Knowledge, Attitudes, and Practices Related to Ebola Virus Disease at the End of a National Epidemic - Guinea, August 2015.

Health communication and social mobilization efforts to improve the public's knowledge, attitudes, and practices (KAP) regarding Ebola virus disease (Ebola) were important in controlling the 2014-2016 Ebola epidemic in Guinea (1), which resulted in 3,814 reported Ebola cases and 2,544 deaths.* Most Ebola cases in Guinea resulted from the washing and touching of persons and corpses infected with Ebola without adequate infection control precautions at home, at funerals, and in health facilities (2,3). As the 18-month epidemic waned in August 2015, Ebola KAP were assessed in a survey among residents of Guinea recruited through multistage cluster sampling procedures in the nation's eight administrative regions (Boké, Conakry, Faranah, Kankan, Kindia, Labé, Mamou, and Nzérékoré). Nearly all participants (92%) were aware of Ebola prevention measures, but 27% believed that Ebola could be transmitted by ambient air, and 49% believed they could protect themselves from Ebola by avoiding mosquito bites. Of the participants, 95% reported taking actions to avoid getting Ebola, especially more frequent handwashing (93%). Nearly all participants (91%) indicated they would send relatives with suspected Ebola to Ebola treatment centers, and 89% said they would engage special Ebola burial teams to remove corpses with suspected Ebola from homes. Of the participants, 66% said they would prefer to observe an Ebola-affected corpse from a safe distance at burials rather than practice traditional funeral rites involving corpse contact. The findings were used to guide the ongoing epidemic response and recovery efforts, including health communication, social mobilization, and planning, to prevent and respond to future outbreaks or sporadic cases of Ebola.

Fertility and Child Mortality in Urban West Africa: Leveraging geo-referenced data to move beyond the urban/rural dichotomy.

Demographic research in sub-Saharan Africa (SSA) has long relied on a blunt urban/rural dichotomy that may obscure important inter-urban fertility and mortality differentials. This paper uses Demographic and Health Survey (DHS) geo-referenced data to look beyond the simple urban/rural division by spatially locating survey clusters along an urban continuum and producing estimates of fertility and child mortality by four city size categories in West Africa. Results show a gradient in urban characteristics and demographic outcomes: the largest cities are the most advantaged and smaller cities least advantaged with respect to access to urban amenities, lower fertility and under-5 survival rates. There is a difference in the patterns of fertility and under-five survival across urban categories, with fertility more linearly associated with city size while the only significant distinction for under-5 survival in urban areas is broadly between the larger and smaller cities. Notably, the small urban "satellite cities" that are adjacent to the largest cities have the most favorable outcomes of all categories. Although smaller urban areas have significantly lower fertility and child mortality than rural areas, in some cases this difference is nearly as large between the smallest and largest urban areas. These results are used to argue for the need to give greater consideration to employing an urban continuum in demographic research.

The fertility of internal migrants to Kinshasa.

The rapid population growth of many African cities has important implications for population health, yet little is known about factors contributing to increasing population, such as the fertility of internal migrants. We examine whether in-migrants to Kinshasa have different fertility patterns than lifetime Kinshasa residents, and identify characteristics of migrants that may explain differences in fertility. We also use detailed migration histories to examine whether fertility differs by features of migration. We use representative data from the PMA2020 Project for 2197 women in Kinshasa, including 340 women who moved to Kinshasa. We examine differences between migrants and non-migrants in fertility and other fertility-related characteristics. We also examine whether fertility differs by duration of residence in Kinshasa, number of lifetime moves, age at first migration, urban/rural classification of birthplace, and the distinction between intra-Kinshasa migration and migration to Kinshasa.. Migrants have significantly higher fertility than permanent Kinshasa residents, but the difference is relatively small in magnitude. This higher fertility appears due in part to patterns of contraceptive use among migrants. There is noteworthy heterogeneity among migrants: higher fertility among migrants is associated with longer duration in Kinshasa, more lifetime moves, urban-Kinshasa migration, older age at first migration, and moving to Kinshasa from outside (as opposed to intra-Kinshasa migration).

Attitudes about vaccines to prevent Ebola virus disease in Guinea at the end of a large Ebola epidemic: Results of a national household survey.

INTRODUCTION: In 2014-2016, an Ebola epidemic devastated Guinea; more than 3800 cases and 2500 deaths were reported to the World Health Organization. In August 2015, as the epidemic waned and clinical trials of an experimental, Ebola vaccine continued in Guinea and neighboring Sierra Leone, we conducted a national household survey about Ebola-related knowledge, attitudes, and practices (KAP) and opinions about "hypothetical" Ebola vaccines. METHODS: Using cluster-randomized sampling, we selected participants aged 15+ years old in Guinea's 8 administrative regions, which had varied cumulative case counts. The questionnaire assessed socio-demographic characteristics, experiences during the epidemic, Ebola-related KAP, and Ebola vaccine attitudes. To assess the potential for Ebola vaccine introduction in Guinea, we examined the association between vaccine attitudes and participants' characteristics using categorical and multivariable analyses. RESULTS: Of 6699 persons invited to participate, 94% responded to at least 1 Ebola vaccine question. Most agreed that vaccines were needed to fight the epidemic (85.8%) and that their family would accept safe, effective Ebola vaccines if they became available in Guinea (84.2%). These measures of interest and acceptability were significantly more common among participants who were male, wealthier, more educated, and lived with young children who had received routine vaccines. Interest and acceptability were also significantly higher among participants who understood Ebola transmission modes, had witnessed Ebola response teams, knew Ebola-affected persons, believed Ebola was not always fatal, and would access Ebola treatment centers. In multivariable analyses of the majority of participants living with young children, interest and acceptability were significantly higher among those living with vaccinated children than among those living with unvaccinated children. DISCUSSION: The high acceptability of hypothetical vaccines indicates strong potential for introducing Ebola vaccines across Guinea. Strategies to build public confidence in use of Ebola vaccines should highlight any similarities with safe, effective vaccines routinely used in Guinea.

