Ebola Virus Disease Outbreak Research Articles

Enacted Ebola Stigma and Health-related Quality of Life in Post Ebola Epidemic: A Psychosocial Mediation Framework Through Social Support, Self-Efficacy, and Coping.

On-site experiences and reports have shown that the multiple outbreaks of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC) resulted in pervasive experience of stigma against many people who have recovered from EVD as well as their families and close relatives. Three evidence-based protective factors which are supposed to mitigate the impact of enacted Ebola stigma on health-related quality of life (HRQoL) of individuals in this epidemic context were identified. We expected that positive religious coping, perceived social support, and general self-efficacy would mediate the relationship between enacted Ebola stigma and HRQoL. These hypotheses were tested through multiple mediation model using the structural equation modeling among a large sample of adult populations (N = 1614; 50% women) in the province of Equateur in the DRC, in the aftermath of the 9th Ebola outbreak. The mediation model yielded adequate fit statistics and the results provided strong evidence that higher levels of enacted Ebola stigma were associated with lower HRQoL. They confirmed the synergetic mediating effects of positive religious coping, perceived social support from family (but not from others sources) and general self-efficacy. Futher exploratory findings revealed that the perceived social support from family buffered the impact of enacted Ebola stigma on HRQoL. If replicated by a longitudinal study, our findings lay a solid foundation for empirical-based community mental health interventions for reducing enacted Ebola stigma and promoting HRQoL during epidemics, especially in the DRC.

Assessing routine health information system performance during the tenth outbreak of Ebola virus disease (2018-2020) in the Democratic Republic of the Congo: A qualitative study in North Kivu.

The Democratic Republic of Congo has implemented reforms to its national routine health information system (RHIS) to improve timeliness, completeness, and use of quality data. However, outbreaks can undermine efforts to strengthen it. We assessed the functioning of the RHIS during the 2018-2020 outbreak of Ebola Virus Disease (EVD) to identify opportunities for future development. We conducted a qualitative study in North Kivu, from March to May 2020. Semi-structured interviews were conducted with 34 key informants purposively selected from among the personnel involved in the production of RHIS data. The topics discussed included RHIS functioning, tools, compilation, validation, quality, sharing, and the use of data. Audio recordings were transcribed verbatim and thematic analysis was used to study the interviewees' lived experience. The RHIS retained its structure, tools, and flow during the outbreak. The need for other types of data to inform the EVD response created other parallel systems to the RHIS. This included data from Ebola treatment centers, vaccination against Ebola, points of entry surveillance, and safe and dignified burial. The informants indicated that the availability of weekly surveillance data had improved, while timeliness and quality of monthly RHIS reporting declined. The compilation of data was late and validation meetings were irregular. The upsurge of patients following the implementation of the free care policy, the departure of healthcare workers for better-paid jobs, and the high prioritization of the outbreak response over routine activities led to RHIS disruptions. Delays in decision-making were one of the consequences of the decline in data timeliness. Adequate allocation of human resources, equitable salary policy, coordination, and integration of the response with local structures are necessary to ensure optimal functioning of the RHIS during an outbreak. Future research should assess the scale of data quality changes during outbreaks.

The Evolution of Medical Countermeasures for Ebola Virus Disease: Lessons Learned and Next Steps.

The Ebola virus disease outbreak that occurred in Western Africa from 2013–2016, and subsequent smaller but increasingly frequent outbreaks of Ebola virus disease in recent years, spurred an unprecedented effort to develop and deploy effective vaccines, therapeutics, and diagnostics. This effort led to the U.S. regulatory approval of a diagnostic test, two vaccines, and two therapeutics for Ebola virus disease indications. Moreover, the establishment of fieldable diagnostic tests improved the speed with which patients can be diagnosed and public health resources mobilized. The United States government has played and continues to play a key role in funding and coordinating these medical countermeasure efforts. Here, we describe the coordinated U.S. government response to develop medical countermeasures for Ebola virus disease and we identify lessons learned that may improve future efforts to develop and deploy effective countermeasures against other filoviruses, such as Sudan virus and Marburg virus.

