Ebola and Its Control in Liberia, 2014-2015 Nyenswah, Tolbert G; Kateh, Francis; Bawo, Luke ...
Emerging infectious diseases,
02/2016, Letnik:
22, Številka:
2
Journal Article
Recenzirano
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The severe epidemic of Ebola virus disease in Liberia started in March 2014. On May 9, 2015, the World Health Organization declared Liberia free of Ebola, 42 days after safe burial of the last known ...case-patient. However, another 6 cases occurred during June-July; on September 3, 2015, the country was again declared free of Ebola. Liberia had by then reported 10,672 cases of Ebola and 4,808 deaths, 37.0% and 42.6%, respectively, of the 28,103 cases and 11,290 deaths reported from the 3 countries that were heavily affected at that time. Essential components of the response included government leadership and sense of urgency, coordinated international assistance, sound technical work, flexibility guided by epidemiologic data, transparency and effective communication, and efforts by communities themselves. Priorities after the epidemic include surveillance in case of resurgence, restoration of health services, infection control in healthcare settings, and strengthening of basic public health systems.
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DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Entrepreneurship has been considered one of the major universal drivers of economic development, and sustainable development while also contributing to the growth of a country’s economy. This study ...explored the perspectives of business entrepreneurs on the contributions of entrepreneurship to economic development in Liberia. A qualitative research approach while an in-depth interview guided by a semi-structured interview was conducted among Liberian entrepreneurs to explore whether entrepreneurship contributes to a country’s economic development based on their views, opinions, and experiences. The findings of the study show that the lack of proper incentives, government support, infrastructure, cost of utilities, entrepreneurship awareness, and lack of entrepreneurship education in schools and universities curriculum is considered to be one of the core factors that is hindering the promotion of entrepreneurship in Liberia. As a result, the study recommends the Liberian government's need to implement policies that will enhance the development of entrepreneurship, provide basic infrastructure, and introduce entrepreneurship education in secondary and tertiary institutions as a core module. This study contributed to the entrepreneurship literature and confirmed that entrepreneurship has played a key role in providing solutions for Liberia’s economy while generating a greater number of employment and enhancing society's living standards.
To derive and validate internally a novel risk assessment tool to identify young children at risk for all-cause mortality ≤60 days of discharge from hospitals in sub-Saharan Africa.OBJECTIVETo derive ...and validate internally a novel risk assessment tool to identify young children at risk for all-cause mortality ≤60 days of discharge from hospitals in sub-Saharan Africa.We performed a prospective observational cohort study of children aged 1-59 months discharged from Muhimbili National Hospital in Dar es Salaam, Tanzania and John F. Kennedy Medical Center in Monrovia, Liberia (2019 to 2022). Caregivers received telephone calls up to 60 days after discharge to ascertain participant vital status. We collected socioeconomic, demographic, clinical, and anthropometric data during hospitalization. Candidate variables with P<0.20 in bivariate analyses were included in a multivariable logistic regression model with best subset selection to identify risk factors for the outcome. We internally validated our tool using bootstrapping with 500 repetitions.STUDY DESIGNWe performed a prospective observational cohort study of children aged 1-59 months discharged from Muhimbili National Hospital in Dar es Salaam, Tanzania and John F. Kennedy Medical Center in Monrovia, Liberia (2019 to 2022). Caregivers received telephone calls up to 60 days after discharge to ascertain participant vital status. We collected socioeconomic, demographic, clinical, and anthropometric data during hospitalization. Candidate variables with P<0.20 in bivariate analyses were included in a multivariable logistic regression model with best subset selection to identify risk factors for the outcome. We internally validated our tool using bootstrapping with 500 repetitions.There were 1,933 young children enrolled in the study. The median (interquartile range) age was 11 (4, 23) months and 58.7% were male. In total, 67 (3.5%) died during follow-up. Ten variables contributed to our tool (total possible score 82). Cancer (adjusted odds ratio aOR 10.6, 95% CI 2.58, 34.6), pedal edema (aOR 6.94, 95% CI 1.69, 22.6), and leaving against medical advice (aOR 6.46, 95% CI 2.46, 15.3) were most predictive of post-discharge mortality. Our risk assessment tool demonstrated good discriminatory value (optimism corrected area under the receiver operating characteristic curve 0.77), high precision, and sufficient calibration.RESULTSThere were 1,933 young children enrolled in the study. The median (interquartile range) age was 11 (4, 23) months and 58.7% were male. In total, 67 (3.5%) died during follow-up. Ten variables contributed to our tool (total possible score 82). Cancer (adjusted odds ratio aOR 10.6, 95% CI 2.58, 34.6), pedal edema (aOR 6.94, 95% CI 1.69, 22.6), and leaving against medical advice (aOR 6.46, 95% CI 2.46, 15.3) were most predictive of post-discharge mortality. Our risk assessment tool demonstrated good discriminatory value (optimism corrected area under the receiver operating characteristic curve 0.77), high precision, and sufficient calibration.After validation, this tool may be used to identify young children at risk for post-discharge mortality to direct resources for follow-up of high-risk children.CONCLUSIONSAfter validation, this tool may be used to identify young children at risk for post-discharge mortality to direct resources for follow-up of high-risk children.
