GroundWork, Hintergasse, Fläsch, Switzerland.
FOCUS 1000, Freetown, Sierra Leone.
PLoS Negl Trop Dis. 2019 Sep 10;13(9):e0007645. doi: 10.1371/journal.pntd.0007645. eCollection 2019 Sep.
This study sought understand how the 2014-2016 EVD Virus Disease (EVD) outbreak impacted the nutrition sector in Sierra Leone and use findings for improving nutrition responses during future outbreaks of this magnitude.
This qualitative study was iterative and emergent. In-depth interviews (n = 42) were conducted over two phases by purposively sampling both key informants (n = 21; government stakeholders, management staff from United Nations (UN) agencies and non-governmental organizations (NGO)), as well as community informants (n = 21; EVD survivors, health workers, community leaders) until data saturation. Multiple analysts collaborated in a team-based coding approach to identify key themes using Dedoose software. Findings are presented as both quotations and tables/figures.
The EVD outbreak effects and the related response strategies, especially movement restriction policies including 21-day quarantines, contributed to disruptions across the food value-chain in Sierra Leone. System-wide impacts were similar to those typically seen in large-scale disasters such as earthquakes. Participants described an array of direct and indirect effects on agricultural production and food storage and processing, as well as on distribution, transport, trade, and retailing. Secondary data were triangulated by interviews which described the aggregate negative effect of this outbreak on key pillars of food security, infant and young child feeding practices, and nutrition. During the humanitarian response, nutrition-specific interventions, including food assistance, were highly accepted, although sharing was reported. Despite EVD impacts across the entire food value-chain, nutrition-sensitive interventions were not central to the initial response as EVD containment and survival took priority. Culturally-appropriate social and behavior change communications were a critical response component for improving health, nutrition, and hygiene-related behaviors through community engagement.
Infectious diseases such as EVD have far-reaching effects that impact health and nutrition through interrelated pathways. In Sierra Leone, the entire food value-chain was broken to the extent that the system-wide damage was on par with that typically resulting from large natural disasters. A food value-chain approach, at minimum, offers a foundational framework from which to position nutrition preparedness and response efforts for outbreaks in similar resource constrained settings.
本研究旨在了解 2014-2016 年埃博拉病毒病（EVD）疫情如何影响塞拉利昂的营养部门，并利用研究结果改善未来此类大规模疫情期间的营养应对措施。
本定性研究是迭代和新兴的。通过有目的地抽样选取关键信息员（n=21；政府利益攸关方、联合国（UN）机构和非政府组织（NGO）的管理人员）和社区信息员（n=21；EVD 幸存者、卫生工作者、社区领袖），进行了两个阶段的深入访谈，直到数据饱和。多名分析人员以团队为基础合作，使用 Dedoose 软件对关键主题进行合作编码。研究结果以引语和表格/图形的形式呈现。
EVD 疫情的影响及其相关应对策略，尤其是包括 21 天隔离在内的限制行动政策，导致塞拉利昂整个食品价值链中断。全系统的影响与地震等大规模灾害类似。参与者描述了对农业生产和粮食储存加工、以及分配、运输、贸易和零售等方面的一系列直接和间接影响。访谈中的二手数据描述了这次疫情对粮食安全、婴幼儿喂养做法和营养的关键支柱的综合负面影响。在人道主义应对期间，营养方面的干预措施，包括粮食援助，得到了高度接受，尽管有报道称存在分享情况。尽管 EVD 对整个食品价值链都有影响，但营养敏感型干预措施并不是最初应对措施的核心，因为 EVD 控制和生存是优先事项。文化上适当的社会和行为改变沟通是改善健康、营养和与卫生相关行为的重要应对组成部分，通过社区参与来实现。
埃博拉等传染病具有深远的影响，通过相互关联的途径影响健康和营养。在塞拉利昂，整个食品价值链都被打破，全系统的破坏程度与通常由大型自然灾害造成的破坏相当。食品价值链方法至少提供了一个基本框架，可以在资源有限的类似环境中为疫情期间的营养准备和应对工作定位。
