Community engagement in Ebola outbreaks in sub-Saharan Africa and implications for COVID-19 control: A systematic review

Objectives There is a paucity of systematic data on the specific roles community engagement played in preventing and managing the Ebola Virus Disease (EVD) outbreak in Sub-Saharan Africa (SSA). We assessed community engagement's role, benefits, and mechanisms to understand its effect on EVD case detection, survival, and mortality in SSA. Implications for COVID-19 prevention and control were also highlighted. Methods We systematically searched for articles between 2010 and 2020 in databases such as MEDLINE and EMBASE. Study types included were randomised trials, quasi-experimental studies, observational studies, case series, and reports. Results A total of 903 records were identified for screening. 216 articles met the review criteria, 103 were initially selected, and 44 were included in the final review. Our findings show that effective community involvement during the EVD outbreak depended on the survival rates, testimonials of survivors, risk perception, and community leaders’ inclusion. Community-based interventions improved knowledge and attitudes, case findings, isolation efforts and treatment. Conclusion Although the studies included in this review were of highly variable quality, community engagement lessons learned from Ebola outbreaks can be applied to COVID-19 pandemic control in SSA.

Influence of Community-Based Interventions on Routine Immunization Uptake among Children Under Five Years in Ntungamo District-Uganda

Evidence of the effectiveness of community-based interventions in improving immunization coverage in populations of low coverage is limited. Vaccine-preventable diseases is a major public health challenge in low-income countries where Uganda lies, and immunization is the only reliable strategy for child survival. The study's objective was to assess the influence of a community-based intervention on the uptake of immunization services to recommend strategies to health stakeholders to improve immunization coverage. A quasi-experimental study was conducted in three phases. Structured and key informant interviews were used as data collection tools. Phase one provided baseline data before the intervention, the second phase was a community-based intervention, and the third phase was post-intervention evaluation. There was no significant difference on the uptake of BCG, POLIO-0, POLIO-1, POLIO-2, DPTHeP-Hib1, DPTHeP-Hib2, PCV1 and PCV2 immunizations between the intervention and control group post-intervention (P= 1.00, α =0.5). The level of knowledge on immunization was 68.8% and 29.6% in the intervention and control groups, respectively. The difference between the two was statistically significant (P=0.00 = α= 0.5). There was a significant association between the level of knowledge of the caregivers on immunization and the uptake of immunization services (P=0.00, α=0.5). There was also a statistically significant difference in immunization coverage between the intervention and control groups (97.5%) and (75.1%) for the intervention and control groups, respectively. The difference was statistically associated with the community-based intervention (P =0.00, α=0.5). Community-based interventions influenced the uptake of routine immunization services.

Effectiveness of community-based livestock protection strategies: a case study of human–lion conflict mitigation

Conservation scientists are increasingly recognizing the need to evaluate the effectiveness of interventions to improve human–wildlife coexistence across different contexts. Here we assessed the long-term efficacy of the Long Shields Community Guardians programme in Zimbabwe. This community-based programme seeks to protect livestock and prevent depredation by lions Panthera leo through non-lethal means, with the ultimate aim of promoting human–lion coexistence. Using a quasi-experimental approach, we measured temporal trends in livestock depredation by lions and the prevalence of retaliatory killing of lions by farmers and wildlife managers. Farmers that were part of the Long Shields programme experienced a significant reduction in livestock loss to lions, and the annual number of lions subject to retaliatory killing by farmers dropped by 41% since the start of the programme in 2013, compared to 2008–2012, before the programme was initiated. Our findings demonstrate the Long Shields programme can be a potential model for limiting livestock depredation by lions. More broadly, our study demonstrates the effectiveness of community-based interventions to engage community members, improve livestock protection and ameliorate levels of retaliatory killing, thereby reducing human–lion conflict.

A comparison of three types of targeted, community-based methods aimed at promoting early detection of new leprosy cases in rural parts of three endemic states in India

