Barriers to supportive care during the Ebola virus disease outbreak in West Africa: Results of a qualitative study

Abstract

BackgroundDuring the 2013–2016 West Africa Ebola outbreak, supportive care was the only non-experimental treatment option for patients with Ebola virus disease (EVD). However, providing care that would otherwise be routine for most clinical settings in the context of a highly contagious and lethal pathogen is much more challenging. The objective of this study was to document and deepen understanding of barriers to provision of supportive care in Ebola treatment units (ETUs) as perceived by those involved in care delivery during the outbreak.MethodsThis qualitative study consisted of 29 in-depth semi-structured interviews with stakeholders (decision-makers, physicians, nurses) involved in patient care delivery during the outbreak. Analysis consisted of interview debriefing and team-based transcript coding in NVivo10 software using thematic analysis.FindingsParticipants emphasized three interconnected barriers to providing high-quality supportive care during the outbreak: 1) lack of material and human resources in ETUs; 2) ETU organizational structure limiting the provision of supportive clinical care; and 3) delayed and poorly coordinated policies limiting the effectiveness of global and national responses. Participants also noted the ethical complexities of defining and enacting best clinical practices in low-income countries. They noted tension between, on one hand, scaling up minimal care and investing in clinical care preparedness to a level sustainable in West Africa and, on the other, providing a higher level of supportive care, which in low-resource health systems would require important investments.ConclusionOur findings identified potentially modifiable barriers to the delivery of supportive care to patients with EVD in West Africa. Addressing these in the inter-outbreak period will be useful to improve patient care and outcomes during inevitable future outbreaks. Promoting community trust and engagement through long-term capacity building of the healthcare workforce and infrastructure would increase both health system resilience and ability to handle other outbreaks of emerging diseases.

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

“…Similar findings emerged from qualitative data gathered by other organizations in the area and synthesized by the Social Science in Humanitarian Action Platform [24]. In the 2014–16 West Africa EVD outbreak, health workers lamented the low level of care provided in many ETCs [10]. When communities recognized that infected persons would be isolated in the ETCs but they may not be provided supportive care, they lost trust in government and foreign aid workers and avoided ETCs [9].…”

“…In Guinea, the 2014–2016 epidemic was complicated by riots, stoning of vehicles, and even deaths of outreach workers [8]. The factors that promoted social resistance included low level of care in EVD treatment centers (ETCs), lack of a traditional burial for the deceased, and a distrust of foreigners “profiting” from the outbreak [8–10]. Past studies during other EVD epidemics suggest that root causes of resistance or reticence relate to five domains: (1) rumours; (2) fear; (3) mistrust and lack of confidence in the authorities; (4) denial of the biomedical discourse; and (5) desire to be autonomous and avoid exogenous contamination [8, 11].…”

Assessing the hospital surge capacity of the Kenyan health system in the face of the COVID-19 pandemic

“…Similar challenges have been faced before in Africa. For instance, the 2014-2016 Ebola epidemic overwhelmed the health systems of West African countries [25][26][27][28]. Our scenarios assume a uniform proportion of symptomatic infections across counties, while, like the experience of other countries has shown, there are likely to be hotspots within the country that will account for a disproportionate amount of COVID-19 cases.…”

Optimization of the intravenous infusion workflow in the isolation ward for patients with coronavirus disease 2019

“…During major public-health emergencies, PPE often becomes a scarce resource. Once PPE is no longer available, it becomes extremely difficult to carry out rescue work [21]. Given the shortage in PPE, the managing team of intravenous infusion workflow optimization conducted a feasibility analysis based on the current situation and optimized the whole workflow, by which not only the work efficacy and patients satisfaction were improved, but also the cost of PPE was reduced.…”