Life After Guns explores how ex-combatants and other post-war youth negotiated a depleted and difficult social and cultural landscape in the years following Liberia’s fourteen-year bloody civil war. ...Unlike others who study child soldiers, Abby Hardgrove’s ethnography looks at both former combatants and also the youth who were not recruited to fight. She focuses on the structural constraints and household and family organizations that either helped or limited opportunities as these young men grew into adulthood. Whether young men fought or not, and whether they had cultural capital before the war or not, family relations mattered a great deal in how they fared after the war.
Over the span of a few weeks during July and August 2014, events in West Africa changed perceptions of Ebola virus disease (EVD) from an exotic tropical disease to a priority for global health ...security. We describe observations during that time of a field team from the Centers for Disease Control and Prevention and personnel of the Liberian Ministry of Health and Social Welfare. We outline the early epidemiology of EVD within Liberia, including the practical limitations on surveillance and the effect on the country's health care system, such as infections among health care workers. During this time, priorities included strengthening EVD surveillance; establishing safe settings for EVD patient care (and considering alternative isolation and care models when Ebola Treatment Units were overwhelmed); improving infection control practices; establishing an incident management system; and working with Liberian airport authorities to implement EVD screening of departing passengers.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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•Extensive Precambrian terranes prospective for many metals and industrial minerals.•Gold, iron ore and diamonds widespread; new gold and iron mines opened since 2011.•Known targets ...for diamonds, base metals, manganese, bauxite, fluorspar and kyanite.•Geology of Liberia poorly known, with little exploration for most mineral commodities.
The Republic of Liberia in West Africa is underlain mostly by Precambrian rocks of Archaean (Liberian) age in the west and of Proterozoic (Eburnean) age in the east. By analogy with similar terranes elsewhere in the world, and in West Africa in particular, the geology of Liberia is favourable for the occurrence of deposits of a wide range of metals and industrial minerals, including gold, iron ore, diamonds, base metals, bauxite, manganese, fluorspar, kyanite and phosphate.
Known gold deposits, mostly orogenic in style, occur widely and are commonly associated with north-east-trending regional shear zones. Gold mining commenced at the New Liberty deposit in western Liberia in 2015, while significant gold resources have also been identified at several other sites in both Archaean and Proterozoic terranes. Liberia has large resources of itabirite-type iron ores, most of which are located in the Liberian terrane, and was the largest producer in Africa prior to the onset of civil war in 1989. Production of iron ore is currently restricted to a single mine, Yekepa, in the Nimba Range. Other important deposits, some of them previously mined, include Bong, the Western Cluster, Putu and Goe Fantro. There is a long history of alluvial diamond production in western and central Liberia, together with more than 160 known occurrences of kimberlite. Most of the known kimberlites occur in three clusters of small pipes and abundant dykes, located at Kumgbor, Mano Godua and Weasua, close to the border with Sierra Leone. Many of these are considered to be part of a single province that includes Jurassic age diamondiferous kimberlites in Sierra Leone and Guinea.
