Journal Article > ResearchFull Text
Confl Health. 30 August 2023; Volume 17 (Issue 1); 41.; DOI:10.1186/s13031-023-00536-7
OKeeffe J, Takahashi E, Otshudiema JO, Malembi E, Ndaliko C, et al.
Confl Health. 30 August 2023; Volume 17 (Issue 1); 41.; DOI:10.1186/s13031-023-00536-7
English
Français
INTRODUCTION
There has been little documentation of the large networks of community health workers that contributed to Ebola Virus Disease (EVD) surveillance during the 2018–2020 Democratic Republic of Congo (DRC) epidemic in the form of community-based surveillance (CBS). These networks, comprised entirely of local community members, were a critical and mostly unrecognized factor in ending the epidemic. Challenges with collection, compilation, and analysis of CBS data have made their contribution difficult to quantify. From November 2019 to March 2020, the DRC Ministry of Health (MoH), the World Health Organization (WHO), and Médecins Sans Frontières (MSF) worked with communities to strengthen existing EVD CBS in two key health areas in Ituri Province, DRC. We describe CBS strengthening activities, detail collaboration with communities and present results of these efforts. We also provide lessons learned to inform future outbreak responses.
METHODS
As the foundation of CBS, community health workers (CHW) completed training to identify and report patients who met the EVD alert definitions. Alerts were investigated and if validated, the patient was sent for isolation and EVD testing. Community members provided early and ongoing input to the CBS system. We established a predefined ratio of community- elected CHW, allocated by population, to assure equal and adequate coverage across areas. Strong performing CHW or local leaders managed the CHWs, providing a robust supervision structure. We made additional efforts to integrate rural villages, revised tools to lighten the reporting burden and focused analysis on key indicators. Phased roll-out of activities ensured time for community discussion and approval. An integrated treatment center (ITC) combined EVD testing and isolation with free primary health care (PHC), referral services, and an ambulance network.
RESULTS
A total of 247 CHW and supervisors completed training. CBS had a retention rate of 94.3% (n?=?233) with an average daily reporting rate of 97.4% (range 75.0-100.0%). Local chiefs and community leaders participated in activities from the early stages. Community feedback, including recommendations to add additional CHW, run separate meetings in rural villages, and strengthen PHC services, improved system coverage and performance. Of 6,711 community referrals made, 98.1% (n?=?6,583) were classified as alerts. Of the alerts, 97.4% (n?=?6,410) were investigated and 3.0% (n?=?190) were validated. Of the community referrals, 73.1% (n?=?4,905) arrived for care at the ITC. The contribution of CBS to total alerts in the surveillance system increased from an average of 47.3% in the four weeks prior to system strengthening to 69.0% after. In one of the two health areas, insufficient reporting in rural villages suggested inadequate coverage, with 8.3% of the total population contributing 6.1% of alerts.
DISCUSSION
CBS demonstrated the capacity of community networks to improve early disease detection and expand access to healthcare. Early and consistent community involvement proved vital to CBS, as measured by system performance, local acceptance of EVD activities, and health service provision. The CBS system had high reporting rates, number of alerts signaled, proportion of alerts investigated, and proportion of community referrals that arrived for care. The change in contribution of CBS to total alerts may have been due in part to system strengthening, but also to the expansion in the EVD suspect case definition. Provision of PHC, referral services, and an ambulance network linked EVD response activities to the existing health system and facilitated CBS performance. More importantly, these activities provided a continuum of care that addressed community prioritized health needs. The involvement of local health promotion teams was vital to the CBS and other EVD and PHC activities. Lessons learned include the importance of early and consistent community involvement in surveillance activities and the recommendation to assure local representation in leadership positions.
There has been little documentation of the large networks of community health workers that contributed to Ebola Virus Disease (EVD) surveillance during the 2018–2020 Democratic Republic of Congo (DRC) epidemic in the form of community-based surveillance (CBS). These networks, comprised entirely of local community members, were a critical and mostly unrecognized factor in ending the epidemic. Challenges with collection, compilation, and analysis of CBS data have made their contribution difficult to quantify. From November 2019 to March 2020, the DRC Ministry of Health (MoH), the World Health Organization (WHO), and Médecins Sans Frontières (MSF) worked with communities to strengthen existing EVD CBS in two key health areas in Ituri Province, DRC. We describe CBS strengthening activities, detail collaboration with communities and present results of these efforts. We also provide lessons learned to inform future outbreak responses.
