International Journal of Infectious Diseases, 2022
Highlights • Health workers were among those most affected by nosocomial Ebola virus disease (EVD... more Highlights • Health workers were among those most affected by nosocomial Ebola virus disease (EVD) in this outbreak.• Children had a higher case fatality rate compared with other patients with nosocomial EVD.• Referral health facilities and privately owned health facilities had the highest number of nosocomial infections (NI).• Clear case definition of NI is required to prompt transmission chain interruption.
The emerging field of outbreak analytics calls attention to the need for data from multiple sourc... more The emerging field of outbreak analytics calls attention to the need for data from multiple sources to inform evidence-based decision making in managing infectious diseases outbreaks. To date, these approaches have not systematically integrated evidence from social and behavioural sciences. During the 2018–2020 Ebola outbreak in Eastern Democratic Republic of the Congo, an innovative solution to systematic and timely generation of integrated and actionable social science evidence emerged in the form of the Cellulle d’Analyse en Sciences Sociales (Social Sciences Analytics Cell) (CASS), a social science analytical cell. CASS worked closely with data scientists and epidemiologists operating under the Epidemiological Cell to produce integrated outbreak analytics (IOA), where quantitative epidemiological analyses were complemented by behavioural field studies and social science analyses to help better explain and understand drivers and barriers to outbreak dynamics. The primary activity...
IntroductionHealth service use among the public can decline during outbreaks and had been predict... more IntroductionHealth service use among the public can decline during outbreaks and had been predicted among low and middle-income countries during the COVID-19 pandemic. In March 2020, the government of the Democratic Republic of the Congo (DRC) started implementing public health measures across Kinshasa, including strict lockdown measures in the Gombe health zone.MethodsUsing monthly time series data from the DRC Health Management Information System (January 2018 to December 2020) and interrupted time series with mixed effects segmented Poisson regression models, we evaluated the impact of the pandemic on the use of essential health services (outpatient visits, maternal health, vaccinations, visits for common infectious diseases and non-communicable diseases) during the first wave of the pandemic in Kinshasa. Analyses were stratified by age, sex, health facility and lockdown policy (ie, Gombe vs other health zones).ResultsHealth service use dropped rapidly following the start of the ...
ABSTRACT Within Oxfam, we continue to question how we could have better integrated gender equalit... more ABSTRACT Within Oxfam, we continue to question how we could have better integrated gender equality in the Ebola response, and how to improve our gender mainstreaming in future emergencies. Why did gender mainstreaming in the Ebola response prove particularly challenging? How did the Ebola response differ from previous emergencies? What did we need to know to improve our response to the outbreak? Are there new ways in which we should approach gender mainstreaming? What lessons have we learned that we can carry forward in our work? Most importantly, what recommendations can we offer beyond those already provided in existing guidelines? In this article, we reflect on our experience as non-medical specialist practitioners involved in the response, to help us answer these questions.
‘Vertical’ responses focused primarily on preventing and containing COVID-19 have been implemente... more ‘Vertical’ responses focused primarily on preventing and containing COVID-19 have been implemented in countries around the world with negative consequences for other health services, people’s access to and use of them, and associated health outcomes, especially in low-income and middle-income countries (LMICs). ‘Lockdowns’ and restrictive measures, especially, have complicated service provision and access, and disrupted key supply chains. Such interventions, alongside more traditional public health measures, interact with baseline health, health system, and social and economic vulnerabilities in LMICs to compound negative impacts. This analysis, based on a rapid evidence assessment by the Social Science in Humanitarian Action Platform in mid-2020, highlights the drivers and evidence of these impacts, emphasises the additional vulnerabilities experienced by marginalised social groups, and provides insight for governments, agencies, organisations and communities to implement more proportionate, appropriate, comprehensive and socially just responses that address COVID-19 in the context of and alongside other disease burdens. In the short term, there is an urgent need to monitor and mitigate impacts of pandemic responses on health service provision, access and use, including through embedding COVID-19 response within integrated health systems approaches. These efforts should also feed into longer-term strategies to strengthen health systems, expand universal healthcare coverage and attend to the social determinants of health—commitments, both existing and new—which governments, donors and international agencies must make and be held accountable to. Crucially, affected communities must be empowered to play a central role in identifying health priorities, allocating resources, and designing and delivering services.
