Community engagement in Ebola outbreaks in sub-Saharan Africa and implications for COVID-19 control: A scoping review.

OBJECTIVES: There is a paucity of scoping data on the specific roles community engagement played in preventing and managing the Ebola Virus Disease outbreak in Sub-Saharan Africa. We assessed the role, benefits, and mechanisms of community engagement to understand its effect on Ebola Virus Disease case detection, survival, and mortality in Sub-Saharan Africa. Implications for COVID-19 prevention and control were also highlighted. METHODS: We searched for articles between 2010 and 2020 in MEDLINE and EMBASE databases. Study types included were randomized trials, quasi-experimental studies, observational studies, case series, and reports. RESULTS: A total of 903 records were identified for screening. 216 articles met the review criteria, 103 were initially selected, and 44 were included in the final review. Our findings show that effective community involvement during the Ebola Virus Disease outbreak depended on the survival rates, testimonials of survivors, risk perception, and the inclusion of community leaders. Community-based interventions improved knowledge and attitudes, case findings, isolation efforts, and treatment uptake. CONCLUSION: Although the studies included in this review were of highly variable quality, findings from this review may provide lessons for the role of community engagement in the COVID-19 ' 'pandemic's prevention and control in Sub-Saharan Africa.

Development of a community-based COVID-19 intervention in rural Ghana: a document analysis.

BACKGROUND: The COVID-19 pandemic has caused the loss of millions of lives and economic breakdowns in many countries across the globe. Despite the limited availability of vaccines and the challenges of poor health infrastructure, few interventions have been developed and implemented for those who live in rural areas, particularly in sub-Saharan Africa. In response, Cocoa360, a global health nonprofit in rural Ghana designed an intervention called Cocoa360's COVID-19 Preparedness and Outbreak Prevention Plan (CoCoPOPP). This paper aimed to examine the extent to which CoCoPOPP's design aligned with the Promoting Action on Research Implementation in Health Services (PARIHS) framework. METHODS: We reviewed documents influencing CoCoPOPP's design between March and June 2021. A total of 11 documents were identified for analysis. Using the Promoting Action on Research Implementation in Health Services (PARIHS) framework as a guide, thematic analysis was done to analyze the extracted data. RESULTS: Overall, CoCoPOPP's design aligned with the evidence, context, and facilitation domains of the PARIHS framework. It positioned CoCoPOPP as an intervention that considered the unique context of a rural Ghanaian setting. It was guided by robust and high-quality published and non-published evidence and engaged external and internal stakeholders during its implementation. CoCoPOPP's context-dependent nature positions it for potential replication in sub-Saharan Africa's rural communities with similar farming contexts. Specific areas that were less well and/or not addressed were the unintended negative consequences of community engagement, the absence of primary data in the guiding evidence, and the lack of a facilitation continuum coupled with the role of power during the facilitation process. CONCLUSION: CoCoPOPP, Cocoa360's response to the COVID-19 pandemic in rural Ghana, is an evidence-driven, context-dependent public health intervention that has been designed to reduce COVID-19 infections and prevent potential deaths. This study underscores the importance of considering the unique community and cultural contexts, employing evidence, and engaging local and external actors as facilitators when designing interventions to respond to global health pandemics.

Halting COVID-19 Requires Collective, Decentralized, and Community-Led Responses.

Many global health organizations are reliant on the funding provided by a few dozen high-income countries, making them fiscally insecure and fragile, especially during times of global crises. The COVID-19 pandemic could be an opportunity to move away from this status quo to a more decentralized, multipolar, and community-led approach. The global health community can take four immediate steps in response to the pandemic to start that paradigm shift now: support more regional and country-specific responses, convince national and regional business houses and philanthropies to make up for response funding shortfalls, leverage public health advocacy to improve investments in public health infrastructure, and put community leaders and members at the frontlines of mitigation efforts.