METHODS
As the foundation of CBS, community health workers (CHW) completed training to identify and report patients who met the EVD alert definitions. Alerts were investigated and if validated, the patient was sent for isolation and EVD testing. Community members provided early and ongoing input to the CBS system. We established a predefined ratio of community- elected CHW, allocated by population, to assure equal and adequate coverage across areas. Strong performing CHW or local leaders managed the CHWs, providing a robust supervision structure. We made additional efforts to integrate rural villages, revised tools to lighten the reporting burden and focused analysis on key indicators. Phased roll-out of activities ensured time for community discussion and approval. An integrated treatment center (ITC) combined EVD testing and isolation with free primary health care (PHC), referral services, and an ambulance network.
RESULTS
A total of 247 CHW and supervisors completed training. CBS had a retention rate of 94.3% (n?=?233) with an average daily reporting rate of 97.4% (range 75.0-100.0%). Local chiefs and community leaders participated in activities from the early stages. Community feedback, including recommendations to add additional CHW, run separate meetings in rural villages, and strengthen PHC services, improved system coverage and performance. Of 6,711 community referrals made, 98.1% (n?=?6,583) were classified as alerts. Of the alerts, 97.4% (n?=?6,410) were investigated and 3.0% (n?=?190) were validated. Of the community referrals, 73.1% (n?=?4,905) arrived for care at the ITC. The contribution of CBS to total alerts in the surveillance system increased from an average of 47.3% in the four weeks prior to system strengthening to 69.0% after. In one of the two health areas, insufficient reporting in rural villages suggested inadequate coverage, with 8.3% of the total population contributing 6.1% of alerts.
DISCUSSION
CBS demonstrated the capacity of community networks to improve early disease detection and expand access to healthcare. Early and consistent community involvement proved vital to CBS, as measured by system performance, local acceptance of EVD activities, and health service provision. The CBS system had high reporting rates, number of alerts signaled, proportion of alerts investigated, and proportion of community referrals that arrived for care. The change in contribution of CBS to total alerts may have been due in part to system strengthening, but also to the expansion in the EVD suspect case definition. Provision of PHC, referral services, and an ambulance network linked EVD response activities to the existing health system and facilitated CBS performance. More importantly, these activities provided a continuum of care that addressed community prioritized health needs. The involvement of local health promotion teams was vital to the CBS and other EVD and PHC activities. Lessons learned include the importance of early and consistent community involvement in surveillance activities and the recommendation to assure local representation in leadership positions.
Conference Material > Slide Presentation
Sadique S, Beversluis D, Caleo GNC, Carter W, Chowdhury SM, et al.
MSF Scientific Day International 2023. 7 June 2023; DOI:10.57740/5qd0-yj04
Conference Material > Abstract
Sadique S, Beversluis D, Caleo GNC, Carter W, Chowdhury SM, et al.
MSF Scientific Day International 2023. 7 June 2023; DOI:10.57740/bzht-7p36
INTRODUCTION
Addressing occupational injury and disease has been declared a national priority in Bangladesh. However critical gaps remain in improving work safety in small-scale peri-urban factories. We aimed to assess the feasibility of collaborating with owners and workers to design and implement interventions to improve work safety in two metal factories in Kamrangirchar, Dhaka.
METHODS
We implemented a participatory mixed methods before-and-after study with four phases. Phase 1 explored the dynamics of injuries, hazards, and risks using hazard assessments, surveillance, in-depth interviews, and focus group discussions. Triangulation of phase 1 findings informed design and implementation of intervention packages implemented in phase 2. In phases 3 and 4, we repeated hazard assessments and used qualitative methods to document changes in hazards and perspectives at 6- and 12-months post-intervention. Observations captured by field notes complemented data generated throughout the study.
ETHICS
The study was approved by the MSF Ethical Review Board (ERB) and by the ERB of the Centre for Injury Prevention and Research, Bangladesh.
