Ninsiima Lesley Rose, Mor Siobhan M, Romano Javier Sánchez, Namakula Lydia Nabawanuka, Kankya Clovice, Kungu Joseph, Mugisha Lawrence, Klein Jörn, Nyakarahuka Luke
Department of Biosecurity, Ecosystems and Veterinary Public Health, Makerere University, Kampala, Uganda.
University of Liverpool, Liverpool, UK.
BMJ Public Health. 2024 Dec 10;2(2):e001267. doi: 10.1136/bmjph-2024-001267. eCollection 2024 Dec.
During the most recent Ebola virus disease (EVD) outbreak in Uganda, a cluster of community deaths with epidemiological linkages to the first reported case were identified to have occurred in Mubende, Kassanda and Kampala districts in September 2022. This study aimed to explore perceived drivers of EVD outbreak among affected communities in Mubende and Kassanda districts, Uganda.
We conducted a descriptive qualitative and participatory epidemiology study using focus group discussions (n=4), in-depth interviews (n=12), key informant interviews (n=12) and participatory landscape mapping. The subcounties of Madudu (Mubende district) and Kikandwa (Kassanda district) were purposively selected within each district because Ebola cases were known to have occurred within these areas. The community expressed their own understanding and perceptions of the drivers of Ebola virus outbreak within these subcounties. Qualitative data were analysed using thematic content analysis in Nvivo V.12 software. Data were analysed using both inductive and deductive approaches, where codes, subthemes and themes in the data were merged with global themes. The results were interpreted in the context of the broader literature on the topic using the social-ecological model and the epidemiological triad using the specific experiences and insights of the study participants. Participant responses were categorised in terms of their themes.
A total of five themes were identified which described the perceived drivers of Ebola virus outbreaks. These included (1) individual: knowledge about EVD (source of the disease and fear due to death of some suspected cases); (2) interpersonal: perceived sources of Ebola virus spillover (ecological, anthropogenic, environmental and cultural); (3) community: impact of EVD to the community (economic loss and survivors lack of support from the government); (4) organisational: health system challenges in outbreaks (delayed laboratory results, poor recording and reporting systems in the facilities and poor surveillance); and (5) policy: recommendations (use of One Health approach and continuous sensitisation).
This study underscores the complex interplay of factors shaping the dynamics of EVD. Understanding Ebola requires not only scientific knowledge but also an appreciation of sociocultural contexts and systemic vulnerabilities within health systems. We therefore recommend comprehensive approaches which integrate scientific expertise with community participation, strengthen health systems and foster collaboration across sectors to mitigate the impact of future outbreaks to address these challenges effectively. Additionally, raising awareness, sensitising the public and safeguarding natural habitats are crucial steps to mitigate the risk of future disease outbreaks.
在乌干达最近一次埃博拉病毒病（EVD）疫情爆发期间，2022年9月在穆本德、卡桑达和坎帕拉地区发现了一群与首例报告病例有流行病学关联的社区死亡病例。本研究旨在探讨乌干达穆本德和卡桑达地区受影响社区中埃博拉病毒病疫情爆发的潜在驱动因素。
我们进行了一项描述性定性和参与性流行病学研究，采用焦点小组讨论（n = 4）、深入访谈（n = 12）、关键信息访谈（n = 12）和参与性景观测绘。在每个地区有目的地选择了马杜杜（穆本德地区）和基坎德瓦（卡桑达地区）的次县，因为已知这些地区发生了埃博拉病例。社区表达了他们对这些次县内埃博拉病毒爆发驱动因素的理解和看法。使用Nvivo V.12软件中的主题内容分析对定性数据进行分析。数据采用归纳法和演绎法进行分析，将数据中的代码、子主题和主题与全球主题合并。利用社会生态模型和流行病学三角理论，结合研究参与者的具体经验和见解，在关于该主题的更广泛文献背景下对结果进行解释。参与者的回答根据其主题进行分类。
共确定了五个主题，描述了埃博拉病毒爆发的潜在驱动因素。这些主题包括：（1）个人层面：对埃博拉病毒病的了解（疾病来源以及因一些疑似病例死亡而产生的恐惧）；（2）人际层面：埃博拉病毒溢出的感知来源（生态、人为、环境和文化方面）；（3）社区层面：埃博拉病毒病对社区的影响（经济损失以及幸存者缺乏政府支持）；（4）组织层面：疫情爆发时卫生系统面临的挑战（实验室结果延迟、医疗机构记录和报告系统不完善以及监测不力）；（5）政策层面：建议（采用“同一健康”方法并持续开展宣传）。
本研究强调了影响埃博拉病毒病动态变化的因素之间复杂的相互作用。了解埃博拉病毒不仅需要科学知识，还需要认识到社会文化背景以及卫生系统内的系统性脆弱性。因此，我们建议采取综合方法，将科学专业知识与社区参与相结合，加强卫生系统，并促进跨部门合作，以减轻未来疫情爆发的影响，有效应对这些挑战。此外，提高认识、对公众进行宣传以及保护自然栖息地是降低未来疾病爆发风险的关键步骤。
