Dynamics of conflict during the Ebola outbreak in the Democratic Republic of the Congo 2018-2019.

Democratic Republic of the Congo / epidemiology Disease Outbreaks Hemorrhagic Fever, Ebola / epidemiology History, 21st Century Humans Incidence Survival Analysis
Conflict Democratic Republic of the Congo Ebola Outbreak Violence

Journal

BMC medicine
ISSN: 1741-7015
Titre abrégé: BMC Med
Pays: England
ID NLM: 101190723

Informations de publication

Date de publication:
27 04 2020
Historique:
received: 02 01 2020
accepted: 24 03 2020
entrez: 28 4 2020
pubmed: 28 4 2020
medline: 16 12 2020
Statut: epublish

Résumé

The 2018-2019 Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo (DRC) is the largest ever recorded in the DRC. It has been declared a Public Health Emergency of International Concern. The outbreak emerged in a region of chronic conflict and insecurity, and directed attacks against health care workers may have interfered with disease response activities. Our study characterizes and quantifies the broader conflict dynamics over the course of the outbreak by pairing epidemiological and all available spatial conflict data. We build a set of conflict variables by mapping the spatial locations of all conflict events and their associated deaths in each of the affected health zones in North Kivu and Ituri, eastern DRC, before and during the outbreak. Using these data, we compare patterns of conflict before and during the outbreak in affected health zones and those not affected. We then test whether conflict is correlated with increased EVD transmission at the health zone level. The incidence of conflict events per capita is ~ 600 times more likely in Ituri and North Kivu than for the rest of the DRC. We identified 15 time periods of substantial uninterrupted transmission across 11 health zones and a total of 120 bi-weeks. We do not find significant short-term associations between the bi-week reproduction numbers and the number of conflicts. However, we do find that the incidence of conflict per capita was correlated with the incidence of EVD per capita at the health zone level for the entire outbreak (Pearson's r = 0.33, 95% CI 0.05-0.57). In the two provinces, the monthly number of conflict events also increased by a factor of 2.7 in Ebola-affected health zones (p value < 0.05) compared to 2.0 where no transmission was reported and 1.3 in the rest of the DRC, in the period between February 2019 and July 2019. We characterized the association between variables documenting broad conflict levels and EVD transmission. Such assessment is important to understand if and how such conflict variables could be used to inform the outbreak response. We found that while these variables can help characterize long-term challenges and susceptibilities of the different regions they provide little insight on the short-term dynamics of EVD transmission.

Sections du résumé

BACKGROUND
The 2018-2019 Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo (DRC) is the largest ever recorded in the DRC. It has been declared a Public Health Emergency of International Concern. The outbreak emerged in a region of chronic conflict and insecurity, and directed attacks against health care workers may have interfered with disease response activities. Our study characterizes and quantifies the broader conflict dynamics over the course of the outbreak by pairing epidemiological and all available spatial conflict data.
METHODS
We build a set of conflict variables by mapping the spatial locations of all conflict events and their associated deaths in each of the affected health zones in North Kivu and Ituri, eastern DRC, before and during the outbreak. Using these data, we compare patterns of conflict before and during the outbreak in affected health zones and those not affected. We then test whether conflict is correlated with increased EVD transmission at the health zone level.
FINDINGS
The incidence of conflict events per capita is ~ 600 times more likely in Ituri and North Kivu than for the rest of the DRC. We identified 15 time periods of substantial uninterrupted transmission across 11 health zones and a total of 120 bi-weeks. We do not find significant short-term associations between the bi-week reproduction numbers and the number of conflicts. However, we do find that the incidence of conflict per capita was correlated with the incidence of EVD per capita at the health zone level for the entire outbreak (Pearson's r = 0.33, 95% CI 0.05-0.57). In the two provinces, the monthly number of conflict events also increased by a factor of 2.7 in Ebola-affected health zones (p value < 0.05) compared to 2.0 where no transmission was reported and 1.3 in the rest of the DRC, in the period between February 2019 and July 2019.
CONCLUSION
We characterized the association between variables documenting broad conflict levels and EVD transmission. Such assessment is important to understand if and how such conflict variables could be used to inform the outbreak response. We found that while these variables can help characterize long-term challenges and susceptibilities of the different regions they provide little insight on the short-term dynamics of EVD transmission.