RESULTS
Overall 136 workers in two factories (A and B) participated in the study (with a turnover of 41.5%). Surveillance captured 129 injuries during phase 1 (from 10th March 2019 in factory A and 30th April 2019 in factory B, to 31st July 2019), and all workers aged under 18 years experienced incidents. Hazard assessments documented hazard risk scores (HRS) of 54% in factory A and 36% in factory B. Qualitative data indicated workers perceived their work as risky, but explained it was prioritised over their health due to financial necessity. Phase 2 intervention packages included engineering controls, personal protective equipment, infrastructure safety and training. Factory owners and workers actively participated in design and implementation. Phase 3 showed a two-fold reduction in HRS in factory A (24%) and a 1.5-fold reduction (21%) in factory B. Phase 4 hazard assessment revealed that improvement was sustained in one factory; the final HRS was 27% in factory A, but returned to the pre-intervention score of 36% in factory B. Workers explained they observed improvements in workplace safety but noted challenges in sustainability due to owner commitment and worker turnover. Observation and qualitative data revealed complex power dynamics in the factories, as well as power imbalances and risks faced by female and young workers.
CONCLUSION
It was feasible to collaborate with workers and owners to implement interventions aimed at improving work safety. However, sustainability was mixed, and long-standing structural inequities that contribute to poor safety remain. Findings indicate urgent action is needed to improve safety and build an inclusive model of occupational health, including social and protection components, with particular attention for female workers and workers aged under 18.
CONFLICTS OF INTEREST
None declared
Addressing occupational injury and disease has been declared a national priority in Bangladesh. However critical gaps remain in improving work safety in small-scale peri-urban factories. We aimed to assess the feasibility of collaborating with owners and workers to design and implement interventions to improve work safety in two metal factories in Kamrangirchar, Dhaka.
METHODS
We implemented a participatory mixed methods before-and-after study with four phases. Phase 1 explored the dynamics of injuries, hazards, and risks using hazard assessments, surveillance, in-depth interviews, and focus group discussions. Triangulation of phase 1 findings informed design and implementation of intervention packages implemented in phase 2. In phases 3 and 4, we repeated hazard assessments and used qualitative methods to document changes in hazards and perspectives at 6- and 12-months post-intervention. Observations captured by field notes complemented data generated throughout the study.
ETHICS
The study was approved by the MSF Ethical Review Board (ERB) and by the ERB of the Centre for Injury Prevention and Research, Bangladesh.
RESULTS
Overall 136 workers in two factories (A and B) participated in the study (with a turnover of 41.5%). Surveillance captured 129 injuries during phase 1 (from 10th March 2019 in factory A and 30th April 2019 in factory B, to 31st July 2019), and all workers aged under 18 years experienced incidents. Hazard assessments documented hazard risk scores (HRS) of 54% in factory A and 36% in factory B. Qualitative data indicated workers perceived their work as risky, but explained it was prioritised over their health due to financial necessity. Phase 2 intervention packages included engineering controls, personal protective equipment, infrastructure safety and training. Factory owners and workers actively participated in design and implementation. Phase 3 showed a two-fold reduction in HRS in factory A (24%) and a 1.5-fold reduction (21%) in factory B. Phase 4 hazard assessment revealed that improvement was sustained in one factory; the final HRS was 27% in factory A, but returned to the pre-intervention score of 36% in factory B. Workers explained they observed improvements in workplace safety but noted challenges in sustainability due to owner commitment and worker turnover. Observation and qualitative data revealed complex power dynamics in the factories, as well as power imbalances and risks faced by female and young workers.
CONCLUSION
It was feasible to collaborate with workers and owners to implement interventions aimed at improving work safety. However, sustainability was mixed, and long-standing structural inequities that contribute to poor safety remain. Findings indicate urgent action is needed to improve safety and build an inclusive model of occupational health, including social and protection components, with particular attention for female workers and workers aged under 18.
CONFLICTS OF INTEREST
None declared
Journal Article > ResearchFull Text
Vaccine. 3 March 2023; Volume S0264-410X (Issue 23); 00037-3.; DOI:10.1016/j.vaccine.2023.01.026
Gelormini M, Gripenberg M, Marke D, Murray MB, Yambasu S, et al.
