26 research outputs found

    Uncertain certainties: an analysis of the American response to the 2014-2016 West African Ebola epidemic.

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    This project examines the construction of scientific facts surrounding the 2014-2016 West African Ebola outbreak as well as the subsequent uptake and transformation of those facts by the United States government. While the Ebolavirus ravaged the communities of Sierra Leone, Liberia, and Guinea, the incidence of the virus in other countries was very low. Nonetheless, the United States spent $576 million on domestic preparedness and response. This study addresses this mismatch in the context of the reinvigorated interest among rhetoricians into writing and science. Applying and expanding the methodology of Jeanne Fahnestock, this study analyzes Ebola-related statements in scientific articles, webpages of the Centers for Disease Control and Prevention (CDC), and governmental documents. Not only does this answer Fahnestock’s call to use her technique to investigate the use of scientific information by political groups, but it uncovers a way in which neo-colonial discourses and actions can emerge from scientific accommodations

    Tears in Heaven: Religiously and Culturally Sensitive Laws for Preventing the Next Pandemic

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    In February 2016, the World Health Organization (WHO) declared a “public health emergency of international concern” due to the increased clusters of microcephaly, Guillain-Barré Syndrome, and other neurological disorders in areas affected by the Zika virus. That declaration came in the wake of the West Africa Ebola crisis. Back to back declarations by WHO of the highest threat level for an international public health emergency underscores how quickly pathogens can now spread and cause devastation across borders. It also highlights the need to implement lessons learned from each pandemic crisis without delay. These crises demonstrate that laws to curtail the spread of deadly contagious diseases need to be drafted and implemented in ways to maximize community acceptance. Without prudently crafted laws in place that are as consistent as possible with community mores, threats from deadly diseases may cause anxiety and panic, and governments may react to political and public pressures and mandate rules that may unnecessarily impinge on personal rights and deeply held religious beliefs. Infringing upon ideological or religious beliefs could lead to increased distrust of government and civil disobedience and could also, paradoxically, undermine the goal of preventing the spread of infectious disease. This article focuses on applying to future pandemics a critical lesson from prior crises — the need for public health officials to accommodate religious and cultural practices of the community to more effectively implement emergency measures. Further, the article proposes an interdisciplinary and proactive approach to development of laws and regulations to create a system that is adaptable, acceptable to the community, and scientifically sound

    Barriers to maternal health services during the Ebola outbreak in three West African countries: a literature review

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    Introduction The Ebola virus disease (EVD) outbreak in West Africa, affecting Guinea, Liberia and Sierra Leone from 2014 to 2016, was a substantial public health crisis with health impacts extending past EVD itself. Access to maternal health services (MHS) was disrupted during the epidemic, with reductions in antenatal care, facility-based deliveries and postnatal care. We aimed to identify and describe barriers related to the uptake and provision of MHS during the 2014–2016 EVD outbreak in West Africa. Methods In June 2020, we conducted a scoping review of peer-reviewed publications and grey literature from relevant stakeholder organisations. Search terms were generated to identify literature that explained underlying access barriers to MHS. Published literature in scientific journals was first searched and extracted from PubMed and Web of Science databases for the period between 1 January 2014 and 27 June 2020. We hand-searched relevant stakeholder websites. A ‘snowball’ approach was used to identify relevant sources uncaptured in the systematic search. The identified literature was examined to synthesise themes using an existing framework. Results Nineteen papers were included, with 26 barriers to MHS uptake and provision identified. Three themes emerged: (1) fear and mistrust, (2) health system and service constraints, and (3) poor communication. Our analysis of the literature indicates that fear, experienced by both service users and providers, was the most recurring barrier to MHS. Constrained health systems negatively impacted MHS on the supply side. Poor communication and inadequately coordinated training efforts disallowed competent provision of MHS. Conclusions Barriers to accessing MHS during the EVD outbreak in West Africa were influenced by complex but inter-related factors at the individual, interpersonal, health system and international level. Future responses to EVD outbreaks need to address underlying reasons for fear and mistrust between patients and providers, and ensure MHS are adequately equipped both routinely and during crises

    Behavioral surveillance during and after the 2014–2016 Ebola outbreak in Sierra Leone

