Perceptions of factors influencing Ebola vaccine acceptance among community members, healthcare workers, and response personnel in Eastern Democratic Republic of the Congo

PLoS ONE · 2026-04-07

BACKGROUND: The 2018-2020 Ebola Virus Disease (EVD) outbreak in Eastern Democratic Republic of the Congo (DRC) occurred amid armed conflict, institutional mistrust, and fragile health systems. The Ebola vaccine was deployed under emergency pre-licensure use, and concerns about it persisted. This study explored community and healthcare worker (HCW) perceptions of the Ebola vaccine to better understand the sociocultural and structural drivers of vaccine acceptance. METHODS: We conducted a qualitative study in three heavily affected health zones in North Kivu province (Beni, Butembo, and Mabalako) in 2021. Data were collected through thirty-three focus group discussions and 15 key informant interviews with EVD survivors, community members, HCWs, and local leaders, purposively sampled to capture diverse perspectives. Transcripts were analyzed using thematic and content analysis. RESULTS: Participants reported concerns about the safety of the vaccine, mistrust in the institutions delivering it, and confusion due to rumors and inconsistent communication from the Ebola response. HCWs reported feeling coerced into vaccination rather than making a voluntary choice. Misinformation, logistical barriers, and perceptions of favoritism and stigmatization linked to ring vaccination were cited as preventing acceptance. Religion played a dual role, both fostering skepticism and encouraging acceptance depending on the stance of local faith leaders. Participants emphasized the need for transparent and balanced communication, equitable access, and greater involvement of trusted and competent community figures in vaccination efforts. CONCLUSIONS: Ebola vaccine decision-making in Eastern DRC was shaped by complex interactions between institutional mistrust, perceived risk, religion, and access constraints within a broader context of sociopolitical instability. This study provides a critical baseline of perceptions during the vaccine's pre-licensure phase and highlights the importance of locally grounded engagement strategies. As vaccines become licensed, understanding local perceptions as well as leveraging the influence of trusted religious and community leaders will be essential for improving vaccine uptake.

Understanding perceptions towards COVID-19 vaccination and strategies to increase vaccine uptake among Ebola- affected communities in North Kivu, Democratic Republic of the Congo: a qualitative study

BMC Public Health · 2026-01-12

BACKGROUND: North Kivu, in eastern Democratic Republic of the Congo (DRC), was the epicenter of the second largest Ebola Virus Disease (EVD) outbreak in history and has been an active conflict zone for decades. The COVID-19 pandemic further exacerbated an already complex situation. This qualitative study, conducted as part of a broader investigation into Ebola vaccine hesitancy and at the onset of COVID-19 vaccination rollout in the DRC, assessed perceptions, beliefs, and attitudes toward the COVID-19 virus and vaccines among community members and healthcare workers who had experienced the 2018-2020 EVD outbreak, during which a novel vaccine was also administered. METHODS: Between May and June 2021, thirty-three focus group discussions (FGDs) and fifteen key informant interviews were conducted across three health zones that had offered Ebola vaccination (rVSV-ZEBOV) during the 2018-2020 EVD outbreak. Participants included healthcare workers (HCWs) and community members, as well as leaders, administrative officials, and frontline workers who had supported outbreak response and vaccination services. RESULTS: Across all locations and groups, perceived risk of COVID-19 was low, with many participants doubting its existence and relevance, particularly when compared to other needs and endemic health conditions in their communities. COVID-19 was believed to primarily affect white, affluent individuals in urban areas, and not those residing in hot climates. Vaccine hesitancy was driven by perceived insufficient transparency and communication regarding COVID-19 vaccines, including questions about their composition, potential side effects, and rationale behind prioritizing certain groups. COVID-19 vaccine perceptions also reflected broader concerns, including mistrust of the government and rumors related to past Ebola outbreaks and vaccination efforts. To increase uptake, respondents recommended ensuring COVID-19 vaccination is voluntary and free of charge, working with non-traditional local demand generation and vaccination actors, strengthening local vaccine production capacity, and increasing the impact of interpersonal communication through social media messaging. CONCLUSIONS: These findings add to growing evidence on how prior exposure to another disease of international concern (Ebola) and the associated vaccine, as well as historical context, influence perceptions of novel vaccines. Community engagement and tailored communication to address community concerns and misinformation are essential to building trust. Policymakers and implementers should consider more innovative approaches for developing and implementing vaccination policies in collaboration with local actors.

