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Objective To quantify the potential impact of engaging religious leaders in promoting safe burial practices during the 2014-2016 Ebola virus disease outbreak in Sierra Leone. Methods We analysed population-based household survey data from 3540 respondents collected around the peak of the outbreak in Sierra Leone, December 2014. Respondents were asked if in the past month they had heard an imam or pastor say that people should not touch or wash a dead body. We used multilevel logistic regression modelling to examine if exposure to religious leaders' messages was associated with protective burial intentions if a family member died at home and other Ebola protective behaviours. Findings Of the respondents, 3148 (89%) had been exposed to faith-based messages from religious leaders on safe Ebola burials and 369 (10%) were unexposed. Exposure to religious leaders' messages was associated with a nearly twofold increase in the intention to accept safe alternatives to traditional burials and the intention to wait [greater than or equal to] 2 days for burial teams (adjusted odds ratio, aOR: 1.69; 95% confidence interval, CI: 1.23-2.31 and aOR: 1.84; 95% CI: 1.38-2.44, respectively). Exposure to messages from religious leaders was also associated with avoidance of traditional burials and of contact with suspected Ebola patients (aOR: 1.46; 95% CI: 1.14-1.89 and aOR: 1.65; 95% CI: 1.27-2.13, respectively). Conclusion Public health messages promoted by religious leaders may have influenced safe burial behaviours during the Ebola outbreak in Sierra Leone. Engagement of religious leaders in risk communication should be prioritized during health emergencies in similar settings. Objectif Quantifier l'impact potentiel de l'implication des autorites religieuses dans la promotion de pratiques funeraires sures durant l'epidemie de maladie a virus Ebola entre 2014 et 2016 en Sierra Leone. Methodes Nous avons analyse les reponses fournies par 3540 menages ayant pris part a des enquetes menees au plus fort de l'epidemie en Sierra Leone, en decembre 2014. Il avait ete demande aux participants si, au cours du mois ecoule, ils avaient entendu un imam, un pretre ou un pasteur dire que les gens ne devaient pas toucher ni laver le corps d'un defunt. Nous avons employe un modele de regression logistique multiniveaux pour determiner si l'exposition aux messages des autorites religieuses entrainait l'adoption de pratiques funeraires preventives en cas de deces d'un proche a domicile, et d'autres comportements de protection contre Ebola en general. Resultats Sur l'ensemble des participants, 3148 (89%) avaient ete exposes a des messages de la part de leurs chefs religieux concernant les pratiques funeraires limitant la propagation d'Ebola, tandis que 369 (10%) n'ont recu aucune information a ce sujet. Ceux exposes aux messages des autorites religieuses ont ete presque deux fois plus nombreux a accepter les alternatives aux enterrements traditionnels et a prevoir d'attendre [greater than or equal to] 2 jours avant de faire appel aux equipes d'inhumation (odds ratio ajuste, ORA: 1,69; intervalle de confiance de 95%, IC: 1,23-2,31 et ORA: 1,84; IC de 95%: 1,38-2,44 respectivement). Lexposition aux messages de la part des chefs religieux a egalement permis d'eviter l'organisation de funerailles traditionnelles et le contact avec des patients susceptibles d'avoir contracte la maladie a virus Ebola (ORA: 1,46; IC de 95%: 1,14-1,89 et ORA: 1,65; IC de 95%: 1,27-2,13 respectivement). Conclusion Le soutien des autorites religieuses aux messages de sante publique pourrait avoir eu une influence positive sur les comportements funeraires durant l'epidemie d'Ebola en Sierra Leone. Il faut privilegier l'implication des instances dirigeantes de chaque confession dans la communication des risques lorsque des urgences sanitaires surviennent dans des environnements similaires. Objetivo Cuantificar el impacto potencial de la implicacion de los lideres religiosos en la promocion de practicas funerarias seguras durante la epidemia del ebola de 2014 a 2016 en Sierra Leona. Metodos Analizamos las respuestas de 3.540 hogares que participaron en las encuestas realizadas en el momento algido de la epidemia en Sierra Leona, en diciembre de 2014. Se pregunto a los participantes si, en el ultimo mes, habian oido a un iman, sacerdote o pastor decir que la gente no debia tocar o lavar el cuerpo de un difunto. Se utilizo un modelo de regresion logistica multinivel para determinar si la exposicion a los mensajes de los lideres religiosos conducia a practicas funerarias preventivas en caso de muerte de un familiar en el hogar, y a otros comportamientos de proteccion contra el ebola en general. Resultados De todos los participantes, 3148 (89%) habian recibido mensajes de sus lideres religiosos sobre las practicas funerarias que limitan la propagacion del ebola, mientras que 369 (10%) no habian recibido ninguna informacion sobre el tema. Las personas expuestas a los mensajes de los lideres religiosos tenian casi el doble de probabilidades de aceptar alternativas a los entierros tradicionales y de planear esperar [greater than or equal to] 2 dias antes de llamar a los servicios funerarios (razon de probabilidades ajustada, aOR: 1,69; intervalo de confianza del 95%, CI: 1,23-2,31 y aOR: 1,84; CI del 95%: 1,38-2,44 respectivamente). La exposicion a los mensajes de los lideres religiosos tambien evito los funerales tradicionales y el contacto con pacientes con riesgo de contraer la enfermedad del ebola (aOR: 1,46; IC del 95%: 1,14-1,89 y aOR: 1,65; IC del 95%: 1,27-2,13 respectivamente). Conclusion El apoyo de los lideres religiosos a traves de los mensajes de salud publica puede haber influido positivamente en el comportamiento funerario durante la epidemia del ebola en Sierra Leona. La implicacion de los lideres religiosos en la comunicacion de riesgos deberia ser prioritaria durante las emergencias sanitarias en entornos similares., Introduction The Ebola virus disease outbreak in West Africa between 2013 and 2016 is the largest in recorded history. (1,2) Sierra Leone was heavily affected by the outbreak with over [...]