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    Background: The first documented case of Ebola Virus Disease (Ebola) in Sierra Leone was confirmed in May 2014 in Kailahun district after cases had been reported in Guinea and Liberia. Ebola is transmitted through contact with infected blood, stool, and other bodily fluids. Transmission risk in West Africa was driven by traditional burials involving physical contact with corpses, caring for infected persons without adequate protection, and delaying medical care. Sexual transmission due to viral persistence in the semen of male survivors posed an additional risk. Experimental Ebola vaccine candidates were implemented to curb transmission among health workers and other high–risk individuals. Reporting of all deaths to a national toll–free line (1–1–7 system) was mandated so that burials could be handled by teams trained in infection prevention and control. Aim: To understand trends in population–level Ebola knowledge, attitudes and prevention practices throughout different stages of the outbreak, acceptability of experimental Ebola vaccines at the peak of the outbreak and reporting of deaths after the outbreak ended. Methods: Four cross–sectional household surveys (N=10,603) were conducted using multi– stage cluster sampling in August 2014, October 2014, December 2014, and July 2015 to measure trends in Ebola–related knowledge, attitudes, and prevention practices (KAP). In– depth interviews (N=31) and focus group discussions (N=35) were conducted with health workers, frontline workers, and community members between December 2014 and January 2014 to understand acceptability of Ebola vaccine. Population–level demand for Ebola vaccine was assessed in a national household survey in December 2014 (N=3,540). After the outbreak ended, in 2017, motivations and barriers related to death reporting were assessed through a national telephone survey (N=1,291) and in–depth interviews (N=32). Quantitative data were analyzed using multilevel and ordered logistic regression modeling to examine various associations. Content analysis was used to identify cross–cutting themes in the qualitative data. Results: Ebola–related knowledge, attitudes, and prevention practices improved throughout the outbreak, especially in high–transmission regions. For example, when comparing before and after the peak of the outbreak, avoidance of physical contact with suspected Ebola patients nearly doubled in high–transmission areas (adjusted odds ratio (aOR) 1.9 [95% confidence interval 1.4–2.5]). Acceptability of Ebola vaccine was discouraged by safety related concerns but encouraged by altruistic motivation to help end the outbreak. Nationally, 74% of the public expressed high demand for Ebola vaccine, which was associated with wanting to be the first to get the vaccine compared to wanting politicians to be the first to get the vaccine (aOR 13.0; [7.8–21.6]). The number of deaths reported to the 1–1–7 system nationally in 2017 after the outbreak had ended represented nearly 12% of the expected deaths in the country versus almost 34% in 2016 and as much as 100% in 2015; albeit not accounting for potential duplicate reporting. After the Ebola outbreak, motivation to report deaths was greater if the decedent experienced one or more Ebola–like symptoms compared to none (aOR 2.3 [1.8–2.9]. Barriers to reporting deaths after the outbreak were driven by the lack of awareness to report all deaths, lack of reciprocal benefits linked to reporting, and negative experiences from the outbreak. Conclusions: Ebola prevention practices improved nationally during the outbreak in Sierra Leone, but the magnitude of improvement was greater in high–transmission regions compared to low–transmission regions. Understanding the drivers of Ebola vaccine acceptability and demand was important to inform ethical and cultural considerations in the implementation of experimental Ebola vaccines. While the 1–1–7 system was ramped up to capture nearly all deaths during the outbreak, reporting substantially declined after the outbreak ended. Failure to report deaths after the outbreak was due to lack of awareness to report all deaths and lack of perceived benefits to report in the post–Ebola–outbreak setting. Nevertheless, knowledge and experiences from the Ebola outbreak increasingly motivated people to report deaths that exhibited Ebola–like symptoms. Post–Ebola–outbreak settings offer an opportunity to implement routine mortality surveillance, however, substantial social mobilization efforts may be required to optimize reporting

    Learning interventions and training methods in health emergencies: A scoping review