Background India achieved elimination of leprosy nationally in 2005, but since then the number of patients with grade 2 disability at diagnosis increased steadily indicating delay in diagnosis. Therefore, there was a need for public health interventions which can increase case finding in their earlier stage. The objective of this study is to compare the effectiveness of three such community-based interventions; 1) Enhancement of community awareness on leprosy; 2) Education and motivation of “Index” leprosy cases; and 3) Involvement of Non-Formal Health Practitioners (NFHPs) to promote early detection of new cases of leprosy. Methodology/principal findings Three community-based interventions were implemented between April 2016 and March 2018, embedded within the National Leprosy Eradication Program (NLEP) of India. Interventions were 1) increasing awareness through involvement of Gram Panchayat (local government) in the community regarding early signs of leprosy (Awareness), 2) providing health education and motivating newly diagnosed leprosy patients to bring suspects from their contacts (Index) and 3) training local non-formal health practitioners (NFHP). Each intervention was implemented in a group of ten blocks (sub-division of district) with an additional ten blocks as control (with no intervention). The main outcomes were number of new cases detected and number of grade 2 disability among them. They were obtained from the routine NLEP information system and compared between these interventions. On an average, there was an addition of 1.98 new cases in Awareness blocks, 1.13 in NFHP blocks and 1.16 cases in Index intervention blocks per month per block after adjusting for changes in control blocks during the same period. In terms of ratio, there was a 61%, 40% and 41% increase in case notification in awareness, Index and NFHP intervention, respectively. Overall, the percentage of grade 2 disability across intervention blocks declined. Conclusion The Awareness intervention appears to be more effective in detection of new cases, compared to Index case motivation and sensitization of NFHPs. However, it is important to stress that while selecting strategies to increase early diagnosis it is important to determine, which is the most appropriate for each context or area and must be decided depending on the local context.

Mental Health Outcomes of Peer-led Therapeutic Adventure for Military Veterans

Background: Skepticism of therapy and stigma are significant barriers for veterans with mental health issues. Therapeutic adventure shows promise in addressing veterans’ mental health needs while circumventing the stigma many veterans face in initiating treatment. Purpose: Given the small group model of therapeutic adventure programs, such programs may be ideal to provide social support for veterans and reduce mental health symptomology. The present study investigated: can a brief peer-led therapeutic adventure program modify veterans’ mental health symptoms? Methodology/Approach: The study's sample included 56 participants attending one Sierra Club Military Outdoors trip lasting at least three days and two nights and involving camping. Participants completed study measurements assessing depression, anxiety, stress, Post-Traumatic Stress Disorder symptoms, substance misuse symptoms, and suicidality at pre-trip, post-trip, one-month post trip, six-months post trip, and 12-months post trip. Six-month and 12-month post-trip data was collected during the COVID-19 pandemic. Findings/Conclusions: Results indicated significant reduction in mental health symptomology from pre-trip to post-trip, but showed few longer-term changes in mental health symptomology. Implications: The present study's findings are consistent with research suggesting improvements in overall psychological well-being immediately following a nature-based intervention and suggest the need for on-going, community-based interventions to support optimally military veterans’ mental health.

The 4-Level Approach: Prevention of Suicidal Behaviour Through Community-Based Intervention

Due to the many different factors contributing to diagnostic and therapeutic deficits concerning depression and the risk of suicidal behaviour, community-based interventions combining different measures are considered the most efficient way to address these important areas of public health. The network of the European Alliance Against Depression has implemented in more than 120 regions within and outside of Europe community-based 4-level-interventions that combine activities at four levels: (i) primary care, (ii) general public, (iii) community facilitators and gatekeepers (e.g., police, journalists, caregivers, pharmacists, and teachers), and (iv) patients, individuals at high risk and their relatives. This review will discuss lessons learned from these broad implementation activities. These include targeting depression and suicidal behaviour within one approach; being simultaneously active on the four different levels; promoting bottom-up initiatives; and avoiding any cooperation with the pharmaceutical industry for reasons of credibility.

Cultural Adaptations to Recruitment Strategies and Community-Based Interventions for Dementia Caregivers

Nearly 30 years after the 1993 National Institute of Health Revitalization Act, minority groups’ low participation in research remains (which required the inclusion of women and racial/ethnic minority groups into government-funded clinical trials). This is particularly the case for participation in research on Alzheimer’s Disease and related dementias (ADRD). Deeply rooted historical race-based mistreatment in research and in the health care system at large persist as barriers to low-participation of minorities (i.e. Black/African American, Hispanic/Latino) and immigrants in research studies, who remain at disparate risk for adverse ADRD health outcomes and expedited mortality. The use of culturally adapted approaches in recruitment strategies and community-based interventions might be helpful to encourage the participation of underrepresented groups into research. As such, this presentation highlights three studies that seek to use cultural adaptation to inform recruitment strategies and community-based interventions. First, Dr. Parker will present how tenets from Critical Race Theory can be used to inform culturally-adapted recruitment strategies of Black/African American caregivers into community-based research by drawing upon two ongoing studies: a randomized trial providing caregiver support through Adult Day Services (ADS) and the evaluation of impact of ADS on stress levels of Black/African American using biomarker measures. Next, Ms. Johnson will present results on cultural adaptions to the ADS-Plus Program for Spanish-speaking populations. Finally, Dr. Nkimbeng will present on the process of culturally-tailoring dementia education for African immigrants in Minnesota. Findings from this presentation identify opportunities for researchers to use cultural adaptations to encourage participation of underrepresented populations into ADRD research.