Vaccine. 3 March 2023; Volume S0264-410X (Issue 23); 00037-3.; DOI:10.1016/j.vaccine.2023.01.026
Background: On 14 August 2017, massive landslides and floods hit Freetown (Sierra Leone). More than 1,000 people lost their lives while approximately 6,000 people were displaced. The areas most affected included parts of the town with challenged access to basic water and sanitation facilities, with communal water sources likely contaminated by the disaster. To avert a possible cholera outbreak following this emergency, the Ministry of Health and Sanitation (MoHS), supported by the World Health Organization (WHO) and international partners, including Médecins Sans Frontières (MSF) and UNICEF, launched a two-dose pre-emptive vaccination campaign using Euvichol™, an oral cholera vaccine (OCV).
Methods: We conducted a stratified cluster survey to estimate vaccination coverage during the OCV campaign and also monitor adverse events. The study population - subsequently stratified by age group and residence area type (urban/rural) - included all individuals aged 1 year or older, living in one of the 25 communities targeted for vaccination.
Results: In total 3,115 households were visited, 7,189 individuals interviewed; 2,822 (39%) people in rural and 4,367 (61%) in urban areas. The two-dose vaccination coverage was 56% (95% confidence interval (CI): 51.0-61.5), 44% (95%CI: 35.2-53.0) in rural and 57% (95%CI: 51.6-62.8) in urban areas. Vaccination coverage with at least one dose was 82% (95%CI: 77.3-85.5), 61% (95%CI: 52.0-70.2) in rural and 83% (95%CI: 78.5-87.1) in urban areas.
Conclusions: The Freetown OCV campaign exemplified a timely public health intervention to prevent a cholera outbreak, even if coverage was lower than expected. We hypothesised that vaccination coverage in Freetown was sufficient in providing at least short-term immunity to the population. However, long-term interventions to ensure access to safe water and sanitation are needed.
Methods: We conducted a stratified cluster survey to estimate vaccination coverage during the OCV campaign and also monitor adverse events. The study population - subsequently stratified by age group and residence area type (urban/rural) - included all individuals aged 1 year or older, living in one of the 25 communities targeted for vaccination.
Results: In total 3,115 households were visited, 7,189 individuals interviewed; 2,822 (39%) people in rural and 4,367 (61%) in urban areas. The two-dose vaccination coverage was 56% (95% confidence interval (CI): 51.0-61.5), 44% (95%CI: 35.2-53.0) in rural and 57% (95%CI: 51.6-62.8) in urban areas. Vaccination coverage with at least one dose was 82% (95%CI: 77.3-85.5), 61% (95%CI: 52.0-70.2) in rural and 83% (95%CI: 78.5-87.1) in urban areas.
Conclusions: The Freetown OCV campaign exemplified a timely public health intervention to prevent a cholera outbreak, even if coverage was lower than expected. We hypothesised that vaccination coverage in Freetown was sufficient in providing at least short-term immunity to the population. However, long-term interventions to ensure access to safe water and sanitation are needed.
Conference Material > Slide Presentation
Lavilla KM, Teal J, Schausberger B, Sankoh M, Conteh AB, et al.
MSF Scientific Days International 2022. 11 May 2022; DOI:10.57740/pyhg-f359
Conference Material > Abstract
Lavilla KM, Teal J, Schausberger B, Sankoh M, Conteh AB, et al.
MSF Scientific Days International 2022. 11 May 2022; DOI:10.57740/8sd6-2h56
INTRODUCTION
MSF and the MoHS implemented a partnership model of free and accessible maternal and child healthcare at primary and hospital-level health facilities in Tonkolili District, Sierra Leone, in order to reduce barriers to care and improve health outcomes. We conducted a health-seeking behaviour (HSB) study in 2021 to evaluate impact and change since a previous HSB study conducted in 2016/17. We also compared MSF-supported primary health unit (PHU) catchment areas with MSF-unsupported PHU’s. In addition, we explored adolescent reproductive health, family planning, and female genital mutilation (FGM).
METHODS
Study design was mixed-methods, similar to that used in 2016/17, including a quantitative household survey, structured interviews with key informants, and qualitative in-depth interviews (IDI’s). We randomly selected 60 clusters; 30 in MSF-supported areas, and 30 in unsupported areas. IDI’s explored topics identified through the survey, and were conducted with purposively-sampled participants, and analyzed thematically.
