Gautier Lara, Houngbedji Koffi Ange, Uwamaliya Jeanne, Coffee Megan
Department of Social and Preventive Medicine, School of Public Health (ESPUM) University of Montreal, Québec, Canada.
Public Health Research Institute (IRSPUM), University of Montreal, Québec, Canada.
Glob Health Res Policy. 2017 Dec 22;2:35. doi: 10.1186/s41256-017-0055-6. eCollection 2017.
Starting in December 2013, the Ebola virus disease (EVD) epidemic spread in West Africa through five countries (Sierra Leone, Liberia, Guinea, Nigeria, and Mali), killing over 11,300 people. In partnership with Côte d'Ivoire's Ministry of Health, the International Rescue Committee instigated a community-led strategy aimed at promoting behavior change in order to prevent potential Ebola outbreaks in the country. The strategy was implemented in Western districts bordering Liberia, Guinea, and Mali. This study aims to analyze the community-led strategy, to document lessons learned from the experience, and to capitalize on the achievements.
A case study in four districts of Western Côte d'Ivoire, i.e. Biankouma, Danané, Odienné and Touba districts was carried out. Qualitative data in 12 villages (i.e., three villages per district) was collected from 62 healthcare workers, community leaders, and ordinary community members. Data was de-identified, coded and analyzed using a thematic approach.
The community-led strategy was socially accepted in the villages. Even though some community leaders reported that sensitization had been, at times, constrained by a lack of equipment, the people interviewed demonstrated accurate understanding of information about prevention practices. Some practices were easily adopted, while others remained difficult to implement (e.g., ensuring safe and dignified dead body management).
This research demonstrates that sensitization efforts led by well-integrated and respected community leaders can be conducive of behavior change. Lessons learned from the community-led strategy could be applied to future disease outbreaks.
自2013年12月起，埃博拉病毒病疫情在西非五个国家（塞拉利昂、利比里亚、几内亚、尼日利亚和马里）蔓延，造成11300多人死亡。国际救援委员会与科特迪瓦卫生部合作，发起了一项由社区主导的战略，旨在促进行为改变，以预防该国可能出现的埃博拉疫情。该战略在与利比里亚、几内亚和马里接壤的西部地区实施。本研究旨在分析由社区主导的战略，记录从该经验中吸取的教训，并利用所取得的成就。
在科特迪瓦西部的四个区，即比安库马、达纳内、奥迪耶内和图巴区开展了一项案例研究。从62名医护人员、社区领袖和普通社区成员那里收集了12个村庄（即每个区三个村庄）的定性数据。对数据进行去识别、编码，并采用主题分析法进行分析。
由社区主导的战略在村庄中得到了社会认可。尽管一些社区领袖报告称宣传工作有时因缺乏设备而受到限制，但接受采访的人们对预防措施信息表现出了准确的理解。一些措施很容易被采纳，而另一些则仍然难以实施（例如，确保安全且有尊严地处理尸体）。
本研究表明，由融入良好且受人尊敬的社区领袖主导的宣传工作有助于行为改变。从由社区主导的战略中吸取的经验教训可应用于未来的疾病爆发应对。
