Vol 8-2 Review and Commentary

Commentary: Early-in-life Isoflurane Exposure Alters Resting-state Functional connectivity in Juvenile Non-human Primates

Viola Neudecker1#, Jose F. Perez-Zoghbi1# and Ansgar M. Brambrink1*

Department of Anesthesiology, Columbia University Medical Center, New York, NY 10032, USA.;

The concern about anesthesia-induced developmental neurotoxicity (AIDN) in infants and young children arises from animal studies indicating potential long-term neurobehavioral impairments following early-in-life anesthesia exposure. While initial clinical studies provided ambiguous results, recent prospective assessments in children indicate associations between early-in-life anesthesia exposure and later behavioral alterations. Ethical constraints and confounding factors in clinical studies pose challenges in establishing a direct causal link and in investigating its mechanisms. This commentary on a recent study in non-human primates (NHPs) focuses on exploring the role of neuroinflammation and alterations in brain functional connectivity in the behavioral impairments following early-in-life anesthesia exposure. In juvenile NHPs, chronic astrogliosis in the amygdala correlates with alterations in functional connectivity between this area with other regions of the brain and with the behavioral impairments, suggesting a potential mechanism for AIDN. Despite acknowledging the study's limitations, these findings emphasize the need for further research with larger cohorts to confirm these associations and to establish a causal link between the neuroinflammation and the behavioral alterations associated with early-in-life anesthesia exposure.

DOI: 10.29245/2578-3009/2024/2.1255 View / Download Pdf
Vol specialissue-3 Original Research Article

Therapeutic Itineraries during the Ebola Epidemic in the Democratic Republic of Congo

Tiaman Diarra1, Joseph Okeibunor2*, Bailo Diallo2, Nkechi Onyeneho3, Barry Rodrigue2, Michel N’da Konan Yao2, Zabulon Yoti2, Soce Fall2

1Independent Consultant, Mali

2World Health Organization, Switzerland

3University of Nigeria, Nsukka

While treating a disease, patients or their relatives make decisions to pursue different therapeutic options, and various stages are involved in searching for a cure. This paper explored the pattern of health-seeking in the Democratic Republic of Congo (DRC) during the 10th Ebola virus disease (EVD) outbreak. Eight hundred randomly selected adults were surveyed using a questionnaire. Qualitative data were also collected through in-depth interviews with 17 community leaders and 20 focus group discussions with community members. The results showed that modern healthcare facilities are not usually considered the first option for treatment. The therapeutic journey generally begins with the patients, who treat themselves based on the information they know about the disease and the resources they have at their disposal. However, if the disease is not cured through self-medication, then patients or their relatives will visit a pharmacy. Patients request medication they know to be effective in treating the disease, and relatives can also assist in obtaining medication in the case of immobile patients. Pharmacies commonly sell the medication to patients or their relatives without a medical prescription.

DOI: 10.29245/2578-3009/2023/S3.1101 View / Download Pdf
Vol specialissue-3 Original Research Article

Epidemic Response amidst Insecurity: Addressing the Ebola Virus Epidemic in the Provinces of North Kivu and Ituri

Tiaman Diarra1, Joseph Okeibunor2*, Bailo Diallo2, Nkechi Onyeneho3, Barry Rodrigue2, Michel N’da Konan Yao2, Zabulon Yoti2, Mamoudou Harouna Djingarey4, Soce Fall2, Abdou Salam Gueye2

1Independent Consultant, Mali

2World Health Organization, Switzerland

3University of Nigeria, Nsukka

This paper examines the impact of insecurity on the management of the Ebola virus disease epidemic in the Democratic Republic of the Congo provinces of North Kivu and Ituri. In these provinces, insecurity has been one of the biggest obstacles in the response to the Ebola outbreak. When the epidemic began, these provinces were already insecure—creating unfavorable circumstances for implementing epidemic response activities. While the ninth epidemic in the Equateur province was brought under control in record time, the same was not true for the tenth epidemic in North Kivu and Ituri. Since the epidemic began, teams were organized to address all aspects of the response. These response teams conducted extensive fieldwork, including epidemiological surveillance, risk communication and community involvement, infection prevention and control, vaccination, dignified and safe burials, care at transit centers and Ebola treatment centers, and medical and psychosocial care for the recovered. They faced confrontational reactions from the communities, which jeopardized their security. The insecure state of the provinces led to the destruction and damage of infrastructure, including healthcare facilities, which affected the ability of rescue teams to access people needing care as well as the resources they needed to care for the ill. Worse yet, the insecurity took other forms, including threatening and kidnapping members of the response teams, lodging protests against the response activities in towns or health zones, committing violence against teams responsible for safe and dignified burials, instigating altercations between community members and members of the response team, and encouraging general resistance by the population. This level of insecurity interrupted or even halted response activities in some areas—sometimes for more than two weeks, decreasing the efficiency of the response teams, particularly in monitoring contacts due to the inability to access certain communities. Additionally, certain acts of protest, such as community members handling bodies as a demonstration of their opposition to safe and dignified burials, likely intensified disease spread. However, the involvement of community leaders, at least, made dialogue and negotiation possible between the response teams and community members, as such efforts led to communities contributing to the security of personnel involved in the fight against the Ebola epidemic in North Kivu and Ituri provinces.