ETHICS
This study was approved by the Sierra Leone Ethical and Scientific Review Committee and by the MSF Ethics Review Board
RESULTS
Between February and August 2021, 1,164 women and 1,177 carers (of 1,559 children aged under 5) participated in the survey; 59 structured interviews and 42 IDI’s were conducted. Compared to the 2016/17 study, access to healthcare improved, with the proportion of women delivering in a health facility increasing from 52.0% (95% confidence intervals (CI) 42-64) to 90.9% (95% CI 89.2-92.5), and the proportion of mothers reporting at least one barrier to accessing care decreasing from 90.0% (95% CI 80-95) to 45.9% (95% CI 43.0-48.8). Outcomes of care also improved over this period, with under-5 mortality decreasing from 1.55 per 10,0000/day (95% CI 1.30-1.86) to 0.25 per 10,000/day (95% CI 0.17-0.36).When comparing unsupported PHU’s versus supported areas in 2021, complications during labour or delivery were higher in unsupported areas (10.9%; 95% CI 8.6-13.6) vs 7.2% (95% CI 5.3-9.7), as was stillbirth (4.5%; 95% CI 3.1-6.5) vs 1.4% (95% CI 0.6-2.8). Under-5 mortality was 0.44 per 10,000/day (95% CI 2.4-7.2) in unsupported areas and 0.17 per 10,000/day (95% CI 0.8-2.9) in supported areas. 42.9% (95% CI 34.7-51.4) of adolescents in unsupported areas and 39.7% (95% CI 31.3- 48.7) in supported areas reported unmet need for contraception. More than 90% (96.6%, 95% CI 95.3-97.5) of women reported FGM. Qualitative data suggests that communities recognized the importance of delivering in a health facility with trained assistance. Nevertheless, health staff and community members felt the current fine system for home births was applied inflexibly in circumstances when distance, transport, or cost restricted or delayed access.
CONCLUSION
Since 2016/17, access to healthcare and outcomes have improved in all areas, but improvement has been greatest in areas where, in addition to hospital care, MSF supported MoHS PHU’s. This provides evidence for ongoing implementation and scale-up of comprehensive models of care. Progress made must not overshadow areas requiring further attention, such as care for adolescents, access to contraception, and the need to reduce stillbirths.
CONFLICTS OF INTEREST
None declared.
MSF and the MoHS implemented a partnership model of free and accessible maternal and child healthcare at primary and hospital-level health facilities in Tonkolili District, Sierra Leone, in order to reduce barriers to care and improve health outcomes. We conducted a health-seeking behaviour (HSB) study in 2021 to evaluate impact and change since a previous HSB study conducted in 2016/17. We also compared MSF-supported primary health unit (PHU) catchment areas with MSF-unsupported PHU’s. In addition, we explored adolescent reproductive health, family planning, and female genital mutilation (FGM).
METHODS
Study design was mixed-methods, similar to that used in 2016/17, including a quantitative household survey, structured interviews with key informants, and qualitative in-depth interviews (IDI’s). We randomly selected 60 clusters; 30 in MSF-supported areas, and 30 in unsupported areas. IDI’s explored topics identified through the survey, and were conducted with purposively-sampled participants, and analyzed thematically.
ETHICS
This study was approved by the Sierra Leone Ethical and Scientific Review Committee and by the MSF Ethics Review Board
RESULTS
Between February and August 2021, 1,164 women and 1,177 carers (of 1,559 children aged under 5) participated in the survey; 59 structured interviews and 42 IDI’s were conducted. Compared to the 2016/17 study, access to healthcare improved, with the proportion of women delivering in a health facility increasing from 52.0% (95% confidence intervals (CI) 42-64) to 90.9% (95% CI 89.2-92.5), and the proportion of mothers reporting at least one barrier to accessing care decreasing from 90.0% (95% CI 80-95) to 45.9% (95% CI 43.0-48.8). Outcomes of care also improved over this period, with under-5 mortality decreasing from 1.55 per 10,0000/day (95% CI 1.30-1.86) to 0.25 per 10,000/day (95% CI 0.17-0.36).When comparing unsupported PHU’s versus supported areas in 2021, complications during labour or delivery were higher in unsupported areas (10.9%; 95% CI 8.6-13.6) vs 7.2% (95% CI 5.3-9.7), as was stillbirth (4.5%; 95% CI 3.1-6.5) vs 1.4% (95% CI 0.6-2.8). Under-5 mortality was 0.44 per 10,000/day (95% CI 2.4-7.2) in unsupported areas and 0.17 per 10,000/day (95% CI 0.8-2.9) in supported areas. 42.9% (95% CI 34.7-51.4) of adolescents in unsupported areas and 39.7% (95% CI 31.3- 48.7) in supported areas reported unmet need for contraception. More than 90% (96.6%, 95% CI 95.3-97.5) of women reported FGM. Qualitative data suggests that communities recognized the importance of delivering in a health facility with trained assistance. Nevertheless, health staff and community members felt the current fine system for home births was applied inflexibly in circumstances when distance, transport, or cost restricted or delayed access.