: Introduction: Population‐based biomarker surveys are the gold standard for estimating HIV prevalence but are susceptible to substantial non‐participation (up to 30%). Analytical missing data methods, including inverse‐probability weighting (IPW) and multiple imputation (MI), are biased when data are missing‐not‐at‐random, for example when people living with HIV more frequently decline participation. Heckman‐type selection models can, under certain assumptions, recover unbiased prevalence estimates in such scenarios. Methods: We pooled data from 142,706 participants aged 15–49 years from nationally representative cross‐sectional Population‐based HIV Impact Assessments in seven countries in sub‐Saharan Africa, conducted between 2015 and 2018 in Tanzania, Uganda, Malawi, Zambia, Zimbabwe, Lesotho and Eswatini. We compared sex‐stratified HIV prevalence estimates from unadjusted, IPW, MI and selection models, controlling for household and individual‐level predictors of non‐participation, and assessed the sensitivity of selection models to the copula function specifying the correlation between study participation and HIV status. Results: In total, 84.1% of participants provided a blood sample to determine HIV serostatus (range: 76% in Malawi to 95% in Uganda). HIV prevalence estimates from selection models diverged from IPW and MI models by up to 5% in Lesotho, without substantial precision loss. In Tanzania, the IPW model yielded lower HIV prevalence estimates among males than the best‐fitting copula selection model (3.8% vs. 7.9%). Conclusions: We demonstrate how HIV prevalence estimates from selection models can differ from those obtained under missing‐at‐random assumptions. Further benefits include exploration of plausible relationships between participation and outcome. While selection models require additional assumptions and careful specification, they are an important tool for triangulating prevalence estimates in surveys with substantial missing data due to non‐participation., INTRODUCTION Accurate HIV prevalence estimates are crucial for monitoring HIV disease burden and guiding testing and clinical management. However, population‐based HIV biomarker surveys, the gold standard for estimating HIV prevalence, [...]

Objective To evaluate changes in Ebola-related knowledge, attitudes and prevention practices during the Sierra Leone outbreak between 2014 and 2015. Methods Four cluster surveys were conducted: two before the outbreak peak (3499 participants) and two after (7104 participants). We assessed the effect of temporal and geographical factors on 16 knowledge, attitude and practice outcomes. Findings Fourteen of 16 knowledge, attitude and prevention practice outcomes improved across all regions from before to after the outbreak peak. The proportion of respondents willing to: (i) welcome Ebola survivors back into the community increased from 60.0% to 89.4% (adjusted odds ratio, aOR: 6.0; 95% confidence interval, CI: 3.9-9.1); and (ii) wait for a burial team following a relative's death increased from 86.0% to 95.9% (aOR: 4.4; 95% CI: 3.2-6.0). The proportion avoiding unsafe traditional burials increased from 27.3% to 48.2% (aOR: 3.1; 95% CI: 2.4-4.2) and the proportion believing spiritual healers can treat Ebola decreased from 15.9% to 5.0% (aOR: 0.2; 95% CI: 0.1-0.3). The likelihood respondents would wait for burial teams increased more in high-transmission (aOR: 6.2; 95% CI: 4.2-9.1) than low- transmission (aOR: 2.3; 95% CI: 1.4-3.8) regions. Self-reported avoidance of physical contact with corpses increased in high but not low-transmission regions, aOR: 1.9 (95% CI: 1.4-2.5) and aOR: 0.8 (95% CI: 0.6-1.2), respectively. Conclusion Ebola knowledge, attitudes and prevention practices improved during the Sierra Leone outbreak, especially in high-transmission regions. Behaviourally-targeted community engagement should be prioritized early during outbreaks. [phrase omitted] [phrase omitted] Objectif Evaluer l'evolution des connaissances, attitudes et techniques de prevention en matiere d'Ebola durant l'epidemie qui a touche la Sierra Leone entre 2014 et 2015. Methodes Quatre enquetes en grappes ont ete menees: deux avant le pic de l'epidemie (3499 participants) et deux apres (7104 