Health Care Providers’ Perspectives of Clinical Decision Support Tools for Pediatric Sepsis in Bangladesh: Qualitative Study

JMIR Formative Research · 2025-08-28

BACKGROUND: Sepsis, a life-threatening condition resulting from a dysregulated immune response to infection, disproportionately affects children in low- and middle-income countries (LMICs). Children with sepsis in LMICs face high mortality rates, with early detection and clinical monitoring posing significant challenges to effective management. There is great potential for digital technologies, such as wearable biosensor devices and mobile health (mHealth) clinical decision support (CDS) tools, together referred to as clinical decision support systems (CDSSs), to enable closer monitoring and more prompt recognition of children at risk of advanced sepsis and death. However, little is known about the perceptions of health care providers (HCPs) regarding the introduction of new digital health tools for pediatric sepsis care in LMICs. OBJECTIVE: The objective of this study was to assess HCPs' understanding, perceptions, and recommendations regarding the design and implementation of digital CDSSs for pediatric sepsis care in Bangladesh. METHODS: Between February and May 2024, 18 individual semistructured in-depth interviews were conducted with HCPs (nurses and physicians) at 3 urban hospitals in Bangladesh. The data were transcribed, translated from Bangla to English, and analyzed using a framework matrix analysis approach. Participants were asked about familiarity with digital health tools, feedback on CDSS design, perceptions of the system's utility, and barriers and facilitators to use of similar tools in clinical settings in Bangladesh. RESULTS: Participants reported overall positive perceptions toward the potential implementation of a CDSS for pediatric sepsis care in Bangladesh. Some key priorities for the design of a CDSS were durability, reusability, cost considerations, reliability, and accuracy. Clinicians desired the CDS tool to also have customizable alarm parameters and include additional functions such as glucose monitoring. Many favored audio (ringtone) or visual (light) alarms to alert about changes in captured vital signs. HCPs believed that a CDSS could enhance patient care by allowing greater staff capacity to monitor patients, reducing management time, and aiding in faster clinical decision-making, with some suggesting it could lower mortality rates. Concerns regarding implementation included internet availability, affordability of the wearable devices, and trust in the CDSS outputs compared to expert clinician judgement. CONCLUSIONS: The findings of this study highlight HCPs' perceptions toward the potential of wearable biosensor devices and CDS tools (CDSSs) for improving pediatric sepsis outcomes in LMICs and highlight the need to address implementation challenges to ensure the effective integration of CDSSs into health care systems.

Preventing, identifying, and managing sepsis in the community: research and clinical priorities

The Lancet Primary Care · 2025-07-01 · 7 citations

Sepsis, defined as life-threatening acute organ dysfunction due to infection, is generally considered a hospital-based issue. However, sepsis usually begins in the community, where knowledge of sepsis is scarce, diagnosis is difficult, and resources vary. Community-based interventions might offer the best opportunity for prevention, prompt diagnosis, and improved outcomes. In this Viewpoint, we address current gaps and limitations in understanding of sepsis in the community and outline research priorities, clinical priorities, and existing initiatives across four domains: mitigation (ie, reduction of population-based sepsis risk), monitoring (ie, screening for sepsis in individuals at high risk of sepsis), measurement (ie, identification of sepsis in the community), and management (ie, treatment of sepsis in the community).

An Evaluation of Enteropathogen-Specific Disease Severity and Duration in Children With Acute Gastroenteritis

Pediatric Emergency Care · 2025-08-05 · 1 citations

OBJECTIVES: Our primary objectives were to describe pathogen-specific symptom severity and duration in a prospective cohort study of children with acute gastroenteritis (AGE). Our secondary objective was to quantify health care resource utilization. METHODS: This secondary analysis of 2 trials included children aged 3 to 48 months with AGE. Children were eligible if they had ≥3 watery stools in the preceding 24 hours and were brought to the Emergency Department. Disease severity was quantified by frequency and duration of vomiting and diarrhea, and the Modified Vesikari Scale score. We used descriptive statistics to summarize severity and regression models to identify associations between pathogen type and outcomes. RESULTS: In total, 1565 trial participants had pathogen testing performed and completed follow-up. Viral pathogens were identified in 47.9% (749/1565) and bacterial pathogens in 5.9% (92/1565). Norovirus (322/1565; 20.6%) was the most frequently identified pathogen. Diarrhea duration was greatest (median 160h, IQR: 98, 216) for children with Salmonella . Vomiting (aOR: 11.02; 95% CI: 7.47, 16.26) occurred more commonly in children with viruses compared with bacteria. The mean duration of diarrhea was shorter for viruses compared with bacteria (aIRR: 0.81, 95% CI: 0.68, 0.96). Mean MVS scores were higher in children with viruses compared with those with bacteria (coefficient: 1.64, 95% CI: 0.46, 2.82). CONCLUSIONS: We describe the clinical course of viral and bacterial pathogens. Although statistically significant, differences in symptom severity across pathogens were not clinically meaningful for distinguishing between them based on symptoms alone.