DOI: 10.29245/2578-3009/2023/S3.1102 View / Download Pdf
Vol specialissue-3 Original Research Article

The Impact of the Ebola Virus Disease Epidemic among Women in the Provinces of North Kivu and Ituri in the Democratic Republic of the Congo

Nkechi G. Onyeneho1*, Ngozi Idemili Aronu1, Ijeoma Igwe1, Joseph Okeibunor2, Tieman Diarra3, Julienne Ngoudougou Anoko2, Mamoudou Harouna Djingarey4, Zabulon Yoti2, Dick Chamla, Abdou Salam Gueye

1University of Nigeria, Nsukka

2World Health Organization, Switzerland

3Independent Consultant, Mali

4Independent Public Health Expert, Niger

Although an outbreak of the Ebola virus disease affects an entire population, women are more susceptible to the virus than men. Throughout the outbreaks of the Ebola virus disease in Central and West Africa, women have been impacted more significantly. Generally, over half of those who become ill are women. The situation is the same in terms of mortality. Further, the outcomes of the epidemic negatively affect women socially, as many become the heads of households following the loss of their spouses, which burdens them with new responsibilities. Women’s access to health services is also lowered, as the epidemic usually leads to fewer healthcare workers, impacting gynecological assistance. Consequently, women are more exposed to health problems, particularly during pregnancy. Several factors contribute to the greater exposure of women to the Ebola virus disease during an epidemic. First, female healthcare workers are at the frontline of the fight against the virus. Second, women’s duties in the domestic context increase their exposure to contamination, as they look after children and care for sick household members. Finally, women are responsible for several community duties such as public tasks and rituals. In the case of rituals, women undertake tasks such as undressing, washing, and dressing the deceased. Likewise, they engage in agricultural work and grocery shopping locally, as well as at cross-border markets. They also manage domestic chores such as fetching water in public places. Additionally, women have less access to information on the disease and its prevention and are thus more vulnerable. However, women’s vulnerability is less visible, since information on the epidemic and response is not gender specific. This is true for the number of suspected cases, confirmed cases, vaccinated people, alerts, contacts, contacts followed up, and screened travelers. It is therefore crucial to highlight the importance of gender in the response to the Ebola virus disease epidemic, as women are the primary victims.

DOI: 10.29245/2578-3009/2023/S3.1103 View / Download Pdf
Vol specialissue-3 Original Research Article

Two Obstacles in Response Efforts to the Ebola Epidemic in the Provinces of North Kivu and Ituri in the Democratic Republic of the Congo: Denial of and Rumors about the Disease

Nkechi G. Onyeneho1*, Ngozi Idemili Aronu1, Ijeoma Igwe1, Joseph Okeibunor2, Tieman Diarra3, Bailo Diallo2, Bairo Hamadou2, Barry Rodrigue2, Mamoudou Harouna Djingarey4, Zabulon Yoti2, Michel N’da Konan Yao2, Soce Fall2, Dick Chamla2, Abdou Salam Gueye2

