ME. Health system adaptions to improve care for people living with non-communicable diseases during COVID-19 in low-middle income countries: A scoping review. J Glob Health 2023; 13:06006. [PMID: 36862142 PMCID: PMC9980283 DOI: 10.7189/iogh.13.06006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Background During the COVID-19 pandemic, access to health care for people living with non-communicable diseases (NCDs) has been significantly disrupted. Calls have been made to adapt health systems and innovate service delivery models to improve access to care. We identified and summarized the health systems adaptions and interventions implemented to improve NCD care and their potential impact on low- and middle-income countries (LMICs). Methods We comprehensively searched Medline/PubMed, Embase, CINAHL, Global Health, PsycINFO, Global Literature on coronavirus disease, and Web of Science for relevant literature published between January 2020 and December 2021. While we targeted articles written in English, we also included papers published in French with abstracts written in English. Results After screening 1313 records, we included 14 papers from six countries. We identified four unique health systems adaptations/interventions for restoring, maintaining, and ensuring continuity of care for people living with NCDs: telemedicine or teleconsultation strategies, NCD medicine drop-off points, decentralization of hypertension follow-up services and provision of free medication to peripheral health centers, and diabetic retinopathy screening with a handheld smartphone-based retinal camera. We found that the adaptations/interventions enhanced continuity of NCD care during the pandemic and helped bring health care closer to patients using technology and easing access to medicines and routine visits. Telephonic aftercare services appear to have saved a significant amount of patients' time and funds. Hypertensive patients recorded better blood pressure controls over the follow-up period. Conclusions Although the identified measures and interventions for adapting health systems resulted in potential improvements in access to NCD care and better clinical outcomes, further exploration is needed to establish the feasibility of these adaptations/interventions in different settings given the importance of context in their successful implementation. Insights from such implementation studies are critical for ongoing health systems strengthening efforts to mitigate the impact of COVID-19 and future global health security threats for people living with NCDs.
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Affiliation(s)
- Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Olutobi A Sanuade
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Luke N Allen
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Seye Abimbola
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Celestin Hategeka
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kwadwo A Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Dolatshahi Z, Nargesi S, Sadeghifar J, Mezginejad F, Jafari A, Bazyar M, Ghafourian S, Sani'ee N. Economic evaluation of laboratory diagnostic test types in Covid-19 epidemic: A systematic review. Int J Surg 2022; 105:106820. [PMID: 35987335 PMCID: PMC9384461 DOI: 10.1016/j.ijsu.2022.106820] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/24/2022] [Accepted: 07/30/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Corona 2 virus (SARS-CoV-2) is known as the causative agent of COVID-19 disease; the World Health Organization (WHO) declared it an epidemic on March 11, 2020. The Joint Guidelines of the Centers for Disease Control and Prevention (CDC) and the WHO including social distancing, the use of face masks, emphasis on hand washing, quarantine, and using diagnosis tests have been used widely, but the value of diagnostic interventions to prevent the transmission of SARS-CoV-2 is unclear. We compared the economic evaluation of different laboratory diagnostic interventions with each other and also with implementing the conservative CDC & WHO guidelines. MATERIAL AND METHODS Electronic searches were conducted on PubMed, Embase, Science Direct, Scopus, Cochrane Library, Web of Knowledge, NHSEED, NHS Health Technology assessment (CRD), and Cost-Effectiveness Analysis Registry databases. Related articles were reviewed from January 2020 to the end of November 2021. RESULTS Out of 1791 initial studies, 13 articles had the inclusion criteria. According to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist, ten studies were of excellent quality, and the remaining two studies were of very good quality. Most studies were cost-effectiveness analysis studies. The entered studies had different time horizons. Diagnostic tests reviewed in the studies included real-time polymerase chain reaction (RT-PCR) test, immunoglobulin G (IgG) & Antigen, point of care tests. Although polymerase chain reaction (PCR) testing improves the quality of life and survival for patients with infected Covid-19 based on its greater effectiveness compared to standard protection protocols, due to the high cost of this intervention, it has been considered a cost-effective method in some countries. CONCLUSION Since most studies have been conducted in developed countries, it unquestionably does not make sense to extend these results to low-income and developing countries. Therefore further studies are required in low-income and developing countries to evaluate the cost-effectiveness of laboratory-based diagnostic methods (RT-PCR) of covid-19 in variable prevalence of infectious cases.
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Affiliation(s)
- Zeinab Dolatshahi
- Department of Health Policy, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shahin Nargesi
- Department of Health Management and Economics, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran.
| | - Jamil Sadeghifar
- Department of Health Management and Economics, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Fateme Mezginejad
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Abdosaleh Jafari
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Bazyar
- Department of Health Management and Economics, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Sobhan Ghafourian
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Nadia Sani'ee
- Ph.D. in Medical Library and Information Science, Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
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Yen W, Liu L, Won E, Testriono. The imperative of state capacity in public health crisis: Asia's early COVID-19 policy responses. GOVERNANCE (OXFORD, ENGLAND) 2022; 35:777-798. [PMID: 35601355 PMCID: PMC9111679 DOI: 10.1111/gove.12695] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 04/01/2022] [Accepted: 04/18/2022] [Indexed: 06/05/2024]
Abstract
Preexisting political institutions influence governments' responses to public health crises in different ways, creating national variations. This article investigates how state capacity, a country's fundamental ability to organize bureaucracy and allocate societal resources, affects the timing and configuration of governments' COVID-19 policy responses. Through comparative case study analysis of five of China's neighboring countries early in the COVID-19 crisis, the paper shows that more-capable states (Singapore, South Korea, Taiwan) initiated crisis response faster, mobilized national resources more extensively, and utilized diverse policy tools when the virus risk level was still low. In contrast, low-capacity states (Thailand and Indonesia) were more reactive in handling the crisis, limited their focus to border-related measures, and were more constrained in the types of tools they could employ. The paper points to the importance of studying the COVID-19 response process rather than the outcome (i.e., confirmed cases/deaths) when unpacking the impacts of political institutions in public health crises.
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Affiliation(s)
- Wei‐Ting Yen
- Franklin and Marshall CollegeLancasterPennsylvaniaUSA
| | | | - Eunji Won
- Northern Illinois UniversityDeKalbIllinoisUSA
| | - Testriono
- Northern Illinois UniversityDeKalbIllinoisUSA
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Yigezu A, Zewdie SA, Mirkuzie AH, Abera A, Hailu A, Agachew M, Memirie ST. Cost-analysis of COVID-19 sample collection, diagnosis, and contact tracing in low resource setting: The case of Addis Ababa, Ethiopia. PLoS One 2022; 17:e0269458. [PMID: 35679290 PMCID: PMC9182302 DOI: 10.1371/journal.pone.0269458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 05/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background Ethiopia has been responding to the COVID-19 pandemic through a combination of interventions, including non-pharmaceutical interventions, quarantine, testing, isolation, contact tracing, and clinical management. Estimating the resources consumed for COVID-19 prevention and control could inform efficient decision-making for epidemic/pandemic-prone diseases in the future. This study aims to estimate the unit cost of COVID-19 sample collection, laboratory diagnosis, and contact tracing in Addis Ababa, Ethiopia. Methods Primary and secondary data were collected to estimate the costs of COVID-19 sample collection, diagnosis, and contact tracing. A healthcare system perspective was used. We used a combination of micro-costing (bottom-up) and top-down approaches to estimate resources consumed and the unit costs of the interventions. We used available cost and outcome data between May and December 2020. The costs were classified into capital and recurrent inputs to estimate unit and total costs. We identified the cost drivers of the interventions. We reported the cost for the following outcome measures: (1) cost per sample collected, (2) cost per laboratory diagnosis, (3) cost per sample collected and laboratory diagnosis, (4) cost per contact traced, and (5) cost per COVID-19 positive test identified. We conducted one-way sensitivity analysis by varying the input parameters. All costs were reported in US dollars (USD). Results The unit cost per sample collected was USD 1.33. The unit cost of tracing a contact of an index case was USD 0.66. The unit cost of COVID-19 diagnosis, excluding the cost for sample collection was USD 3.91. The unit cost of sample collection per COVID-19 positive individual was USD 11.63. The unit cost for COVID-19 positive test through contact tracing was USD 54.00. The unit cost COVID-19 DNA PCR diagnosis for identifying COVID-19 positive individuals, excluding the sample collection and transport cost, was USD 37.70. The cost per COVID-19 positive case identified was USD 49.33 including both sample collection and laboratory diagnosis costs. Among the cost drivers, personnel cost (salary and food cost) takes the highest share for all interventions, ranging from 51–76% of the total cost. Conclusion The costs of sample collection, diagnosis, and contact tracing for COVID-19 were high given the low per capita health expenditure in Ethiopia and other low-income settings. Since the personnel cost accounts for the highest cost, decision-makers should focus on minimizing this cost when faced with pandemic-prone diseases by strengthening the health system and using digital platforms. The findings of this study can help decision-makers prioritize and allocate resources for effective public health emergency response.
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Affiliation(s)
- Amanuel Yigezu
- National Data Management Center for Health, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
- * E-mail:
| | - Samuel Abera Zewdie
- Partnership and Cooperation Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | - Alemnesh H. Mirkuzie
- National Data Management Center for Health, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Adugna Abera
- Parasitology Department, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Alemayehu Hailu
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care Medicine, University of Bergen, Bergen, Norway
| | - Mesfin Agachew
- National Data Management Center for Health, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Solomon Tessema Memirie
- Addis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Keita M, Lucaccioni H, Ilumbulumbu MK, Polonsky J, Nsio-Mbeta J, Panda GT, Adikey PC, Ngwama JK, Tosalisana MK, Diallo B, Subissi L, Dakissaga A, Finci I, de Almeida MM, Guha-Sapir D, Talisuna A, Delamou A, Dagron S, Keiser O, Ahuka-Mundeke S. Evaluation of Early Warning, Alert and Response System for Ebola Virus Disease, Democratic Republic of the Congo, 2018-2020. Emerg Infect Dis 2021; 27:2988-2998. [PMID: 34808084 PMCID: PMC8632192 DOI: 10.3201/eid2712.210290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The 10th and largest Ebola virus disease epidemic in the Democratic Republic of the Congo (DRC) was declared in North Kivu Province in August 2018 and ended in June 2020. We describe and evaluate an Early Warning, Alert and Response System (EWARS) implemented in the Beni health zone of DRC during August 5, 2018–June 30, 2020. During this period, 194,768 alerts were received, of which 30,728 (15.8%) were validated as suspected cases. From these, 801 confirmed and 3 probable cases were detected. EWARS showed an overall good performance: sensitivity and specificity >80%, nearly all (97%) of alerts investigated within 2 hours of notification, and good demographic representativeness. The average cost of the system was US $438/case detected and US $1.8/alert received. The system was stable, despite occasional disruptions caused by political insecurity. Our results demonstrate that EWARS was a cost-effective component of the Ebola surveillance strategy in this setting.