Developing mental health services during and in the aftermath of the Ebola virus disease outbreak in armed conflict settings: a scoping review

BackgroundMental health is mostly affected by numerous socioeconomic factors that need to be addressed through comprehensive strategies. The aftermath of armed conflict and natural disasters such as Ebola disease virus (EVD) outbreaks is frequently associated with poor access to mental healthcare. To design the basis of improving mental health services via the integration of mental health into primary health care in the Democratic Republic of Congo (DRC), we conducted a scoping review of available literature regarding mental illness in armed conflict and EVD outbreak settings.MethodsThis scoping review of studies conducted in armed conflict and EVD outbreak of DRC settings synthesize the findings and suggestions related to improve the provision of mental health services. We sued the extension of Preferred Reporting Items for Systematic Reviews and Meta-Analyses to scoping studies. A mapping of evidence related to mental disorders in the eastern part of DRC from studies identified through searches of electronic databases (MEDLINE, Scopus, Psych Info, Google Scholar, and CINAHL). Screening and extraction of data were conducted by two reviewers independently.ResultsThis review identified seven papers and described the findings in a narrative approach. It reveals that the burden of mental illness is consistent, although mental healthcare is not integrated into primary health care. Access to mental healthcare requires the involvement of affected communities in their problem-solving process. This review highlights the basis of the implementation of a comprehensive mental health care, through the application of mental health Gap Action Program (mhGAP) at community level. Lastly, it calls for further implementation research perspectives on the integration of mental healthcare into the health system of areas affecting by civil instability and natural disasters.ConclusionThis paper acknowledges poor implementation of community mental health services into primary health care in regions affected by armed conflict and natural disasters. All relevant stakeholders involved in the provision of mental health services should need to rethink to implementation of mhGAP into the emergency response against outbreaks and natural disasters.

Patterns and conversational structure of knowledge sharing on Ebola virus disease among healthcare practitioners: Observations from a pilot study

This pilot study was designed to determine the conversational structure on Ebola Virus Disease (EVD), pattern of knowledge sharing and knowledge sharing behaviour of healthcare practitioners (HCP) on Medscape online network. The study was guided by Conversation Theory, and deployed a retrospective document/content analysis research design. Ninety-two comments from healthcare practitioners including 16 EVD newsposts out of 37 EVD news were randomly extracted from the network between 2014 and 2018. Extracted data were analysed using NVivo and Microsoft Excel applications. An EVD knowledge taxonomy was developed from the content mapping of EVD topics posted on the network. Results from the pilot study revealed that news on EVD were mostly on EVD outbreak management at the peak period of EVD outbreak in 2014. Also, the HCPs mostly engaged in knowledge sharing on issues relating to EVD risk. Findings revealed that the entire (37) newsposts were of interest to HCPs and they responded to 16 newsposts. There were three active and influential HCPs on the network. The novelty of this study stems from its focus on conversation patterns of HCP on online knowledge sharing using the variables of Conversation theory to examine their knowledge sharing behaviours. The outcome of the study could serve as a model for other studies on other trending viral diseases such as Coronavirus, Lassa Fever, Monkey pox, etc. This study thus recommends replicate analysis in the main study with a larger data set with further findings using network analysis and other statistical tools to examine the conversational structure on EVD and pattern of knowledge sharing among the HCPs.

Evaluation and comparison of three virucidal agents on inactivation of Nipah virus

Modern human activity is profoundly changing our relationship with microorganisms with the startling rise in the rate of emerging infectious diseases. Nipah virus together with Ebola virus and SARS-CoV-2 are prominent examples. Since COVID-19 and the West African Ebola virus disease outbreak, different chemical disinfectants have been developed for preventing the direct spread of viruses and their efficacy has also been evaluated. However, there are currently no published efficacy studies for the chemical disinfection of Nipah virus. In this study, the virucidal efficacy of three disinfectants (Micro-Chem Plus detergent disinfectant cleaner, FWD and Medical EtOH) against Nipah virus was evaluated in quantitative suspension tests including. Our results showed that the > 4 log reduction achieved for all products in inactivating Nipah virus in 15 s. Even, 19% ethanol was able to inactivate Nipah virus when applied for at least 8 min contact time. Comparative analysis displayed virucidal efficacy of each of the evaluated disinfectants against SARS-CoV-2, Ebola virus and Nipah virus, with only minor differences in working concentrations and contact times required for complete inactivation. We expect that our study can assist in decontamination in healthcare settings and high level biosafety laboratories and can be beneficial to control for emerging enveloped viruses.

