Introduction
Over the last decade, an unparalleled number of public health emergencies have been recorded that threaten global health security.1 This includes outbreaks of infectious epidemic-prone and pandemic-prone diseases including Ebola, H1N1, SARS, Monkeypox and COVID-19. Due to their weak health systems, public health surveillance and fragile economies, countries in sub-Saharan Africa are disproportionately affected by infectious disease epidemics. The social, economic and health costs of the Ebola virus disease outbreak from 2014 to 2016 in West Africa, for example, were devastating.2
One cornerstone of effective epidemic and pandemic preparedness and response is widely acknowledged to be community engagement.3 During epidemics and pandemics, engaging community members has been identified as critical for reducing pathogen transmission and controlling the spread of infection at the individual and community level.4 By working closely with community members, public health officials can improve communication, mobilise local resources, promote behaviour change and build sustainable systems that are better able to respond to both ongoing and future outbreaks.5 Insights drawn from past pandemics, including the 2014 Ebola virus disease outbreak and the current COVID-19 pandemic, reveal that a lack of trust among community members in health authorities and the spread of rumours within communities can impede effective responses to outbreaks and pandemics.6 7 Well-implemented community engagement measures can help promote the acceptance and adherence to non-pharmaceutical interventions such as lockdowns, physical distancing and contact tracing that can help reduce the spread of infectious diseases.8 These measures contribute to breaking individual chains of transmission and preventing outbreaks and are thus critical in limiting the spread of infectious disease, particularly in the absence of vaccines and therapeutics.4 9 Community engagement is also essential as it helps to ensure that people have access to information and resources, which they need to protect themselves and their communities. It can also help to build trust and promote collaboration, which is crucial in controlling the spread of infectious diseases.10 11
Despite the pivotal role that community engagement plays in epidemic and pandemic preparedness and response activities, strategies to engage communities have been underexplored in reviews to date, particularly in countries of sub-Sahara Africa. Where reviews were conducted, these have focused on maternal and child health12 and health disparities13 and not on outbreaks of infectious epidemic-prone and pandemic-prone diseases. Where reviews focused on infectious diseases, these have focused on high-income countries14 or single diseases such as malaria, and not included evidence from the latest pandemic, COVID-19.15 16 This scoping review aims to address this gap by documenting through available literature, the strategies for community engagement for epidemic and pandemic preparedness and response in sub-Sahara Africa.
Review objectives
This scoping review seeks to explore, through a search of available literature, the strategies for community engagement that have been used as part of interventions against epidemics and pandemics in Africa. Specifically, the objectives of the review are to (1) provide an overview of the strategies for community engagement for epidemic and pandemic preparedness and response in sub-Saharan Africa, (2) identifiy the enablers and barriers to engaging communities for epidemic and pandemic preparedness and response in sub-Saharan Africa countries.
Methods and analyses
For the scoping review, we will draw on the methodological framework developed by Arskey and O’Malley17 and will apply the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) to guide the review process.18 Arskey and O’Malley’s framework recognises five stages and an optional sixth stage in conducting scoping reviews: (1) identifying the research question, (2) identifying relevant studies, (3) selecting studies, (4) charting the data, (5) collating, summarising and reporting of findings and (6) consulting with relevant stakeholders.17 The protocol for this review was registered in the Open Science Framework and can be accessed at https://doi.org/10.17605/osf.io/d478z
Stage 1: identifying the research question
Based on preliminary searches of the available literature, we have framed our research question in terms of the population to study, and the concept of community or public engagement in the context of public health practice.
The main research question guiding the review is as follows: What strategies for community engagement have been used to prepare and respond to epidemics and pandemics in sub-Saharan Africa? In addition, we will ask: What are the facilitators and barriers to engaging communities for epidemic and pandemic preparedness and response in sub-Saharan Africa?
Stage 2: identifying the relevant studies
To help answer our research questions, a comprehensive research strategy will be developed. Given the heterogeneous nature of literature on the topic, the search strategy will be designed to identify both peer-reviewed and grey literature. We will include documents published between January 2014 and December 2023, to include evidence from the Ebola virus disease outbreak. The peer-reviewed literature search will be conducted using the following databases: Embase, EBSCO-host, PubMed, Global Health, CINAHL, Google Scholar and Web of Science. We will source grey literature from the websites of international organisations including the WHO and the International Federation of the Red Cross and Red Cresent (IFRC), public health institutes including the Center for Disease Control (CDC) and Africa CDC, and Government Ministries of Health in African countries.