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Languon S, Quaye O. Impacts of the Filoviridae family. Curr Opin Pharmacol 2021; 60:268-274. [PMID: 34482213 DOI: 10.1016/j.coph.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/13/2021] [Accepted: 07/27/2021] [Indexed: 11/19/2022]
Abstract
Over 40 filovirus disease outbreaks have been reported since the discovery of the first member of the Filoviridae family, and most of the outbreaks have occurred in Africa. In addition to deaths (primary impacts), there have also been health, social, economic, and political effects (secondary impacts) due to the outbreaks. Two large filovirus disease outbreaks have occurred in West and Central Africa in recent times, and direct and indirect repercussions resulting from the outbreaks underscores the need to strengthen the capacity of health services in disease hotspots.
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Affiliation(s)
- Sylvester Languon
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana; Global Virus Network (GVN), 725 West Lombard St., Baltimore, MD, 21201, USA
| | - Osbourne Quaye
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana; Global Virus Network (GVN), 725 West Lombard St., Baltimore, MD, 21201, USA.
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Analysis of Residents’ Preparedness Protocols during Ebola Pandemic in Urban Environment. SUSTAINABILITY 2021. [DOI: 10.3390/su13168934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The study provided empirical analysis of the change in hygiene behavioural practices among community in Ogun and Lagos State with respect to Ebola outbreak in Nigeria. Methods: The data were extracted from a 2015 Cross-Sectional Survey on wellness, knowledge, attitude and practices towards the control and prevention of Ebola virus disease (EVD). Out of 1093 respondents selected in the main survey through simple random sampling technique within two enumeration areas (EAs), only 933 data cases were analyzable, leaving an attrition rate of 14.6%. The EAs represents the sampling points within the local government areas selected for the interviewed. Descriptive and inferential statistical techniques were both employed in the data analysis. Results: The results revealed high level of knowledge of EVD but over 70% were not aware of centre for treatment of EVD; 60.2% believed they cannot be susceptible to EVD. There were changes in certain practices that were canvassed and earlier adhered to during the outbreak. The practice of handshaking reduced, eating of hunted animals decreased only marginally by 6.9% and washing with soap increased by 4%. Conclusion: The study provides helpful insights for public health policy on possible mitigating strategies, especially in terms of behavioral risk factors that are prone to Ebola virus infections or other communicable diseases. The study emphasises that regular hand washing with soap and the use of sanitising agents including availability of treatment centres would be helpful in preventing the occurrence or re-occurrence of pandemic. The protocols identified in this study could be relevant to both medical personnel and the community for adoption especially as the unlikelihood of Ebola (or other pandemic) re-emergence have not been established.
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8
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Rakotonanahary RJL, Andriambolamanana H, Razafinjato B, Raza-Fanomezanjanahary EM, Ramanandraitsiory V, Ralaivavikoa F, Tsirinomen'ny Aina A, Rahajatiana L, Rakotonirina L, Haruna J, Cordier LF, Murray MB, Cowley G, Jordan D, Krasnow MA, Wright PC, Gillespie TR, Docherty M, Loyd T, Evans MV, Drake JM, Ngonghala CN, Rich ML, Popper SJ, Miller AC, Ihantamalala FA, Randrianambinina A, Ramiandrisoa B, Rakotozafy E, Rasolofomanana A, Rakotozafy G, Andriamahatana Vololoniaina MC, Andriamihaja B, Garchitorena A, Rakotonirina J, Mayfield A, Finnegan KE, Bonds MH. Integrating Health Systems and Science to Respond to COVID-19 in a Model District of Rural Madagascar. Front Public Health 2021; 9:654299. [PMID: 34368043 PMCID: PMC8333873 DOI: 10.3389/fpubh.2021.654299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/31/2021] [Indexed: 11/17/2022] Open
Abstract
There are many outstanding questions about how to control the global COVID-19 pandemic. The information void has been especially stark in the World Health Organization Africa Region, which has low per capita reported cases, low testing rates, low access to therapeutic drugs, and has the longest wait for vaccines. As with all disease, the central challenge in responding to COVID-19 is that it requires integrating complex health systems that incorporate prevention, testing, front line health care, and reliable data to inform policies and their implementation within a relevant timeframe. It requires that the population can rely on the health system, and decision-makers can rely on the data. To understand the process and challenges of such an integrated response in an under-resourced rural African setting, we present the COVID-19 strategy in Ifanadiana District, where a partnership between Malagasy Ministry of Public Health (MoPH) and non-governmental organizations integrates prevention, diagnosis, surveillance, and treatment, in the context of a model health system. These efforts touch every level of the health system in the district-community, primary care centers, hospital-including the establishment of the only RT-PCR lab for SARS-CoV-2 testing outside of the capital. Starting in March of 2021, a second wave of COVID-19 occurred in Madagascar, but there remain fewer cases in Ifanadiana than for many other diseases (e.g., malaria). At the Ifanadiana District Hospital, there have been two deaths that are officially attributed to COVID-19. Here, we describe the main components and challenges of this integrated response, the broad epidemiological contours of the epidemic, and how complex data sources can be developed to address many questions of COVID-19 science. Because of data limitations, it still remains unclear how this epidemic will affect rural areas of Madagascar and other developing countries where health system utilization is relatively low and there is limited capacity to diagnose and treat COVID-19 patients. Widespread population based seroprevalence studies are being implemented in Ifanadiana to inform the COVID-19 response strategy as health systems must simultaneously manage perennial and endemic disease threats.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Megan B. Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | | | - Demetrice Jordan
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Mark A. Krasnow
- Centre Valbio, Ranomafana, Madagascar
- Department of Biochemistry, Stanford University, Stanford, CA, United States
| | - Patricia C. Wright
- Centre Valbio, Ranomafana, Madagascar
- Institute for the Conservation of Tropical Environments, Stony Brook University, Stony Brook, NY, United States
- Department of Anthropology, Stony Brook University, Stony Brook, NY, United States
| | - Thomas R. Gillespie
- Centre Valbio, Ranomafana, Madagascar
- Department of Environmental Sciences and Program in Population Biology, Ecology, and Evolutionary Biology, Emory University, Atlanta, GA, United States
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | | | - Michelle V. Evans
- Odum School of Ecology and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, United States
| | - John M. Drake
- Odum School of Ecology and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, United States
| | - Calistus N. Ngonghala
- Department of Mathematics, University of Florida, Gainesville, FL, United States
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
- Center for African Studies, University of Florida, Gainesville, FL, United States
| | - Michael L. Rich
- PIVOT NGO, Ranomafana, Madagascar
- Brigham and Women's Hospital, Boston, MA, United States
- Partners in Health, Boston, MA, United States
| | - Stephen J. Popper
- PIVOT NGO, Ranomafana, Madagascar
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Ann C. Miller
- PIVOT NGO, Ranomafana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | | | | | | | | | | | | | | | | | - Andres Garchitorena
- PIVOT NGO, Ranomafana, Madagascar
- MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
| | - Julio Rakotonirina
- Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
| | - Alishya Mayfield
- PIVOT NGO, Ranomafana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
- Brigham and Women's Hospital, Boston, MA, United States
| | - Karen E. Finnegan
- PIVOT NGO, Ranomafana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Matthew H. Bonds
- PIVOT NGO, Ranomafana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
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A multi-stage stochastic programming approach to epidemic resource allocation with equity considerations. Health Care Manag Sci 2021; 24:597-622. [PMID: 33970390 PMCID: PMC8107811 DOI: 10.1007/s10729-021-09559-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 02/19/2021] [Indexed: 01/16/2023]
Abstract
Existing compartmental models in epidemiology are limited in terms of optimizing the resource allocation to control an epidemic outbreak under disease growth uncertainty. In this study, we address this core limitation by presenting a multi-stage stochastic programming compartmental model, which integrates the uncertain disease progression and resource allocation to control an infectious disease outbreak. The proposed multi-stage stochastic program involves various disease growth scenarios and optimizes the distribution of treatment centers and resources while minimizing the total expected number of new infections and funerals. We define two new equity metrics, namely infection and capacity equity, and explicitly consider equity for allocating treatment funds and facilities over multiple time stages. We also study the multi-stage value of the stochastic solution (VSS), which demonstrates the superiority of the proposed stochastic programming model over its deterministic counterpart. We apply the proposed formulation to control the Ebola Virus Disease (EVD) in Guinea, Sierra Leone, and Liberia of West Africa to determine the optimal and fair resource-allocation strategies. Our model balances the proportion of infections over all regions, even without including the infection equity or prevalence equity constraints. Model results also show that allocating treatment resources proportional to population is sub-optimal, and enforcing such a resource allocation policy might adversely impact the total number of infections and deaths, and thus resulting in a high cost that we have to pay for the fairness. Our multi-stage stochastic epidemic-logistics model is practical and can be adapted to control other infectious diseases in meta-populations and dynamically evolving situations.
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10
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Saxena A, Bouvier PA, Shamsi-Gooshki E, Köhler J, Schwartz LJ. WHO guidance on ethics in outbreaks and the COVID-19 pandemic: a critical appraisal. JOURNAL OF MEDICAL ETHICS 2021; 47:medethics-2020-106959. [PMID: 33789948 PMCID: PMC8025252 DOI: 10.1136/medethics-2020-106959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 06/12/2023]
Abstract
In 2016, following pandemic influenza threats and the 2014-2016 Ebola virus disease outbreaks, the WHO developed a guidance document for managing ethical issues in infectious disease outbreaks. In this article, we analyse some ethical issues that have had a predominant role in decision making in response to the current COVID-19 pandemic but were absent or not addressed in the same ways in the 2016 guidance document. A pandemic results in a health crisis and social and political crises both nationally and globally. The ethical implications of these global effects should be properly identified so that appropriate actions can be taken globally and not just in national isolation. Our analysis, which is a starting point to test the broader relevance of the 2016 WHO document that remains the only available guidance document applicable globally, concludes that the WHO guidance should be updated to provide reasoned and thoughtful comprehensive ethics advice for the sound management of the current and future pandemics.
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Affiliation(s)
- Abha Saxena
- Institute Éthique Histoire Humanités, University of Geneva, Geneva, Switzerland
- Independent Bioethics Consultant, Geneva, Switzerland
| | - Paul André Bouvier
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Department of Social Sciences, University of Fribourg, Fribourg, Switzerland
| | - Ehsan Shamsi-Gooshki
- Department of Medical Ethics, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Johannes Köhler
- Department of Anesthesiology and Critical Care Medicine, Kantonsspital Münsterlingen, Munsterlingen, Thurgau, Switzerland
| | - Lisa J Schwartz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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11
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Kwaja CMA, Olivieri DJ, Boland S, Henwood PC, Card B, Polatty DP, Levine AC. Civilian perception of the role of the military in Nigeria's 2014 Ebola outbreak and health-related responses in the North East region. BMJ Mil Health 2021; 169:e9-e14. [PMID: 33547194 DOI: 10.1136/bmjmilitary-2020-001696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Civilian-military relations play an important yet under-researched role in low-income and middle-income country epidemic response. One crucial component of civilian-military relations is defining the role of the military. This paper evaluates the role of Nigerian military during the 2014-2016 West African Ebola epidemic. METHODS Focus groups and key informant interviews were conducted throughout three states in North East region of Nigeria: Borno, Yobe and Adamawa. Participants were identified through mapping of stakeholder involvement in Nigerian epidemic response. English-translated transcripts of each key informant interview and focus group discussion were then coded and key themes were elucidated and analysed. RESULTS Major themes elucidated include developing inclusive coordination plans between civilian and military entities, facilitating human rights reporting mechanisms and distributing military resources more equitably across geographical catchment areas. The Nigerian Military served numerous functions: 37% (22/59) of respondents indicated 'security/peace' as the military's primary function, while 42% (25/59) cited health services. Variations across geographic settings were also noted: 35% (7/20) of participants in Borno stated the military primarily provided transportation, while 73% (11/15) in Adamawa and 29% (7/24) in Yobe listed health services. CONCLUSIONS Robust civilian-military relations require an appropriately defined role of the military and clear civilian-military communication. Important considerations to contextualise civilian-military relations include military cultural-linguistic understanding, human rights promotion, and community-based needs assessments; such foci can facilitate the military's understanding of community norms and civilian cooperation with military aims. In turn, more robust civilian-military relations can promote overall epidemic response and reduce the global burden of disease.
