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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
‘When Ebola enters a home, a family, a community’: A qualitative study of population perspectives on Ebola control measures in rural and urban areas of Sierra Leone
PLoS Neglected Tropical Diseases, Volume 12, No. 6, Article e0006461, Year 2018
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Description
Background: During the West Africa Ebola outbreak, cultural practices have been described as hindering response efforts. The acceptance of control measures improved during the outbreak, but little is known about how and why this occurred. We conducted a qualitative study in two administrative districts of Sierra Leone to understand Ebola survivor, community, and health worker perspectives on Ebola control measures. We aimed to gain an understanding of community interactions with the Ebola response to inform future intervention strategies. Methodology/Principal findings: Participants (25 survivors, 24 community members, and 16 health workers) were recruited purposively. A flexible participatory method gathered data through field notes and in-depth, topic-led interviews. These were analysed thematically with NVivo10© by open coding, constant comparison, and the principles of grounded theory. The primary theme, ‘when Ebola is real’, centred on denial, knowledge, and acceptance. Ebola was denied until it was experienced or observed first-hand and thus health promotion was more effective if undertaken by those directly exposed to Ebola rather than by mass media communication. Factors that enabled acceptance and engagement with control measures included: access to good, proximate care and prevention activities; seeing that people can survive infection; and the co-option of trusted or influential local leadership, with bylaws implemented by community leaders being strongly respected. All participants noted that dignity, respect, and compassion were key components of effective control measures. Conclusions: Successful control approaches need strong community leadership, with the aim of achieving collective understanding between communities and health workers. Health promotion for communities at risk is best conducted through people who have had close interaction with or who have survived Ebola as opposed to reliance on broad mass communication strategies.
Authors & Co-Authors
Gray, Nell
Switzerland, Geneva
Medecins Sans Frontieres
Stringer, Beverley
Switzerland, Geneva
Medecins Sans Frontieres
Bark, Gina
Switzerland, Geneva
Medecins Sans Frontieres
Heller Perache, Andre
Switzerland, Geneva
Medecins Sans Frontieres
Jephcott, Freya Louise
Switzerland, Geneva
Medecins Sans Frontieres
Broeder, Rob
United Kingdom, Cambridge
Queens' College
Kremer, Ronald
United Kingdom, Cambridge
Queens' College
Jimissa, Augustin
Sierra Leone, Freetown
Ministry of Health and Sanitation
Samba, Thomas Takpau
Sierra Leone, Freetown
National Public Health Agency
Statistics
Citations: 23
Authors: 9
Affiliations: 4
Identifiers
Doi:
10.1371/journal.pntd.0006461
ISSN:
19352727
e-ISSN:
19352735
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Randomised Control Trial
Cross Sectional Study
Grounded Theory
Study Approach
Qualitative
Study Locations
Multi-countries
Sierra Leone