What questions we should be asking about COVID-19 in humanitarian settings: perspectives from the... more What questions we should be asking about COVID-19 in humanitarian settings: perspectives from the Social Sciences Analysis Cell in the Democratic Republic of the Congo
Ebola Treatment Units were able to provide only 60% of necessary treatment beds in Sierra Leone. ... more Ebola Treatment Units were able to provide only 60% of necessary treatment beds in Sierra Leone. As a result, the Government of Sierra Leone decided to construct Community Care Centers. These were intended to increase treatment-seeking behavior and reduce the community-level spread of Ebola by facilitating access to care closer to communities. Through qualitative data collection in 3 districts, this study seeks to understand the perceived impact that proximity to such Centers had on treatment-seeking behavior. Feedback from community members and Community Health Volunteers indicates that proximity to treatment reduced fears, especially those arising from the use of ambulances, lack of familiarity with medical Centers, and loss of contact with family members taken for treatment. Participants report that having a Center close to their home enables them to walk to treatment and witness survivors being discharged. Living close to Centers also enables communities to be involved in their design and daily operation, helping to build trust in them as acceptable treatment facilities. Further research is required to understand the appropriate design, operation, and epidemiological impact of Centers. Further investigation should incorporate the effect of an outbreak’s severity and the stage (duration) of the outbreak on potential acceptance of Centers.
Nine months after the start of the Ebola outbreak in Sierra Leone in May 2014, communities in Por... more Nine months after the start of the Ebola outbreak in Sierra Leone in May 2014, communities in Port Loko continued to engage in high-risk practices; many remained unwilling to seek treatment. In the face of such behaviors, Oxfam Community Outreach teams conducted qualitative research using in-depth interviews, focus groups, and questionnaires to better understand the barriers and enablers affecting treatment-seeking behavior. Analysis of their results highlights 3 primary barriers to treatment seeking: fear and limited information, concern about unknown outsiders, and the often prohibitive distance and limited accessibility of treatment. Communities were asked to provide suggestions on how to address these barriers. Their recommendations fell into 4 main categories: providing information and better communication, including community members in decisions, providing closer treatment facilities with opportunities to learn how they operate, and using survivors to inspire hope for other sufferers. This research highlights the need for social mobilization programs to invest early in understanding the underlying causes of risky behaviors in order to develop programs that address them.
International Journal of Infectious Diseases, 2022
Highlights • Health workers were among those most affected by nosocomial Ebola virus disease (EVD... more Highlights • Health workers were among those most affected by nosocomial Ebola virus disease (EVD) in this outbreak.• Children had a higher case fatality rate compared with other patients with nosocomial EVD.• Referral health facilities and privately owned health facilities had the highest number of nosocomial infections (NI).• Clear case definition of NI is required to prompt transmission chain interruption.
The emerging field of outbreak analytics calls attention to the need for data from multiple sourc... more The emerging field of outbreak analytics calls attention to the need for data from multiple sources to inform evidence-based decision making in managing infectious diseases outbreaks. To date, these approaches have not systematically integrated evidence from social and behavioural sciences. During the 2018–2020 Ebola outbreak in Eastern Democratic Republic of the Congo, an innovative solution to systematic and timely generation of integrated and actionable social science evidence emerged in the form of the Cellulle d’Analyse en Sciences Sociales (Social Sciences Analytics Cell) (CASS), a social science analytical cell. CASS worked closely with data scientists and epidemiologists operating under the Epidemiological Cell to produce integrated outbreak analytics (IOA), where quantitative epidemiological analyses were complemented by behavioural field studies and social science analyses to help better explain and understand drivers and barriers to outbreak dynamics. The primary activity...