Identifiants

DOI: 10.1186/s12916-020-01574-1 PMID: 32336281 PMC: PMC7184697
pubmed: 32336281
doi: 10.1186/s12916-020-01574-1
pii: 10.1186/s12916-020-01574-1
pmc: PMC7184697
doi:

Types de publication

Historical Article Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

113

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Auteurs

Moritz U G Kraemer (MUG)

Department of Zoology, University of Oxford, Oxford, UK. moritz.kraemer@zoo.ox.ac.uk.
Harvard Medical School, Harvard University, Boston, USA. moritz.kraemer@zoo.ox.ac.uk.
Computational Epidemiology Group, Boston Children's Hospital, Boston, USA. moritz.kraemer@zoo.ox.ac.uk.

David M Pigott (DM)

Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.
Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.

Sarah C Hill (SC)

Department of Zoology, University of Oxford, Oxford, UK.

Samantha Vanderslott (S)

Oxford Vaccine Group & Oxford Martin School, University of Oxford, Oxford, UK.

Robert C Reiner (RC)

Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.
Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.

Stephanie Stasse (S)

European Union Delegation to the Democratic Republic of the Congo, Kinshasa, Democratic Republic of the Congo.

John S Brownstein (JS)

Harvard Medical School, Harvard University, Boston, USA.
Computational Epidemiology Group, Boston Children's Hospital, Boston, USA.

Bernardo Gutierrez (B)

Department of Zoology, University of Oxford, Oxford, UK.
School of Biological and Environmental Sciences, Universidad San Francisco de Quito USFQ, Quito, Ecuador.

Francis Dennig (F)

Yale-NUS College, Singapore, Singapore.

Simon I Hay (SI)

Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.
Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.

G R William Wint (GRW)

Environmental Research Group Oxford, Department of Zoology, University of Oxford, Oxford, UK.

Oliver G Pybus (OG)

Department of Zoology, University of Oxford, Oxford, UK.

Marcia C Castro (MC)

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.

Patrick Vinck (P)

Harvard Medical School, Harvard University, Boston, USA.
Program on Infectious Diseases and Emergencies, Harvard Humanitarian Initiative, Harvard University, Cambridge, USA.
Brigham and Women's Hospital, Boston, USA.

Phuong N Pham (PN)

Harvard Medical School, Harvard University, Boston, USA.
Program on Infectious Diseases and Emergencies, Harvard Humanitarian Initiative, Harvard University, Cambridge, USA.
Brigham and Women's Hospital, Boston, USA.

Eric J Nilles (EJ)

Harvard Medical School, Harvard University, Boston, USA.
Program on Infectious Diseases and Emergencies, Harvard Humanitarian Initiative, Harvard University, Cambridge, USA.
Brigham and Women's Hospital, Boston, USA.

Simon Cauchemez (S)

Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, CNRS, UMR2000, Paris, France. simon.cauchemez@pasteur.fr.

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Classifications MeSH

questionsmedicales.fr › Régions géographiques › Afrique › Afrique subsaharienne › Afrique centrale › République démocratique du Congo › Dynamics of conflict during the Ebola outbreak...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Épidémies de maladies › Dynamics of conflict during the Ebola outbreak...
questionsmedicales.fr › Infection › Maladies virales › Infections à virus à ARN › Infections à Mononegavirales › Infections à Filoviridae › Fièvre hémorragique à virus Ebola › Dynamics of conflict during the Ebola outbreak...
questionsmedicales.fr › Sciences humaines › Histoire › Histoire moderne 1601- › Histoire du 21ème siècle › Dynamics of conflict during the Ebola outbreak...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Dynamics of conflict during the Ebola outbreak...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Morbidité › Incidence › Dynamics of conflict during the Ebola outbreak...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Analyse de survie › Dynamics of conflict during the Ebola outbreak...