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Affiliation(s)
- Chris M A Kwaja
- Centre for Peace and Security Studies, Modibbo Adama University of Technology, Yola, Adamawa, Nigeria
| | - D J Olivieri
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.,Center for Human Rights and Humanitarian Studies, Watson Institute for International and Public Affairs, Brown University, Providence, Rhode Island, USA
| | - S Boland
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | - P C Henwood
- Office of Global Affairs, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - B Card
- Center for Human Rights and Humanitarian Studies, Watson Institute for International and Public Affairs, Brown University, Providence, Rhode Island, USA
| | - D P Polatty
- Humanitarian Response Program, US Naval War College, Newport, Rhode Island, USA
| | - A C Levine
- Center for Human Rights and Humanitarian Studies, Watson Institute for International and Public Affairs, Brown University, Providence, Rhode Island, USA
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12
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Gwenzi W. Dangerous liaisons? As the COVID-19 wave hits Africa with potential for novel transmission dynamics: a perspective. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2021; 30:1353-1366. [PMID: 33425657 PMCID: PMC7778499 DOI: 10.1007/s10389-020-01467-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/15/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Willis Gwenzi
- Biosystems and Environmental Engineering Research Group, Department of Soil Science and Agricultural Engineering, Faculty of Agriculture, University of Zimbabwe, P.O. Box MP 167, Mount Pleasant, Harare, Zimbabwe
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13
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Reddy KP, Shebl FM, Foote JHA, Harling G, Scott JA, Panella C, Fitzmaurice KP, Flanagan C, Hyle EP, Neilan AM, Mohareb AM, Bekker LG, Lessells RJ, Ciaranello AL, Wood R, Losina E, Freedberg KA, Kazemian P, Siedner MJ. Cost-effectiveness of public health strategies for COVID-19 epidemic control in South Africa: a microsimulation modelling study. LANCET GLOBAL HEALTH 2020; 9:e120-e129. [PMID: 33188729 PMCID: PMC7834260 DOI: 10.1016/s2214-109x(20)30452-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/25/2020] [Accepted: 10/06/2020] [Indexed: 12/24/2022]
Abstract
Background Health-care resource constraints in low-income and middle-income countries necessitate the identification of cost-effective public health interventions to address COVID-19. We aimed to develop a dynamic COVID-19 microsimulation model to assess clinical and economic outcomes and cost-effectiveness of epidemic control strategies in KwaZulu-Natal province, South Africa. Methods We compared different combinations of five public health interventions: health-care testing alone, where diagnostic testing is done only for individuals presenting to health-care centres; contact tracing in households of cases; isolation centres, for cases not requiring hospital admission; mass symptom screening and molecular testing for symptomatic individuals by community health-care workers; and quarantine centres, for household contacts who test negative. We calibrated infection transmission rates to match effective reproduction number (Re) estimates reported in South Africa. We assessed two main epidemic scenarios for a period of 360 days, with an Re of 1·5 and 1·2. Strategies with incremental cost-effectiveness ratio (ICER) of less than US$3250 per year of life saved were considered cost-effective. We also did sensitivity analyses by varying key parameters (Re values, molecular testing sensitivity, and efficacies and costs of interventions) to determine the effect on clinical and cost projections. Findings When Re was 1·5, health-care testing alone resulted in the highest number of COVID-19 deaths during the 360-day period. Compared with health-care testing alone, a combination of health-care testing, contact tracing, use of isolation centres, mass symptom screening, and use of quarantine centres reduced mortality by 94%, increased health-care costs by 33%, and was cost-effective (ICER $340 per year of life saved). In settings where quarantine centres were not feasible, a combination of health-care testing, contact tracing, use of isolation centres, and mass symptom screening was cost-effective compared with health-care testing alone (ICER $590 per year of life saved). When Re was 1·2, health-care testing, contact tracing, use of isolation centres, and use of quarantine centres was the least costly strategy, and no other strategies were cost-effective. In sensitivity analyses, a combination of health-care testing, contact tracing, use of isolation centres, mass symptom screening, and use of quarantine centres was generally cost-effective, with the exception of scenarios in which Re was 2·6 and when efficacies of isolation centres and quarantine centres for transmission reduction were reduced. Interpretation In South Africa, strategies involving household contact tracing, isolation, mass symptom screening, and quarantining household contacts who test negative would substantially reduce COVID-19 mortality and would be cost-effective. The optimal combination of interventions depends on epidemic growth characteristics and practical implementation considerations. Funding US National Institutes of Health, Royal Society, Wellcome Trust.
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Affiliation(s)
- Krishna P Reddy
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Fatma M Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Julia H A Foote
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Guy Harling
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard Center for Population and Development Studies, Harvard T H Chan School of Public Health, Boston, MA, USA; Africa Health Research Institute, Durban, South Africa; Institute for Global Health, University College London, London, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of Witwatersrand, Johannesburg, South Africa
| | - Justine A Scott
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Panella
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Kieran P Fitzmaurice
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Clare Flanagan
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Emily P Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard University Center for AIDS Research, Cambridge, MA, USA
| | - Anne M Neilan
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Amir M Mohareb
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - Richard J Lessells
- KwaZulu-Natal Research Innovation and Sequencing, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Andrea L Ciaranello
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard University Center for AIDS Research, Cambridge, MA, USA
| | - Robin Wood
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - Elena Losina
- Harvard Medical School, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; Orthopaedic and Arthritis Center for Outcomes Research and Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Pooyan Kazemian
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Mark J Siedner
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Africa Health Research Institute, Durban, South Africa
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14
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Reddy KP, Shebl FM, Foote JHA, Harling G, Scott JA, Panella C, Fitzmaurice KP, Flanagan C, Hyle EP, Neilan AM, Mohareb AM, Bekker LG, Lessells RJ, Ciaranello AL, Wood R, Losina E, Freedberg KA, Kazemian P, Siedner MJ. Cost-effectiveness of public health strategies for COVID-19 epidemic control in South Africa: a microsimulation modelling study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 32637979 PMCID: PMC7340205 DOI: 10.1101/2020.06.29.20140111] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Healthcare resource constraints in low and middle-income countries necessitate selection of cost-effective public health interventions to address COVID-19. Methods We developed a dynamic COVID-19 microsimulation model to evaluate clinical and economic outcomes and cost-effectiveness of epidemic control strategies in KwaZulu-Natal, South Africa. Interventions assessed were Healthcare Testing (HT), where diagnostic testing is performed only for those presenting to healthcare centres; Contact Tracing (CT) in households of cases; Isolation Centres (IC), for cases not requiring hospitalisation; community health worker-led Mass Symptom Screening and molecular testing for symptomatic individuals (MS); and Quarantine Centres (QC), for household contacts who test negative. Given uncertainties about epidemic dynamics in South Africa, we evaluated two main epidemic scenarios over 360 days, with effective reproduction numbers (Re) of 1·5 and 1·2. We compared HT, HT+CT, HT+CT+IC, HT+CT+IC+MS, HT+CT+IC+QC, and HT+CT+IC+MS+QC, considering strategies with incremental cost-effectiveness ratio (ICER) <US$3,250/year-of-life saved (YLS) cost-effective. In sensitivity analyses, we varied Re, molecular testing sensitivity, and efficacies and costs of interventions. Findings With Re 1·5, HT resulted in the most COVID-19 deaths over 360 days. Compared with HT, HT+CT+IC+MS+QC reduced mortality by 94%, increased costs by 33%, and was cost-effective (ICER $340/YLS). In settings where quarantine centres cannot be implemented, HT+CT+IC+MS was cost-effective compared with HT (ICER $590/YLS). With Re 1·2, HT+CT+IC+QC was the least costly strategy, and no other strategy was cost-effective. HT+CT+IC+MS+QC was cost-effective in many sensitivity analyses; notable exceptions were when Re was 2·6 and when efficacies of ICs and QCs for transmission reduction were reduced. Interpretation In South Africa, strategies involving household contact tracing, isolation, mass symptom screening, and quarantining household contacts who test negative would substantially reduce COVID-19 mortality and be cost-effective. The optimal combination of interventions depends on epidemic growth characteristics and practical implementation considerations.
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Affiliation(s)
- Krishna P Reddy
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Fatma M Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Julia H A Foote
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Guy Harling
- Department of Epidemiology and Harvard Center for Population & Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Africa Health Research Institute, KwaZulu-Natal, South Africa.,Institute for Global Health, University College London, London, UK.,MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of Witwatersrand, South Africa
| | - Justine A Scott
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Panella
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Kieran P Fitzmaurice
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Clare Flanagan
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Emily P Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard University Center for AIDS Research, Cambridge, MA, USA
| | - Anne M Neilan
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Amir M Mohareb
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - Richard J Lessells
- KwaZulu-Natal Research Innovation and Sequencing (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Andrea L Ciaranello
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard University Center for AIDS Research, Cambridge, MA, USA
| | - Robin Wood
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - Elena Losina
- Harvard Medical School, Boston, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.,Orthopedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Policy and Innovation eValuation in Orthopedic Treatments (PIVOT) Center, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Pooyan Kazemian
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Mark J Siedner
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Africa Health Research Institute, KwaZulu-Natal, South Africa.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
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15
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Holding M, Ihekweazu C, Stuart JM, Oliver I. Learning from the Epidemiological Response to the 2014/15 Ebola Virus Disease Outbreak. J Epidemiol Glob Health 2020; 9:169-175. [PMID: 31529934 PMCID: PMC7310819 DOI: 10.2991/jegh.k.190808.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/07/2019] [Indexed: 11/10/2022] Open
Abstract
A large international response was needed to bring the 2014/15 West African Ebola virus disease outbreak under control. This study sought to learn lessons from this epidemic to strengthen the response to future outbreaks of international significance by identifying priorities for future epidemiology training and response. Epidemiologists who were deployed to West Africa were recruited through a snowball sampling method and surveyed using an online anonymous questionnaire. Associations between demographics, training, qualifications, and role while in-country were explored alongside respondents’ experience during deployment. Of 128 responses, 105 met the inclusion criteria. Respondents originated from 25 countries worldwide, for many (62%), this was their first deployment abroad. The most common tasks carried out while deployed were surveillance, training, contact tracing, and cluster investigation. Epidemiologists would value more detailed predeployment briefings including organizational aspects of the response. Gaps in technical skills reported were mostly about geographical information systems; however, epidemiologists identified the need for those deployed in future to have greater knowledge about roles and responsibilities of organizations involved in the response, better cultural awareness, and leadership and management skills. Respondents felt that the public health community must improve the timeliness of the response in future outbreaks and strengthen collaboration and coordination between organizations.