IntroductionHealth service use among the public can decline during outbreaks and had been predict... more IntroductionHealth service use among the public can decline during outbreaks and had been predicted among low and middle-income countries during the COVID-19 pandemic. In March 2020, the government of the Democratic Republic of the Congo (DRC) started implementing public health measures across Kinshasa, including strict lockdown measures in the Gombe health zone.MethodsUsing monthly time series data from the DRC Health Management Information System (January 2018 to December 2020) and interrupted time series with mixed effects segmented Poisson regression models, we evaluated the impact of the pandemic on the use of essential health services (outpatient visits, maternal health, vaccinations, visits for common infectious diseases and non-communicable diseases) during the first wave of the pandemic in Kinshasa. Analyses were stratified by age, sex, health facility and lockdown policy (ie, Gombe vs other health zones).ResultsHealth service use dropped rapidly following the start of the ...
ABSTRACT Within Oxfam, we continue to question how we could have better integrated gender equalit... more ABSTRACT Within Oxfam, we continue to question how we could have better integrated gender equality in the Ebola response, and how to improve our gender mainstreaming in future emergencies. Why did gender mainstreaming in the Ebola response prove particularly challenging? How did the Ebola response differ from previous emergencies? What did we need to know to improve our response to the outbreak? Are there new ways in which we should approach gender mainstreaming? What lessons have we learned that we can carry forward in our work? Most importantly, what recommendations can we offer beyond those already provided in existing guidelines? In this article, we reflect on our experience as non-medical specialist practitioners involved in the response, to help us answer these questions.
‘Vertical’ responses focused primarily on preventing and containing COVID-19 have been implemente... more ‘Vertical’ responses focused primarily on preventing and containing COVID-19 have been implemented in countries around the world with negative consequences for other health services, people’s access to and use of them, and associated health outcomes, especially in low-income and middle-income countries (LMICs). ‘Lockdowns’ and restrictive measures, especially, have complicated service provision and access, and disrupted key supply chains. Such interventions, alongside more traditional public health measures, interact with baseline health, health system, and social and economic vulnerabilities in LMICs to compound negative impacts. This analysis, based on a rapid evidence assessment by the Social Science in Humanitarian Action Platform in mid-2020, highlights the drivers and evidence of these impacts, emphasises the additional vulnerabilities experienced by marginalised social groups, and provides insight for governments, agencies, organisations and communities to implement more proportionate, appropriate, comprehensive and socially just responses that address COVID-19 in the context of and alongside other disease burdens. In the short term, there is an urgent need to monitor and mitigate impacts of pandemic responses on health service provision, access and use, including through embedding COVID-19 response within integrated health systems approaches. These efforts should also feed into longer-term strategies to strengthen health systems, expand universal healthcare coverage and attend to the social determinants of health—commitments, both existing and new—which governments, donors and international agencies must make and be held accountable to. Crucially, affected communities must be empowered to play a central role in identifying health priorities, allocating resources, and designing and delivering services.
What questions we should be asking about COVID-19 in humanitarian settings: perspectives from the... more What questions we should be asking about COVID-19 in humanitarian settings: perspectives from the Social Sciences Analysis Cell in the Democratic Republic of the Congo
Ebola Treatment Units were able to provide only 60% of necessary treatment beds in Sierra Leone. ... more Ebola Treatment Units were able to provide only 60% of necessary treatment beds in Sierra Leone. As a result, the Government of Sierra Leone decided to construct Community Care Centers. These were intended to increase treatment-seeking behavior and reduce the community-level spread of Ebola by facilitating access to care closer to communities. Through qualitative data collection in 3 districts, this study seeks to understand the perceived impact that proximity to such Centers had on treatment-seeking behavior. Feedback from community members and Community Health Volunteers indicates that proximity to treatment reduced fears, especially those arising from the use of ambulances, lack of familiarity with medical Centers, and loss of contact with family members taken for treatment. Participants report that having a Center close to their home enables them to walk to treatment and witness survivors being discharged. Living close to Centers also enables communities to be involved in their design and daily operation, helping to build trust in them as acceptable treatment facilities. Further research is required to understand the appropriate design, operation, and epidemiological impact of Centers. Further investigation should incorporate the effect of an outbreak’s severity and the stage (duration) of the outbreak on potential acceptance of Centers.