Child mortality after the Ebola virus disease outbreak across Guinea, Liberia, and Sierra Leone

ObjectivesThe Ebola virus disease outbreak in 2014—2016 had a substantial impact on population health in Guinea, Liberia, and Sierra Leone. This study aimed to assess whether the impact continued after the outbreak ended regarding child mortality. MethodsCross-sectional logistic regressions were run using data from the Demographic and Health Surveys in the three countries. ResultsThe average child mortality rate was significantly lower for children born after the outbreak than for those born before. However, the association of the child mortality rate with an increase in the number of Ebola cases per 100,000 people was significantly stronger for children born after the outbreak ended. Also, the change in the utilization of maternal health services after the outbreak varied across health services. ConclusionRestoring disrupted child health services to pre-Ebola levels may be more difficult in areas that suffered a higher number of Ebola cases. The recovery of maternal health services after the outbreak might be affected by factors such as the resilience of health systems at the subnational level. This study suggests that strengthening the health system is crucial to fully recover from the Ebola outbreak and cope with future epidemics.

EE58 Value-Based Pricing of an Ebola Vaccine in Resource-Constrained Countries Based on Cost-Effectiveness Analysis

Pricing, affordability, and access are important deliberations around infectious disease interventions. Determining a fair price that not only incentivizes development but ensures value and access for patients is critical given the increasing global health crisis. Using ebola virus disease (EVD) as exemplar, we aim to elucidate the estimation of a value-based price (VBP) for a vaccine package and to consider how the price compares across selected countries that have experienced EVD outbreaks.

Zaire ebolavirus surveillance near the Bikoro region of the Democratic Republic of the Congo during the 2018 outbreak reveals presence of seropositive bats.

On the 8th of May, 2018, an outbreak of Ebola virus disease (EVD) was declared, originating in the Bikoro region of the Democratic Republic of the Congo (DRC) near the border with neighboring Republic of the Congo (ROC). Frequent trade and migration occur between DRC and ROC-based communities residing along the Congo River. In June 2018, a field team was deployed to determine whether Zaire ebolavirus (Ebola virus (EBOV)) was contemporaneously circulating in local bats at the human-animal interface in ROC near the Bikoro EVD outbreak. Samples were collected from bats in the Cuvette and Likouala departments, ROC, bordering the Équateur Province in DRC where the Bikoro EVD outbreak was first detected. EBOV genomic material was not detected in bat-derived samples by targeted quantitative reverse transcription-polymerase chain reaction or by family-level consensus polymerase chain reaction; however, serological data suggests recent exposure to EBOV in bats in the region. We collected serum from 144 bats in the Cuvette department with 6.9% seropositivity against the EBOV glycoprotein and 14.3% seropositivity for serum collected from 27 fruit bats and one Molossinae in the Likouala department. We conclude that proactive investment in longitudinal sampling for filoviruses at the human-animal interface, coupled with ecological investigations are needed to identify EBOV wildlife reservoirs.

