Community-centered responses to Ebola in urban Liberia: the view from below.
Community-centered responses to Ebola in urban Liberia: the view from below.
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DOI：
10.1371/journal.pntd.0003706
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发表时间：
2015-04
影响因子：
3.8
通讯作者：
Omidian PA
中科院分区：
文献类型：
--
作者：
Abramowitz SA;McLean KE;McKune SL;Bardosh KL;Fallah M;Monger J;Tehoungue K;Omidian PA
西非埃博拉疫情表明，现有的针对新出现疾病爆发的医疗和流行病学应对措施还不够，特别是在医疗基础设施极其薄弱的冲突后环境中。在这方面，事实证明，以社区为基础的应对措施对于遏制埃博拉病毒病和改变流行曲线至关重要。尽管人们对有效遏制这一流行病的地方创新的兴趣大增，但社区应对机制仍不清楚。这项研究提供了以社区为基础的流行病控制优先事项的基线信息，并确定了在利比里亚遏制EVD的创新性地方战略。这项研究于2014年9月在利比里亚埃博拉疫情震中之一的蒙罗维亚和蒙特塞拉多县的15个社区进行。与386名社区领导人进行的15次重点小组讨论的结果确定了正在采取的战略，并就在当时现有条件下社区应对埃博拉病毒的方式提出了建议。收集了关于以下主题的数据：预防、监测、护理、社区治疗和支持、网络和热线、应对小组、埃博拉治疗单位和医院、尸体管理、检疫和隔离、孤儿、纪念以及社区培训和教育的必要性。研究结果已作为基于社区的战略和建议提出，用于（1）预防，（2）治疗和反应，（3）社区后遗症和恢复。与会者提出了几种以社区为基础管理当前埃博拉疫情的模式。其他调查结果表明，对早期埃博拉幸存者的态度是积极的，需要以社区为基础的心理社会支持。当地社区的策略和建议让我们深入了解利比里亚城市社区如何遏制EVD疫情，同时应对初始国家和国际应对措施的系统性失败。利比里亚城市社区采用多种应对战略来适应这一流行病。在缺乏保健、基础设施和物质支助的情况下，当地人民自力更生，以便在微观社会一级控制这一流行病。这些创新被认为是必要的，但不如得到充分支持的基于卫生系统的应对措施那么可取;并被认为涉及相当大的个人、社会和公共卫生成本，包括增加感染的脆弱性。在这项研究中，作者分析了2014年利比里亚蒙罗维亚和蒙特塞拉多县埃博拉疫情的数据。收集这些数据是为了世界卫生组织（WHO）和利比里亚政府（GOL）的项目设计和评估，以确定：（1）当地对EVD的了解，（2）当地对疫情的应对措施，以及（3）以社区为基础的遏制病毒的创新。在收集数据时，国际埃博拉应对措施几乎不了解利比里亚当地社区对埃博拉的了解程度，以及社区在由于医院和诊所普遍关闭而无法获得护理时如何管理疫情。方法包括与来自活跃埃博拉病例地区的社区领导人进行15次焦点小组讨论。与会者被问及最佳做法以及他们目前在各自社区管理EVD方面所做的工作，目的是根据当地的叙述制定当地应对措施的概念模型。调查结果显示，社区以多种方式应对疫情，既支持也不鼓励遏制疾病传播的正式努力。这项研究将为全球卫生政策提供信息，以应对当前和未来的流行病和大流行病。
The West African Ebola epidemic has demonstrated that the existing range of medical and epidemiological responses to emerging disease outbreaks is insufficient, especially in post-conflict contexts with exceedingly poor healthcare infrastructures. In this context, community-based responses have proven vital for containing Ebola virus disease (EVD) and shifting the epidemic curve. Despite a surge in interest in local innovations that effectively contained the epidemic, the mechanisms for community-based response remain unclear. This study provides baseline information on community-based epidemic control priorities and identifies innovative local strategies for containing EVD in Liberia. This study was conducted in September 2014 in 15 communities in Monrovia and Montserrado County, Liberia – one of the epicenters of the Ebola outbreak. Findings from 15 focus group discussions with 386 community leaders identified strategies being undertaken and recommendations for what a community-based response to Ebola should look like under then-existing conditions. Data were collected on the following topics: prevention, surveillance, care-giving, community-based treatment and support, networks and hotlines, response teams, Ebola treatment units (ETUs) and hospitals, the management of corpses, quarantine and isolation, orphans, memorialization, and the need for community-based training and education. Findings have been presented as community-based strategies and recommendations for (1) prevention, (2) treatment and response, and (3) community sequelae and recovery. Several models for community-based management of the current Ebola outbreak were proposed. Additional findings indicate positive attitudes towards early Ebola survivors, and the need for community-based psychosocial support. Local communities’ strategies and recommendations give insight into how urban Liberian communities contained the EVD outbreak while navigating the systemic failures of the initial state and international response. Communities in urban Liberia adapted to the epidemic using multiple coping strategies. In the absence of health, infrastructural and material supports, local people engaged in self-reliance in order to contain the epidemic at the micro-social level. These innovations were regarded as necessary, but as less desirable than a well-supported health-systems based response; and were seen as involving considerable individual, social, and public health costs, including heightened vulnerability to infection. In this study the authors analyzed data from the 2014 Ebola outbreak in Monrovia and Montserrado County, Liberia. The data were collected for the purposes of program design and evaluation by the World Health Organization (WHO) and the Government of Liberia (GOL), in order to identify: (1) local knowledge about EVD, (2) local responses to the outbreak, and (3) community-based innovations to contain the virus. At the time of data collection, the international Ebola response had little insight into how much local Liberian communities knew about Ebola, and how communities managed the epidemic when they could not get access to care due to widespread hospital and clinic closures. Methods included 15 focus group discussions with community leaders from areas with active Ebola cases. Participants were asked about best practices and what they were currently doing to manage EVD in their respective communities, with the goal of developing conceptual models of local responses informed by local narratives. Findings reveal that communities responded to the outbreak in numerous ways that both supported and discouraged formal efforts to contain the spread of the disease. This research will inform global health policy for both this, and future, epidemic and pandemic responses.