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 others to the disease.

This report presents results of a rapid anthropological assessment conducted in response to a request from the U.S. Centers for Disease Control and Prevention’s (CDC) Epidemiology Team in Monrovia in December 2014 for qualitative data to better understand why EVD deaths were occurring at home in urban Montserrado County. Data from the International Federation of Red Cross and Red Crescent Societies (IFRC) had indicated that 30% of the 60-90 deceased persons collected weekly from ETUs and community settings in Monrovia by Liberian Red Cross burial teams between early November and early December had tested positive for EVD and nearly half of those had been collected in homes.This raised concerns that EVD case-finding and prevention efforts were not as effective as they could be.

The assessment found that concerns about the quality of care and lack of information from ETUs, widespread opposition to cremation, concerns about being subjected to Ebola-related stigma, concerns about the lack of food for quarantined households as well as limited access to health services for non-Ebola illnesses, amongst others, were factors that contributed to delayed care-seeking and home deaths among suspected or confirmed EVD cases in urban Montserrado County. It is anticipated that findings presented in this report will contribute to the evaluation of Liberia’s EVD response efforts.

2014 / Centers for Disease Control and Prevention

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