Perceived drivers of the Ebola virus disease outbreak in Mubende and Kassanda districts, Uganda: a qualitative study.

Introduction: During the most recent Ebola virus disease (EVD) outbreak in Uganda, a cluster of community deaths with epidemiological linkages to the first reported case were identified to have occurred in Mubende, Kassanda and Kampala districts in September 2022. This study aimed to explore perceived drivers of EVD outbreak among affected communities in Mubende and Kassanda districts, Uganda. Methods: We conducted a descriptive qualitative and participatory epidemiology study using focus group discussions (n=4), in-depth interviews (n=12), key informant interviews (n=12) and participatory landscape mapping. The subcounties of Madudu (Mubende district) and Kikandwa (Kassanda district) were purposively selected within each district because Ebola cases were known to have occurred within these areas. The community expressed their own understanding and perceptions of the drivers of Ebola virus outbreak within these subcounties. Qualitative data were analysed using thematic content analysis in Nvivo V.12 software. Data were analysed using both inductive and deductive approaches, where codes, subthemes and themes in the data were merged with global themes. The results were interpreted in the context of the broader literature on the topic using the social-ecological model and the epidemiological triad using the specific experiences and insights of the study participants. Participant responses were categorised in terms of their themes. Results: A total of five themes were identified which described the perceived drivers of Ebola virus outbreaks. These included (1) individual: knowledge about EVD (source of the disease and fear due to death of some suspected cases); (2) interpersonal: perceived sources of Ebola virus spillover (ecological, anthropogenic, environmental and cultural); (3) community: impact of EVD to the community (economic loss and survivors lack of support from the government); (4) organisational: health system challenges in outbreaks (delayed laboratory results, poor recording and reporting systems in the facilities and poor surveillance); and (5) policy: recommendations (use of One Health approach and continuous sensitisation). Conclusions: This study underscores the complex interplay of factors shaping the dynamics of EVD. Understanding Ebola requires not only scientific knowledge but also an appreciation of sociocultural contexts and systemic vulnerabilities within health systems. We therefore recommend comprehensive approaches which integrate scientific expertise with community participation, strengthen health systems and foster collaboration across sectors to mitigate the impact of future outbreaks to address these challenges effectively. Additionally, raising awareness, sensitising the public and safeguarding natural habitats are crucial steps to mitigate the risk of future disease outbreaks.