participants). Nous avons mesure l'impact des facteurs geographiques et temporels sur 16 resultats lies aux connaissances, aux attitudes et aux techniques de prevention. Resultats Quatorze des seize resultats lies aux connaissances, aux attitudes et aux techniques de prevention ont progresse dans toutes les regions entre la periode avant le pic et celle apres le pic. La proportion de repondants disposes a: (i) accueillir les survivants a Ebola de retour dans leur communaute est passee de 60,0% a 89,4% (odds ratio ajuste, ORA: 6,0; intervalle de confiance de 95%, IC: 3,9-9,1); et (ii) attendre l'equipe d'inhumation apres la mort d'un proche a egalement augmente, passant de 86,0% a 95,9% (ORA: 4,4; IC de 95%: 3,2-6,0). La proportion de repondants ayant abandonne la pratique risquee des funerailles traditionnelles est passee de 27,3% a 48,2% (ORA: 3,1; IC de 95%: 2,4-4,2), tandis que celle convaincue de l'efficacite des guerisseurs spirituels pour traiter Ebola a diminue, passant de 15,9% a 5,0% (ORA: 0,2; IC de 95%: 0,1-03). La probabilite que les repondants attendent les equipes d'inhumation a augmente dans les regions a haut risque de transmission (ORA: 6,2; IC de 95%: 4,2-9,1), plus que dans les regions a faible risque de transmission (ORA: 2,3; IC de 95%: 1,4-3,8). Les repondants declarent avoir davantage evite tout contact physique avec les corps dans les regions a haut risque de transmission, mais pas dans les regions a faible risque de transmission (ORA: 1,9; IC de 95%: 1,4--2,5 et ORA: 0,8; IC de 95%: 0,6-1,2). Conclusion Les connaissances, attitudes et techniques de prevention en matiere d'Ebola ont evolue durant l'epidemie qui a touche la Sierra Leone, surtout dans les regions a haut risque de transmission. Il faut privilegier l'engagement communautaire axe sur le comportement des les premiers stades de l'epidemie. [phrase omitted] Objetivo Evaluar los cambios en los conocimientos, las actitudes y las practicas de prevencion relacionadas con el ebola durante el brote ocurrido en Sierra Leona entre 2014 y 2015. Metodos Se realizaron cuatro encuestas por conglomerados: dos antes del pico del brote (3499 participantes) y dos despues (7104 participantes). Se evaluo el efecto de los factores temporales y geograficos en 16 resultados de conocimientos, actitudes y practicas de prevencion. Resultados 14 de 16 resultados de conocimientos, actitudes y practicas de prevencion mejoraron en todas las regiones desde antes hasta despues del pico del brote. El porcentaje de los encuestados dispuestos a: (i) acoger a los supervivientes del ebola en la comunidad aumento del 60,0 % al 89,4 % (proporcion de probabilidad ajustada, aOR: 6,0; intervalo de confianza del 95 %, IC: 3,9-9,1); y (ii) esperar al servicio funerario tras la muerte de un familiar aumento del 86,0 % al 95,9 % (aOR: 4,4; IC del 95 %: 3,2-6,0). El porcentaje de personas que evitaron los entierros tradicionales inseguros aumento del 27,3 % al 48,2 % (aOR: 3,1; IC del 95 %: 2,4-4,2) y el porcentaje de personas que creen que los sanadores espirituales pueden tratar el ebola disminuyo del 15,9 % al 5,0 % (aOR: 0,2; IC del 95 %: 0,1-03). La probabilidad de que los encuestados esperan a los servicios funerarios aumento mas en las regiones de alta transmision (aOR: 6,2; IC del 95 %: 4,2-9,1) que en las de baja transmision (aOR: 2,3; IC del 95 %: 1,4-3,8). Segun los reportes de los mismos encuestados, se evito mas el contacto fisico con los cadaveres en las regiones de alta pero no de baja transmision, aOR: 1,9 (IC del 95 %: 1,4-2,5) y aOR: 0,8 (IC del 95 %: 0,6-1,2), respectivamente. Conclusion Los conocimientos, las actitudes y las practicas de prevencion del ebola mejoraron durante el brote en Sierra Leona, en especial en las regiones de alta transmision. Se debe dar prioridad a la participacion de la comunidad orientada al comportamiento en las primeras etapas de los brotes., Introduction The 2013-2016 Ebola virus disease outbreak in West Africa mostly affected Guinea, Liberia and Sierra Leone. In Sierra Leone, over 14 000 cases of Ebola and about 4000 deaths [...]

West Africa detected its first case of Ebola virus disease (EVD) in March 2014 within the forest region of Guinea; shortly thereafter, Liberia and Sierra Leone detected cases of the [...]