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Affiliation(s)
- Maya Holding
- NIHR Health Protection Research Unit on Evaluation of Interventions, University of Bristol, Bristol, UK.,Field Service, National Infection Service, Public Health England, Bristol, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Chikwe Ihekweazu
- Nigeria Centre for Disease Control, Abuja, Nigeria.,ECOWAS Regional Centre for Surveillance and Disease Control, Abuja, Nigeria
| | - James MacNaughton Stuart
- NIHR Health Protection Research Unit on Evaluation of Interventions, University of Bristol, Bristol, UK.,School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Isabel Oliver
- NIHR Health Protection Research Unit on Evaluation of Interventions, University of Bristol, Bristol, UK.,Field Service, National Infection Service, Public Health England, Bristol, UK
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16
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Ming DK, Sangkaew S, Chanh HQ, Nhat PTH, Yacoub S, Georgiou P, Holmes AH. Continuous physiological monitoring using wearable technology to inform individual management of infectious diseases, public health and outbreak responses. Int J Infect Dis 2020; 96:648-654. [PMID: 32497806 PMCID: PMC7263257 DOI: 10.1016/j.ijid.2020.05.086] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/15/2020] [Accepted: 05/23/2020] [Indexed: 01/12/2023] Open
Abstract
Optimal management of infectious diseases is guided by up-to-date information at the individual and public health levels. For infections of global importance, including emerging pandemics such as COVID-19 or prevalent endemic diseases such as dengue, identifying patients at risk of severe disease and clinical deterioration can be challenging, considering that the majority present with a mild illness. In our article, we describe the use of wearable technology for continuous physiological monitoring in healthcare settings. Deployment of wearables in hospital settings for the management of infectious diseases, or in the community to support syndromic surveillance during outbreaks, could provide significant, cost-effective advantages and improve healthcare delivery. We highlight a range of promising technologies employed by wearable devices and discuss the technical and ethical issues relating to implementation in the clinic, focusing on low- and middle- income countries. Finally, we propose a set of essential criteria for the rollout of wearable technology for clinical use.
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Affiliation(s)
- Damien K Ming
- NIHR-Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK; Centre for Antimicrobial Optimisation (CAMO), Imperial College London, UK.
| | - Sorawat Sangkaew
- NIHR-Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK; Department of Family Medicine, Hat Yai Regional Hospital, Thailand
| | - Ho Q Chanh
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Viet Nam
| | - Phung T H Nhat
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Viet Nam
| | - Sophie Yacoub
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, University of Oxford, UK
| | | | - Alison H Holmes
- NIHR-Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK; Centre for Antimicrobial Optimisation (CAMO), Imperial College London, UK
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17
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Quasispecies dynamics in disease prevention and control. VIRUS AS POPULATIONS 2020. [PMCID: PMC7153035 DOI: 10.1016/b978-0-12-816331-3.00008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Medical interventions to prevent and treat viral disease constitute evolutionary forces that may modify the genetic composition of viral populations that replicate in an infected host and influence the genomic composition of those viruses that are transmitted and progress at the epidemiological level. Given the adaptive potential of viruses in general and the RNA viruses in particular, the selection of viral mutants that display some degree of resistance to inhibitors or vaccines is a tangible challenge. Mutant selection may jeopardize control of the viral disease. Strategies intended to minimize vaccination and treatment failures are proposed and justified based on fundamental features of viral dynamics explained in the preceding chapters. The recommended use of complex, multiepitopic vaccines, and combination therapies as early as possible after initiation of infection falls under the general concept that complexity cannot be combated with simplicity. It also follows that sociopolitical action to interrupt virus replication and spread as soon as possible is as important as scientifically sound treatment designs to control viral disease on a global scale.
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18
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The International Red Cross and Red Crescent Movement Response to the West African Ebola Outbreak 2014. INFECTIOUS DISEASES IN THE NEW MILLENNIUM 2020. [PMCID: PMC7226897 DOI: 10.1007/978-3-030-39819-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The International Health Regulations 2005 (IHR) are the most up to date international legal rules on the control of infectious diseases and provide a unified code for infectious disease control. The IHR name the International Federation of the Red Cross (IFRC) as one of the international organisations with whom the WHO must cooperate and co-ordinate in implementing the IHR. It was organisations like the IFRC and MSF, that worked to stop the spread of Ebola following the outbreak in 2014. The focus of this chapter is the work of the IFRC during the Ebola outbreak. The IFRC carries out relief operations to assist victims of disasters, and combines this with development work to strengthen the capacities of its member National Societies. The IFRC’s work focuses on four core areas: promoting humanitarian values, disaster response, disaster preparedness, and health and community care. Combining a study of the IFRC as an organisation with a legal mandate of its own, elucidated in the Statutes of the International Red Cross and Red Crescent Movement, and the more general international legal framework, this chapter uses international law as a framework to reflect on the limits and effectiveness of legal measures in responding to Ebola. To this end, international law provides a logical and global method to respond to infectious diseases. This chapter finds that the mandate and practice of the IFRC in the response to Ebola provides material to critically analyse each of these parts in light of infectious disease proliferation in 2014–2016. Since outbreak was announced in early 2014 more than 10,000 Red Cross volunteers were trained in Ebola response. IFRC supported emergency operations in Guinea, Liberia, and Sierra Leone have targeted 23 million people.
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19
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Bempong NE, Ruiz De Castañeda R, Schütte S, Bolon I, Keiser O, Escher G, Flahault A. Precision Global Health - The case of Ebola: a scoping review. J Glob Health 2019; 9:010404. [PMID: 30701068 PMCID: PMC6344070 DOI: 10.7189/jogh.09.010404] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The 2014-2016 Ebola outbreak across West Africa was devastating, acting not only as a wake-up call for the global health community, but also as a catalyst for innovative change and global action. Improved infectious disease monitoring is the stepping-stone toward better disease prevention and control efforts, and recent research has revealed the potential of digital technologies to transform the field of global health. This scoping review aimed to identify which digital technologies may improve disease prevention and control, with regard to the 2014-2016 Ebola outbreak in West Africa. METHODS A search was conducted on PubMed, EBSCOhost and Web of Science, with search dates ranging from 2013 (01/01/2013) - 2017 (13/06/2017). Data was extracted into a summative table and data synthesized through grouping digital technology domains, using narrative and graphical methods. FINDINGS The scoping review identified 82 full-text articles, and revealed big data (48%, n = 39) and modeling (26%, n = 21) technologies to be the most utilized within the Ebola outbreak. Digital technologies were mainly used for surveillance purposes (90%, n = 74), and key challenges were related to scalability and misinformation from social media platforms. INTERPRETATION Digital technologies demonstrated their potential during the Ebola outbreak through: more rapid diagnostics, more precise predictions and estimations, increased knowledge transfer, and raising situational awareness through mHealth and social media platforms such as Twitter and Weibo. However, better integration into both citizen and health professionals' communities is necessary to maximise the potential of digital technologies.
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Affiliation(s)
- Nefti-Eboni Bempong
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
| | | | - Stefanie Schütte
- Centre Virchow-Villermé for Public Health Paris- Berlin, Descartes, Université Sorbonne Paris Cité, France
| | - Isabelle Bolon
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
| | - Olivia Keiser
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
| | - Gérard Escher
- Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Antoine Flahault
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
- Centre Virchow-Villermé for Public Health Paris- Berlin, Descartes, Université Sorbonne Paris Cité, France
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20
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Semenza JC, Sewe MO, Lindgren E, Brusin S, Aaslav KK, Mollet T, Rocklöv J. Systemic resilience to cross-border infectious disease threat events in Europe. Transbound Emerg Dis 2019; 66:1855-1863. [PMID: 31022321 PMCID: PMC6852001 DOI: 10.1111/tbed.13211] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/09/2019] [Accepted: 04/20/2019] [Indexed: 12/16/2022]
Abstract
Recurrent health emergencies threaten global health security. International Health Regulations (IHR) aim to prevent, detect and respond to such threats, through increase in national public health core capacities, but whether IHR core capacity implementation is necessary and sufficient has been contested. With a longitudinal study we relate changes in national IHR core capacities to changes in cross-border infectious disease threat events (IDTE) between 2010 and 2016, collected through epidemic intelligence at the European Centre for Disease Prevention and Control (ECDC). By combining all IHR core capacities into one composite measure we found that a 10% increase in the mean of this composite IHR core capacity to be associated with a 19% decrease (p = 0.017) in the incidence of cross-border IDTE in the EU. With respect to specific IHR core capacities, an individual increase in national legislation, policy & financing; coordination and communication with relevant sectors; surveillance; response; preparedness; risk communication; human resource capacity; or laboratory capacity was associated with a significant decrease in cross-border IDTE incidence. In contrast, our analysis showed that IHR core capacities relating to point-of-entry, zoonotic events or food safety were not associated with IDTE in the EU. Due to high internal correlations between core capacities, we conducted a principal component analysis which confirmed a 20% decrease in risk of IDTE for every 10% increase in the core capacity score (95% CI: 0.73, 0.88). Globally (EU excluded), a 10% increase in the mean of all IHR core capacities combined was associated with a 14% decrease (p = 0.077) in cross-border IDTE incidence. We provide quantitative evidence that improvements in IHR core capacities at country-level are associated with fewer cross-border IDTE in the EU, which may also hold true for other parts of the world.
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Affiliation(s)
- Jan C Semenza
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Maquines Odhiambo Sewe
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Elisabet Lindgren
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Sergio Brusin
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Thomas Mollet
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
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21
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Palagyi A, Marais BJ, Abimbola S, Topp SM, McBryde ES, Negin J. Health system preparedness for emerging infectious diseases: A synthesis of the literature. Glob Public Health 2019; 14:1847-1868. [PMID: 31084412 DOI: 10.1080/17441692.2019.1614645] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This review reflects on what the literature to date has taught us about how health systems of low- and middle-income countries (LMICs) respond to emerging infectious disease (EID) outbreaks. These findings are then applied to propose a conceptual framework characterising an EID prepared health system. A narrative synthesis approach was adopted to explore the key elements of LMIC health systems during an EID outbreak. Overarching themes ('core health system constructs') and sub-themes ('elements') relevant to EID preparedness were extracted from 49 peer-reviewed articles. The resulting conceptual framework recognised six core constructs: four focused on material resources and structures (i.e. system 'hardware'), including (i) Surveillance, (ii) Infrastructure and medical supplies, (iii) Workforce, and (iv) Communication mechanisms; and two focused on human and institutional relationships, values and norms (i.e. system 'software'), including (i) Governance, and (ii) Trust. The article reinforces the interconnectedness of the traditional health system building blocks to EID detection, prevention and response, and highlights the critical role of system 'software' (i.e. governance and trust) in enabling LMIC health systems to achieve and maintain EID preparedness. The review provides recommendations for refining a set of indicators for an 'optimised' health system EID preparedness tool to aid health system strengthening efforts.
