Knowledge, attitudes, and practices among members of households actively monitored or quarantined to prevent transmission of Ebola virus disease – Margibi county, Liberia: February–March 2015
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Background: In early 2015, a patient from a cluster of cases of Ebola Virus Disease (EVD) in Monrovia, Liberia traveled to a rural village in Margibi County, potentially exposing numerous persons. The patient died in the village and post-mortem testing confirmed Ebola Virus infection. Problem: The Margibi County Health Team (CHT; Kakata, Margibi, Liberia) needed to prevent further transmission of EVD within and outside of the affected villages, and they needed to better understand the factors that support or impede compliance with measures to stop the spread of EVD. Methods: In February-March 2015, the Margibi CHT instituted a 21-day quarantine and active monitoring for two villages where the patient had contact with numerous residents, and a 21-day active monitoring for five other villages where the patient had possible contact with an unknown number of persons. One contact developed EVD and quarantine was extended an additional 12 days in one village. In April 2015, the Margibi CHT conducted a household-based EVD knowledge, attitudes, and practices (KAP) survey of the seven villages. From April 24-29, 2015, interview teams approached every household in the seven villages and collected information on demographics, knowledge of EVD, attitudes about quarantine to prevent the spread of EVD, and their quarantine experiences and practices. Descriptive statistics were calculated. Results: One hundred fifteen interviews were conducted, representing the majority of the households in the seven villages. Most (99%) correctly identified touching an infected person’s body fluids and contact with the body of someone who has died from EVD as transmission routes. However, interviewees sometimes incorrectly identified mosquito bites (58%) and airborne spread (32%) as routes of EVD transmission, and 72% incorrectly identified the longest EVD incubation period as ≤seven days. Eight of 16 households in the two quarantined villages (50%) reported times when there was not enough water or food during quarantine. Nine of 16 (56%) reported that a household member had illnesses or injuries during quarantine; of these, all (100%) obtained care from a clinic, hospital, or Ebola treatment unit (ETU). Conclusion: Residents’ knowledge of EVD transmission routes and incubation period were suboptimal. Public health authorities should consider assessing residents’ understanding of Ebola transmission routes and effectively educate them to ensure correct understanding. Quarantined residents should be provided with sufficient food, water, and access to medical care. Wilken JA , Pordell P , Goode B , Jarteh R , Miller Z , Saygar BG Sr. , Maximore L , Borbor WM , Carmue M , Walker GW , Yeiah A . Knowledge, attitudes, and practices among members of households actively monitored or quarantined to prevent transmission of Ebola Virus Disease — Margibi County, Liberia: February-March 2015 . Prehosp Disaster Med . 2017 ; 32 ( 6 ): 673 – 678 .
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People in or after quarantine experienced emotional distress including annoyance, anxiety, boredom, disappointment, life dissatisfaction, fear of infection, isolation, loneliness and mistrust.
“Among people in or after quarantine, some experienced emotional distress, including: annoyance,32 anxiety,25,29 boredom,23,25,32 disappointment and life dissatisfaction,24,32,35 fear of infection,23,25,30,34 isolation,23,25,32 loneliness25,32 and mistrust.31”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [34]
Nine studies stressed how mass quarantine aggravated inequalities in individuals' access to, understanding of, and actions on prevention and control of infections.
“Nine studies stressed how mass quarantine aggravated inequalities in individuals’ access to, understanding of, and actions on prevention and control of infections.21,23–26,31–34”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [34]
Mass quarantine-induced mobility restrictions impacted every step of the food supply chain, including production, transportation, access and storage.
“Mass quarantine-induced mobility restrictions impacted every step of the food supply chain, including production,29 transportation,24,29,30 access22–24,27,29,31,34 and storage.23,29”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [34]
Another Liberian study of EVD suggested that high quarantine compliance among village residents was attributed to designated health care personnel on-site.
“Another Liberian study of EVD suggested that high quarantine compliance among village residents was attributed to designated health care personnel on-site.34”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [34]
Compared with pre-EVD situations, all villagers (n=9) with sick family members in a study of the EVD outbreak in Liberia reported full access to medical care, which was supported by local governments' medical transportation services.
“Conversely, compared with pre-EVD situations, all villagers (n = 9) with sick family members in a study of the EVD outbreak in Liberia reported full access to medical care, which was supported by local governments’ medical transportation services.34”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [34]
The majority of surveyed respondents in two studies agreed that governments should provide quarantined individuals with food, shelter and other basic needs.
“When asked about ways to increase food security, the majority of surveyed respondents in two studies agreed that governments should provide quarantined individuals with food, shelter and other basic needs.33,34”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [34]
The review found negative psychological impacts of mass quarantine, such as low life satisfaction, emotional isolation and fear of infection.
“Consistent with previous studies,10,36,37 our review presents a range of negative psychological impacts of mass quarantine, such as low life satisfaction, emotional isolation and fear of infection.23–25,30,32,34,35”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [34]
Levels of food inaccessibility were reported at 4% (n=501) in one study of the SARS outbreak in Canada and at 50% (n=16) in another study of the EVD outbreak in Liberia.
“Levels of food inaccessibility were reported at 4% (n = 501) in one study of the SARS outbreak in Canada22 and at 50% (n = 16) in another study of the EVD outbreak in Liberia.34”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [34]
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- Authors
- Wilken, J. A., Pordell, P., Goode, B., Jarteh, R., Miller, Z., Saygar, B. G., Maximore, L., Borbor, W. M., Carmue, M., Walker, G. W., & Yeiah, A.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Wilken, Jason A.
- Venue
- Prehospital and Disaster Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2017-07-27
- Volume
- 32
- Issue
- 6
- Pages
- 673-678
- ISSN
- 0882-7397 (ISSN-L)
- 1049-023X
- 1945-1938
- PMC
- PMC11318090
- OpenAlex
- W2740368168
- Cited by
- 95
- References
- 13
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 6 · 2023: 9 · 2022: 15 · 2021: 30 · 2020: 28 · 2018: 1 · 2017: 1
- FWCI
- 6.31
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Prehospital and Disaster Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (CC999999)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Outbreaks Research
- Social Sciences › Sociology and Political Science › COVID-19 Prevention and Impact
- Life Sciences › Agricultural and Biological Sciences › Agronomy and Crop Science › Animal Disease Management and Epidemiology
- Keywords
- Ebola virus disease, knowledge, attitudes and practices, quarantine, transmission routes, incubation period, community compliance, health education, Ebola outbreak response, Ebola treatment units, contact tracing
- MeSH terms
- Adult, Disease Outbreaks, Family Characteristics, Female, Humans, Interviews as Topic, Health Knowledge, Attitudes, Practice, Liberia, Male, Quarantine, Surveys and Questionnaires, Rural Population, Hemorrhagic Fever, Ebola
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