Abstract
An analysis of Health Behavior Factors associated with Initial Confirmed Ebola Cases in West Africa
Laurasona Leigh, PhD, MPH1, Jiunn-Jye Sheu, PhD, MSPH, MCHES1, Tavis Glassman, PhD, MPH, MSEd, MCHES, CCPH2, Colleen Taylor, PhD, RN, FNP-BC1 and Amy Thompson, Ph.D., CHES1
(1)University of Toledo, Toledo, OH, (2)The University of Toledo, Toledo, OH
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: In the 2014 Ebola outbreak, there were approximately 15,200 confirmed cases in Guinea, Liberia and Sierra Leone. Since its initial discovery in 1976, Ebola has caused at least 14 outbreaks in the African region. There has been substantial research conducted on the biological and epidemiological features of the virus. Unfortunately, there is limit research on how an individual's health behavior attributes to the spread of the disease. This study aims to bridge the gap.
Methods: Three English speaking West African countries, i.e. Liberia, Nigeria and Sierra Leone, were used for this ecological analysis. Each country's Ministry of Health conducted daily reports on the initial confirmed cases within each of their districts. Possible health behavior determinants were compiled from surveys conducted by each country's Ministry of Health with the assistance of credible international agencies. Spearman Rho Correlation and Stepwise Linear Regression were conducted to determine the determinants associated with the spread and transmission of Ebola.
Results: Stepwise Linear Regression analysis determined that 65% of the variance in initial confirmed cases could be explained by the following significant predictors: female unemployment, female literacy, male educational attainment, male recent sexual activity and the treatment of fever among children under the age of 5.
Conclusion: Multiple levels of health behavior factors such as social, environmental and behavioral factors contribute immensely to the rapid spread and transmission of the Ebola virus. Tailored interventions are needed to address health behavior factors that might be associated with high morbidity rates in the African region.
Protection of the public in relation to communicable diseases including prevention or control Public health or related education Public health or related research Social and behavioral sciences
Abstract
Modeling Fear-Related Behaviors as Vectors of Transmission in the West Africa Ebola Pandemic
James Shultz, M.S., Ph.D.1 and Zelde Espinel Ben-Amy, MD, MA, MPH2
(1)University of Miami Miller School of Medicine, Miami, FL, (2)University of Miami Miller School of Medicine / Jackson Memorial Medical Center, Miami, FL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction: Diminishing multinational or global spread of infectious diseases is an international health priority. The 2014/2015 West Africa Ebola Virus Disease (EVD) pandemic was the largest, longest, deadliest, and most geographically expansive since EVD was discovered in 1976. Fear-related behaviors (FRBs) were drivers of viral transmission. Cascades of escalating risk occurred as EVD provoked fear and associated FRBs that propelled disease spread; rising case counts then triggered more waves of FRBs.
Methods: A team of infectious disease, complexity sciences, and psychiatric experts are working to model the contribution of FRBs to infectious disease spread based on retrospective analysis of the West Africa outbreak. This is a critical endeavor because behavioral risks for infectious disease transmission may potentially be prevented or mitigated. In the West Africa outbreak, behaviors such as avoiding or fleeing treatment units, harboring and caring for patients at home, and performing secret burial ceremonies facilitated direct contact viral transmission.
Results: Preliminary analyses indicate that a high proportion of early cases in the West Africa Ebola outbreak were precipitated by FRBs. The serial nature of person-to-person infectious disease transmission amplified the effects of FRBs on epidemic dynamics. Modeling results will be presented that estimate the proportion of the 28,600 cases that were either directly triggered by FRBs or occurred downstream from FRB transmission cases.
Conclusions: The multi-disciplinary approach, incorporating spatio-temporal modeling of disease spread, on-scene observation of behavioral contributions to the risk of EVD spread, and the "lens" of complex systems thinking, has enriched the process of elucidating the role of FRBs. Infectious diseases generate fear of contagion and associated FRBs that may paradoxically increase transmission risks. The West Africa Ebola outbreak serves as a laboratory for examination of FRBs in relation to transmission and the potential for prevention and mitigation.