Investigation of rodent reservoirs of emerging pathogens in Côte d'Ivoire, West Africa

Background: One of the main health problems in West Africa remains upsurge of emerging pathogens. Ebola virus disease outbreak occurred in 2014 in Liberia, Guinea and Sierra Leone, Monkeypox virus in Nigeria in 2017 and most recently Lassa virus in Nigeria, Togo and Benin in 2018. These pathogens have animal reservoirs as vectors for transmission. Proper investigation of the pathogens in their rodent vectors could help reduce and manage their emergence and spread.
 Methodology: This study was conducted with an approval from the Côte d’Ivoire Bioethics Community. Small mammal trappings were carried out in 9 sites within three zones namely, peri-urban, peri-rural and protected areas. Liver, lung and kidney tissues from trapped small mammals were sampled in accordance with the recommended conditions of biosafety and bioethics. The organs were transported in liquid nitrogen to the laboratory. Molecular tests were used to detect pathogens. Orthopoxviruses and Monkeypox virus were detected in the organs by PCR using consensus primers targeting the virus surface membrane haemagglutinin (HA) genes, while Leptospira species were detected by PCR using primers targeting the rrs and lfb1 genes.
 Results: Out of 4930 night-traps, 256 (5.19%) small mammals were trapped including Crocidura, Rattus, Lophuromys, Praomys, Mus and Mastomys. Leptospira species were detected in 6 genera from 7 study sites and the infected small mammals accounted for 13.3%. Leptospira sp was detected mainly in the rodent vector genera Rattus (32.3%), Lophuromys (29.0%), and Praomys (16.1%). Three species of Leptospira were detected and Leptospira interrogans was the most common frequent species (74.2%). Monkeypox virus was not detected from studied small mammals.
 Conclusion: The initial data from our investigation indicates the presence of Leptospira sp in rodent vectors, Rattus, Lophuromys and Praomys, which are the potential small mammalian reservoirs of this pathogen in Cote d’Ivoire.

An Overview of Ebola Virus Disease

Ebola virus disease (EVD) is a life-threatening viral disease with a fatality rate ranging from around 30% to 90%. It is one of the world's most virulent diseases, previously known as Ebola haemorrhagic fever. This Ebola disease is severe, often fatal illness, with a case fatality rate of up to 90%. Ebola first appeared in 1976 in 2 simultaneous outbreaks in Nzara, Sudan and in Yambuku. Congo. EVD outbreaks occur primarily in remote village near the Ebola River. Signs and symptoms usually start with fever, sore throat, muscular pain and headaches, vomiting, diarrhoea and rash, along with reduced liver and kidney function, between two days and three weeks after contracting the virus. Some individuals start to bleed both internally and externally at this time. Outbreaks occurred in the Central Africa region, including Zaire, Sudan and Uganda. However, between March and October 2014, over 10 000 cases of EVD have been recorded in West Africa, such as in Guinea, Liberia, Sierra Leone, and Nigeria, and a few hospital or secondary infections of EVD have occurred in Spain and the United States of America..

Data flows during public health emergencies in LMICs: A people-centered mapping of data flows during the 2018 ebola epidemic in Equateur, DRC

In infectious outbreaks, rapid case detection and reporting, coordination, and context-specific strategies are needed for rapid containment. Data sharing between actors, and the speed and content of data flows, is essential for expediting epidemic response. In this study, researchers mapped data flows during the 2018 Ebola Virus Disease (EVD) outbreak in Equateur Province in the Democratic Republic of the Congo using semi-structured interviews, ethnographic research, and focus groups with EVD response actors. During this research, we mapped and tracked data collection, transmission, storage, sharing, and use patterns. Target participants included: key organizational actors in the EVD outbreaks responses, including local (primary health, community-based, hospital), provincial (MoPH, DRC Red Cross), and international (WHO, UN organizations, international first-responders) stakeholders. We found that a community-based surveillance system enabled the rapid detection of a hemorrhagic fever outbreak, resulting in the rapid laboratory confirmation of EVD. With the arrival of international organizations to provide support to the EVD response, routine surveillance systems continued to function robustly. However, the establishment of a vertical EVD response architecture created challenges for the response. Data flows during the Equateur outbreak were hampered by numerous challenges in the domains of early warning, line lists of cases, and contact tracing, which impeded surveillance and data flows. We therefore argue that structuring health information systems for preparedness requires taking a person-centered approach to data production, flow, and analysis.