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Affiliation(s)
- Anna Palagyi
- Faculty of Medicine and Health, The University of Sydney School of Public Health , Sydney , Australia.,The George Institute for Global Health, University of New South Wales , Sydney , Australia
| | - Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity and the Children's Hospital at Westmead, University of Sydney , Sydney , Australia
| | - Seye Abimbola
- Faculty of Medicine and Health, The University of Sydney School of Public Health , Sydney , Australia.,The George Institute for Global Health, University of New South Wales , Sydney , Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University , Townsville , Australia.,Nossal Institute for Global Health, University of Melbourne , Melbourne , Australia
| | - Emma S McBryde
- Australian Institute of Tropical Health & Medicine, James Cook University , Townsville , Australia
| | - Joel Negin
- Faculty of Medicine and Health, The University of Sydney School of Public Health , Sydney , Australia
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22
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Walker JW, Han BA, Ott IM, Drake JM. Transmissibility of emerging viral zoonoses. PLoS One 2018; 13:e0206926. [PMID: 30403733 PMCID: PMC6221319 DOI: 10.1371/journal.pone.0206926] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/17/2018] [Indexed: 01/23/2023] Open
Abstract
Effective public health research and preparedness requires an accurate understanding of which virus species possess or are at risk of developing human transmissibility. Unfortunately, our ability to identify these viruses is limited by gaps in disease surveillance and an incomplete understanding of the process of viral adaptation. By fitting boosted regression trees to data on 224 human viruses and their associated traits, we developed a model that predicts the human transmission ability of zoonotic viruses with over 84% accuracy. This model identifies several viruses that may have an undocumented capacity for transmission between humans. Viral traits that predicted human transmissibility included infection of nonhuman primates, the absence of a lipid envelope, and detection in the human nervous system and respiratory tract. This predictive model can be used to prioritize high-risk viruses for future research and surveillance, and could inform an integrated early warning system for emerging infectious diseases.
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Affiliation(s)
- Joseph W. Walker
- Odum School of Ecology, University of Georgia, Athens, Georgia, United States of America
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, United States of America
| | - Barbara A. Han
- Cary Institute for Ecosystem Studies, Millbrook, New York, United States of America
| | - Isabel M. Ott
- Southeastern Cooperative Wildlife Disease Study, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - John M. Drake
- Odum School of Ecology, University of Georgia, Athens, Georgia, United States of America
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, United States of America
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23
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Sethi N. Research and Global Health Emergencies: On the Essential Role of Best Practice. Public Health Ethics 2018; 11:237-250. [PMID: 30429871 PMCID: PMC6225813 DOI: 10.1093/phe/phy014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article addresses an important, overlooked regulatory challenge during global health emergencies (GHEs). It provides novel insights into how, and why, best practice can support decision makers in interpreting and implementing key guidance on conducting research during GHEs. The ability to conduct research before, during and after such events is crucial. The recent West-African Ebola outbreaks and the Zika virus have highlighted considerable room for improvement in meeting the imperative to research and rapidly develop effective therapies. A means of effectively capturing these experiences and folding them into future decision-making is lacking; the need for effective practical translational measures remains. The challenge for the research community lies in extracting meaningful action-guiding content from pre-existing guidelines-which draw upon practical examples of guidelines 'in action'-that assist in determining how to act in a particular (future) situation. Insights are provided into the role of best practice as a means to do so; such examples can provide invaluable support to decision makers in interpreting high-level guidance; overarching guidelines retain their necessary level of generality and flexibility, whilst corresponding best practice examples-which incorporate important lessons learned-illustrate how such guidelines can be interpreted at a practical level.
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Affiliation(s)
- Nayha Sethi
- Liminal Spaces, Mason Institute, University of Edinburgh
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24
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Ling EJ, Larson E, Macauley RJ, Kodl Y, VanDeBogert B, Baawo S, Kruk ME. Beyond the crisis: did the Ebola epidemic improve resilience of Liberia's health system? Health Policy Plan 2018; 32:iii40-iii47. [PMID: 29149311 DOI: 10.1093/heapol/czx109] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 11/13/2022] Open
Abstract
Resilience was widely identified as a critical attribute for strong health systems following the 2014-15 West Africa Ebola epidemic. In Liberia, Sierra Leone and Guinea, struggles to control the disease and suspension of the operation of many health services demonstrated that health systems must plan for resilience long before a crisis. However, the operational elements of resilience and ways that a crisis experience can shape resilience are not well described in the literature. To understand how a health system adapts to crisis and how the priorities of different health system actors influence this response we conducted interviews with global, national, and local respondents in Liberia between July and September 2015 (n = 108), several months after the country was first declared Ebola-free. We found that health system resilience functions prioritized by global and national actors improved to a greater extent than those valued by community leaders and local health actors over the course of the epidemic. Although the Ebola epidemic stimulated some positive adaptations in Liberia's health system, building a truly resilient health system will require longer-term investments and sustained attention long beyond the crisis.
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Affiliation(s)
- Emilia J Ling
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Elysia Larson
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Rose Jallah Macauley
- John Snow, Inc., Horton Building, Horton Avenue, Capitol By Pass, Monrovia, Liberia
| | - Yvonne Kodl
- John Snow, Inc., Horton Building, Horton Avenue, Capitol By Pass, Monrovia, Liberia
| | - Brian VanDeBogert
- John Snow, Inc., Horton Building, Horton Avenue, Capitol By Pass, Monrovia, Liberia
| | | | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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25
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Nohrstedt D, Baekkeskov E. Political drivers of epidemic response: foreign healthcare workers and the 2014 Ebola outbreak. DISASTERS 2018; 42:41-61. [PMID: 28440550 DOI: 10.1111/disa.12238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study demonstrates that countries responded quite differently to calls for healthcare workers (HCWs) during the Ebola epidemic in West Africa in 2014. Using a new dataset on the scale and timing of national pledges and the deployment of HCWs to states experiencing outbreaks of the virus disease (principally, Guinea, Liberia, and Sierra Leone), it shows that few foreign nations deployed HCWs early, some made pledges but then fulfilled them slowly, and most sent no HCWs at all. To aid understanding of such national responses, the paper reviews five theoretical perspectives that offer potentially competing or complementary explanations of foreign government medical assistance for international public health emergencies. The study systematically validates that countries varied greatly in whether and when they addressed HCW deployment needs during the Ebola crisis of 2014, and offers suggestions for a theory-driven inquiry to elucidate the logics of foreign interventions in critical infectious disease epidemics.
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Affiliation(s)
- Daniel Nohrstedt
- Associate Professor of Political Science, Department of Government and Center for Natural Disaster Science, Uppsala University, Sweden
| | - Erik Baekkeskov
- Lecturer in Public Policy, School of Social and Political Sciences, University of Melbourne, Australia
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26
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Agyepong IA, Sewankambo N, Binagwaho A, Coll-Seck AM, Corrah T, Ezeh A, Fekadu A, Kilonzo N, Lamptey P, Masiye F, Mayosi B, Mboup S, Muyembe JJ, Pate M, Sidibe M, Simons B, Tlou S, Gheorghe A, Legido-Quigley H, McManus J, Ng E, O'Leary M, Enoch J, Kassebaum N, Piot P. The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa. Lancet 2017; 390:2803-2859. [PMID: 28917958 DOI: 10.1016/s0140-6736(17)31509-x] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/25/2017] [Accepted: 05/01/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Irene Akua Agyepong
- Ghana Health Service, Accra, Ghana; Ghana College of Physicians and Surgeons, Public Health Faculty, Accra, Ghana
| | | | | | | | | | - Alex Ezeh
- African Population and Health Research Center, Nairobi, Kenya
| | - Abebaw Fekadu
- Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nduku Kilonzo
- National AIDS Control Council, Ministry of Health, Nairobi, Kenya
| | - Peter Lamptey
- FHI360, Durham, NC, USA; London School of Hygiene & Tropical Medicine, London, UK
| | - Felix Masiye
- Department of Economics, University of Zambia, Lusaka, Zambia
| | - Bongani Mayosi
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Souleymane Mboup
- Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formation, Dakar, Senegal
| | | | | | | | | | - Sheila Tlou
- Regional Support Team for Eastern and Southern Africa, UNAIDS, Johannesburg, South Africa
| | - Adrian Gheorghe
- London School of Hygiene & Tropical Medicine, London, UK; Oxford Policy Management, Oxford, UK
| | - Helena Legido-Quigley
- London School of Hygiene & Tropical Medicine, London, UK; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Edmond Ng
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Jamie Enoch
- London School of Hygiene & Tropical Medicine, London, UK
| | - Nicholas Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peter Piot
- London School of Hygiene & Tropical Medicine, London, UK.
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27
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Undurraga EA, Carias C, Meltzer MI, Kahn EB. Potential for broad-scale transmission of Ebola virus disease during the West Africa crisis: lessons for the Global Health security agenda. Infect Dis Poverty 2017; 6:159. [PMID: 29191243 PMCID: PMC5710062 DOI: 10.1186/s40249-017-0373-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 10/27/2017] [Indexed: 01/19/2023] Open
Abstract
Background The 2014–2016 Ebola crisis in West Africa had approximately eight times as many reported deaths as the sum of all previous Ebola outbreaks. The outbreak magnitude and occurrence of multiple Ebola cases in at least seven countries beyond Liberia, Sierra Leone, and Guinea, hinted at the possibility of broad-scale transmission of Ebola. Main text Using a modeling tool developed by the US Centers for Disease Control and Prevention during the Ebola outbreak, we estimated the number of Ebola cases that might have occurred had the disease spread beyond the three countries in West Africa to cities in other countries at high risk for disease transmission (based on late 2014 air travel patterns). We estimated Ebola cases in three scenarios: a delayed response, a Liberia-like response, and a fast response scenario. Based on our estimates of the number of Ebola cases that could have occurred had Ebola spread to other countries beyond the West African foci, we emphasize the need for improved levels of preparedness and response to public health threats, which is the goal of the Global Health Security Agenda. Our estimates suggest that Ebola could have potentially spread widely beyond the West Africa foci, had local and international health workers and organizations not committed to a major response effort. Our results underscore the importance of rapid detection and initiation of an effective, organized response, and the challenges faced by countries with limited public health systems. Actionable lessons for strengthening local public health systems in countries at high risk of disease transmission include increasing health personnel, bolstering primary and critical healthcare facilities, developing public health infrastructure (e.g. laboratory capacity), and improving disease surveillance. With stronger local public health systems infectious disease outbreaks would still occur, but their rapid escalation would be considerably less likely, minimizing the impact of public health threats such as Ebola. Conclusions The Ebola outbreak could have potentially spread to other countries, where limited public health surveillance and response capabilities may have resulted in additional foci. Health security requires robust local health systems that can rapidly detect and effectively respond to an infectious disease outbreak. Electronic supplementary material The online version of this article (10.1186/s40249-017-0373-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eduardo A Undurraga
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. .,Present address: School of Government, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile.
| | - Cristina Carias
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Martin I Meltzer
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily B Kahn
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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28
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Cori A, Donnelly CA, Dorigatti I, Ferguson NM, Fraser C, Garske T, Jombart T, Nedjati-Gilani G, Nouvellet P, Riley S, Van Kerkhove MD, Mills HL, Blake IM. Key data for outbreak evaluation: building on the Ebola experience. Philos Trans R Soc Lond B Biol Sci 2017; 372:20160371. [PMID: 28396480 PMCID: PMC5394647 DOI: 10.1098/rstb.2016.0371] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2016] [Indexed: 01/15/2023] Open
Abstract
Following the detection of an infectious disease outbreak, rapid epidemiological assessment is critical for guiding an effective public health response. To understand the transmission dynamics and potential impact of an outbreak, several types of data are necessary. Here we build on experience gained in the West African Ebola epidemic and prior emerging infectious disease outbreaks to set out a checklist of data needed to: (1) quantify severity and transmissibility; (2) characterize heterogeneities in transmission and their determinants; and (3) assess the effectiveness of different interventions. We differentiate data needs into individual-level data (e.g. a detailed list of reported cases), exposure data (e.g. identifying where/how cases may have been infected) and population-level data (e.g. size/demographics of the population(s) affected and when/where interventions were implemented). A remarkable amount of individual-level and exposure data was collected during the West African Ebola epidemic, which allowed the assessment of (1) and (2). However, gaps in population-level data (particularly around which interventions were applied when and where) posed challenges to the assessment of (3). Here we highlight recurrent data issues, give practical suggestions for addressing these issues and discuss priorities for improvements in data collection in future outbreaks.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'.
