The factors affecting household transmission dynamics and community compliance with Ebola control measures: a mixed-methods study in a rural village in Sierra Leone.
The factors affecting household transmission dynamics and community compliance with Ebola control measures: a mixed-methods study in a rural village in Sierra Leone.
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DOI：
10.1186/s12889-018-5158-6
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发表时间：
2018-02-13
影响因子：
4.5
通讯作者：
Greig J
中科院分区：
文献类型：
--
作者：
Caleo G;Duncombe J;Jephcott F;Lokuge K;Mills C;Looijen E;Theoharaki F;Kremer R;Kleijer K;Squire J;Lamin M;Stringer B;Weiss HA;Culli D;Di Tanna GL;Greig J
人们对埃博拉病毒病（EVD）的传播动态以及社区对防控措施的长期依从性了解甚少。如果要使干预措施在未来的疫情爆发中有效，了解这些相互作用至关重要。我们在塞拉利昂凯拉洪区一个经历了持续埃博拉病毒传播的乡村进行了一项混合方法研究，以探究这些因素。
我们利用2015年4月进行的一项横断面调查重建了传播动态，并将我们的结果与监测、丧葬和埃博拉管理中心（EMC）的数据进行了交叉参考。通过考克斯比例风险回归评估了与埃博拉病毒传播相关的因素。在调查之后，定性的半结构化访谈探究了社区信息提供者和家庭的看法。
所有家庭（n = 240；1161人）都参与了调查。31例埃博拉病毒可能/确诊病例中有29例死亡（病死率为93.5%）；其他监测系统遗漏了6例死亡病例（20.6%）。历经五代的传播持续了16周。尽管大多数家庭的成员数≤5人，但成员数＞5人的家庭感染埃博拉病毒的风险显著增加。感染埃博拉病毒的风险还与年龄较大有关。病例在空间上呈聚集性；所有病例都发生在15个家庭中。
当社区的经历开始与所传达的公共卫生信息相符时，人们对埃博拉病毒传播有了更好的理解。对接触者追踪的看法从侵犯隐私和出卖人转变为确保社区安全。用塑料袋下葬，没有女性参加或祈祷，被认为是不体面的。依从性低的其他原因包括埃博拉管理中心的存活率低、家庭认为有照顾亲属的道德责任、与埃博拉管理中心沟通不畅以及因隔离而失去生计。只有在第二代之后，随着限制性地方法规的实施、第一名幸存者的归来、与尸体接触的减少以及患者被收治到埃博拉管理中心，对防控措施的依从性才有所提高。
传播主要发生在少数几个大家庭中，传播时间长且死亡人数多。一名幸存者回到村庄以及更有效地实施控制策略与对控制措施依从性的提高同时发生，随后的病例很少。基于这一经验，我们对埃博拉病毒病爆发的管理提出了关键建议。
Little is understood of Ebola virus disease (EVD) transmission dynamics and community compliance with control measures over time. Understanding these interactions is essential if interventions are to be effective in future outbreaks. We conducted a mixed-methods study to explore these factors in a rural village that experienced sustained EVD transmission in Kailahun District, Sierra Leone. We reconstructed transmission dynamics using a cross-sectional survey conducted in April 2015, and cross-referenced our results with surveillance, burial, and Ebola Management Centre (EMC) data. Factors associated with EVD transmission were assessed with Cox proportional hazards regression. Following the survey, qualitative semi-structured interviews explored views of community informants and households. All households (n = 240; 1161 individuals) participated in the survey. 29 of 31 EVD probable/confirmed cases died (93·5% case fatality rate); six deaths (20·6%) had been missed by other surveillance systems. Transmission over five generations lasted 16 weeks. Although most households had ≤5 members there was a significant increase in risk of Ebola in households with > 5 members. Risk of EVD was also associated with older age. Cases were spatially clustered; all occurred in 15 households. EVD transmission was better understood when the community experience started to concord with public health messages being given. Perceptions of contact tracing changed from invading privacy and selling people to ensuring community safety. Burials in plastic bags, without female attendants or prayer, were perceived as dishonourable. Further reasons for low compliance were low EMC survival rates, family perceptions of a moral duty to provide care to relatives, poor communication with the EMC, and loss of livelihoods due to quarantine. Compliance with response measures increased only after the second generation, coinciding with the implementation of restrictive by-laws, return of the first survivor, reduced contact with dead bodies, and admission of patients to the EMC. Transmission occurred primarily in a few large households, with prolonged transmission and a high death toll. Return of a survivor to the village and more effective implementation of control strategies coincided with increased compliance to control measures, with few subsequent cases. We propose key recommendations for management of EVD outbreaks based on this experience.
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影响因子：
11.8
作者：
Lindblade KA;Kateh F;Nagbe TK;Neatherlin JC;Pillai SK;Attfield KR;Dweh E;Barradas DT;Williams SG;Blackley DJ;Kirking HL;Patel MR;Dea M;Massoudi MS;Wannemuehler K;Barskey AE;Zarecki SL;Fomba M;Grube S;Belcher L;Broyles LN;Maxwell TN;Hagan JE;Yeoman K;Westercamp M;Forrester J;Mott J;Mahoney F;Slutsker L;DeCock KM;Nyenswah T
通讯作者：
Nyenswah T
影响因子：
3.8
作者：
Yamanis T;Nolan E;Shepler S
通讯作者：
Shepler S
影响因子：
56.3
作者：
Glynn, Judith R.;Bower, Hilary;Tedder, Richard S.
通讯作者：
Tedder, Richard S.
影响因子：
2
作者：
Adams, Ben
通讯作者：
Adams, Ben
在塞拉利昂西部地区的埃博拉病毒疾病爆发期间接触追踪：未来的埃博拉疫情反应的教训。
影响因子：
5.2
作者：
Olu OO;Lamunu M;Nanyunja M;Dafae F;Samba T;Sempiira N;Kuti-George F;Abebe FZ;Sensasi B;Chimbaru A;Ganda L;Gausi K;Gilroy S;Mugume J
通讯作者：
Mugume J