A community's experience during and after the Ebola epidemic of 2014-2016 in Sierra Leone: A qualitative study.

BACKGROUND: The 2014-2016 Ebola epidemic devastated families and communities throughout West Africa. Due to its high mortality rate and infectious nature, most Ebola research to date has focused on healthcare response and interventions; however, little is known about the experiences of Ebola survivors and communities. This qualitative study aimed to better understand the lived experiences of community members, including children, during and after the Ebola epidemic in Sierra Leone. METHODS: During June 2016 and June 2017, we conducted four focus groups comprised of primary school students, female caretakers, male caretakers, and teachers, and two individual in-depth interviews with local nurses in Calaba Town, a small village outside of Freetown. Interviews were recorded, transcribed verbatim, and coded using a modified grounded theory methodology. FINDINGS: All participants shared that they experienced significant challenges during and after the Ebola epidemic. During the epidemic, participants endured daily life challenges pertaining to fear, financial distress, and school closures. They also experienced suffering, loss, isolation, grief, and compromised culture. Confusion and distrust were also prevalent during the epidemic, with participants reporting confusion around Ebola transmission and distrust in the government and healthcare services. We also found that the struggle for food and grief stemming from the loss of loved ones continued more than a year after the epidemic ended. Despite Sierra Leone being declared Ebola-free, stigma and fear persisted and community members shared their continuing distrust of the government due to their actions during and after the epidemic. CONCLUSIONS: The findings of this qualitative study reveal that the Ebola epidemic was a traumatizing period for the Calaba Town community, and that confusion and distrust toward the government health care system have continued. Future studies should explore the extended impact of the epidemic on communities, including long-term psychological, social, and economic consequences of this outbreak.

Association between private drinking water wells and the incidence of Campylobacteriosis in Maryland: An ecological analysis using Foodborne Diseases Active Surveillance Network (FoodNet) data (2007-2016).

Campylobacter is a leading cause of bacterial foodborne illness in the United States. Campylobacter infections have most often been associated with food-related risk factors, such as the consumption of poultry and raw milk. Socioeconomic, agricultural and environmental factors, including drinking water source, can also influence the risk of campylobacteriosis. Approximately 19% of Maryland residents rely on private wells as their sole source of water. Given that the federal Safe Drinking Water Act does not regulate the water quality of private wells, these could be important non-foodborne transmission pathways for Campylobacter. To address this issue, data on the number of culture-confirmed cases of Campylobacter infection in Maryland between 2007 and 2016 were obtained from the Foodborne Diseases Active Surveillance Network. Cases were linked by zip code with data from the Maryland well permits registry, the 2010 U.S. Census, the 2016 American Community Survey, and the USDA Agricultural Census. Campylobacteriosis incidence rates and well prevalence were calculated by zip code. Negative binomial regression models were then constructed to evaluate the association between the prevalence of private wells, presence/absence of animal feeding operations and the incidence of campylobacteriosis across the physiographic provinces in Maryland. From 2007 to 2016, a total of 5746 cases of campylobacteriosis were reported in Maryland, and annual incidence rates ranged from 6.65 to 11.59 per 100,000 people. In our statewide analysis, a significant positive association was observed between well prevalence and increased campylobacteriosis incidence at the zip code level (Incidence Rate Ratio (IRR) = 1.35, 95% Confidence Interval (CI) = 1.11, 1.63). A significant positive association was also observed between well prevalence and increased campylobacteriosis incidence in the Appalachian and Coastal provinces of Maryland (IRR = 2.94, 95% CI = 1.11, 7.76 and IRR = 1.70, 95% CI = 1.25, 2.31, respectively). The presence of broiler chicken operations, increasing median age and percentage of residents living in poverty were also significantly associated with campylobacteriosis incidence at the zip code level in some physiographic provinces in Maryland. To our knowledge, these are the first US data to demonstrate an association between prevalence of private wells and campylobacteriosis incidence at the zip code level.

Prevalence of Salmonella and Listeria monocytogenes in non-traditional irrigation waters in the Mid-Atlantic United States is affected by water type, season, and recovery method.

