Community-centered responses to Ebola in urban Liberia: the view from below
Open accessAbstract
BACKGROUND: The West African Ebola epidemic has demonstrated that the existing range of medical and epidemiological responses to emerging disease outbreaks is insufficient, especially in post-conflict contexts with exceedingly poor healthcare infrastructures. In this context, community-based responses have proven vital for containing Ebola virus disease (EVD) and shifting the epidemic curve. Despite a surge in interest in local innovations that effectively contained the epidemic, the mechanisms for community-based response remain unclear. This study provides baseline information on community-based epidemic control priorities and identifies innovative local strategies for containing EVD in Liberia. METHODOLOGY/PRINCIPAL FINDINGS: This study was conducted in September 2014 in 15 communities in Monrovia and Montserrado County, Liberia--one of the epicenters of the Ebola outbreak. Findings from 15 focus group discussions with 386 community leaders identified strategies being undertaken and recommendations for what a community-based response to Ebola should look like under then-existing conditions. Data were collected on the following topics: prevention, surveillance, care-giving, community-based treatment and support, networks and hotlines, response teams, Ebola treatment units (ETUs) and hospitals, the management of corpses, quarantine and isolation, orphans, memorialization, and the need for community-based training and education. Findings have been presented as community-based strategies and recommendations for (1) prevention, (2) treatment and response, and (3) community sequelae and recovery. Several models for community-based management of the current Ebola outbreak were proposed. Additional findings indicate positive attitudes towards early Ebola survivors, and the need for community-based psychosocial support. CONCLUSIONS/SIGNIFICANCE: Local communities' strategies and recommendations give insight into how urban Liberian communities contained the EVD outbreak while navigating the systemic failures of the initial state and international response. Communities in urban Liberia adapted to the epidemic using multiple coping strategies. In the absence of health, infrastructural and material supports, local people engaged in self-reliance in order to contain the epidemic at the micro-social level. These innovations were regarded as necessary, but as less desirable than a well-supported health-systems based response; and were seen as involving considerable individual, social, and public health costs, including heightened vulnerability to infection.
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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 [21]
Housing conditions, poverty and the presence of health care facilities were reported as determinants of individuals' compliance with mass quarantine.
“Housing conditions, poverty and the presence of health care facilities were reported as determinants of individuals’ compliance with mass quarantine.21,24,31”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [21]
Liberian community leaders argued that, despite being aware of EVD, they could not respond effectively to EVD control without a functioning health care system.
“Liberian community leaders argued that, despite being aware of EVD, they could not respond effectively to EVD control without a functioning health care system.21”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [21]
In one study of the EVD outbreak in Liberia, some informants observed an increased number of deaths and complications from preventable health conditions, as most medical facilities within reasonable travel distances were closed.
“In one study of the EVD outbreak in Liberia, some informants observed an increased number of deaths and complications from preventable health conditions, as most medical facilities within reasonable travel distances were closed.21”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [21]
Three studies revealed changes in health-seeking behaviour during lockdowns, including reduced visits to nutrition screening, hiding treatable illnesses and seeking help from unverified sources.
“Three studies revealed changes in health-seeking behaviour during lockdowns, including reduced visits to nutrition screening, hiding treatable illnesses and seeking help from unverified sources.21,29,31”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [21]
Four studies stressed how school closures under lockdowns affected children and adolescents.
“Four studies stressed how school closures under lockdowns affected children and adolescents.21,24,25,29”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [21]
During the EVD outbreak, informants in Sierra Leone reported no schooling in general.
“During the EVD outbreak, informants in Sierra Leone reported no schooling in general, whereas several community members in Liberia took on the responsibility to educate children who had lost their parents.21,29”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [21]
Female participants described strategies for making protective equipment using available but non-standardized materials to deliver home-based care during the EVD outbreak.
“Female participants described their strategies for making protective equipment using available but non-standardized materials to deliver home-based care during the EVD outbreak.”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [21]
Three articles highlighted how mass quarantine and movement restrictions could deepen gender inequality and gender-based violence.
“Three articles highlighted how mass quarantine and movement restrictions could deepen gender inequality and gender-based violence.21,28,30”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [21]
The authors of the included study argued that women might delay visits to hospitals because being hospitalized would risk their family care responsibilities.
“The authors also argued that women might delay visits to hospitals because being hospitalized would risk their family care responsibilities.”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [21]
Abramowitz et al. described inequality of housework distribution, as women were regarded as default caregivers of children and sick family members at home.
“Abramowitz et al.21 described the inequality of housework distribution, as women were regarded as default caregivers of children and sick family members at home.”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [21]
During the EVD outbreak, several community members in Liberia took on the responsibility to educate children who had lost their parents.
“During the EVD outbreak, informants in Sierra Leone reported no schooling in general, whereas several community members in Liberia took on the responsibility to educate children who had lost their parents.21,29”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [21]
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- Authors
- Abramowitz, S. A., McLean, K. E., McKune, S. L., Bardosh, K. L., Fallah, M., Monger, J., Tehoungue, K., & Omidian, P. A.
- Affiliations
- University of Florida (US)
- Yale University (US)
- Action Contre la Faim (FR)
- Corresponding author
- McLean, Kristen E.
- ORCID
- Venue
- PLOS Neglected Tropical Diseases
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-04-09
- Volume
- 9
- Issue
- 4
- Pages
- e0003706
- ISSN
- 1935-2727 (ISSN-L)
- 1935-2735
- PMC
- PMC4391876
- OpenAlex
- W2161752078
- Cited by
- 298
- References
- 60
- Citations by year
- 2026: 16 · 2025: 16 · 2024: 18 · 2023: 20 · 2022: 21 · 2021: 41 · 2020: 72 · 2019: 19 · 2018: 16 · 2017: 26 · 2016: 25 · 2015: 7
- FWCI
- 19.47
- Type
- journal article
- Language
- en
- Update notices
- correction (2015-05-07)
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS neglected tropical diseases (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Issue Lab (Candid) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- World Health Organization
- Yale University
- UNICEF
- University of Florida
- Center for African Studies
- Topics
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Outbreaks Research
- Health Sciences › Health Professions › Emergency Medical Services › Disaster Response and Management
- Social Sciences › Sociology and Political Science › COVID-19 Prevention and Impact
- Keywords
- Ebola virus disease, Monrovia, community leaders, Ebola prevention, Ebola treatment units, community-based care, corpse management, quarantine and isolation, psychosocial support, Ebola survivors, community coping strategies, post-conflict health systems
- MeSH terms
- Communicable Disease Control, Community Health Services, Humans, Liberia, Public Health, Hemorrhagic Fever, Ebola, Epidemics
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