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Health Promot Int. 2016 Jun;31(2):440-9. doi: 10.1093/heapro/dav003. Epub 2015 Feb 12.

A community-engaged infection prevention and control approach to Ebola.

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Department of Health, Western Cape Government: Health, 8 Riebeek Street, Cape Town, South Africa Division of Community Health, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa.
School of Public Health, University of California Berkeley, 50 University Hall, Berkeley, CA 94720-7360, USA
Department of Family Medicine, CIET, McGill University, 5858 Ch. De la Côte-des-Neiges, 3rd Floor, Montreal, QC H3S 1Z1, Canada.
Urban/Regional Planning and Development, Nairobi, Kenya.
Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Tygerberg 7505, Cape Town, South Africa Infection Control Africa Network, Tygerberg 7505, Cape Town, South Africa.
The Nongoma Clinic and Emma Thompson Nursing Home, Main Street, Kenema, Nongoma, South Africa.
City and Regional Planning and Public Health, University of California, Berkeley, Berkeley, CA 94720-7360, USA.


The real missing link in Ebola control efforts to date may lie in the failure to apply core principles of health promotion: the early, active and sustained engagement of affected communities, their trusted leaders, networks and lay knowledge, to help inform what local control teams do, and how they may better do it, in partnership with communities. The predominant focus on viral transmission has inadvertently stigmatized and created fear-driven responses among affected individuals, families and communities. While rigorous adherence to standard infection prevention and control (IPC) precautions and safety standards for Ebola is critical, we may be more successful if we validate and combine local community knowledge and experiences with that of IPC medical teams. In an environment of trust, community partners can help us learn of modest adjustments that would not compromise safety but could improve community understanding of, and responses to, disease control protocol, so that it better reflects their 'community protocol' (local customs, beliefs, knowledge and practices) and concerns. Drawing on the experience of local experts in several African nations and of community-engaged health promotion leaders in the USA, Canada and WHO, we present an eight step model, from entering communities with cultural humility, though reciprocal learning and trust, multi-method communication, development of the joint protocol, to assessing progress and outcomes and building for sustainability. Using examples of changes that are culturally relevant yet maintain safety, we illustrate how often minor adjustments can help prevent and treat the most serious emerging infectious disease since HIV/AIDS.


Ebola; IPC; community participation; global health

[Indexed for MEDLINE]

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