Epidemiology Planning of health education strategies, interventions, and programs Protection of the public in relation to communicable diseases including prevention or control Public health or related public policy Social and behavioral sciences Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Identifying the Cutaneous Manifestations of the emerging Zika virus
Benjamin Farahnik, BA
University of Vermont College of Medicine, Burlington, VT
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
The current Zika virus outbreak as a global health threat has drawn attention to the virus in the medical community and media. Zika virus is a single-stranded RNA arbovirus in the Flaviviridae family. The main cutaneous finding of Zika virus is a nonspecific, diffuse rash consisting of macules and papules that typically spare the palms and soles, and appears three to twelve days following the initial infection. The rash may be either morbiliform or scarlintiform, beginning on the face and subsequently extending to the trunk and extremities. It begins to fade within 2-3 days with complete resolution likely within one week of onset. Physician awareness and diagnostic tests including RT-PCR , ELISA, Zika specific IgM antibodies, and plaque-reduction neutralization tests may aid in disease spread and early identification of disease.
Clinical medicine applied in public health Environmental health sciences Epidemiology Protection of the public in relation to communicable diseases including prevention or control
Abstract
Identifying and Understanding Maternal Barriers to Using and Accessing ART and HIV Health Services for Infants in Uganda
Julie Bergmann, PhD(c), MHS1, Rhoda Wanyenze, PhD2 and Jamila K. Stockman, PhD, MPH1
(1)University of California San Diego, La Jolla, CA, (2)Makerere University School of Public Health, Kampala, Uganda
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Vertical transmission of HIV is responsible for 20% of new infections each year in Uganda. Perpetuating the epidemic are barriers that prevent women from accessing and using infant HIV medications and care. This mixed methods study sought to quantitatively identify correlates to mothers giving nevirapine to infants immediately after birth and to qualitatively identify barriers mothers face when accessing HIV medications and health services for their infants. We used data collected from a cross-sectional survey (n=384) and focus group discussions (n=6) conducted with HIV-positive women in Masaka, Luwero, and Mityana districts in Uganda between 2014-2015. Quantitative data were analyzed through bivariate and multivariate logistic regressions. Focus group transcripts were reviewed and coded for a priori and emergent themes. Of the 384 women, 20% did not give nevirapine to their infants immediately after birth. Factors independently associated with nevirapine use were lack of adherence to antiretroviral therapy (AOR: 3.13, 95% CI: 1.06-1.76), receiving antiretovirals during labor (AOR: 1.37, 95% CI: 1.50-7.02), and a non-health facility birth (AOR: 0.02, 95% CI: 0.003-0.1). Focus group discussions identified four themes associated with barriers to accessing infant health services: support groups, health care worker attitudes, lack of partner support, and poor antiretroviral therapy health service messaging. Health care worker messaging regarding antiretroviral therapy use must be simplified and social/ familial support must be increased to improve HIV-positive mothers' access to medication and services for themselves and their infants. Eliminating these barriers will prevent numerous infections and save many exposed-infant lives.
Biostatistics, economics Epidemiology Public health or related research Social and behavioral sciences
Abstract
All-cause child mortality reductions from malaria bed net campaigns in the Democratic Republic of the Congo
Carrie Dolan, MPH
Virginia Commonwealth University, Richmond, VA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction: Malaria remains a leading cause of childhood death in much of the developing world. The global health community currently spends approximately $2.6 billion USD annually on malaria-related efforts. Despite this substantial investment, there is very little systematic evidence on the relationship between this aid and health outcomes at subnational levels. Existing research on foreign aid has largely relied on country-level data, because systematic collection of sub-national data was previously unavailable. While these studies have contributed greatly to our knowledge of aid effectiveness as well as being influential in the designing of follow-on or new aid programs, the result is that aggregate data is being used to make important decisions regarding individual- or project-level level programs.
Methods: This geospatial impact evaluation combines data from four sources (Demographic and Health Surveys, Malaria Ecology Index, President's Malaria Initiative, and AidData) to examine the relationship between active insecticide treated net (ITN) mass campaigns and all-cause child mortality. It tests the hypothesis that under 5 all cause child mortality decreases as targeted health aid becomes active. This research uses a cox proportional hazard model with a differences in differences framework and includes district level fixed effects.
Results/Conclusion: Preliminary findings indicate that ITN net campaigns decreased the hazard of child mortality to 60 months by 13% (HR=.87, CI=.765-1.002). By identifying the overall impact of malaria campaigns on all-cause child mortality, we can determine the overall program effectiveness. The findings can be used to provide scientific evidence that will ultimately inform decisions on malaria aid resource allocation.
Biostatistics, economics Epidemiology Public health or related public policy Public health or related research