Factors Associated With the Use of Telehealth in Middle-Aged and Older Adults During the COVID-19 Pandemic

The COVID-19 pandemic has promoted the adoption and use of telehealth, particularly in the early months of the pandemic. However, people with diverse characteristics may, or may not, be able to use telehealth, presenting digital divide in health care and potential health equity-related issues. This study aimed to assess the use of telehealth among middle-aged and older adults during COVID-19, and to explore factors associated with their telehealth utilization. We used publicly available data from the California Health Interview Survey collected during January 2019 and December 2020 (N=15, 279; mean age= 64.23±11.59; female: 52.7%). Approximately 11.0% of the sample used telehealth at least once. Bivariate and multivariate logistical regression analyses found that, compared with non-users, telehealth users were more likely to be having higher numbers of chronic conditions, with self-reported mental distress, living in urban areas, born in the US, with higher English proficiency, higher education, and having higher incomes. Age, race/ethnicity, and gender were not significantly correlated with telehealth usage. Logistic regression revealed that having mental distress (OR=1.48, 95% CI=1.29-1.71, p<0.01), more chronic conditions (OR=1.48, 95% CI=1.29-1.71, p<0.001) and living in an urban area (OR=1.93, 95% CI=1.36-2.74, p<0.001) were independently related to telehealth use. These findings suggest that telehealth, while being beneficial during the pandemic, might also introduce new challenges that exacerbate existing health inequity and disparities. Policy and community-based interventions are needed to promote the use of telehealth among middle-aged and older adults with diverse characteristics.

Health promotion interventions for the control of hypertension in Africa, a systematic scoping review from 2011 to 2021

Background A proportion of hypertension patients live in developing countries with low awareness, poor control capabilities, and limited health resources. Prevention and control of hypertension can be achieved by applying both targeted and population-based health promotion interventions. This study synthesised the health promotion interventions for the control of hypertension in Africa. Methods An in-depth search of PubMed, CINAHL, EMBASE, Cochrane library, web of science, google scholar yielded 646 titles and 615 after duplicates were removed. Full text (112) was screened, and ten articles were selected. The data analysis method was thematic analysis through the incorporation of convergent synthesis. The major sub-themes that were identified were reduction in the prevalence of hypertension, increase in knowledge, impact and feasibility, role in the reduction of risk factors, and the cost associated with health promotion interventions. Results Health promotion interventions led to a remarkable decrease in the prevalence of hypertension, increased knowledge and awareness in the intervention compared to the control groups. Community-based interventions were noted to have a positive impact on people’s adoption of measures to reduce risk or identify early symptoms of hypertension. There was a significant relationship for the reduction in salt consumption, smoking, alcohol use, and increased physical activity after the administration of an intervention. Interventions using community health workers were cost-effective. Conclusion To sustain health promotion interventions and achieve control of hypertension especially in the long term, interventions must be culturally friendly and incorporate locally available resources in Africa.

Mortality in rural coastal Kenya measured using the Kilifi Health and Demographic Surveillance System: a 16-year descriptive analysis

Background: The Kilifi Health and Demographic Surveillance System (KHDSS) was established in 2000 to define the incidence and prevalence of local diseases and evaluate the impact of community-based interventions. KHDSS morbidity data have been reported comprehensively but mortality has not been described. This analysis describes mortality in the KHDSS over 16 years. Methods: We calculated mortality rates from 2003–2018 in four intervals of equal duration and assessed differences in mortality across these intervals by age and sex. We calculated the period survival function and median survival using the Kaplan–Meier method and mean life expectancies using abridged life tables. We estimated trend and seasonality by decomposing a time series of monthly mortality rates. We used choropleth maps and random-effects Poisson regression to investigate geographical heterogeneity. Results: Mortality declined by 36% overall between 2003–2018 and by 59% in children aged <5 years. Most of the decline occurred between 2003 and 2006. Among adults, the greatest decline (49%) was observed in those aged 15–54 years. Life expectancy at birth increased by 12 years. Females outlived males by 6 years. Seasonality was only evident in the 1–4 year age group in the first four years. Geographical variation in mortality was ±10% of the median value and did not change over time. Conclusions: Between 2003 and 2018, mortality among children and young adults has improved substantially. The steep decline in 2003–2006 followed by a much slower reduction thereafter suggests improvements in health and wellbeing have plateaued in the last 12 years. However, there is substantial inequality in mortality experience by geographical location.