Identifying and Diagnosing Cases

Supporting early diagnosis by understanding how people recognise the symptoms of Ebola and how they seek care;  identifying the challenges to early presentation including cost, fear, shame, and perceptions of care providers; integrating knowledge about local patterns of health seeking into strategies which encourage early detection and reduced transmission.

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 →

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 →

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 →

Policy Briefing on Community-based Ebola Care Centres

A component of the Ebola epidemic control policy in Sierra Leone is triage and isolation in decentralised Community Care Centres (CCCs) or Holding Units, from where transfer to Ebola treatment units (ETUs) is arranged for those diagnosed as positive. The epidemic is currently waning, there are sufficient beds in the ETU, yet new micro-epidemics emerge, raising questions about the future role and relevance of the CCC. This briefing summarizes the preliminary findings of a formative evaluation conducted by the UK based Ebola Response Anthropology Platform Continue reading →

Community-based reports of co-morbidity, co-mortality, and health-seeking behaviors in four Monrovia communities during the West African Ebola epidemic

This working paper reports on a study to collect data on co-morbidity and co-mortality among urban Liberian populations during the Ebola epidemic from September to October 2014. Particular attention is paid to how local communities defined their symptoms and sicknesses, the patterns of healthcare-seeking that they pursued in a context of highly restricted health care access, the types of treatment regimens that they deployed to support home based care within their communities, and their perceptions of the causes of disease.  

Community-Centered Responses to Ebola in Urban Liberia: The View from Below

This working paper reports on a study to identify epidemic control priorities among 15 communities in Monrovia and Montserrado County, Liberia. Data were collected in September 2014 on the following topics: prevention, surveillance, care-giving, community-based treatment and support, networking/hotlines/calling response teams and referrals, management of corpses, quarantine and isolation, orphans, memorialization, and the need for community-based training and education. The study also reviewed issues of fear and stigma towards Ebola victims and survivors, and support for those who have been affected by Ebola. The findings Continue reading →

Increasing early presentation to ECU through improving care

Current Ebola epidemic control policy in Sierra Leone focuses on (a) triage and isolation in decentralised, ideally community-based Ebola Care Units (ECUs), leading to (b) transfer to Ebola treatment units (ETUs) for those diagnosed as positive. Increasing early presentation to ECUs is essential for this strategy to be effective in reducing Ro. This note outlines ways in which improved and socially-appropriate care – in ECUs, and at home – can assist this.

Mobilising informal health workers for the Ebola response: potential and programme considerations

Informal health workers are important care providers in the region and continue to be so during the current Ebola Virus Disease (EVD) outbreak. Many are well respected and trusted members of the community who can mobilise large numbers of people for a particular activity and lend legitimacy to a particular programme.    

Local beliefs and behaviour change for preventing Ebola in Sierra Leone

‘The Ebola epidemic ravaging parts of West Africa is the most severe acute public health emergency seen in modern times.  Never before in recorded history has a biosafety level four pathogen infected so many people so quickly, over such a broad geographical area, for so long’ (Margaret Chan, 26th September 2014, WHO). This report focuses on the local beliefs and practices around illnesses and death, the transmission of disease and spirituality, which affect decision-making around health-seeking behaviour, caring for relatives and the nature of burials.  Continue reading →