Health system resilience during COVID-19 understanding SRH service adaptation in North Kivu

BackgroundThere is often collateral damage to health systems during epidemics, affecting women and girls the most, with reduced access to non-outbreak related services, particularly in humanitarian settings. This rapid case study examines sexual and reproductive health (SRH) services in the Democratic Republic of the Congo when the COVID-19 hit, towards the end of an Ebola Virus Disease (EVD) outbreak, and in a context of protracted insecurity.MethodsThis study draws on quantitative analysis of routine data from four health zones, a document review of policies and protocols, and 13 key-informant interviews with staff from the Ministry of Public Health, United Nations agencies, international and national non-governmental organizations, and civil society organizations.ResultsUtilization of SRH services decreased initially but recovered by August 2020. Significant fluctuations remained across areas, due to the end of free care once Ebola funding ceased, insecurity, number of COVID-19 cases, and funding levels. The response to COVID-19 was top-down, focused on infection and prevention control measures, with a lack of funding, technical expertise and overall momentum that characterized the EVD response. Communities and civil society did not play an active role for the planning of the COVID-19 response. While health zone and facility staff showed resilience, developing adaptations to maintain SRH provision, these adaptations were short-lived and inconsistent without external support and funding.ConclusionThe EVD outbreak was an opportunity for health system strengthening that was not sustained during COVID-19. This had consequences for access to SRH services, with limited-resources available and deprioritization of SRH.

Evaluation of Community Perceptions and Prevention Practices Related to Ebola Virus as Part of Outbreak Preparedness in Uganda, 2020.

During the 2018-2020 Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo, risk communication and community engagement (RCCE) were prioritized in geographic areas in Uganda considered at high risk of introduction of EVD. To inform EVD preparedness in Uganda, we evaluated community perceptions and prevention practices related to EVD in 6 districts in Uganda. In March 2020, we conducted a population-based survey in 6 purposively selected districts in Uganda using multistage cluster sampling. We examined differences between districts classified as high- versus low risk for EVD in terms of their message exposure from RCCE; risk perception; and EVD knowledge, attitudes, and prevention practices. A total of 3,485 respondents were interviewed (91% response rate). EVD message exposure was more common in the high- versus low-risk districts. EVD risk perceptions were low overall but greater in the high- versus low-risk districts. Comprehensive knowledge was significantly greater in the high- versus low-risk districts (adjusted prevalence ratio [aPR] 1.61, 95% confidence interval [CI]=1.35, 1.93). Respondents' engagement in all 3 EVD prevention practices (frequent handwashing with soap, avoiding physical contact with suspected Ebola patients, and avoiding burials involving contact with a corpse) was very low (4%). However, respondents with comprehensive knowledge were more likely to engage in all 3 EVD prevention practices compared to respondents without comprehensive knowledge (aPR 1.87, 95% CI=1.08, 3.25). Our findings suggest that while RCCE efforts as part of EVD outbreak preparedness may have contributed to higher EVD knowledge in the targeted high-risk districts, uptake of prevention behaviors was similarly low across districts. In a non-outbreak setting, implementing targeted RCCE strategies may not be sufficient to motivate people to adopt protective behaviors in the absence of a high threshold of perceived threat such as in an active outbreak.

Risk Factors for Ebola Virus Persistence in Semen of Survivors in Liberia.

Long-term persistence of Ebola virus (EBOV) in immunologically privileged sites has been implicated in recent outbreaks of Ebola virus disease (EVD) in Guinea and the Democratic Republic of Congo. This study was designed to understand how the acute course of EVD, convalescence, and host immune and genetic factors may play a role in prolonged viral persistence in semen. A cohort of 131 male EVD survivors in Liberia were enrolled in a case-case study. "Early clearers" were defined as those with 2 consecutive negative EBOV semen test results by real-time reverse-transcription polymerase chain reaction (rRT-PCR) ≥2 weeks apart within 1 year after discharge from the Ebola treatment unit or acute EVD. "Late clearers" had detectable EBOV RNA by rRT-PCR >1 year after discharge from the Ebola treatment unit or acute EVD. Retrospective histories of their EVD clinical course were collected by questionnaire, followed by complete physical examinations and blood work. Compared with early clearers, late clearers were older (median, 42.5 years; P < .001) and experienced fewer severe clinical symptoms (median 2, P = .006). Late clearers had more lens opacifications (odds ratio, 3.9 [95% confidence interval, 1.1-13.3]; P = .03), after accounting for age, higher total serum immunoglobulin G3 (IgG3) titers (P = .005), and increased expression of the HLA-C*03:04 allele (0.14 [.02-.70]; P = .007). Older age, decreased illness severity, elevated total serum IgG3 and HLA-C*03:04 allele expression may be risk factors for the persistence of EBOV in the semen of EVD survivors. EBOV persistence in semen may also be associated with its persistence in other immunologically protected sites, such as the eye.