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    BackgroundKeeping the health workforce and the public informed about the latest evolving health information during a health emergency is critical to preventing, detecting and responding to infectious disease outbreaks or other health emergencies. Having a well-informed, ready, willing, and skilled workforce and an informed public can help save lives, reduce diseases and suffering, and minimize socio-economic loss in affected communities and countries. Providing “just in time” support and opportunities for learning in health emergencies is much needed for capacity building. In this paper, ‘learning intervention’ refers to the provision of ad-hoc, focused, or personalized training sessions with the goal of preparing the health workers for emergencies or filling specific knowledge or skill gaps. We refer to ‘training methods’ as instructional design strategies used to teach someone the necessary knowledge and skills to perform a task. MethodsWe conducted a scoping review to map and better understand what learning interventions and training methods have been used in different types of health emergencies and by whom. Studies were identified using six databases (Pubmed/Medline, Embase, Hinari, WorldCat, CABI and Web of Science) and by consulting with experts. Characteristics of studies were mapped and displayed and major topic areas were identified. Results Of the 319 records that were included, contexts most frequently covered were COVID-19, disasters in general, Ebola and wars. Four prominent topic areas were identified: 1) Knowledge acquisition, 2) Emergency plans, 3) Impact of the learning intervention, and 4) Training methods. Much of the evidence was based on observational methods with few trials, which likely reflects the unique context of each health emergency. Evolution of methods was apparent, particularly in virtual learning. Learning during health emergencies appeared to improve knowledge, general management of the situation, quality of life of both trainers and affected population, satisfaction and clinical outcomesConclusion This is the first scoping review to map the evidence, which serves as a first step in developing urgently needed global guidance to further improve the quality and reach of learning interventions and training methods in this context. <br/

    Epidemic Intelligence Service (EIS) 2017 annual update

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    Bibliography (EIS Contributions to Public Health Literature: Publications with Authors in the 2014-2016 EIS Classes): p. 15-40.Epidemic Intelligence Service Program, Epidemiology Workforce Branch, Division of Scientific Education and Professional Development Center for Surveillance, Epidemiology and Laboratory Services, Office of Public Health Scientific Services, Centers for Disease Control and Preventioneis-annual-update-2017.pdfA Note from the Chief -- Overview of EIS -- Epidemiology Workforce Branch Leadership -- 2016-2017 EAC Members -- EIS Class of 2017 -- Host Assignments for EIS Classes of 2015 and 2016 -- Training EIS Officers -- Field Investigations -- Measuring Progress -- EIS Contributions to the Public Health Workforce -- Hiring an EIS Graduate -- EIS Officer Publications

    (Mal) adjustment to societal crisis: a case study from the analysis of coping expressions on social media

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    The present research had the goal to explore how individuals perceived, reacted to and coped with the Ebola virus outbreak in 2014, which was considered to be a health epidemic. When confronted with public health events perceived as threats, people tend to adapt to them by individually and collectively make sense of them (e.g. concerning the source of contagion) and manage resources to best cope with the demands posed. One of the maladaptive side-effects of this sense making process occurs when individuals associate the epidemic and its related features to specific social groups, for example by blaming them for the outbreak and ultimately, stigmatizing. In the specific case of the Ebola epidemic, we aimed to comprehend whether it was 1) more associated to the African continent and its related social groups (Africans; African countries; …) than to other countries, as evidence of a Symbolic Othering effect; and 2) if there were natural manifestations of this othering, by means of coping with the perceived threat, in the form of escape and opposition coping strategies.. Hence, we aimed to demonstrate the Symbolic Othering effect by means of a web-based questionnaire in which participants estimated the percentage of cases of human contamination, in non-contaminated African and non-African countries. Secondly, we aimed to present evidence of naturally occurring instances of Symbolic Othering in the form of coping expressions collected on social media, namely Twitter. This multi-method approach allowed both a qualitative and quantitative analysis. Results showed a strong association between the Ebola epidemic and the African continent, with more human contamination cases identified in African countries, even though they had an actual zero percentage of cases. Moreover, the qualitative analysis of twitter data showed direct and indirect mentions to the social group – Africa/Africans/African countries – in addition to the identification of other groups to blame for the epidemic and its social amplification, such as the government, media and other targets. Overall, these results present themselves as a relevant for health crisis managers and communicators, given that Symbolic Othering effects may be found when people perceived health related events as threats, which may eventually lead into social stigmatization processes.A presente investigação teve como objetivo explorar de que forma os indivíduos percepcionaram, reagiram e lidaram com o surto do vírus Ébola em 2014, o qual foi considerado uma epidemia de saúde. Quando confrontadas com eventos de saúde pública avaliados enquanto ameaças, as pessoas tendem adaptar-se às mesmas, de forma individual e coletiva, de modo a conferir-lhes um sentido (por exemplo, em relação à fonte de contágio) e gerir recursos para melhor lidar com as exigências. Um dos efeitos colaterais deste processo de procura de sentido é desadaptativo, dado que consiste em associar a epidemia e as suas características a grupos sociais específicos, por exemplo, culpando-os e, eventualmente, estigmatizando-os. No caso específico da epidemia do Ébola, o nosso objetivo foi compreender se: 1) esta estaria mais associada ao continente Africano/países africanos (em comparação a outros países), como evidência de um efeito de othering simbólico; e 2) se existiam expressões naturais deste othering, através de estratégias de enfrentamento como o escape e a oposição. Deste modo, procurámos demonstrar o efeito de othering simbólico através da aplicação de um questionário online, no qual os aprticipantes estimavam a percentagem de casos de contaminação humana em países africanos e não-africanos, todos não contaminados. Segundo, procurámos apresentar evidências de othering simbólico refletidas em estratégias específicas de enfrentamento, extraídas dos media sociais, nomeadamente, do Twitter. Esta abordagem multi-método permitiu uma análise qualitativa e quantitativa. Os resultados mostram uma forte associação entre a epidemia do Ébola e o continente Africano, com mais casos de contaminação humana identificados nos países africanos, apesar da percentagem real ser de zero casos. A análise qualitativa dos dados recolhidos no Twitter demonstrou menções diretas e indiretas ao grupo social – África / Africanos / países africanos – bem como identificação de outros grupos sociais – por exemplo, o governo, os meios de comunicação e outras entidades – que foram alvos de culpabilização não só pela epidemia em si, como também pela sua amplificação social. De um modo geral, estes resultados são relevantes para gestores e comunicadores de crises de saúde, tendo em conta que os efeitos do othering simbólico podem ser encontrados quando as pessoas percecionam eventos relacionados com saúde enquanto ameaças e que podem, eventualmente, resultar em processos de estigmatização social