According to Arksey and O’Malley,17 liaising with practitioners from national and local health authorities can provide additional references for potential studies to include in the review. To this end, we will liaise with officials from the Ministry of Health and Ghana Health Service and those from CDC, WHO and IFRC country offices in Ghana. These stakeholders may provide additional insights for fine-tuning the search strategy and identifying relevant grey literature.
Key concepts around which the search terms would be derived include community/public/social engagement, strategies/approaches, pandemic preparedness and response. The search strategy is attached in table 1.
Search strategy
Medical Subject Headings (MeSH) terms and subject headings will be used to capture the possible representations of community engagement, and strategies for pandemic preparedness or response. The reference lists of included articles will be hand searched to identify any other relevant studies.
Inclusion and exclusion criteria
Studies and reports from grey literature will be eligible for inclusion if they: (1) are from or were conducted in a country in sub-Sahara Africa; (2) use either qualitative, quantitative or mixed methods; (3) describe strategies for epidemic or pandemic preparedness and response that engage or aim to engage community members; (4) are written between 2014 and 2023. The researchers will choose 2014 as the starting because it coincides with the beginning of the West Africa Ebola outbreak. It was during the Ebola outbreak that application of community engagement practices became regarded as a crucial part of the outbreak response19 and (5) are written in English language.
Studies will be excluded if they are commentaries, editorials, letters, conference abstracts, study protocols and those not written in English.
Stage 3: study selection
Using the inclusion and exclusion criteria, two authors (GRI and HT-F) will review the search results independently from the databases exported into Rayyan, a web-based platform for conducting reviews. Duplicates will be merged in Rayyan. Articles will first be excluded based on an initial title and abstract screening. A subset of 50 randomly selected titles and abstracts will be compared to reach 100% agreement between the two authors. For articles that are included after the title and abstract screening, a full-text review will be carried out. The full text of the remaining papers will be sourced and independently evaluated by the two authors to determine whether all inclusion and exclusion criteria are met. The two researchers will then meet and discuss each paper to determine whether it should be included in the scoping review. Any disagreements will be forwarded to a third author (EA-B), who will evaluate the article(s) for inclusion independently and make the final decision.
Stage 4: data extraction
A data collection tool will be designed in Microsoft Excel by the two authors who conducted the screening and full-text review. To ensure clarity, the tool will be piloted by both authors using a subset of three papers each. The tool will serve as a guide to extract data on the characteristics of the studies and reports included. Data will be extracted according to the nature of the epidemic or pandemic, country, population, data collection method(s), community engagement strategies, actors involved in implementing the strategies, as well as barriers and facilitators to community engagement (table 2). Where key data are missing from the studies or reports, the authors may be contacted. If missing data are unavailable, characteristics will be reported as unknown or missing.
Data extraction instrument
Stage 5: collating, summarising and reporting of findings
We will employ a narrative strategy to summarise and synthetise extracted data selected for review. Additionally, we would include thematic analysis of the extracted data as an extension of the scoping review as recommended by Levac et al.
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The primary analysis data will be based on the following themes: (1) study characteristics, (2) strategies employed to engage communities and (3) facilitators and barriers to community engagement. We will categorise the strategies according to the type of epidemic or pandemic. This is because different diseases require different preparedness and response activities.
To bring clarity to the results, quantitative and qualitative studies will be synthesised separately. Individual reviewers will summarise the findings from all included studies. The reviewers will then discuss their findings and merge them. Findings will then be shared with the whole research team.
A flow diagram which conforms to the PRISMA-ScR statement for scoping reviews will be developed which illustrates which reports or articles were excluded and at what stage of screening. In addition, an Excel table will be created to display information about study characteristics from retrieved documents. This table will display information about the author (s), year of publication, title of paper, setting of the study, study design, sampling methods, strategy for community engagement, barriers and facilitators to engagement and limitations of the study. The research team will discuss and consolidate the results.
We will provide a narrative synthesis of key strategies for community engagement and the barriers and facilitators to community engagement. Overall, the scoping reviews aim to develop a map of the strategies that have been used for community engagement in epidemic and pandemic preparedness and response in Africa.
Stage 6: consulting with relevant stakeholders
We developed the question, the literature search and other aspects of the review in consultation with public health practitioners and academics in the epidemic and pandemic response field. Primarily public health practitioners from the Ghana Health Service and academicians from Ghana and German universities made valuable inputs into the design of the scoping review.
Ethics and dissemination
The scoping review does not require ethical approval because the methodology involves the collection and review of publicly available literature. The findings from this scoping review will be disseminated through publications in a peer-reviewed journal, presentations in conferences and meetings with relevant stakeholders including public health authorities.
This post was originally published on https://bmjopen.bmj.com