Fears and Misperceptions of the Ebola Response System during the 2014-2015 Outbreak in Sierra Leone.
Fears and Misperceptions of the Ebola Response System during the 2014-2015 Outbreak in Sierra Leone.
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DOI：
10.1371/journal.pntd.0005077
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发表时间：
2016-10
影响因子：
3.8
通讯作者：
Shepler S
中科院分区：
文献类型：
--
作者：
Yamanis T;Nolan E;Shepler S
未来的传染病疫情可能会对卫生系统薄弱的国家产生不成比例的影响，加剧全球的脆弱性。为了降低这些地区疫情的严重程度，可以从西非的埃博拉疫情中吸取教训。关于公众对要求公民报告和治疗埃博拉病例的公共卫生应对系统的看法，相关文献匮乏。流行病学报告显示，诊断和治疗存在延误。我们研究的目的是探究在疫情高峰期阻止塞拉利昂人信任和使用埃博拉应对系统的障碍。
我们聘请了一位经验丰富的民族志学者，在受埃博拉影响地区的公共场所进行了30次半结构化的深度访谈。参与者年龄至少18岁，会说克里奥语，且报告在最近21天内未与埃博拉感染者接触。我们使用归纳编码法，并记录下浮现的主题。
大多数参与者担心，为他们认为感染了埃博拉的人拨打国家热线会导致那个人死亡。许多人表示，如果他们发烧，他们会认为不是埃博拉，而是自行用药。一些人认为救护车工作人员喷洒的氯是有毒的。尽管大多数人知道有针对埃博拉的实验室检测，但一些人错误地认为随处可见的温度计就是检测手段，而且大多数人不理解在出现埃博拉症状时需要重新检测。
与对应对系统缺乏信任相关的恐惧和误解，可能导致塞拉利昂在埃博拉疫情期间就医延迟。未来应对疫情的方案应纳入动态的定性研究，以了解和解决人们的看法。增强对应对系统信任的策略，比如社区动员，可能会特别有效。
为了降低卫生系统控制疫情能力不发达的国家疫情的严重程度，可以从西非的埃博拉疫情中吸取教训。据我们所知，这是第一项使用定性研究方法来了解塞拉利昂疫情期间社区成员对使用埃博拉应对系统看法的研究。我们在两个人口最多的地区进行了这项研究，当时仍有大量与埃博拉相关的死亡病例，而且埃博拉应对系统已经扩大规模。虽然全国家庭调查显示当时使用应对系统的意愿较高，但流行病学报告显示，寻求检测和治疗存在延误。我们使用半结构化的深度访谈以及一位在塞拉利昂有经验的民族志学者，提高了我们了解人们的恐惧和误解的能力。对应对系统的担忧集中在三个关键主题上：对拨打国家热线的恐惧、对氯喷雾的负面看法以及对埃博拉实验室检测和重新检测必要性的误解。这些恐惧和误解可能导致人们延迟就医。我们的研究结果支持这样的观点，即对公共卫生应对系统的信任是公民使用该系统不可或缺的一部分。我们就埃博拉疫情期间如何增强信任提出了几条建议。未来疫情的应对方案应纳入动态和定性研究，既要了解对应对系统的看法，又要利用这些数据制定更有效的应对措施。
Future infectious disease epidemics are likely to disproportionately affect countries with weak health systems, exacerbating global vulnerability. To decrease the severity of epidemics in these settings, lessons can be drawn from the Ebola outbreak in West Africa. There is a dearth of literature on public perceptions of the public health response system that required citizens to report and treat Ebola cases. Epidemiological reports suggested that there were delays in diagnosis and treatment. The purpose of our study was to explore the barriers preventing Sierra Leoneans from trusting and using the Ebola response system during the height of the outbreak. Using an experienced ethnographer, we conducted 30 semi-structured in-depth interviews in public spaces in Ebola-affected areas. Participants were at least age 18, spoke Krio, and reported no contact in the recent 21 days with an Ebola-infected person. We used inductive coding and noted emergent themes. Most participants feared that calling the national hotline for someone they believed had Ebola would result in that person’s death. Many stated that if they developed a fever they would assume it was not Ebola and self-medicate. Some thought the chlorine sprayed by ambulance workers was toxic. Although most knew there was a laboratory test for Ebola, some erroneously assumed the ubiquitous thermometers were the test and most did not understand the need to re-test in the presence of Ebola symptoms. Fears and misperceptions, related to lack of trust in the response system, may have delayed care-seeking during the Ebola outbreak in Sierra Leone. Protocols for future outbreak responses should incorporate dynamic, qualitative research to understand and address people’s perceptions. Strategies that enhance trust in the response system, such as community mobilization, may be particularly effective. To decrease the severity of epidemics in countries with under-developed health system capacity to control outbreaks, lessons can be drawn from the Ebola outbreak in West Africa. This is the first study, to our knowledge, to use qualitative research methods to understand community members’ perceptions of using the Ebola response system during the outbreak in Sierra Leone. We conducted this study in two of the most populous districts during a time when there were still a high number of Ebola-related fatalities, and the Ebola response system had been scaled up. While national household surveys demonstrated high levels of intent to use the response system at the time, epidemiological reports suggested that there were delays in seeking testing and treatment. Our use of semi-structured in-depth interviews, as well as an ethnographer with experience in Sierra Leone, enhanced our ability to elicit people’s fears and misperceptions. Concerns about the response system clustered around three key themes: fears of calling the national hotline, negative perceptions of the chlorine spray, and misperceptions about the Ebola laboratory test and the need to re-test. These fears and misperceptions likely delayed people from seeking care. Our results lend support to the argument that trust in the public health response system was integral to citizens’ use of the system. We make several recommendations for how trust could have been enhanced during the Ebola outbreak. Protocols for future outbreaks should incorporate dynamic and qualitative research both to understand perceptions of the response system and to use these data to inform a more effective response.
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DOI：
10.1126/science.1260612
发表时间：
2014-11-21
期刊：
Science (New York, N.Y.)
影响因子：
--
作者：
Pandey A;Atkins KE;Medlock J;Wenzel N;Townsend JP;Childs JE;Nyenswah TG;Ndeffo-Mbah ML;Galvani AP
通讯作者：
Galvani AP
影响因子：
2.5
作者：
Carrion Martin, A. I.;Derrough, T.;Jansa, J. M.
通讯作者：
Jansa, J. M.
影响因子：
168.9
作者：
Moon, Suerie;Sridhar, Devi;Piot, Peter
通讯作者：
Piot, Peter
影响因子：
4.4
作者：
Cairns, Georgina;de Andrade, Marisa;MacDonald, Laura
通讯作者：
MacDonald, Laura
影响因子：
2.7
作者：
Peters, Dexnell;Youssef, Farid F.
通讯作者：
Youssef, Farid F.