1University of Nigeria, Nsukka

2World Health Organization, Switzerland

3Independent Consultant, Mali

4Independent Public Health Expert, Niger

Denial and rumors are two major obstacles impairing the implementation of activities in response to the Ebola virus disease (EVD) epidemic. This study investigated the roles of denial and rumors, among other challenges, in complicating the response to the EVD outbreak in the North Kivu and Ituri provinces of the Democratic Republic of the Congo. A total of 800 randomly selected respondents were surveyed using a structured questionnaire. In-depth interviews were conducted with 17 community religious and opinion leaders, as well as Ebola survivors. Furthermore, 20 focus group discussions were conducted with adult and youth male and female participants, and health care workers. The results revealed that the existence of the disease is widely denied by many, including political leaders, village chiefs, neighborhood chiefs, street chiefs, avenue chiefs, and members of the general population. These individuals generally consider the EVD to be the result of a misbehavior or a curse; consequently, the general population, including community members, teachers, and even health care professionals, refuse to comply with the authorities’ strategies to fight the epidemic. Rumors are another obstacle in response efforts. Rumors pertaining to the denial of the existence of the EVD, as well as the epidemic, Ebola treatment centers, hospitals, vaccines, and safe and dignified burials have been identified. Rumors about the EVD and the response, spread by clerics, traditional therapists, men, and women, including healthcare professionals in focus group discussions, portrayed the EVD as an invention, as if the virus had been created. The response to the EVD has been marked by these two constraints, which have often hindered the involvement of community members in the fight against the disease.

DOI: 10.29245/2578-3009/2023/S3.1104 View / Download Pdf
Vol specialissue-3 Original Research Article

Survivors and the Response to the Ebola Virus Disease in the Provinces of North Kivu and Ituri in the Democratic Republic of Congo

Joseph Okeibunor1*, Tieman Diarra2, Nkechi Onyeneho3, Bailo Diallo1, Michel N’da Konan Yao1, Mamoudou Harouna Djingarey4, Zabulon Yoti1, Soce Fall3, Dick Chamla1, Abdou Salam Gueye1

1World Health Organization, Switzerland

2Independent Consultant, Mali

3University of Nigeria, Nsukka

4Independent Public Health Expert, Niger

We explored issues around the integration of survivors in communities and the implications of the Ebola Virus Disease (EVD) response in the Democratic Republic of Congo (DRC). We conducted a survey with 800 randomly selected respondents using a structured questionnaire. Respondents were persons aged 18 years and above. Focus group discussions (FGDs) and in-depth interviews (IDIs) were employed to obtain contextual data on the issues. Community leaders, health workers, and response pillar leads engaged in IDIs, while community members were involved in FGDs. The results revealed that the survivors suffered stigmatization and, upon return to the communities, were avoided by the community members due to fear of contamination. Some thought that the survivors should be supported in adjusting to the community, while some recommended engaging the survivors in EVD response activities.

DOI: 10.29245/2578-3009/2023/S3.1105 View / Download Pdf
Vol specialissue-3 Original Research Article

Exploring Alternative Care Platforms for Symptomatic People in the Fight against the Ebola Virus Disease Outbreak

Nkechi G. Onyeneho1*, Ngozi Idemili Aronu1, Ijeoma Igwe1, Joseph Okeibunor2, Tieman Diarra3, Bailo Diallo2, Bairo Hamadou2, Barry Rodrigue2, Mamoudou Harouna Djingarey4, Zabulon Yoti2, Michel N’da Konan Yao2, Soce Fall2

1University of Nigeria, Nsukka

2World Health Organization, Switzerland

3Independent Consultant, Mali

4Independent Public Health Expert, Niger

Treatment centers (TCs) are the only locations designed to care for people with Ebola virus disease (EVD) symptoms. These people and their families are held at a TC as soon as they arrive at an Ebola treatment center (ETC); however, some people escape from TCs. This paper explored alternative care platforms for symptomatic people in the fight against the EVD outbreak in the Democratic Republic of Congo. Eight hundred randomly selected adults aged 18 years and above were surveyed with a uniform set of structured questionnaires. In-depth interviews were conducted with 20 community/opinion leaders, while focus group discussions were held with community members who were not involved in the questionnaire study. Our findings demonstrated that people who were suspected of having EVD preferred to be treated discreetly and at home, and were more willing to be tested at home than at a TC. People were afraid of being stigmatized if the TC exposed their admittance to the general public. This article proposes an alternative to the TCs. We suggest a temporary containment facility within the community, such as a room in the suspected person’s home. However, this requires negotiation between the response team and community members, with the latter having a significant responsibility in caring for their symptomatic relatives. The place or room for domestic temporary isolation should be chosen discreetly and placed far from the view of others. Community members will, thus, bear more responsibility for what happens while the patient is in isolation. The temporary containment area will assist in decentralizing the treatment of those with EVD symptoms. Its implementation will contribute to greater accountability of community members in the fight against EVD.