Assessments of Ebola knowledge, attitudes and practices in Forécariah, Guinea and Kambia, Sierra Leone, July-August 2015.

The border region of Forécariah (Guinea) and Kambia (Sierra Leone) was of immense interest to the West Africa Ebola response. Cross-sectional household surveys with multi-stage cluster sampling procedure were used to collect random samples from Kambia (n = 635) in July 2015 and Forécariah (n = 502) in August 2015 to assess public knowledge, attitudes and practices related to Ebola. Knowledge of the disease was high in both places, and handwashing with soap and water was the most widespread prevention practice. Acceptance of safe alternatives to traditional burials was significantly lower in Forécariah compared with Kambia. In both locations, there was a minority who held discriminatory attitudes towards survivors. Radio was the predominant source of information in both locations, but those from Kambia were more likely to have received Ebola information from community sources (mosques/churches, community meetings or health workers) compared with those in Forécariah. These findings contextualize the utility of Ebola health messaging during the epidemic and suggest the importance of continued partnership with community leaders, including religious leaders, as a prominent part of future public health protection.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'.

Applying a Total Market Lens: Increased IUD Service Delivery Through Complementary Public- and Private-Sector Interventions in 4 Countries.

Increasing access to the intrauterine device (IUD), as part of a comprehensive method mix, is a key strategy for reducing unintended pregnancy and maternal mortality in low-income countries. To expand access to IUDs within the framework of informed choice, Population Services International (PSI) has historically supported increased IUD service delivery through private providers. In applying a total market lens to better understand the family planning market and address major market gaps, PSI identified a lack of high-quality public provision of IUDs. In 2013, PSI started a pilot in 4 countries (Guatemala, Laos, Mali, and Uganda) to grow public-provider IUD service delivery through increased public-sector engagement while maintaining its ongoing focus on private providers. In collaboration with country governments, PSI affiliates carried out family planning market analyses in the 4 pilot countries to identify gaps in IUD service delivery and create sustainable strategies for scaling up IUD services in the public sector. Country-specific interventions to increase service delivery were implemented across all levels of the public health system, including targeted advocacy at the national level to promote government ownership and program sustainability. Mechanisms to ensure government ownership were built into the program design, including a proof-of-concept approach to convince governments of the feasibility and value of taking over and scaling up interventions. In the first 2 years of the pilot (2013-2014), 102,055 IUD services were provided to women at 417 targeted public-sector facilities. These preliminary results suggest that there is untapped demand for IUD service delivery in the public sector that can be met in part through greater participation of the public sector in family planning and IUD provision.

Mental health and urban living in sub-Saharan Africa: major depressive episodes among the urban poor in Ouagadougou, Burkina Faso.

BACKGROUND: In sub-Saharan African cities, the epidemiological transition has shifted a greater proportion of the burden of non-communicable diseases, including mental and behavioral disorder, to the adult population. The burden of major depressive disorder and its social risk factors in the urban sub-Saharan African population are not well understood and estimates vary widely. We conducted a study in Ouagadougou, Burkina Faso, in order to estimate the prevalence of major depressive episodes among adults in this urban setting. METHODS: The Ouagadougou Health and Demographic System Site (HDSS) has followed the inhabitants of five outlying neighborhoods of the city since 2008. In 2010, a representative sample of 2,187 adults (aged 15 and over) from the Ouaga HDSS was interviewed in depth regarding their physical and mental health. Using criteria from the Mini International Neuropsychiatric Interview (MINI), we identified the prevalence of a major depressive episode at the time of the interview among respondents and analyzed its association with demographic, socioeconomic, and health characteristics through a multivariate analysis. RESULTS: Major depressive episode prevalence was 4.3 % (95 % CI: 3.1-5.5 %) among the survey respondents. We found a strong association between major depressive episode and reported chronic health problems, functional limitations, ethnicity and religion, household food shortages, having been recently a victim of physical violence and regularly drinking alcohol. Results show a U-shaped association of the relationship between major depressive episode and standard of living, with individuals in both the poorest and richest groups most likely to suffer from major depressive disorder than those in the middle. Though, the poorest group remains the most vulnerable one, even when controlling by health characteristics. CONCLUSIONS: Major depressive disorder is a reality for many urban residents in Burkina Faso and likely urbanites throughout sub-Saharan Africa. Countries in the region should incorporate aspects of mental health prevention and treatment as part of overall approaches to improving health among the region's growing urban populations.