CONCLUSION
Since 2016/17, access to healthcare and outcomes have improved in all areas, but improvement has been greatest in areas where, in addition to hospital care, MSF supported MoHS PHU’s. This provides evidence for ongoing implementation and scale-up of comprehensive models of care. Progress made must not overshadow areas requiring further attention, such as care for adolescents, access to contraception, and the need to reduce stillbirths.
CONFLICTS OF INTEREST
None declared.
Conference Material > Abstract
Croft LA, Puig-García M, Silver C, Pearlman J, Stellmach DUS, et al.
MSF Scientific Days International 2022. 9 May 2022; DOI:10.57740/b641-d608
INTRODUCTION
Between 2020 and 2021, MSF’s social sciences team designed and supported implementation of qualitative assessments to better understand community-level outbreak responses and well-being in the context of Covid-19. Assessments were conducted in seven sites, specifically Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland. Although a single protocol was designed and followed, each site was unique in terms of its setting (e.g. camp, conflict, urban, or rural), who implemented assessments (e.g. field epidemiologists, health promotion staff), timing of implementation (early phase of the pandemic versus late phase), and community involvement. Here we present a synthesis of the assessments to inform future public health responses.
METHODS
Synthesis involved secondary analysis of qualitative reports over five iterative phases. Phase 1 involved in-depth reading of each report, during which analytic annotation and note-taking took place. In Phase 2, each report was coded inductively. In Phase 3, codes were reviewed, defined, and clustered into initial categories and themes. Phase 4 involved reviewing and refining codes, categories, and themes, and establishing connections. In Phase 5, synthesis findings were organised and written up. The process was managed using the software ATLAS.ti.
ETHICS
This synthesis is an a posteriori analysis of secondary data. Ethics approval for primary data was granted by officials in Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland and the MSF Ethics Review Board.
RESULTS
Overall 138, people participated in the assessments, of which 21 (15%) were women. Participants included health workers, community members, traditional healers, chiefs, young people, women’s leaders and local staff. Four themes were identified: 1) exacerbation of pre-existing vulnerabilities and inequalities; 2) disruption of coping mechanisms; 3) awareness of the risks of Covid-19; 4) community as a public health enabler. The pandemic was seen to magnify existing social inequalities and overall health burden. Public health measures to control the spread of Covid-19 often disrupted community coping mechanisms by causing fear of separation and practical challenges around compliance. Awareness of the risks of Covid-19 and understanding of prevention measures were high, with socio-economic costs of compliance relying on external funding and relief. A community led intervention for effective public health controls varied between sites, depending on previous outbreak experiences (e.g. Ebola and tuberculosis), and/or settings experiencing protracted conflict (e.g. Syria, and Iraq).
CONCLUSION
Our synthesis illustrates syndemic effects of the pandemic. From an operational perspective, there is a need to diversify humanitarian, social, and health interventions, and strengthen approaches to working with communities to identify how best to take forward public health measures in humanitarian settings.
CONFLICTS OF INTEREST
None declared.
Between 2020 and 2021, MSF’s social sciences team designed and supported implementation of qualitative assessments to better understand community-level outbreak responses and well-being in the context of Covid-19. Assessments were conducted in seven sites, specifically Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland. Although a single protocol was designed and followed, each site was unique in terms of its setting (e.g. camp, conflict, urban, or rural), who implemented assessments (e.g. field epidemiologists, health promotion staff), timing of implementation (early phase of the pandemic versus late phase), and community involvement. Here we present a synthesis of the assessments to inform future public health responses.
