Social resistance drives persistent transmission of Ebola virus disease in Eastern Democratic Republic of Congo: A mixed-methods study


Autoři: Kasereka Masumbuko Claude aff001;  Jack Underschultz aff002;  Michael T. Hawkes aff002
Působiště autorů: Department of Medicine, Université Catholique de Graben, Butembo, Democratic Republic of Congo aff001;  Department of Pediatrics, University of Alberta, Edmonton, Canada aff002;  Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Canada aff003;  Department of Global Health, School of Public Health, University of Alberta, Edmonton, Canada aff004
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223104

Souhrn

Background

The second largest Ebola virus disease (EVD) epidemic in history is currently raging in Eastern Democratic Republic of Congo (DRC). Stubbornly persistent EVD transmission has been associated with social resistance, ranging from passive non-compliance to overt acts of aggression toward EVD reponse teams.

Methods

We explored community resistance using focus group discussions and assessed the prevalence of resistant views using standardized questionnaires.

Results

Despite being generally cooperative and appreciative of the EVD response (led by the government of DRC with support from the international community), focus group participants provided eyewitness accounts of aggressive resistance to control efforts, consistent with recent media reports. Mistrust of EVD response teams was fueled by perceived inadequacies of the response effort (“herd medicine”), suspicion of mercenary motives, and violation of cultural burial mores (“makeshift plastic morgue”). Survey questionnaires found that the majority of respondents had compliant attitudes with respect to EVD control. Nonetheless, 78/630 (12%) respondents believed that EVD was fabricated and did not exist in the area, 482/630 (72%) were dissatisfied with or mistrustful of the EVD response, and 60/630 (9%) sympathized with perpetrators of overt hostility. Furthermore, 102/630 (15%) expressed non-compliant intentions in the case of EVD illness or death in a family member, including hiding from the health authorities, touching the body, or refusing to welcome an official burial team. Denial of the biomedical discourse and dissatisfaction/mistrust of the EVD response were statistically significantly associated with indicators of social resistance.

Conclusions

We concluded that social resistance to EVD control efforts was prevalent among focus group and survey participants. Mistrust, with deep political and historical roots in this area besieged by chronic violence and neglected by the outside world, may fuel social resistance. Resistant attitudes may be refractory to short-lived community engagement efforts targeting the epidemic but not the broader humanitarian crisis in Eastern DRC.

Klíčová slova:

Ebola hemorrhagic fever – Medical doctors – Nurses – Public and occupational health – Questionnaires – Surveys – Vaccination and immunization – Vaccines


Zdroje

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