Social resistance drives persistent transmission of Ebola virus disease in Eastern Democratic Republic of Congo: A mixed-methods study
Social resistance drives persistent transmission of Ebola virus disease in Eastern Democratic Republic of Congo: A mixed-methods study
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DOI：
10.1371/journal.pone.0223104
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发表时间：
2019-09-26
期刊：
影响因子：
3.7
通讯作者：
Hawkes, Michael T.
中科院分区：
文献类型：
--
作者：
Claude, Kasereka Masumbuko;Underschultz, Jack;Hawkes, Michael T.
研究背景埃博拉病毒病（EVD）疫情目前在刚果（DRC）东部肆虐，疫情规模居历史第二位。顽固的持续性EVD传播与社会阻力有关，从被动的不遵守到对EVD response teams. MethodsWe的攻击行为，我们使用焦点小组讨论探讨了社区阻力，并使用标准化问卷评估了阻力观点的流行率。（由刚果民主共和国政府在国际社会支持下领导），焦点小组参与者提供了与最近媒体报道一致的对控制努力进行积极抵抗的目击者描述。对埃博拉病毒病反应小组的不信任是由于反应工作的不足（"群体医学"）、对雇佣军动机的怀疑以及违反文化埋葬习俗（"临时塑料停尸房"）。调查问卷发现，大多数受访者对EVD控制持顺从态度。尽管如此，78/630（12%）的受访者认为EVD是捏造的，在该地区不存在，482/630（72%）不满意或不信任EVD的反应，60/630（9%）同情公开敌对的肇事者。此外，102/630（15%）表示，在EVD疾病或家庭成员死亡的情况下，有不遵守的意图，包括躲避卫生当局，触摸尸体或拒绝欢迎官方葬礼团队。否认的生物医学的话语和不满/不信任的EVD响应统计显着相关的社会resistance.ConclusionsWe的结论是，EVD控制工作的社会阻力是普遍存在的焦点小组和调查参与者的指标。在这个长期遭受暴力和被外界忽视的地区，不信任有着深刻的政治和历史根源，可能会助长社会抵抗。抵制态度可能难以应对针对流行病而不是刚果民主共和国东部更广泛的人道主义危机的短暂社区参与努力。
BackgroundThe second largest Ebola virus disease (EVD) epidemic in history is currently raging in Eastern Democratic Republic of Congo (DRC). Stubbornly persistent EVD transmission has been associated with social resistance, ranging from passive non-compliance to overt acts of aggression toward EVD reponse teams.MethodsWe explored community resistance using focus group discussions and assessed the prevalence of resistant views using standardized questionnaires.ResultsDespite being generally cooperative and appreciative of the EVD response (led by the government of DRC with support from the international community), focus group participants provided eyewitness accounts of aggressive resistance to control efforts, consistent with recent media reports. Mistrust of EVD response teams was fueled by perceived inadequacies of the response effort ("herd medicine"), suspicion of mercenary motives, and violation of cultural burial mores ("makeshift plastic morgue"). Survey questionnaires found that the majority of respondents had compliant attitudes with respect to EVD control. Nonetheless, 78/630 (12%) respondents believed that EVD was fabricated and did not exist in the area, 482/630 (72%) were dissatisfied with or mistrustful of the EVD response, and 60/630 (9%) sympathized with perpetrators of overt hostility. Furthermore, 102/630 (15%) expressed non-compliant intentions in the case of EVD illness or death in a family member, including hiding from the health authorities, touching the body, or refusing to welcome an official burial team. Denial of the biomedical discourse and dissatisfaction/mistrust of the EVD response were statistically significantly associated with indicators of social resistance.ConclusionsWe concluded that social resistance to EVD control efforts was prevalent among focus group and survey participants. Mistrust, with deep political and historical roots in this area besieged by chronic violence and neglected by the outside world, may fuel social resistance. Resistant attitudes may be refractory to short-lived community engagement efforts targeting the epidemic but not the broader humanitarian crisis in Eastern DRC.