Mental distress before and during the COVID-19 pandemic: A longitudinal study among communities affected by Ebola virus disease in the DR Congo

BackgroundAssociated with high mortality rate, fear, and anxiety, Ebola Virus Disease (EVD) is a significant risk factor for mental distress. This longitudinal study aims to investigate the prevalence and predictors associated with mental distress among populations affected by EVD outbreaks in the Province of Equateur in DR Congo. MethodsSurveys were administered in zones affected by the 2018 EVD outbreak in Equateur Province with a 16-month interval. Measures assessed sociodemographic characteristics, mental distress (GHQ-12), COVID-19 and EVD exposure and related stigmatization, and Resilience. Models of logistic regression and path analysis were used to estimate factors related to mental distress outcomes. ResultsPrevalence of mental distress decreased from Wave 1 to Wave 2 (Mental distressT1= 57.04%, Mental distressT2= 40.29%, x2= 23.981, p<.001). Clinical mental distress score at follow-up was predicted by greater levels of exposure to Ebola at baseline (B= .412, p<.001) and at Wave 2 (B= .453, p<.001) as well as Ebola stigmatization at baseline (B= .752, p<.001), and Protestant religion (B= .474, p=.038). Clinical mental distress score at follow-up was significantly associated with higher levels of exposure to COVID-19 (B= .389, p=.002) and COVID-19 related stigmatization (B= .480, p<.001). COVID-19 related stigmatization partially mediated the association between exposure to EVD (Time 1) and mental distress (B= .409, p<.001). ConclusionsAlthough a decrease in mental distress symptoms was observed, its prevalence remains high. The results show that mental health programs need to develop better health and education communication strategies to reduce stigmatization.

Lessons learned from the World Health Organization's late initial response to the 2014-2016 Ebola outbreak in West Africa.

The purpose of this article is to 1) examine the role of the World Health Organization (WHO) in controlling infectious disease outbreaks, 2) evaluate if the WHO’s initial response to the 2014-2016 Ebola crisis was appropriate, 3) evaluate current WHO’s efforts to prevent future disease outbreaks after the Ebola elimination, and 4) suggest how WHO should be further reformed to provide prompt and accurate guidance to multi-sectoral health stakeholders at local, national, regional and global level for effective surveillance preparedness and response. This is a non-systematic narrative literature review. The articles from PubMed, Scopus, Medline, books, WHO documents and websites, and mass media were collected to be analyzed. WHO is the only specialized agency in the United Nations (UN) that promotes people’s health with legitimacy around the globe. Due to the lack of funding and health workforce, weak global health governance, and political and economic concerns about afflicted countries, WHO failed to respond promptly to the 2014-2016 Ebola outbreak in West Africa. WHO has a central role in the architecture of global health governance. Although WHO was not the only one to be responsible for devastating 2014-2016 Ebola Virus Disease (EVD) outbreak in West Africa, it is undeniable that WHO was unprepared to respond to the EVD and failed to govern the global health response system. Furthermore, WHO should always remember its unique responsibility of taking the initiative to respond to the infectious disease outbreak by alarming a distress call.

