Quantifying the Risk of Conflict on Recent Ebola Outbreaks in Guinea and the Democratic Republic of Congo

Abstract

Background Reducing Ebola virus transmission relies on the ability to limit contact with infected bodily fluids through biosecurity, safe sex practices, safe burial and vaccination. However, armed conflicts can complicate outbreak interventions due to the widespread disruption they cause to the government and the population. Guinea and the Democratic Republic of Congo have historically reported the largest and the most recent Ebola virus outbreaks, and understanding if conflict has played a role in these outbreaks may help in identifying key risks factors which can be used to improve disease control.

Methods We used data from a range of publicly available data sources for both Ebola virus cases and conflict events for 2018 to 2021 in Guinea and the DRC. We fitted these data to conditional logistic regression models using the Self-Controlled Case Series methodology, to quantify the magnitude in which conflict increased the risk of reported Ebola virus cases in terms of incidence rate ratio. We re-ran our analysis sub-nationally, by conflict sub-event type and tested the effect of lag.

Results Conflict was significantly associated with an increased risk of reported EVD cases in both the DRC and Guinea in recent outbreaks. The effect was of a similar magnitude at 1.88 and 1.98 for the DRC and Guinea, respectively. The greatest effects (often higher than the national values) were found in the most conflict prone areas and during protest/riot-related conflict events. Conflict was influential in terms of Ebola virus risk from 1 week following the event and remained important and, in some cases, more so by 10 weeks.

Conclusion Extra vigilance is needed following protests and riot-related conflict events in terms of Ebola virus transmission. These events are highly disruptive in nature, in terms of access to transportation and healthcare and are often in dense urban areas, with high population densities. Additional public health messaging around these types of conflict events, relating to the risks and clinical symptoms may be helpful in reducing transmission. Future work should aim to further understand and quantify conflict severity and intensity, to evaluate a dose-response relationships in terms of disease risk.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The work presented here received no specific funding, however we acknowledge joint Centre funding from the UK Medical Research Council and Department for International Development [MR/R0156600/1]. The funder played no role in the design of the study and collection of data, the analysis, and interpretation of data and in writing the manuscript.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Although the work presented here uses human data, all the data used are from public available data sources, which are none identifiable and therefore ethical approval was waivered for this analysis.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

The datasets analysed during this study are all publicly available and references throughout the manuscript. Further code related to the methods and data visualization here are available at: github.co.uk/GinaCharnley.

List of abbreviationsACLEDArmed Conflict Location & Event Data ProjectCIConfidence IntervalDRCDemocratic Republic of CongoEVDEbola Virus DiseaseGUIGuineaHEMAHumanitarian Emergency Response AfricaIRRIncidence Rate RatioMoHMinistry of HealthNGOsNon-Governmental OrganisationsSCCSSelf-Controlled Case SeriesWASHWater, Sanitation and Hygiene

留言 (0)

沒有登入
gif