Overcoming Operational Challenges to Ebola Case Investigation in Sierra Leone
Overcoming Operational Challenges to Ebola Case Investigation in Sierra Leone
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DOI：
10.9745/ghsp-d-17-00126
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发表时间：
2017-09-27
影响因子：
4
通讯作者：
Tran, Anh-Minh A.
中科院分区：
文献类型：
--
作者：
Boland, Samuel T.;Polich, Erin;Tran, Anh-Minh A.
2013年袭击西非的埃博拉病毒病（EVD）疫情是有史以来最严重的EVD疫情。虽然关于国际和国家一级的EVD应对措施已经发表了很多，但关于地区一级的协调和运作结构、成功和失败的文献很少。本文旨在了解如何在地区一级开展EVD响应，即在塞拉利昂洛科港和坎比亚地区爆发期间实施EVD监测的挑战。我们在这里介绍了GOAL Global对EVD响应期间案件调查操作的基本挑战的理解，包括环境和基础设施，社会文化，政治和组织挑战，并通过对42名案件调查人员的调查补充了见解。主要挑战包括交通和通信资源不足、案件调查人员士气低落和疲劳、数据管理不善、社区之间互不信任以及领导力挑战。如果不解决这些业务挑战，技术监督解决方案就难以实施，而且由于收集的数据质量和数量都很差，相关性也有限。对业务需求的不重视造成了高昂的代价。为解决这一问题，全球打击毒品和犯罪组织解决了这些业务挑战，获得了关键的运输和通信资源，包括车辆、船只、燃料、司机、电话和封闭的用户群体，以便利案件调查;通过雇用更多的案件调查员、及时付款、安排休假以及提供膳食和个人防护设备，解决了疲劳和士气低落的问题;通过标准作业程序、培训和辅导改善数据跟踪工作，以建立更高质量的病历，并使获取信息更容易;通过确保案件调查人员的熟悉和一致性，加强社区的信任;通过会议和定期协调，改善行动领导方面的挑战，在洛科港建立积极的监测战略，并进行行动后审查。解决或应对这些挑战至关重要，是对EVD病例调查实施流行病学技术补充的必要条件。
The Ebola virus disease (EVD) epidemic that hit West Africa in 2013 was the worst outbreak of EVD in recorded history. While much has been published regarding the international and national-level EVD responses, there is a dearth of literature on district-level coordination and operational structures, successes, and failures. This article seeks to understand how the EVD response unfolded at the district level, namely the challenges to operationalizing EVD surveillance over the course of the outbreak in Port Loko and Kambia districts of Sierra Leone. We present here GOAL Global's understanding of the fundamental challenges to case investigation operations during the EVD response, including environmental and infrastructural, sociocultural, and political and organizational challenges, with insight complemented by a survey of 42 case investigators. Major challenges included deficiencies in transportation and communication resources, low morale and fatigue among case investigators, mismanagement of data, mistrust among communities, and leadership challenges. Without addressing these operational challenges, technical surveillance solutions are difficult to implement and hold limited relevance, due to the poor quality and quantity of data being collected. The low prioritization of operational needs came at a high cost. To mediate this, GOAL addressed these operational challenges by acquiring critical transportation and communication resources to facilitate case investigation, including vehicles, boats, fuel, drivers, phones, and closed user groups; addressing fatigue and low morale by hiring more case investigators, making timely payments, arranging for time off, and providing meals and personal protective equipment; improving data tracking efforts through standard operating procedures, training, and mentorship to build higher-quality case histories and make it easier to access information; strengthening trust in communities by ensuring familiarity and consistency of case investigators; and improving operational leadership challenges through meetings and regular coordination, establishing an active surveillance strategy in Port Loko, and conducting an after-action review. Resolving or addressing these challenges was of primary importance, and requisite for the implementation of technical epidemiological complements to EVD case investigation.