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The first mile: community experience of outbreak control during an Ebola outbreak in Luwero District, Uganda

Background: A major challenge to outbreak control lies in early detection of viral haemorrhagic fevers (VHFs) in local community contexts during the critical initial stages of an epidemic, when risk of spreading is its highest (“the first mile”). This paper documents how a major Ebola outbreak control effort in central Uganda in 2012 was experienced from the perspective of the community. It asks to what extent the community became a resource for early detection, and identifies problems encountered with community health worker and social mobilization strategies. Continue reading →

Biosocial Approaches to the 2013-2015 Ebola Pandemic

Despite more than 25 documented outbreaks of Ebola since 1976, our understanding of the disease is limited, in particular the social, political, ecological, and economic forces that promote (or limit) its spread. In the following study, we seek to provide new ways of understanding the 2013-2015 Ebola pandemic. We use the term, ‘pandemic,’ instead of ‘epidemic,’ so as not to elide the global forces that shape every localized outbreak of infectious disease. By situating life histories via a biosocial approach, the forces promoting or retarding Continue reading →

Diaspora communications and Health seeking behaviour in the time of Ebola: findings from the Sierra Leonean community in London

The Sierra Leonean diaspora was active in responding to the Ebola outbreak that hit Sierra Leone in March 2014, both by providing financial and material support, and through direct communication with relatives, friends and colleagues back home. This paper looks at the role of diaspora communications on health seeking behaviour in Sierra Leone. It examines the range of communication strategies employed by members of the diaspora; the dynamics of communications as the epidemic spread during 2014/15, and the role of diaspora associations in liaising with Continue reading →

Community-led Ebola Action (CLEA) and the Social Mobilisation Action Consortium (SMAC)

The Community Led Ebola Action (CLEA) has empowered communities to do their own analysis and take their own action to become Ebola-free in Sierra Leone. CLEA has focused on triggering collective action by inspiring communities to understand the urgency and the steps they take to protect themselves from Ebola. Community Mobilisers have facilitated this process and communities have modified norms, beliefs and behaviours in response to the conditions around them. The CLEA Approach was used to trigger 9,285 communities in Sierra Leone as of April Continue reading →

Communities are the real heroes – Doing social mobilisation differently: lessons and recommendations from the Ebola outbreak

The Ebola outbreak in West Africa has reinvigorated the debate about the role of ‘social mobilisation’ and ‘community engagement’, not only in response to devastating disease but a range of other intractable issues affecting Africa and the rest of the developing world. But what do we mean by ‘social mobilisation’? And why are we only learning now that community leadership is important? Sierra Leone’s communities are the true heroes of the Ebola response. Over the course of 18 months, a huge proportion of the population Continue reading →

Contextualising Ebola rumours from a political, historical and social perspective to understand people’s perceptions of Ebola and the responses to it

This briefing explores how rumours about Ebola in Sierra Leone influences people’s perception and response to Ebola, from the political, historical and social perspectives. Despite the efforts of the World Health Organisation to control the Ebola outbreak, achieving zero cases and providing support for survivors, rumours about the cause of Ebola and the response to it continue to circulate. These rumours, a product of  the initially over stretched and poorly implemented Ebola response, were more often linked to long-term issues of structural violence that also contributed to the unprecedented Continue reading →

Community Led Ebola Management and Eradication (CLEME)

The CLEME (Community Led Ebola Man- agement and Eradication) programme aims at triggering the behavioural change needed by the communities to strengthen community resilience to the outbreak and prevent further resurgence by ensuring real and sustainable improvements through: Providing the communities with the means to conduct their own appraisal and analysis of the Ebola outbreak, their safety regarding the disease and its con- sequence if nothing is done; Instilling a feeling of urgency in engaging in community actions that will prevent the community experiencing infections; Supporting Continue reading →

Terms of Reference: Individual or team to conduct assessment of Ebola contact tracing mHealth application

A team of researchers from the London School of Hygiene & Tropical Medicine and Innovations for Poverty Action Sierra Leone developed a study evaluating the use of mobile technology in improving the process of tracing contacts of Ebola patients in Sierra Leone. As part of this study, the team, with the help of a developer, designed a customized application using Dimagi’s CommCare that has been implemented in the district of Port Loko. The research team seeks an individual or small group of mHealth experts to Continue reading →

Two evaluations of community Ebola interventions, two different results

This spring, when my team from the Ebola Response Anthropology Platform evaluated Community-Based Ebola Care Centres (CCCs) in Sierra Leone, one thing we constantly heard complaints about was human-resource management. Residents of the communities where the Centres were located grumbled about favouritism: well-paying jobs in the Centres were given to friends and family of the local paramount chiefs. Local health authorities questioned the medical competency of CCC staff. Staff in primary health units complained about unequal pay and benefits. We focused on the views on the development, implementation and Continue reading →

Understanding why ebola deaths occur at home in urban Montserrado County, Liberia

Ebola Virus Disease (EVD) home deaths occur as the result of infected persons not being detected early and sent to Ebola Treatment Units (ETU) where they can access care and have an improved chance of survival. From a public health standpoint, EVD deaths should not occur at home. Individuals suspected of being infected with EVD should be identified through case investigations or contact tracing efforts and then referred to an ETU, thus decreasing their risk of dying as well as minimising the risk of exposing Continue reading →