Deposits and occurrences of a wide range of other metals and industrial minerals are also known. Several of these have been worked on a small scale in the past, mainly by artisanal miners, but most are poorly known in detail with sub-surface information available at only a few localities. By comparison with most other countries in West Africa, the geology of Liberia is poorly known and there has been very little systematic exploration carried out for most commodities other than gold, iron ore and diamonds since the 1960s and 1970s. Further detailed field and laboratory investigations using modern techniques are required to properly evaluate the potential for the occurrence of economic deposits of many minerals and metals in a variety of geological settings. Digital geological, geochemical, geophysical and mineral occurrence datasets, including new national airborne geophysical survey data, provide a sound basis for the identification of new exploration targets, but in almost every part of the country there is a need for new and more detailed geological surveys to underpin mineral exploration.
We measured the reproduction number before and after interventions were implemented to reduce Ebola transmission in 9 outbreaks in Liberia during 2014. We evaluated risk factors for secondary cases ...and the association between patient admission to an Ebola treatment unit (ETU) and survival. The reproduction number declined 94% from 1.7 (95% CI 1.1-2.6) to 0.1 (95% CI 0.02-0.6) after interventions began. The risk for secondary infections was 90% lower for patients admitted to an ETU (risk ratio 0.1, 95% CI 0.04-0.3) than for those who died in the community. The case-fatality rate was 68% (95% CI 60-74), and ETU admission was associated with a 50% reduction in death (hazard ratio 0.5, 95% CI 0.4-0.8). Isolation and treatment of Ebola patients had the dual benefit of interrupting community transmission and improving survival.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
The importance of community engagement (CE) for health system resilience is established in theoretical and empirical literature. The practical dimensions of how to operationalize theory and ...implement its principles have been less explored, especially within low-resource crisis settings. It is therefore unclear how CE is drawn upon and how, if at all, it facilitates health system resilience in times of health system crises. To address this critical gap, we adapt and apply existing theoretical CE frameworks to analyse qualitative data from 92 in-depth interviews and 16 focus group discussions collected with health system stakeholders in Liberia in the aftermath of the 2014–15 Ebola outbreak. Health system stakeholders indicated that CE was a crucial contributing factor in addressing the Ebola epidemic in Liberia. Multiple forms of CE were used during the outbreak; however, only some forms were perceived as meaningful, such as the formation of community-based surveillance teams. To achieve meaningful CE, participants recommended that communities be treated as active participants in—as opposed to passive recipients of—health response efforts and that communication platforms for CE be established ahead of a crisis. Participant responses highlight that meaningful CE led to improved communication with and increased trust in health authorities and programming. This facilitated health system response efforts, leading to a fortuitous cycle of increased trust, improved communication and continued meaningful CE—all necessary conditions for health system resilience. This study refines our understanding of CE and demonstrates the ways in which meaningful CE and trust work together in mutually reinforcing and beneficial ways. These findings provide empirical evidence on which to base policies and programmes aimed at improving health system resilience in low-resource settings to more effectively respond to health system crises.
In this extended meditation, Jean Lave interweaves analysis of the process of apprenticeship among the Vai and Gola tailors of Liberia with reflections on the evolution of her research on those ...tailors in the late 1970s. In so doing, she provides both a detailed account of her apprenticeship in the art of sustained fieldwork and an insightful overview of thirty years of changes in the empirical and theoretical facets of ethnographic practice. Examining the issues she confronted in her own work, Lave shows how the critical questions raised by ethnographic research erode conventional assumptions, altering the direction of the work that follows. As ethnography takes on increasing significance to an ever widening field of thinkers on topics from education to ecology, this erudite but accessible book will be essential to anyone tackling the question of what it means to undertake critical and conceptually challenging fieldwork. Apprenticeship in Critical Ethnographic Practice explains how to seriously explore what it means to be human in a complex world—and why it is so important.
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