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      Challenges to Ebola preparedness during an ongoing outbreak: An analysis of borderland livelihoods and trust in Uganda

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          Abstract

          Ebola Virus Disease in the Democratic Republic of Congo (DRC) was declared a public health emergency of international concern on July 17, 2019. The first case to cross the border into Uganda in June 2019 demonstrates the importance of better understanding border dynamics in a context of Ebola. This paper adopts a political economy approach to contextualize epidemic response programs conducted in moderate- and high-risk border districts in Uganda, through a qualitative study with 287 participants. To that end, our aim was to describe the historical underpinnings of the borderlands context; the role of livelihood strategies in constraining risk avoidance decisions; and the dynamics of trust in authority figures, including health workers. This paper reports that border communities are highly connected, for a variety of social and economic reasons. These daily realities are in direct opposition to guidance to limit travel during an active Ebola epidemic. We argue that an ability to limit movement is constrained by the economic need to seek livelihood strategies wherever that may be. Moreover, border regions are populated by communities with long-standing distrust in authority figures, particularly in fishing areas. This distrust spills over with consequences for Ebola prevention and control activities. This research indexes the importance of tailoring Ebola programming and policies to consider the political and economic dynamics of borderlands.

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          Cultural Violence

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            Ebola: limitations of correcting misinformation.

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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: Conceptualization
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                26 March 2020
                2020
                : 15
                : 3
                : e0230683
                Affiliations
                [1 ] Department of Social Work and Social Administration, Makerere University School of Social Sciences, Kampala, Uganda
                [2 ] Center for Social Science Research on AIDS, Makerere University School of Social Sciences, Kampala, Uganda
                [3 ] Department of Anthropology, Case Western Reserve University, Cleveland, Ohio, United States of America
                [4 ] UNICEF Uganda, Kampala, Uganda
                [5 ] Uganda Ministry of Health, Kampala, Uganda
                Tulane University, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-3669-7527
                Article
                PONE-D-19-31957
                10.1371/journal.pone.0230683
                7098638
                32214381
                9ee24220-ae07-499a-ba9a-8b122373670a
                © 2020 Schmidt-Sane et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 17 November 2019
                : 5 March 2020
                Page count
                Figures: 0, Tables: 3, Pages: 15
                Funding
                DKM received funding from UNICEF Uganda ( https://www.unicef.org/uganda/) to conduct this work. The funders did not play a role in study design, data collection, analysis. The funders did approve the publication of this study and contributed to the preparation of the manuscript.
                Categories
                Research Article
                People and Places
                Geographical Locations
                Africa
                Uganda
                Social Sciences
                Economics
                Health Economics
                Medicine and Health Sciences
                Health Care
                Health Economics
                Social Sciences
                Sociology
                Culture
                People and Places
                Population Groupings
                Ethnicities
                African People
                Kongo People
                Social Sciences
                Anthropology
                Cultural Anthropology
                Religion
                Social Sciences
                Sociology
                Religion
                Engineering and Technology
                Transportation
                Boats
                Biology and life sciences
                Organisms
                Viruses
                RNA viruses
                Filoviruses
                Ebola Virus
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Hemorrhagic Fever Viruses
                Ebola Virus
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Viral Pathogens
                Hemorrhagic Fever Viruses
                Ebola Virus
                Biology and Life Sciences
                Organisms
                Viruses
                Viral Pathogens
                Hemorrhagic Fever Viruses
                Ebola Virus
                Biology and Life Sciences
                Organisms
                Viruses
                Hemorrhagic Fever Viruses
                Ebola Virus
                Medicine and Health Sciences
                Tropical Diseases
                Neglected Tropical Diseases
                Viral Hemorrhagic Fevers
                Ebola Hemorrhagic Fever
                Medicine and Health Sciences
                Infectious Diseases
                Viral Diseases
                Viral Hemorrhagic Fevers
                Ebola Hemorrhagic Fever
                Custom metadata
                All interview and focus group discussion transcripts are available from the Open ICPSR database. The DOI and information for our data in ICPSR is: Kaawa-Mafigiri, David, and Schmidt-Sane, Megan. Challenges to Ebola preparedness during an ongoing outbreak. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2020-02-21. https://doi.org/10.3886/E117869V1.

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