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Affiliation(s)
- Anne Cori
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Christl A Donnelly
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Ilaria Dorigatti
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Neil M Ferguson
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Christophe Fraser
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Tini Garske
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Thibaut Jombart
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Gemma Nedjati-Gilani
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Pierre Nouvellet
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Steven Riley
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Maria D Van Kerkhove
- Centre for Global Health, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
| | - Harriet L Mills
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
- School of Veterinary Sciences, University of Bristol, Bristol BS40 5DU, UK
| | - Isobel M Blake
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
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Honigsbaum M. Between Securitisation and Neglect: Managing Ebola at the Borders of Global Health. MEDICAL HISTORY 2017; 61:270-294. [PMID: 28260567 PMCID: PMC5426310 DOI: 10.1017/mdh.2017.6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
In 2014 the World Health Organization (WHO) was widely criticised for failing to anticipate that an outbreak of Ebola in a remote forested region of south-eastern Guinea would trigger a public health emergency of international concern (pheic). In explaining the WHO's failure, critics have pointed to structural restraints on the United Nations organisation and a leadership 'vacuum' in Geneva, among other factors. This paper takes a different approach. Drawing on internal WHO documents and interviews with key actors in the epidemic response, I argue that the WHO's failure is better understood as a consequence of Ebola's shifting medical identity and of triage systems for managing emerging infectious disease (EID) risks. Focusing on the discursive and non-discursive practices that produced Ebola as a 'problem' for global health security, I argue that by 2014 Ebola was no longer regarded as a paradigmatic EID and potential biothreat so much as a neglected tropical disease. The result was to relegate Ebola to the fringes of biosecurity concerns just at the moment when the virus was crossing international borders in West Africa and triggering large urban outbreaks for the first time. Ebola's fluctuating medical identity also helps explain the prominence of fear and rumours during the epidemic and social resistance to Ebola control measures. Contrasting the WHO's delay over declaring a pheic in 2014, with its rapid declaration of pheics in relation to H1N1 swine flu in 2009 and polio in 2014, I conclude that such 'missed alarms' may be an inescapable consequence of pandemic preparedness systems that seek to rationalise responses to the emergence of new diseases.
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Affiliation(s)
- Mark Honigsbaum
- School of History, Queen Mary University of London, Mile End Road, E1 4NS, UK
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30
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Siedner MJ, Kraemer JD. The end of the Ebola virus disease epidemic: has the work just begun? THE LANCET GLOBAL HEALTH 2017; 5:e381-e382. [DOI: 10.1016/s2214-109x(17)30079-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 02/09/2017] [Indexed: 10/20/2022] Open
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Semenza JC, Lindgren E, Balkanyi L, Espinosa L, Almqvist MS, Penttinen P, Rocklöv J. Determinants and Drivers of Infectious Disease Threat Events in Europe. Emerg Infect Dis 2016; 22:581-9. [PMID: 26982104 DOI: 10.3201/eid2204] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Infectious disease threat events (IDTEs) are increasing in frequency worldwide. We analyzed underlying drivers of 116 IDTEs detected in Europe during 2008-2013 by epidemic intelligence at the European Centre of Disease Prevention and Control. Seventeen drivers were identified and categorized into 3 groups: globalization and environment, sociodemographic, and public health systems. A combination of >2 drivers was responsible for most IDTEs. The driver category globalization and environment contributed to 61% of individual IDTEs, and the top 5 individual drivers of all IDTEs were travel and tourism, food and water quality, natural environment, global trade, and climate. Hierarchical cluster analysis of all drivers identified travel and tourism as a distinctly separate driver. Monitoring and modeling such disease drivers can help anticipate future IDTEs and strengthen control measures. More important, intervening directly on these underlying drivers can diminish the likelihood of the occurrence of an IDTE and reduce the associated human and economic costs.
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32
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Semenza JC, Lindgren E, Balkanyi L, Espinosa L, Almqvist MS, Penttinen P, Rocklöv J. Determinants and Drivers of Infectious Disease Threat Events in Europe. Emerg Infect Dis 2016. [PMID: 26982104 PMCID: PMC4806948 DOI: 10.3201/eid2204.151073] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Globalization and environment, the most frequent underlying drivers, should be targeted for interventions to prevent such events. Infectious disease threat events (IDTEs) are increasing in frequency worldwide. We analyzed underlying drivers of 116 IDTEs detected in Europe during 2008–2013 by epidemic intelligence at the European Centre of Disease Prevention and Control. Seventeen drivers were identified and categorized into 3 groups: globalization and environment, sociodemographic, and public health systems. A combination of >2 drivers was responsible for most IDTEs. The driver category globalization and environment contributed to 61% of individual IDTEs, and the top 5 individual drivers of all IDTEs were travel and tourism, food and water quality, natural environment, global trade, and climate. Hierarchical cluster analysis of all drivers identified travel and tourism as a distinctly separate driver. Monitoring and modeling such disease drivers can help anticipate future IDTEs and strengthen control measures. More important, intervening directly on these underlying drivers can diminish the likelihood of the occurrence of an IDTE and reduce the associated human and economic costs.
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Mackey TK. The Ebola Outbreak: Catalyzing a "Shift" in Global Health Governance? BMC Infect Dis 2016; 16:699. [PMID: 27881085 PMCID: PMC5121963 DOI: 10.1186/s12879-016-2016-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022] Open
Abstract
Background As the 2014 Ebola virus disease outbreak (EVD) transitions to its post-endemic phase, its impact on the future of global public health, particularly the World Health Organization (WHO), is the subject of continued debate. Criticism of WHO’s performance grew louder in the outbreak’s wake, placing this international health UN-specialized agency in the difficult position of navigating a complex series of reform recommendations put forth by different stakeholders. Decisions on WHO governance reform and the broader role of the United Nations could very well shape the future landscape of 21st century global health and how the international community responds to health emergencies. Discussion In order to better understand the implications of the EVD outbreak on global health and infectious disease governance, this debate article critically examines a series of reports issued by four high-level commissions/panels convened to specifically assess WHO’s performance post-Ebola. Collectively, these recommendations add increasing complexity to the urgent need for WHO reform, a process that the agency must carry out in order to maintain its legitimacy. Proposals that garnered strong support included the formation of an independent WHO Centre for Emergency Preparedness and Response, the urgent need to increase WHO infectious disease funding and capacity, and establishing better operational and policy coordination between WHO, UN agencies, and other global health partners. The recommendations also raise more fundamental questions about restructuring the global health architecture, and whether the UN should play a more active role in global health governance. Summary Despite the need for a fully modernized WHO, reform proposals recently announced by WHO fail to achieve the “evolution” in global health governance needed in order to ensure that global society is adequately protected against the multifaceted and increasingly complex nature of modern public health emergencies. Instead, the lasting legacy of the EVD outbreak may be its foreshadowing of a governance “shift” in formal sharing of the complex responsibilities of global health, health security, outbreak response, and managing health emergencies to other international structures, most notably the United Nations. Only time will tell if the legacy of EVD will include a WHO that has the full support of the international community and is capable of leading human society in this brave new era of the globalization of infectious diseases.
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Affiliation(s)
- Tim K Mackey
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA, USA. .,Department of Medicine, Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA. .,Global Health Policy Institute, 6256 Greenwich Drive, Mail Code: 0172X, San Diego, CA, 92122, USA.
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Amat Camacho N, Hughes A, Burkle FM, Ingrassia PL, Ragazzoni L, Redmond A, Norton I, von Schreeb J. Education and Training of Emergency Medical Teams: Recommendations for a Global Operational Learning Framework. PLOS CURRENTS 2016; 8. [PMID: 27917306 PMCID: PMC5104687 DOI: 10.1371/currents.dis.292033689209611ad5e4a7a3e61520d0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An increasing number of international emergency medical teams are deployed to assist disaster-affected populations worldwide. Since Haiti earthquake those teams have been criticised for ill adapted care, lack of preparedness in addition to not coordinating with the affected country healthcare system. The Emergency Medical Teams (EMTs) initiative, as part of the Word Health Organization’s Global Health Emergency Workforce program, aims to address these shortcomings by improved EMT coordination, and mechanisms to ensure quality and accountability of national and international EMTs. An essential component to reach this goal is appropriate education and training. Multiple disaster education and training programs are available. However, most are centred on individuals’ professional development rather than on the EMTs operational performance. Moreover, no common overarching or standardised training frameworks exist. In this report, an expert panel review and discuss the current approaches to disaster education and training and propose a three-step operational learning framework that could be used for EMTs globally. The proposed framework includes the following steps: 1) ensure professional competence and license to practice, 2) support adaptation of technical and non-technical professional capacities into the low-resource and emergency context and 3) prepare for an effective team performance in the field. A combination of training methodologies is also recommended, including individual theory based education, immersive simulations and team training. Agreed curriculum and open access training materials for EMTs need to be further developed, ideally through collaborative efforts between WHO, operational EMT organizations, universities, professional bodies and training agencies. Keywords: disasters; education; emergencies; global health; learning
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Affiliation(s)
| | - Amy Hughes
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK
| | - Frederick M Burkle
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts, USA
| | - Pier Luigi Ingrassia
- Research Center in Emergency and Disaster Medicine and Computer Science applied to Medicine (CRIMEDIM); Università del Piemonte Orientale, Novara, Italy
| | - Luca Ragazzoni
- CRIMEDIM - Research Center in Emergency and Disaster Medicine and Computer Science applied to Medical Practice; Università del Piemonte Orientale, Novara, Italy
| | - Anthony Redmond
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK
| | - Ian Norton
- Emergency Medical Teams (EMT) Project - Policy, Practice and Evaluation Unit, Emergency Risk Management and Humanitarian Response, World Health Organization, Geneva, Switzerland
| | - Johan von Schreeb
- Centre for Research on Health Care in Disasters, Health System and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Perrone LA, Voeurng V, Sek S, Song S, Vong N, Tous C, Flandin JF, Confer D, Costa A, Martin R. Implementation research: a mentoring programme to improve laboratory quality in Cambodia. Bull World Health Organ 2016; 94:743-751. [PMID: 27843164 PMCID: PMC5043202 DOI: 10.2471/blt.15.163824] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To implement a mentored laboratory quality stepwise implementation (LQSI) programme to strengthen the quality and capacity of Cambodian hospital laboratories. METHODS We recruited four laboratory technicians to be mentors and trained them in mentoring skills, laboratory quality management practices and international standard organization (ISO) 15189 requirements for medical laboratories. Separately, we trained staff from 12 referral hospital laboratories in laboratory quality management systems followed by tri-weekly in-person mentoring on quality management systems implementation using the LQSI tool, which is aligned with the ISO 15189 standard. The tool was adapted from a web-based resource into a software-based spreadsheet checklist, which includes a detailed action plan and can be used to qualitatively monitor each laboratory's progress. The tool - translated into Khmer - included a set of quality improvement activities grouped into four phases for implementation with increasing complexity. Project staff reviewed the laboratories' progress and challenges in weekly conference calls and bi-monthly meetings with focal points of the health ministry, participating laboratories and local partners. We present the achievements in implementation from September 2014 to March 2016. FINDINGS As of March 2016, the 12 laboratories have completed 74-90% of the 104 activities in phase 1, 53-78% of the 178 activities in phase 2, and 18-26% of the 129 activities in phase 3. CONCLUSION Regular on-site mentoring of laboratories using a detailed action plan in the local language allows staff to learn concepts of quality management system and learn on the job without disruption to laboratory service provision.