DOI: 10.29245/2578-3009/2023/S3.1106 View / Download Pdf
Vol specialissue-3 Original Research Article

Traditional therapists in Ebola virus disease outbreak response: Lessons learned from the fight against the Ebola virus disease epidemic in North Kivu and Ituri, Democratic Republic of the Congo

Nkechi G. Onyeneho1*, Ngozi Idemili Aronu1, Ijeoma Igwe1, Joseph Okeibunor2, Tieman Diarra3, Julienne Ngoudougou Anoko2, Mamoudou Harouna Djingarey4, Zabulon Yoti2

1University of Nigeria, Nsukka

2World Health Organization

3Independent Consultant, Mali

4Independent Public Health Expert, Niger

Traditional healers co-exist with orthodox medicine, especially in cases with perceived supernatural causes and during outbreaks of infectious diseases like the Ebola virus disease (EVD) in the North Kivu and Ituri provinces in the Democratic Republic of the Congo (DRC). In this study, we examined the role and potential of involving traditional healers in the national response to the Ebola virus disease outbreak in the DRC. Seventeen community leaders and 20 traditional healers were interviewed. The traditional healers managed symptoms with herbs and were not inclined to refer cases to orthodox healthcare facilities because of their confidence in their ability to handle cases with supernatural causes. The community leaders attested to the acceptance of the traditional healers in the communities, which they attributed to the efficacy of traditional healing, its uncomplicated treatment process, cause of the prolonged cough, as well as cost and the need for secrecy. Traditional healers can be educated to promptly refer cases to Ebola treatment centers for timely diagnosis and appropriate treatment.

DOI: 10.29245/2578-3009/2023/S3.1108 View / Download Pdf
Vol specialissue-3 Original Research Article

Involvement of Civil Society Organizations and Other Community Groups in the Response to the Ebola Virus Disease Outbreak in the North Kivu and Ituri Provinces of the Democratic Republic of Congo

Tiaman Diarra1, Joseph Okeibunor2, Bailo Diallo2, Nkechi Onyeneho3, Barry Rodrigue2, Michel N’da Konan Yao2, Zabulon Yoti2, Soce Fall2

1Independent Consultant, Mali

2World Health Organization

3University of Nigeria, Nsukka

We reviewed the involvement of civil society organizations as well as other community level organizations and structures in the response to the Ebola Virus Disease (EVD) outbreak in the Democratic Republic of Congo. A total of 800 randomly selected adults were surveyed using a uniform set of structured questionnaires. An in-depth interview guide was employed to collect information from community members and religious leaders, while focus group discussions were held with community members. The results revealed some involvement of the different organizations in the communities in the response to the EVD outbreak. However, several challenges were encountered, namely security issues, poor awareness, and non-compliance to safety measures. The findings underscore that despite considerable experience over a long period with outbreaks in the DRC, people still need to be educated about the disease.

DOI: 10.29245/2578-3009/2023/S3.1109 View / Download Pdf
Vol specialissue-3 Original Research Article

Community Involvement in Response to Ebola Virus Disease Epidemic in North Kivu and Ituri, Democratic Republic of Congo: A Mixed-Methods Study

Tiaman Diarra1, Joseph Okeibunor2, Bailo Diallo2, Nkechi Onyeneho3, Bairo Hamadou2, Michel N’da Konan Yao2, Zabulon Yoti2, Soce Fall2

1Independent Consultant, Mali

2World Health Organization

3University of Nigeria, Nsukka

We investigated the involvement of community members in response to the Ebola Virus Disease (EVD) epidemic in the North Kivu and Ituri provinces of the Democratic Republic of Congo. This cross-sectional study, conducted using mixed methods of data collection, included a uniformly structured questionnaire survey, which was administered to 800 randomly selected adults (aged ≥ 18 years). Further, we used qualitative tools of inquiry—focus group discussions (FGD) and in-depth interviews (IDI)—to guide the context of the information collected in the survey. Community leaders, religious leaders, and Ebola survivors were interviewed using the IDI guide, while young men (≤ 30 years), young women (≤30 years), adult community males (<30 years), and adult community females (<30 years) were in separate FGD sessions. The results revealed that the urban area was the most affected by the epidemic (79.2%) compared to 20.8% in rural areas. The χ2 calculated was 18.183 (P<0.001). Community members exhibited varying degrees of involvement in response to the EVD epidemic in the two provinces. Community members were mostly engaged in information dissemination. However, they believe they could have contributed more if they had been fully engaged. These findings were derived from the qualitative data. The study contributes to evidence on how community involvement could help response to public health events globally, hence this study provides valuable insights for future public health interventions and response.