METHODS
Synthesis involved secondary analysis of qualitative reports over five iterative phases. Phase 1 involved in-depth reading of each report, during which analytic annotation and note-taking took place. In Phase 2, each report was coded inductively. In Phase 3, codes were reviewed, defined, and clustered into initial categories and themes. Phase 4 involved reviewing and refining codes, categories, and themes, and establishing connections. In Phase 5, synthesis findings were organised and written up. The process was managed using the software ATLAS.ti.
ETHICS
This synthesis is an a posteriori analysis of secondary data. Ethics approval for primary data was granted by officials in Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland and the MSF Ethics Review Board.
RESULTS
Overall 138, people participated in the assessments, of which 21 (15%) were women. Participants included health workers, community members, traditional healers, chiefs, young people, women’s leaders and local staff. Four themes were identified: 1) exacerbation of pre-existing vulnerabilities and inequalities; 2) disruption of coping mechanisms; 3) awareness of the risks of Covid-19; 4) community as a public health enabler. The pandemic was seen to magnify existing social inequalities and overall health burden. Public health measures to control the spread of Covid-19 often disrupted community coping mechanisms by causing fear of separation and practical challenges around compliance. Awareness of the risks of Covid-19 and understanding of prevention measures were high, with socio-economic costs of compliance relying on external funding and relief. A community led intervention for effective public health controls varied between sites, depending on previous outbreak experiences (e.g. Ebola and tuberculosis), and/or settings experiencing protracted conflict (e.g. Syria, and Iraq).
CONCLUSION
Our synthesis illustrates syndemic effects of the pandemic. From an operational perspective, there is a need to diversify humanitarian, social, and health interventions, and strengthen approaches to working with communities to identify how best to take forward public health measures in humanitarian settings.
CONFLICTS OF INTEREST
None declared.
Conference Material > Slide Presentation
Croft LA, Puig-García M, Silver C, Pearlman J, Stellmach DUS, et al.
MSF Scientific Days International 2022. 9 May 2022; DOI:10.57740/pe41-5813
Journal Article > Short ReportFull Text
Pan Afr Med J. 18 January 2017; Volume 26; DOI:10.11604/pamj.2017.26.27.11111
Asfaw Y, Boateng I, Calderon M, Caleo GNC, Conteh LA, et al.
Pan Afr Med J. 18 January 2017; Volume 26; DOI:10.11604/pamj.2017.26.27.11111
Protocol > Research Protocol
Elston JWT, Snag S, Kazungu DS, Jimissa A, Caleo GNC, et al.
1 July 2018
To describe health seeking behaviour during pregnancy, for childbirth and in children under the age of five years, and to identify barriers to accessing and receiving healthcare services at the time of the study and since the start of the Ebola outbreak in an urban and rural area of Tonkolili District.
PRIMARY OBJECTIVES
1. To estimate utilisation of health facilities by women for childbirth in Magburaka town and Yoni chiefdom since the start of the Ebola outbreak ;
2. To estimate utilisation of healthcare services by children aged <5 years in Magburaka town and Yoni chiefdom during their most recent febrile illness within the three month period preceding the day of the survey.
3. To identify and describe factors influencing utilisation of health services and delays in seeking and receiving adequate healthcare during pregnancy and for childbirth
4. To identify and describe factors influencing utilisation of health services and delays in seeking and receiving adequate healthcare for febrile illness in children aged <5 years
PRIMARY OBJECTIVES
1. To estimate utilisation of health facilities by women for childbirth in Magburaka town and Yoni chiefdom since the start of the Ebola outbreak ;
2. To estimate utilisation of healthcare services by children aged <5 years in Magburaka town and Yoni chiefdom during their most recent febrile illness within the three month period preceding the day of the survey.
3. To identify and describe factors influencing utilisation of health services and delays in seeking and receiving adequate healthcare during pregnancy and for childbirth
4. To identify and describe factors influencing utilisation of health services and delays in seeking and receiving adequate healthcare for febrile illness in children aged <5 years