Abramowitz Sharon Alane, McLean Kristen E, McKune Sarah Lindley, Bardosh Kevin Louis, Fallah Mosoka, Monger Josephine, Tehoungue Kodjo, Omidian Patricia A
Department of Anthropology & Center for African Studies, University of Florida, Gainesville, Florida, United States of America.
Department of Anthropology, Yale University, New Haven, Connecticut, United States of America.
PLoS Negl Trop Dis. 2015 Apr 9;9(4):e0003706. doi: 10.1371/journal.pntd.0003706. eCollection 2015 Apr.
The West African Ebola epidemic has demonstrated that the existing range of medical and epidemiological responses to emerging disease outbreaks is insufficient, especially in post-conflict contexts with exceedingly poor healthcare infrastructures. In this context, community-based responses have proven vital for containing Ebola virus disease (EVD) and shifting the epidemic curve. Despite a surge in interest in local innovations that effectively contained the epidemic, the mechanisms for community-based response remain unclear. This study provides baseline information on community-based epidemic control priorities and identifies innovative local strategies for containing EVD in Liberia.
METHODOLOGY/PRINCIPAL FINDINGS: This study was conducted in September 2014 in 15 communities in Monrovia and Montserrado County, Liberia--one of the epicenters of the Ebola outbreak. Findings from 15 focus group discussions with 386 community leaders identified strategies being undertaken and recommendations for what a community-based response to Ebola should look like under then-existing conditions. Data were collected on the following topics: prevention, surveillance, care-giving, community-based treatment and support, networks and hotlines, response teams, Ebola treatment units (ETUs) and hospitals, the management of corpses, quarantine and isolation, orphans, memorialization, and the need for community-based training and education. Findings have been presented as community-based strategies and recommendations for (1) prevention, (2) treatment and response, and (3) community sequelae and recovery. Several models for community-based management of the current Ebola outbreak were proposed. Additional findings indicate positive attitudes towards early Ebola survivors, and the need for community-based psychosocial support.
CONCLUSIONS/SIGNIFICANCE: Local communities' strategies and recommendations give insight into how urban Liberian communities contained the EVD outbreak while navigating the systemic failures of the initial state and international response. Communities in urban Liberia adapted to the epidemic using multiple coping strategies. In the absence of health, infrastructural and material supports, local people engaged in self-reliance in order to contain the epidemic at the micro-social level. These innovations were regarded as necessary, but as less desirable than a well-supported health-systems based response; and were seen as involving considerable individual, social, and public health costs, including heightened vulnerability to infection.
西非埃博拉疫情表明，现有的针对新发疾病暴发的医学和流行病学应对措施并不充分，尤其是在医疗基础设施极其薄弱的冲突后环境中。在这种背景下，基于社区的应对措施已被证明对于控制埃博拉病毒病（EVD）和扭转疫情曲线至关重要。尽管人们对有效控制疫情的本土创新兴趣激增，但基于社区的应对机制仍不明确。本研究提供了关于基于社区的疫情防控重点的基线信息，并确定了利比里亚控制埃博拉病毒病的本土创新策略。
方法/主要发现：本研究于2014年9月在利比里亚蒙罗维亚和蒙特塞拉多县的15个社区开展，这里是埃博拉疫情的中心之一。与386名社区领袖进行的15次焦点小组讨论的结果确定了正在采取的策略，以及在当时现有条件下基于社区的埃博拉应对措施应是什么样的建议。收集了以下主题的数据：预防、监测、护理、基于社区的治疗与支持、网络与热线、应对小组、埃博拉治疗单位（ETUs）与医院、尸体管理、隔离与检疫、孤儿、纪念活动，以及基于社区的培训与教育需求。研究结果已呈现为基于社区的（1）预防、（2）治疗与应对、（3）社区后遗症与恢复的策略和建议。提出了几种基于社区的当前埃博拉疫情管理模式。其他研究结果表明，人们对早期埃博拉幸存者持积极态度，且需要基于社区的社会心理支持。
结论/意义：当地社区的策略和建议让我们深入了解了利比里亚城市社区在应对最初国家和国际应对措施的系统性失灵时是如何控制埃博拉病毒病疫情的。利比里亚城市社区采用多种应对策略来适应疫情。在缺乏卫生、基础设施和物资支持的情况下，当地居民依靠自身力量在微观社会层面控制疫情。这些创新被认为是必要的，但不如得到充分支持的基于卫生系统的应对措施理想；并且被视为涉及相当大的个人、社会和公共卫生成本，包括感染易感性增加。