DOI: 10.29245/2578-3009/2023/S3.1110 View / Download Pdf
Vol specialissue-3 Original Research Article

Perceptions and Rumors About the Ebola Virus Disease Vaccine in the Ituri and Kivu Provinces of the Democratic Republic of Congo

Ijeoma Igwe1, Nkechi Onyeneho1, Joseph C Okeibunor2, Michel N’da Konan Yao2, Tieman Diarra3, Mamoudou Harouna Djingarey4, Soce Fall2, Abdou Salam Gueye2

1University of Nigeria Nsukka

2World Health Organization

3Independent Consultant, Mali

4Independent Scientist, Niger

Perceptions and rumors about vaccinations can contribute to vaccine hesitancy. This study aimed to examine perceptions and rumors about the Ebola vaccine during the 10th Ebola Virus Disease outbreak in the Ituri and North Kivu provinces of the Democratic Republic of Congo. Eight hundred randomly selected respondents were surveyed with a uniform structured questionnaire. Further, we collected qualitative data through focus group discussions and using in-depth interview guides. Results revealed several misperceptions and rumors about the vaccine, which led to some level of vaccine hesitancy and refusal among the people. The acceptance rate of the vaccine was 67.3% (below the 80% threshold needed to create herd immunity in the population). More of the urban population (31.3%) than the rural population (10.4%) accepted the vaccine. Refusals were largely due to fear that the vaccine could activate other diseases in the body and could even kill. Some feared that it was a conspiracy of the government to reduce the population in the study area through forced fertility control and death, among other such concerns. In conclusion, these rumors increased mistrust, which challenged the efforts of the government and its partners to safeguard the health of the people.

DOI: 10.29245/2578-3009/2023/S3.1111 View / Download Pdf
Vol specialissue-3 Original Research Article

Perceptions, Disease Representations, and Response Obstacles Regarding the Ebola Virus Disease Epidemic in the North Kivu and Ituri Provinces of the Democratic Republic of the Congo

Nkechi Onyeneho1, Joseph Okeibunor2, Ijeoma Igwe1, Ngozi Idemili Aronu1, Bailo Diallo2, Tiaman Diarra3, Barry Rodrigue2, Michel N’da Konan Yao2, Mamoudou HAROUNA DJINGAREY4, Soce Fall2

1University of Nigeria, Nsukka

2World Health Organization

3Independent Consultant, Mali

4Independent Public Health Expert, Niger

We explored the perceptions and representations of diseases in the North Kivu and Ituri provinces of the Democratic Republic of Congo to identify perceived obstacles regarding responses to the country’s Ebola virus disease (EVD) outbreak using a mix-methods approach. We surveyed a representative sample including 800 adults aged 18 years and older, held in-depth interviews with 17 community leaders, and conducted 10 focus group discussions with community members (using same-sex interviewers/discussion leaders). The results revealed the existence of several health conditions among members of the two communities. Locals consider nearly 80 of these ailments as untreatable by orthodox medicines and methods, even when symptoms are similar to EVD. Creating awareness must be considered a critical goal of community education to further educate these populations about EVD and other health problems and their respective treatments.

DOI: 10.29245/2578-3009/2023/S3.1112 View / Download Pdf
Vol specialissue-3

Response of Healthcare Service Providers to the Ebola Virus Disease Epidemic in the Democratic Republic of Congo’s North Kivu and Ituri Provinces

Tieman Diarra1, Nkechi Onyeneho2, Joseph Okeibunor3*, Bailo Dialloa3, Michel N’da Konan Yao3, Mamoudou Harouna Djingarey4, Soce Fall3, Dick Chamla, Abdou Salam Gueye

1Independent Consultant, Mali

2University of Nigeria, Nsukka

3World Health Organization, Switzerland

4Independent Public Health Expert, Niger

Healthcare service providers are crucial for effective responses to disease outbreaks. However, their performance is dependent on the level of system inputs, people’s perception of the system, and their willingness to use health services. This study investigated the functionality of health services and healthcare providers in the Democratic Republic of Congo during the tenth Ebola virus disease outbreak. It employed qualitative methods, including 24 in-depth interviews of healthcare providers and community leaders, and 12 focus-group discussions with community members. The responses showed that the staff did not desert the health centers and remained at their jobs. Throughout this research, only one case of abandonment of duty by a nurse was reported. The healthcare system thus played a major role in responding to the COVID-19 pandemic. However, the healthcare service providers faced several challenges. Suggestions are made to enhance the contributions of healthcare service and its providers to health emergencies in the future.

DOI: 10.29245/2578-3009/2023/S3.1107 View / Download Pdf