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Affiliation(s)
- Lucy A Perrone
- International Training and Education Center for Health, Department of Global Health, School of Public Health, University of Washington, 901 Boren Ave, Suite 1100, Seattle, WA 98104, United States of America
| | - Vireak Voeurng
- International Training and Education Center for Health-Cambodia, Phnom Penh, Cambodia
| | - Sophat Sek
- International Training and Education Center for Health-Cambodia, Phnom Penh, Cambodia
| | - Sophanna Song
- International Training and Education Center for Health-Cambodia, Phnom Penh, Cambodia
| | - Nora Vong
- International Training and Education Center for Health-Cambodia, Phnom Penh, Cambodia
| | - Chansamrach Tous
- International Training and Education Center for Health-Cambodia, Phnom Penh, Cambodia
| | - Jean-Frederic Flandin
- International Training and Education Center for Health, Department of Global Health, School of Public Health, University of Washington, 901 Boren Ave, Suite 1100, Seattle, WA 98104, United States of America
| | - Deborah Confer
- International Training and Education Center for Health, Department of Global Health, School of Public Health, University of Washington, 901 Boren Ave, Suite 1100, Seattle, WA 98104, United States of America
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Kentoffio K, Kraemer JD, Griffiths T, Kenny A, Panjabi R, Sechler GA, Selinsky S, Siedner MJ. Charting health system reconstruction in post-war Liberia: a comparison of rural vs. remote healthcare utilization. BMC Health Serv Res 2016; 16:478. [PMID: 27604708 PMCID: PMC5015243 DOI: 10.1186/s12913-016-1709-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 08/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background Despite a growing global emphasis on universal healthcare, access to basic primary care for remote populations in post-conflict countries remains a challenge. To better understand health sector recovery in post-conflict Liberia, this paper seeks to evaluate changes in utilization of health services among rural populations across a 5-year time span. Methods We assessed trends in healthcare utilization among the national rural population using the Liberian Demographic and Health Survey (DHS) from 2007 and 2013. We compared these results to results obtained from a two-staged cluster survey in 2012 in the district of Konobo, Liberia, to assess for differential health utilization in an isolated, remote region. Our primary outcomes of interest were maternal and child health service care seeking and utilization. Results Most child and maternal health indicators improved in the DHS rural sub-sample from 2007 to 2013. However, this progress was not reflected in the remote Konobo population. A lower proportion of women received 4+ antenatal care visits (AOR 0.28, P < 0.001) or any postnatal care (AOR 0.25, P <0.001) in Konobo as compared to the 2013 DHS. Similarly, a lower proportion of children received professional care for common childhood illnesses, including acute respiratory infection (9 % vs. 52 %, P < 0.001) or diarrhea (11 % vs. 46 %, P < 0.001). Conclusions Our data suggest that, despite the demonstrable success of post-war rehabilitation in rural regions, particularly remote populations in Liberia remain at disproportionate risk for limited access to basic health services. As a renewed effort is placed on health systems reconstruction in the wake of the Ebola-epidemic, a specific focus on solutions to reach isolated populations will be necessary in order to ensure extension of coverage to remote regions such as Konobo. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1709-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katherine Kentoffio
- Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA. .,Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - John D Kraemer
- Georgetown University Medical Center, 231 St. Mary's Hall, 3700 Reservoir Road NW, Washington, DC, 20057-1107, USA
| | | | - Avi Kenny
- Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA
| | - Rajesh Panjabi
- Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA.,Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.,Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - G Andrew Sechler
- Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA.,Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.,Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | | | - Mark J Siedner
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, USA
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Moss R, Hickson RI, McVernon J, McCaw JM, Hort K, Black J, Madden JR, Tran NH, McBryde ES, Geard N. Model-Informed Risk Assessment and Decision Making for an Emerging Infectious Disease in the Asia-Pacific Region. PLoS Negl Trop Dis 2016; 10:e0005018. [PMID: 27661978 PMCID: PMC5035030 DOI: 10.1371/journal.pntd.0005018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 09/01/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Effective response to emerging infectious disease (EID) threats relies on health care systems that can detect and contain localised outbreaks before they reach a national or international scale. The Asia-Pacific region contains low and middle income countries in which the risk of EID outbreaks is elevated and whose health care systems may require international support to effectively detect and respond to such events. The absence of comprehensive data on populations, health care systems and disease characteristics in this region makes risk assessment and decisions about the provision of such support challenging. METHODOLOGY/PRINCIPAL FINDINGS We describe a mathematical modelling framework that can inform this process by integrating available data sources, systematically explore the effects of uncertainty, and provide estimates of outbreak risk under a range of intervention scenarios. We illustrate the use of this framework in the context of a potential importation of Ebola Virus Disease into the Asia-Pacific region. Results suggest that, across a wide range of plausible scenarios, preemptive interventions supporting the timely detection of early cases provide substantially greater reductions in the probability of large outbreaks than interventions that support health care system capacity after an outbreak has commenced. CONCLUSIONS/SIGNIFICANCE Our study demonstrates how, in the presence of substantial uncertainty about health care system infrastructure and other relevant aspects of disease control, mathematical models can be used to assess the constraints that limited resources place upon the ability of local health care systems to detect and respond to EID outbreaks in a timely and effective fashion. Our framework can help evaluate the relative impact of these constraints to identify resourcing priorities for health care system support, in order to inform principled and quantifiable decision making.
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Affiliation(s)
- Robert Moss
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, The University of Melbourne, Melbourne, Australia
| | | | - Jodie McVernon
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, The University of Melbourne, Melbourne, Australia
- Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, Australia
| | - James M. McCaw
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, The University of Melbourne, Melbourne, Australia
- Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, Australia
- School of Mathematics and Statistics, The University of Melbourne, Melbourne, Australia
| | - Krishna Hort
- Nossal Institute, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jim Black
- Nossal Institute, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - John R. Madden
- Centre of Policy Studies, Victoria University, Melbourne, Australia
| | - Nhi H. Tran
- Centre of Policy Studies, Victoria University, Melbourne, Australia
| | - Emma S. McBryde
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Nicholas Geard
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, The University of Melbourne, Melbourne, Australia
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Facility-Based Delivery during the Ebola Virus Disease Epidemic in Rural Liberia: Analysis from a Cross-Sectional, Population-Based Household Survey. PLoS Med 2016; 13:e1002096. [PMID: 27482706 PMCID: PMC4970816 DOI: 10.1371/journal.pmed.1002096] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/17/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Ebola virus disease (EVD) epidemic has threatened access to basic health services through facility closures, resource diversion, and decreased demand due to community fear and distrust. While modeling studies have attempted to estimate the impact of these disruptions, no studies have yet utilized population-based survey data. METHODS AND FINDINGS We conducted a two-stage, cluster-sample household survey in Rivercess County, Liberia, in March-April 2015, which included a maternal and reproductive health module. We constructed a retrospective cohort of births beginning 4 y before the first day of survey administration (beginning March 24, 2011). We then fit logistic regression models to estimate associations between our primary outcome, facility-based delivery (FBD), and time period, defined as the pre-EVD period (March 24, 2011-June 14, 2014) or EVD period (June 15, 2014-April 13, 2015). We fit both univariable and multivariable models, adjusted for known predictors of facility delivery, accounting for clustering using linearized standard errors. To strengthen causal inference, we also conducted stratified analyses to assess changes in FBD by whether respondents believed that health facility attendance was an EVD risk factor. A total of 1,298 women from 941 households completed the survey. Median age at the time of survey was 29 y, and over 80% had a primary education or less. There were 686 births reported in the pre-EVD period and 212 in the EVD period. The unadjusted odds ratio of facility-based delivery in the EVD period was 0.66 (95% confidence interval [CI] 0.48-0.90, p-value = 0.010). Adjustment for potential confounders did not change the observed association, either in the principal model (adjusted odds ratio [AOR] = 0.70, 95%CI 0.50-0.98, p = 0.037) or a fully adjusted model (AOR = 0.69, 95%CI 0.50-0.97, p = 0.033). The association was robust in sensitivity analyses. The reduction in FBD during the EVD period was observed among those reporting a belief that health facilities are or may be a source of Ebola transmission (AOR = 0.59, 95%CI 0.36-0.97, p = 0.038), but not those without such a belief (AOR = 0.90, 95%CI 0.59-1.37, p = 0.612). Limitations include the possibility of FBD secular trends coincident with the EVD period, recall errors, and social desirability bias. CONCLUSIONS We detected a 30% decreased odds of FBD after the start of EVD in a rural Liberian county with relatively few cases. Because health facilities never closed in Rivercess County, this estimate may under-approximate the effect seen in the most heavily affected areas. These are the first population-based survey data to show collateral disruptions to facility-based delivery caused by the West African EVD epidemic, and they reinforce the need to consider the full spectrum of implications caused by public health emergencies.
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Self-Centric and Altruistic Unmet Needs for Ebola: Barriers to International Preparedness. Disaster Med Public Health Prep 2016; 10:644-8. [PMID: 27322192 DOI: 10.1017/dmp.2016.64] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Barriers to international Ebola preparedness may be elucidated by identifying heterogeneities in arguments to invest in countermeasures during "peace time." METHODS For each patent family (related patent documents that differed only by limited alterations to the same invention) concerning Ebola and published until the end of 2014 the oldest patent document was analyzed. Grounded theory coding identified 5 unmet needs for (1) vaccines and therapies, (2) control of outbreaks in endemic areas, (3) detection and control of outbreaks in nonendemic areas, (4) better understanding of filoviruses, and (5) protection against bioterrorism. Odds ratios for unmet needs by geographic regions and institution types were compared by using Pearson's chi-square test. RESULTS Statistically significant heterogeneities in unmet need profiles were found. US applicants combined self-centric and altruistic arguments, focusing on medical unmet needs and bioterrorism protection. Russian and Asian applicants emphasized self-centric motives, specifically, detection and control of nonendemic outbreaks. A clear, statistically significant mismatch between industry and academia was found: whereas industrial applicants focused on bioterrorism and neglected detection and control of nonendemic outbreaks, academic applicants did the opposite. CONCLUSIONS This research identified heterogeneities in articulated needs between geographic regions and stakeholder types. Structural articulation of unmet needs may form the basis for attuning stakeholder engagement strategies while progression across the demand-driven value chain might necessitate international concordance. (Disaster Med Public Health Preparedness. 2016;10:644-648).
