Institutional trust and misinformation in the response to the 2018-19 Ebola outbreak in North Kivu, DR Congo: a population-based survey
Institutional trust and misinformation in the response to the 2018-19 Ebola outbreak in North Kivu, DR Congo: a population-based survey
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DOI：
10.1016/s1473-3099(19)30063-5
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发表时间：
2019-05-01
影响因子：
56.3
通讯作者：
Nilles, Eric J.
中科院分区：
文献类型：
--
作者：
Vinck, Patrick;Pham, Phuong N.;Nilles, Eric J.
背景目前在刚果民主共和国东部爆发的埃博拉疫情始于2018年，是在复杂和暴力的政治和安全环境中出现的。社区一级的预防和疫情控制措施似乎取决于公众对有关当局和信息的信任，但很少有学者探讨这些问题。我们的目的是调查在埃博拉病毒病（EVD）爆发期间，信任和错误信息对个人预防行为的作用。方法我们在2018年9月1日至9月16日期间调查了961名成年人。我们在刚果民主共和国北基伍省的贝尼和布滕博采用了多阶段抽样设计。在412个街道和牢房（最低行政结构;贝尼99个，布滕博313个）中，我们在每个城市随机选择了30个。在每条街道或每个小区，使用卫生组织扩大免疫方案的随机游走方法选择了16个家庭。在每个家庭中，随机选择一名成年人（年龄≥ 18岁）进行访谈。标准化的问卷由经验丰富的面试官进行管理。我们使用多变量模型来研究中间变量的利益，包括机构的信任和信念，在选定的错误信息，与EVD预防behaviors.Findings相关的利益的结果在961名受访者中，349（31.9%，95%CI 27.4-36.9）相信，地方当局代表他们的利益。相信错误信息的人很普遍，230名（25.5%，21.7-29.6）受访者认为埃博拉疫情不是真实的。机构信任度低和相信错误信息与采取预防行为，包括接受埃博拉疫苗的可能性降低有关（比值比0.22，95% CI 0.21-0.22和1.40，1.39-1.42）和寻求正规医疗保健（0.06，0.05-0.06，和1.16，1.15-1.17）.解释研究结果强调了不信任和错误信息对疫情控制的实际影响。这些因素与对社会和行为改变信息的依从性低以及拒绝寻求正规医疗或接受疫苗有关，这反过来又增加了EVD传播的风险。
Background The current outbreak of Ebola in eastern DR Congo, beginning in 2018, emerged in a complex and violent political and security environment. Community-level prevention and outbreak control measures appear to be dependent on public trust in relevant authorities and information, but little scholarship has explored these issues. We aimed to investigate the role of trust and misinformation on individual preventive behaviours during an outbreak of Ebola virus disease (EVD).Methods We surveyed 961 adults between Sept 1 and Sept 16, 2018. We used a multistage sampling design in Beni and Butembo in North Kivu, DR Congo. Of 412 avenues and cells (the lowest administrative structures; 99 in Beni and 313 in Butembo), we randomly selected 30 in each city. In each avenue or cell, 16 households were selected using the WHO Expanded Programme on Immunization's random walk approach. In each household, one adult (aged >= 18 years) was randomly selected for interview. Standardised questionnaires were administered by experienced interviewers. We used multivariate models to examine the intermediate variables of interest, including institutional trust and belief in selected misinformation, with outcomes of interest related to EVD prevention behaviours.Findings Among 961 respondents, 349 (31.9%, 95% CI 27.4-36.9) trusted that local authorities represent their interest. Belief in misinformation was widespread, with 230 (25.5%, 21.7-29.6) respondents believing that the Ebola outbreak was not real. Low institutional trust and belief in misinformation were associated with a decreased likelihood of adopting preventive behaviours, including acceptance of Ebola vaccines (odds ratio 0.22, 95% CI 0.21-0.22, and 1.40, 1.39-1.42) and seeking formal health care (0.06, 0.05-0.06, and 1.16, 1.15-1.17).Interpretation The findings underscore the practical implications of mistrust and misinformation for outbreak control. These factors are associated with low compliance with messages of social and behavioural change and refusal to seek formal medical care or accept vaccines, which in turn increases the risk of spread of EVD.