Evaluating clinical utility of multi-category outcome risk prediction models

medRxiv · 2025-04-28

Abstract Diagnostic models are typically evaluated by assessing their calibration and discrimination; however, neither criterion assesses the practical consequences of using a model. Decision Curve Analysis (DCA) is a method for measuring clinical utility for binary outcome models over a range of risk thresholds. While the utility of polytomous outcome models can be assessed by applying DCA to different dichotomizations of their categories, no method exists to synthesize the binary measures into a single value. This paper illustrates DCA for polytomous outcomes and extends its concepts to develop a summary utility measure for polytomous outcome models. We apply this method to three ordinal logistic regression models, including the NIRUDAK and DHAKA models for predicting dehydration severity in patients over and under five years of age, respectively. Combining the concepts of Standardized Net Benefit (sNB) and Weighted Area Under the Net Benefit Curve, we propose the Weighted Area Under the sNB Curve ( wAUC sNB ), which can be determined for every dichotomization of a polytomous outcome. Next, we propose an average of wAUC sNB s weighted by the relative clinical importance of each dichotomized outcome. We term these weights importance weights and define this new measure as the Integrated Weighted Area Under the sNB Curve ( IwAUC sNB ). We apply binary DCA to the dehydration models, discuss its limitations, and apply the Integrated wAUC sNB to evaluate the average utility of each model. Finally, we compare these models to criteria from the World Health Organization (WHO) and observe how the results vary for different distributional assumptions of the risk thresholds. Applied to the NIRUDAK, DHAKA, and WHO models, the Integrated wAUC sNB demonstrated that both the DHAKA and NIRUDAK models could classify individuals as benefiting from treatment better than the WHO algorithms and either of the reference strategies of treating everyone or no one.

Anti-Leucine-rich Glioma-inactivated 1 Antibody Encephalitis as a Rare Etiology of a Common Medical ICU Presentation: Severe Hyponatremia and Altered Mental Status

American Journal of Respiratory and Critical Care Medicine · 2025-05-01

Abstract Introduction: Severe hyponatremia is a common issue in the ICU and can be associated with altered mental status. Primary neurologic processes can cause both altered mental status and syndrome of inappropriate antidiuretic hormone (SIADH) leading to hyponatremia. Diagnosis of the underlying etiology is essential for management of these patients. Case Report: The patient is a 73-year-old female with a history of hypertension, hyperlipidemia, and pre-diabetes who was fully independent until a few weeks prior to admission, when she would intermittently have face and arm involuntary contractions followed by short term confusion. The episodes increased in frequency in the week prior to admission. On the morning of admission, the patient's husband found her confused after a fall. In the emergency room, she was hemodynamically stable, awake, alert, and conversant. On examination, she had frequent face and arm involuntary movements. Her laboratory results were notable for hyponatremia to 117 mmol/L (136 – 145 mmol/L) with urine sodium 21 mmol/L and urine osmolality 806 mOSM/kg, concerning for syndrome of inappropriate antidiuretic hormone secretion (SIADH). She was admitted to the MICU for further workup and management. In the ICU, she was given hypertonic saline and placed on video electroencephalography (VEEG). She had trouble following prolonged conversations and continued to have frequent involuntary movements. Neurology was consulted, and her movements were recognized as faciobrachial dystonic seizures (FBDS), a pathognomonic syndrome allowing for clinical diagnosis of anti-leucine-rich glioma-inactivated 1 (LGI1) antibody encephalitis. Her mental status improved with pulse corticosteroid therapy and intravenous immunoglobulin. She continued to have antiseizure medication resistant ictal activity on VEEG which decreased with rituximab. Importance: Autoimmune encephalitis has identifiable clinical signs and symptoms and is a rare etiology of SIADH which can lead to severe symptomatic hyponatremia. While this phenomenon has been described in neurology literature, it has not been previously reported in the critical care literature. Intensivists frequently manage hyponatremia and should maintain autoimmune encephalitis on their differential. In our patient, rapid identification of her anti-LGI1 encephalitis allowed for appropriate treatment and mitigated further neurologic injury.

Gauging public perceptions of military and police roles in US domestic pandemic response during COVID-19

Frontiers in Public Health · 2025-06-18

Introduction: Militaries and police forces have been increasingly deployed in response to humanitarian crises and public health emergencies. Existing studies have largely been concentrated around international interventions, overlooking US domestic contexts and the perceptions of those receiving aid. Methods: In recognition of these gaps, this research involved a survey of 1,500 Americans to understand opinions toward the utilization of the US military and local law enforcement as COVID-19 domestic pandemic responders at an unprecedented scale. Results: A majority were complimentary of and comfortable with these armed actors' role in the response and supportive of involvement in future crises, with the military regarded more favorably than police. Trust in civilians, the military, and police is found to be role-based; favorability was inherently tied to the nature of services provided, whether healthcare, logistics, or enforcement-related. Perceptions were also strongly linked to one's vaccination status, political party affiliation, ideology, age, and gender. Underlying trust in civilian providers was evident, but often did not preclude one from favorable views of the military and law enforcement. Conclusion: Ultimately, these results have implications on domestic policy in future national crisis scenarios and highlight the need for further research exploring if sentiment holds steady beyond the realm of public health and pandemics.

Then, We Lost Everything:’ Afghan Refugee Mental Health Challenges Post-2021 Evacuation

Journal of Immigrant and Minority Health · 2025-01-04 · 4 citations