    Emerging Infections: The World is not safe until Countries invest in Public Health Infrastructure. A Closer Look at Sub Saharan Africa (SSA) Public Health Infrastructure during COVID-19 Pandemic.

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    COVID-19 pandemic threatens public health systems across the globe. The ravaging COVID-19 virus does not spare public health systems of large economies such as the US. There are global shortages of PPE, laboratory, and critical care capacity is overwhelmed by the pandemic. Well-resourced public health care infrastructure is essential in reducing mortality, and disease burden in an epidemic, promoting global health security and safeguarding the progress made in other health programs such as HIV/AIDS and TB. When public health care systems in high-income countries are struggling to manage COVID-19, the situation is worse for under-funded public health systems in SSA. Endemic disease burden and brain drain are straining the deprioritized public health care systems. The 2014-2016 Ebola virus tested Africa\u27s healthcare infrastructure\u27s preparedness. There was no physical infrastructure, and public health systems were ill-equipped before the Ebola outbreak in Guinea, Liberia, and Sierra Leone. Three years later, public healthcare infrastructural gaps still exist in SSA during the COVID-19 pandemic. Laboratory and critical care capacity, readily available medical supplies, and healthcare personnel are crucial in fighting a highly transmissible viral disease such as COVID-19. SSA still suffers from inadequate public health infrastructure, which slows down efforts to manage the COVID-19 pandemic. Reliable and sustainable funding towards health enables long term planning, thereby allowing healthcare systems to improve and deliver better and timely responses to public health threats. Creating domestic capacity for medical supplies offers readily available supplies while setting up pandemic funds provides immediate financial support during a pandemic. Keywords: Health system, healthcare infrastructure, public health infrastructure, global health security, emerging infections, endemic diseases, public health threats, sustainable funding

    An ethics of anthropology-informed community engagement with COVID-19 clinical trials in Africa

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    The COVID-19 pandemic has reinforced the critical role of ethics and community engagement in designing and conducting clinical research during infectious disease outbreaks where no vaccine or treatment already exists. In reviewing current practices across Africa, we distinguish between three distinct roles for community engagement in clinical research that are often conflated: 1) the importance of community engagement for identifying and honouring cultural sensitivities; 2) the importance of recognising the socio-political context in which the research is proposed; and 3) the importance of understanding what is in the interest of communities recruited to research according to their own views and values. By making these distinctions, we show that current practice of clinical research could draw on anthropology in ways which are sometimes unnecessary to solicit local cultural values, overlook the importance of socio-political contexts and wider societal structures within which it works, potentially serving to reinforce unjust political or social regimes, and threaten to cast doubt on the trustworthiness of the research. We argue that more discerning anthropological engagement as well as wider collaboration with other social scientists and those working in the humanities is urgently needed to improve the ethics of current biomedical and pharmaceutical research practice in Africa
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