Nine months after the start of the Ebola outbreak in Sierra Leone in May 2014, communities in Por... more Nine months after the start of the Ebola outbreak in Sierra Leone in May 2014, communities in Port Loko continued to engage in high-risk practices; many remained unwilling to seek treatment. In the face of such behaviors, Oxfam Community Outreach teams conducted qualitative research using in-depth interviews, focus groups, and questionnaires to better understand the barriers and enablers affecting treatment-seeking behavior. Analysis of their results highlights 3 primary barriers to treatment seeking: fear and limited information, concern about unknown outsiders, and the often prohibitive distance and limited accessibility of treatment. Communities were asked to provide suggestions on how to address these barriers. Their recommendations fell into 4 main categories: providing information and better communication, including community members in decisions, providing closer treatment facilities with opportunities to learn how they operate, and using survivors to inspire hope for other sufferers. This research highlights the need for social mobilization programs to invest early in understanding the underlying causes of risky behaviors in order to develop programs that address them.
Introduction: Uganda’s current success story in its battle against the HIV/AIDS epidemic is being... more Introduction: Uganda’s current success story in its battle against the HIV/AIDS epidemic is being questioned as recent research has estimated a possible increase in both prevalence and incidence across the country, specifically within the rural southwest. Rakai district has long been recognized as the Ugandan epicentre of HIV/AIDS and appears to again be in a vulnerable positive. As universal care to free HIV treatment has only been available in Uganda in 2004, there remains a paucity of literature understanding the current barriers to access and adherence to HIV treatment programs, especially among young people living in the heavily affected southwestern community of Lyantonde. Therefore, objectives of this thesis were to: 1. Investigate the current barriers young men and women experience when attempting to access HIV treatment and care in town;(2) Document the barriers young women and men living in this peri-urban setting experience when attempting to adhere to HIV treatment while living in town; (3) Develop community appropriate recommendations to address the results found within this study. Results: Participants not accessing treatment identified three barriers to treatment access: relationship-based fears, workplace-based fears and food insecurity leading to treatment attrition. None of the participants who were accessing treatment at the time of the study were able to remain adherent to their treatment, all of which reported that food insecurity was their only barrier to adherence. Discussion: these data indicate that the conditions for young people living with HIV/AIDS in Lyantonde remain incredibly difficult and, despite free treatment availability, many are not able to access care and those who are, face such food security-related barriers that they are unable to adhere to their treatment. Recommended actions include community based farming programs for young people living with HIV/AIDS, small household farming workshops, micro-credit groups for young people and finally the training of couples to offer dual counselling for both concordant and discordant couples during HIV/AIDS educational workshops and testing times.
online webinar on Community Engagement in WaSH
following Oxfam's framework for Community Engageme... more online webinar on Community Engagement in WaSH following Oxfam's framework for Community Engagement in WaSH
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Papers by Simone E Carter
been recognized as the Ugandan epicentre of HIV/AIDS and appears to again be in a vulnerable positive. As universal care to free HIV treatment has only been available in Uganda in 2004, there remains a paucity of literature understanding the current barriers to access and adherence to HIV treatment programs, especially among young people living in the heavily affected southwestern community of Lyantonde. Therefore, objectives of this thesis were to:
1. Investigate the current barriers young men and women experience when attempting to access HIV treatment and care in town;(2) Document the barriers young women and men living in this peri-urban setting experience when attempting to adhere to HIV treatment while living in town; (3) Develop community appropriate recommendations to address the results found within this study. Results: Participants not accessing treatment identified three barriers to treatment access: relationship-based fears, workplace-based fears and food insecurity leading to treatment attrition. None of the participants who were accessing treatment at the time of the study were able to remain adherent to their treatment, all of which reported that food insecurity was their only barrier to adherence.
Discussion: these data indicate that the conditions for young people living with HIV/AIDS in Lyantonde remain incredibly difficult and, despite free treatment availability, many are not able to access care and those who are, face such food security-related barriers that they are unable to adhere to their treatment. Recommended actions include community based farming programs for young people living with HIV/AIDS, small household farming workshops, micro-credit groups for young people and finally the training of couples to offer dual counselling for both concordant and discordant couples during HIV/AIDS educational workshops and testing times.
following Oxfam's framework for Community Engagement in WaSH