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Quaglio G, Pizzol D, Bome D, Kebbie A, Bangura Z, Massaquoi V, Frasson C, Dalla Riva D, Putoto G. Maintaining Maternal and Child Health Services During the Ebola Outbreak: Experience from Pujehun, Sierra Leone. PLOS CURRENTS 2016; 8. [PMID: 28503359 PMCID: PMC5419839 DOI: 10.1371/currents.outbreaks.d67aea257f572201f835772d7f188ba5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND During the Ebola outbreak the overall confidence of the population in the national health system declined in Sierra Leone, with a reduction in the use of health services. The objective of this study is to provide information on understanding of how Ebola impacted maternal and child health services in Sierra Leone. Data come from an operational setting which is representative of the communities affected by the outbreak. METHODS By integrating hospital registers and contact tracing form data with healthcare workers and local population interviews, the transmission chain was reconstructed. Data on the utilization of maternal and neonatal health services were collected from the local district's Health Management Information System. The main measures put in place to control the Ebola epidemic were: the organization of a rapid response to the crisis by the local health authorities; triage, contact tracing and quarantine; isolation, clinical management and safe burials; training and community sensitization. RESULTS A total of 49 case patients were registered between July and November 2014 in the Pujehun district. Hospitalization rate was 89%. Overall, 74.3% of transmission events occurred between members of the same family, 17.9% in the community and 7.7% in hospital. The mean number of contacts investigated per case raised from 11.5 in July to 25 in September 2014. The 2014 admission trend in the pediatric ward shows a decrease after beginning of June: the reduction was almost significant in the period July-December (p 0.05). The admission in the maternity ward showed no statistical differences in comparison with the previous year (p 0.07). Also the number of deliveries appeared to be similar to the previous year, without significant variations (p 0.41). CONCLUSION The Ebola outbreak reduced the number of patients at hospital level in Pujehun district. However, the activities undertaken to manage Ebola, reduced the spread of infection and the impact of the disease in mothers and children. A number of reasons which may explain these results are presented and discussed.
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Affiliation(s)
- GianLuca Quaglio
- Directorate-General for Parliamentary Research Services (EPRS), European Parliament, Brussels, Belgium
| | - Damiano Pizzol
- Operational Research Unit, Doctors with Africa, Padova, Italy
| | - David Bome
- Ministry of Health and Sanitation, Pujehun District, Freetown, Sierra Leone
| | - Atiba Kebbie
- Pujehun Hospital, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Zainab Bangura
- Pujehun Hospital, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Vandi Massaquoi
- Pujehun Hospital, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Giovanni Putoto
- Doctors with Africa CUAMM, Operational Research Unit, Padova, Italy
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Kennedy SB, Neaton JD, Lane HC, Kieh MWS, Massaquoi MBF, Touchette NA, Nason MC, Follmann DA, Boley FK, Johnson MP, Larson G, Kateh FN, Nyenswah TG. Implementation of an Ebola virus disease vaccine clinical trial during the Ebola epidemic in Liberia: Design, procedures, and challenges. Clin Trials 2016; 13:49-56. [PMID: 26768572 DOI: 10.1177/1740774515621037] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The index case of the Ebola virus disease epidemic in West Africa is believed to have originated in Guinea. By June 2014, Guinea, Liberia, and Sierra Leone were in the midst of a full-blown and complex global health emergency. The devastating effects of this Ebola epidemic in West Africa put the global health response in acute focus for urgent international interventions. Accordingly, in October 2014, a World Health Organization high-level meeting endorsed the concept of a phase 2/3 clinical trial in Liberia to study Ebola vaccines. As a follow-up to the global response, in November 2014, the Government of Liberia and the US Government signed an agreement to form a research partnership to investigate Ebola and to assess intervention strategies for treating, controlling, and preventing the disease in Liberia. This agreement led to the establishment of the Joint Liberia-US Partnership for Research on Ebola Virus in Liberia as the beginning of a long-term collaborative partnership in clinical research between the two countries. In this article, we discuss the methodology and related challenges associated with the implementation of the Ebola vaccines clinical trial, based on a double-blinded randomized controlled trial, in Liberia.
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Affiliation(s)
- Stephen B Kennedy
- Liberia-US Clinical Trials Partnership Program, Partnership for Research on Ebola Vaccines in Liberia (PREVAIL), Monrovia, Liberia Incident Management System (IMS), Emergency Operations Center (EoC), Ministry of Health (MoH), Monrovia, Liberia
| | - James D Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - H Clifford Lane
- Division of Clinical Research, National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Mark W S Kieh
- Liberia-US Clinical Trials Partnership Program, Partnership for Research on Ebola Vaccines in Liberia (PREVAIL), Monrovia, Liberia
| | - Moses B F Massaquoi
- Liberia-US Clinical Trials Partnership Program, Partnership for Research on Ebola Vaccines in Liberia (PREVAIL), Monrovia, Liberia Incident Management System (IMS), Emergency Operations Center (EoC), Ministry of Health (MoH), Monrovia, Liberia
| | - Nancy A Touchette
- Division of Clinical Research, National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Martha C Nason
- Division of Clinical Research, National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Dean A Follmann
- Division of Clinical Research, National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Fatorma K Boley
- Liberia-US Clinical Trials Partnership Program, Partnership for Research on Ebola Vaccines in Liberia (PREVAIL), Monrovia, Liberia Liberian Institute for Biomedical Research (LIBR), Margibi, Liberia
| | - Melvin P Johnson
- Liberia-US Clinical Trials Partnership Program, Partnership for Research on Ebola Vaccines in Liberia (PREVAIL), Monrovia, Liberia
| | - Gregg Larson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Francis N Kateh
- Incident Management System (IMS), Emergency Operations Center (EoC), Ministry of Health (MoH), Monrovia, Liberia Ministry of Health (MoH), Monrovia, Liberia
| | - Tolbert G Nyenswah
- Incident Management System (IMS), Emergency Operations Center (EoC), Ministry of Health (MoH), Monrovia, Liberia Ministry of Health (MoH), Monrovia, Liberia
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Kenny A, Basu G, Ballard M, Griffiths T, Kentoffio K, Niyonzima JB, Sechler GA, Selinsky S, Panjabi RR, Siedner MJ, Kraemer JD. Remoteness and maternal and child health service utilization in rural Liberia: A population-based survey. J Glob Health 2015; 5:020401. [PMID: 26207180 PMCID: PMC4512264 DOI: 10.7189/jogh.05.020401] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study seeks to understand distance from health facilities as a barrier to maternal and child health service uptake within a rural Liberian population. Better understanding the relationship between distance from health facilities and rural health care utilization is important for post-Ebola health systems reconstruction and for general rural health system planning in sub-Saharan Africa. METHODS Cluster-sample survey data collected in 2012 in a very rural southeastern Liberian population were analyzed to determine associations between quartiles of GPS-measured distance from the nearest health facility and the odds of maternal (ANC, facility-based delivery, and PNC) and child (deworming and care seeking for ARI, diarrhea, and fever) service use. We estimated associations by fitting simple and multiple logistic regression models, with standard errors adjusted for clustered data. FINDINGS Living in the farthest quartile was associated with lower odds of attending 1-or-more ANC checkup (AOR = 0.04, P < 0.001), 4-or-more ANC checkups (AOR = 0.13, P < 0.001), delivering in a facility (AOR = 0.41, P = 0.006), and postnatal care from a health care worker (AOR = 0.44, P = 0.009). Children living in all other quartiles had lower odds of seeking facility-based fever care (AOR for fourth quartile = 0.06, P < 0.001) than those in the nearest quartile. Children in the fourth quartile were less likely to receive deworming treatment (AOR = 0.16, P < 0.001) and less likely (but with only marginal statistical significance) to seek ARI care from a formal HCW (AOR = 0.05, P = 0.05). Parents in distant quartiles more often sought ARI and diarrhea care from informal providers. CONCLUSIONS Within a rural Liberian population, distance is associated with reduced health care uptake. As Liberia rebuilds its health system after Ebola, overcoming geographic disparities, including through further dissemination of providers and greater use of community health workers should be prioritized.
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Affiliation(s)
| | - Gaurab Basu
- Last Mile Health, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA ; Cambridge Health Alliance, Cambridge, MA, USA
| | | | | | | | | | - G Andrew Sechler
- Last Mile Health, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA ; Brigham and Women's Hospital, Boston, MA, USA
| | | | - Rajesh R Panjabi
- Last Mile Health, Boston, MA, USA ; Brigham and Women's Hospital, Boston, MA, USA
| | | | - John D Kraemer
- Georgetown University Medical Center, Washington, DC, USA
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Kraemer JD, Siedner MJ, Stoto MA. Analyzing Variability in Ebola-Related Controls Applied to Returned Travelers in the United States. Health Secur 2015; 13:295-306. [PMID: 26348222 PMCID: PMC4582682 DOI: 10.1089/hs.2015.0016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/05/2015] [Indexed: 11/12/2022] Open
Abstract
Public health authorities have adopted entry screening and subsequent restrictions on travelers from Ebola-affected West African countries as a strategy to prevent importation of Ebola virus disease (EVD) cases. We analyzed international, federal, and state policies-principally based on the policy documents themselves and media reports-to evaluate policy variability. We employed means-ends fit analysis to elucidate policy objectives. We found substantial variation in the specific approaches favored by WHO, CDC, and various American states. Several US states impose compulsory quarantine on a broader range of travelers or require more extensive monitoring than recommended by CDC or WHO. Observed differences likely partially resulted from different actors having different policy goals-particularly the federal government having to balance foreign policy objectives less salient to states. Further, some state-level variation appears to be motivated by short-term political goals. We propose recommendations to improve future policies, which include the following: (1) actors should explicitly clarify their objectives, (2) legal authority should be modernized and clarified, and (3) the federal government should consider preempting state approaches that imperil its goals.
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Affiliation(s)
- John D Kraemer
- John D. Kraemer, JD, MPH, and Michael A. Stoto, PhD, are with the Department of Health Systems Administration and the O'Neill Institute for National and Global Health Law at Georgetown University , Washington, DC. Mark J. Siedner, MD, MPH, is with the Center for Global Health at Massachusetts General Hospital and Harvard Medical School
| | - Mark J Siedner
- John D. Kraemer, JD, MPH, and Michael A. Stoto, PhD, are with the Department of Health Systems Administration and the O'Neill Institute for National and Global Health Law at Georgetown University , Washington, DC. Mark J. Siedner, MD, MPH, is with the Center for Global Health at Massachusetts General Hospital and Harvard Medical School
| | - Michael A Stoto
- John D. Kraemer, JD, MPH, and Michael A. Stoto, PhD, are with the Department of Health Systems Administration and the O'Neill Institute for National and Global Health Law at Georgetown University , Washington, DC. Mark J. Siedner, MD, MPH, is with the Center for Global Health at Massachusetts General Hospital and Harvard Medical School
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