Irrigation water contaminated with Salmonella enterica and Listeria monocytogenes may provide a route of contamination of raw or minimally processed fruits and vegetables. While previous work has surveyed specific and singular types of agricultural irrigation water for bacterial pathogens, few studies have simultaneously surveyed different water sources repeatedly over an extended period of time. This study quantified S. enterica and L. monocytogenes levels (MPN/L) at 6 sites, including river waters: tidal freshwater river (MA04, n = 34), non-tidal freshwater river, (MA05, n = 32), one reclaimed water holding pond (MA06, n = 25), two pond water sites (MA10, n = 35; MA11, n = 34), and one produce wash water site (MA12, n = 10) from September 2016-October 2018. Overall, 50% (84/168) and 31% (53/170) of sampling events recovered S. enterica and L. monocytogenes, respectively. Results showed that river waters supported significantly (p < 0.05) greater levels of S. enterica than pond or reclaimed waters. The non-tidal river water sites (MA05) with the lowest water temperature supported significantly greater level of L. monocytogenes compared to all other sites; L. monocytogenes levels were also lower in winter and spring compared to summer seasons. Filtering 10 L of water through a modified Moore swab (MMS) was 43.5 (Odds ratio, p < 0.001) and 25.5 (p < 0.001) times more likely to recover S. enterica than filtering 1 L and 0.1 L, respectively; filtering 10 L was 4.8 (p < 0.05) and 3.9 (p < 0.05) times more likely to recover L. monocytogenes than 1L and 0.1 L, respectively. Work presented here shows that S. enterica and L. monocytogenes levels are higher in river waters compared to pond or reclaimed waters in the Mid-Atlantic region of the U.S., and quantitatively shows that analyzing 10 L water is more likely recover pathogens than smaller samples of environmental waters.

Prevalence of Microbiological and Chemical Contaminants in Private Drinking Water Wells in Maryland, USA.

Although many U.S. homes rely on private wells, few studies have investigated the quality of these water sources. This cross-sectional study evaluated private well water quality in Maryland, and explored possible environmental sources that could impact water quality. Well water samples (n = 118) were collected in four Maryland counties and were analyzed for microbiological and chemical contaminants. Data from the U.S. Census of Agriculture were used to evaluate associations between the presence of animal feeding operations and well water quality at the zip code level using logistic regression. Overall, 43.2% of tested wells did not meet at least one federal health-based drinking water standard. Total coliforms, fecal coliforms, enterococci, and Escherichia coli were detected in 25.4%, 15.3%, 5.1%, and 3.4% of tested wells, respectively. Approximately 26%, 3.4%, and <1% of wells did not meet standards for pH, nitrate-N, and total dissolved solids, respectively. There were no statistically significant associations between the presence of cattle, dairy, broiler, turkey, or aquaculture operations and the detection of fecal indicator bacteria in tested wells. In conclusion, nearly half of tested wells did not meet federal health-based drinking water standards, and additional research is needed to evaluate factors that impact well water quality. However, homeowner education on well water testing and well maintenance could be important for public health.

Environmental Justice Radar: A Tool for Community-Based Mapping to Increase Environmental Awareness and Participatory Decision Making.

BACKGROUND: As part of the Charleston Area Pollution Prevention Partnership (CAPs), studies have been performed to address environmental health issues using various techniques including Geographic Information Systems (GIS) mapping. Most of the mapping has been conducted by academic team members; however, there is a need for more community-based mapping to ensure the sustainability and effectiveness of community-driven efforts to eliminate environmental hazards and health disparities. The emergence of public participatory GIS (PPGIS) has been shown as a way to democratize science, build community capacity, and empower local citizens to address environmental health issues. PURPOSE: This article describes the development of the Environmental Justice (EJ) Radar, a PPGIS tool that provides stakeholders in South Carolina with a way to raise environmental awareness and improve citizen participation in local environmental decision-making. We describe the functionality of EJ Radar and discuss feedback received from stakeholders to improve the utility of the PPGIS tool.