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   Table of Contents      
LETTER TO EDITOR
Year : 2016  |  Volume : 21  |  Issue : 1  |  Page : 105-106

Ebola outbreak in West Africa: Bridging the gap between the public health authorities and the community


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Chennai, Tamil Nadu, India

Date of Web Publication25-Jan-2016

Correspondence Address:
Saurabh R Shrivastava
Department of Community Medicine, 3rd Floor, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, Thiruporur-Guduvancherry Main Road, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1735-9066.174746

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How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Ebola outbreak in West Africa: Bridging the gap between the public health authorities and the community. Iranian J Nursing Midwifery Res 2016;21:105-6

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Ebola outbreak in West Africa: Bridging the gap between the public health authorities and the community. Iranian J Nursing Midwifery Res [serial online] 2016 [cited 2020 Feb 28];21:105-6. Available from: http://www.ijnmrjournal.net/text.asp?2016/21/1/105/174746

Sir,

The 2014 outbreak of Ebola virus disease has been declared as an international public health emergency and since inception, the disease has accounted for almost 27,550 cases and 11,235 associated deaths till the end of June 2015 in the affected countries.[1] A wide range of factors like lack of preparedness,[2] weak public health system,[3] ineffective diagnostic and case management services,[4] absence of an effective vaccine,[3] and minimal community participation [4],[5] have allowed the current outbreak to grow to epidemic proportions. In fact, the retrospective assessment of the outbreak indicated that the disease could have been tackled much better, provided the public health authorities had not failed to build a level of trust and involve the members of the community.[2]

Community refers to a social group, the members of which know and interact with each other, and which is determined by geographical boundaries and/or common values and interests.[6] In the current outbreak of Ebola disease, the community comprises all the people staying in the affected regions.[2] The program managers have realized that universal coverage of primary health care cannot be achieved without the involvement of the local community and, thus, continuous efforts should be taken to ensure meaningful involvement of the community in the planning, implementation, and maintenance of health services.[6] In order to significantly reduce the burden of the disease, all stakeholders including program managers, the World Health Organization, health/nursing professionals, and members of the community work in a concerted manner.[4],[5]

It was observed that multiple risk behaviors and parameters from the community viewpoint, such as consumption of improperly cooked meat products,[4] questionable hand hygiene practices,[3] limited awareness about the disease attributes (viz. symptoms of Ebola, mode of transmission, prophylactic measures, etc.),[2],[5] practice of intensive contact with the body of the deceased at times of cremation,[7] and migration of people across the borders of affected countries (so-called hot zones),[2] have played a crucial role in both the emergence and amplification of the disease. Thus, the role of community becomes crucial as the majority of the cases result owing to the adoption of high-risk behavior and non-adherence to the preventive measures.[4],[8]

Moreover, due to the ignorant behavior,[2] risk of stigma or outcast from the society,[3] lack of trust on public health authorities,[4],[5] and fear among the local residents,[5] the people have shown poor treatment-seeking behavior. Furthermore, some sections of the community have even approached traditional healers for their symptoms, which has thereby enhanced the rate of complications and case fatality.[7] In addition, the practice of contact tracing has also received limited support from the community, and thus, case load in the community has remained significantly high.[9]

In order to counter the disease and bridge the gap between the public health authorities and community, the international welfare agencies have proposed a comprehensive package of interventions to neutralize the influence of community-related factors.[4],[5] These recommendations, in general, advocate for the development of a community-based approach to manage the disease, as evidenced in Sierra Leone and Liberia.[8],[10] However, integration of the community participation in the existing institutional mechanisms for managing the disease has also been recommended.[4],[5] It is of utmost importance that the health/nursing professionals should realize the importance of community engagement and, thus, plan and implement targeted measures to address the identified risk behaviors.[2],[4],[5]

In addition, strategies like alterations in the traditional funeral procedures till the disease is active in the specified area;[7] sensitization of community about the modes of transmission, high-risk behavior, and essential preventive measures;[3],[11],[12] orienting health/nursing staff about the need and importance of contact tracing;[9] adhering to the standardized recommendations during travel;[13],[14] and encouraging people to extend full support to the health/nursing staffs [3],[4],[9],[14] have also been advocated to counter the rising trend of the disease.

To conclude, in order to enhance the extent of community participation in the affected nations, the need of the hour is to develop culturally sensitive interventions so that the burden of the disease can be significantly decreased.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. Ebola situation report-1 July 2015; 2015. Available from: .[Last accessed on 2015 Jul 8].  Back to cited text no. 1
    
2.
Chan M. Ebola virus disease in West Africa-no early end to the outbreak. N Engl J Med 2014;371:1183-5.  Back to cited text no. 2
    
3.
World Health Organization. Ebola virus disease-Fact sheet No. 103; 2014. Available from: . [Last accessed on 2015 Jan 11].  Back to cited text no. 3
    
4.
Frieden TR, Damon I, Bell BP, Kenyon T, Nichol S. Ebola 2014-new challenges, new global response and responsibility. N Engl J Med 2014;371:1177-80.  Back to cited text no. 4
    
5.
World Health Organization. Ebola in West Africa: Heading for catastrophe? 2014. Available from: . [Last accessed on 2015 Jan 8].  Back to cited text no. 5
    
6.
Park K. Health care of the community. In: Park K, editor. Textbook of Preventive and Social Medicine. 20th ed. Jabalpur: Banarsidas Bhanot Publishers; 2009. p. 583-4,791-4.  Back to cited text no. 6
    
7.
World Health Organization. Sierra Leone: A traditional healer and a funeral; 2014. Available from: . [Last accessed on 2015 Jan 5].  Back to cited text no. 7
    
8.
World Health Organization. When Ebola came calling: How communities in Sierra Leone faced the challenge; 2014. Available from: . [Last accessed on 2015 Jan 17].  Back to cited text no. 8
    
9.
World Health Organization. Contact tracing during an outbreak of Ebola virus disease: Disease surveillance and response programme area disease prevention and control cluster. Republic of Congo: WHO Press; 2014. p. 1-7.  Back to cited text no. 9
    
10.
World Health Organization. Liberia: Survivors help train health workers for Ebola care; 2014. Available from: . [Last accessed on 2015 Jan 17].  Back to cited text no. 10
    
11.
World Health Organization. Interim infection prevention and control guidance for care of patients with suspected or confirmed filovirus haemorrhagic fever in health-care settings, with focus on Ebola. Geneva: WHO Press; 2014. p. 7-15.  Back to cited text no. 11
    
12.
World Health Organization. Communication for behavioural impact (COMBI): A toolkit for behavioural and social communication in outbreak response. Geneva: WHO Press; 2012. p. 4-12.  Back to cited text no. 12
    
13.
Centers for Disease Control and Prevention. Interim guidance about Ebola virus infection for airline flight crews, cleaning personnel, and cargo personnel. Atlanta: CDC; 2014.  Back to cited text no. 13
    
14.
Green A. WHO and partners launch Ebola response plan. Lancet 2014;384:481.  Back to cited text no. 14
    



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