The post-colonialist condition, suspicion, and social resistance during the West African Ebola epidemic: The importance of Frantz Fanon for global health

The scholarship of Frantz Fanon has been recognized across numerous disciplines as a unique and necessary intervention for critical analyses of the (post)colonial condition. Yet, thus far, his oeuvre has largely been ignored in global health research. In this article we introduce and demonstrate the relevance of Fanon's work for the field of global health. To illustrate, we draw from Fanon's conceptual framework and observations to analyze the 2014–16 Ebola Virus Disease outbreak response in West Africa. During this Ebola epidemic, although not necessarily as widespread as Western media made it seem, numerous instances of “resistance”—sometimes violent—were levied by members of the community toward foreign outbreak response teams. In this article, we argue that the keen insights proffered by Fanon more than half a century ago help facilitate a deeper understanding of some of the reactions of community members and public health officials during the Ebola response. In calling attention to colonial histories and structural relations of power, poverty, and violence, Fanon's work can help us to effectively move towards “decolonizing” global health interventions, thus providing a framework with which to better understand and more humanely intervene in future epidemic outbreaks in the Global South.

Modelling the Role of Human Behaviour in Ebola Virus Disease (EVD) Transmission Dynamics.

The role of human behaviour in the dynamics of infectious diseases cannot be underestimated. A clear understanding of how human behaviour influences the spread of infectious diseases is critical in establishing and designing control measures. To study the role that human behaviour plays in Ebola disease dynamics, in this paper, we design an Ebola virus disease model with disease transmission dynamics based on a new exponential nonlinear incidence function. This new incidence function that captures the reduction in disease transmission due to human behaviour innovatively considers the efficacy and the speed of behaviour change. The model's steady states are determined and suitable Lyapunov functions are built. The proofs of the global stability of equilibrium points are presented. To demonstrate the utility of the model, we fit the model to Ebola virus disease data from Liberia and Sierra Leone. The results which are comparable to existing findings from the outbreak of 2014 − 2016 show a better fit when the efficacy and the speed of behaviour change are higher. A rapid and efficacious behaviour change as a control measure to rapidly control an Ebola virus disease epidemic is advocated. Consequently, this model has implications for the management and control of future Ebola virus disease outbreaks.

Evaluation of the first two Frontline cohorts of the field epidemiology training program in Guinea, West Africa

BackgroundThe 2014–2016 Ebola virus disease outbreak in West Africa revealed weaknesses in the health systems of the three most heavily affected countries, including a shortage of public health professionals at the local level trained in surveillance and outbreak investigation. In response, the Frontline Field Epidemiology Training Program (FETP) was created by CDC in 2015 as a 3-month, accelerated training program in field epidemiology that specifically targets the district level. In Guinea, the first two FETP-Frontline cohorts were held from January to May, and from June to September 2017. Here, we report the results of a cross-sectional evaluation of these first two cohorts of FETP-Frontline in Guinea.MethodsThe evaluation was conducted in April 2018 and consisted of interviews with graduates, their supervisors, and directors of nearby health facilities, as well as direct observation of data reports and surveillance tools at health facilities. Interviews and site visits were conducted using standardized questionnaires and checklists. Qualitative data were coded under common themes and analyzed using descriptive statistics.ResultsThe evaluation revealed a significant perception of improvement in all assessed skills by the graduates, as well as high levels of self-reported involvement in key activities related to data collection, analysis, and reporting. Supervisors highlighted improvements to systematic and quality case and summary reporting as key benefits of the FETP-Frontline program. At the health facility level, staff reported the training had resulted in improvements to information sharing and case notifications. Reported barriers included lack of transportation, available support personnel, and other resources. Graduates and supervisors both emphasized the importance of continued and additional training to solidify and retain skills.ConclusionsThe evaluation demonstrated a strongly positive perceived benefit of the FETP-Frontline training on the professional activities of graduates as well as the overall surveillance system. However, efforts are needed to ensure greater gender equity and to recruit more junior trainee candidates for future cohorts. Moreover, although improvements to the surveillance system were observed concurrent with the completion of the two cohorts, the evaluation was not designed to directly measure impact on surveillance or response functions. Combined with the rapid implementation of FETP-Frontline around the world, this suggests an opportunity to develop standardized evaluation toolkits, which could incorporate metrics that would directly assess the impact of equitable field epidemiology workforce development on countries’ abilities to prevent, detect, and respond to public health threats.