A qualitative study to understand how Ebola virus disease affected nutrition in Sierra Leone – a food value-chain framework for improving future response strategies
Open accessAbstract
BACKGROUND: This study sought understand how the 2014-2016 EVD Virus Disease (EVD) outbreak impacted the nutrition sector in Sierra Leone and use findings for improving nutrition responses during future outbreaks of this magnitude. METHODOLOGY: This qualitative study was iterative and emergent. In-depth interviews (n = 42) were conducted over two phases by purposively sampling both key informants (n = 21; government stakeholders, management staff from United Nations (UN) agencies and non-governmental organizations (NGO)), as well as community informants (n = 21; EVD survivors, health workers, community leaders) until data saturation. Multiple analysts collaborated in a team-based coding approach to identify key themes using Dedoose software. Findings are presented as both quotations and tables/figures. RESULTS: The EVD outbreak effects and the related response strategies, especially movement restriction policies including 21-day quarantines, contributed to disruptions across the food value-chain in Sierra Leone. System-wide impacts were similar to those typically seen in large-scale disasters such as earthquakes. Participants described an array of direct and indirect effects on agricultural production and food storage and processing, as well as on distribution, transport, trade, and retailing. Secondary data were triangulated by interviews which described the aggregate negative effect of this outbreak on key pillars of food security, infant and young child feeding practices, and nutrition. During the humanitarian response, nutrition-specific interventions, including food assistance, were highly accepted, although sharing was reported. Despite EVD impacts across the entire food value-chain, nutrition-sensitive interventions were not central to the initial response as EVD containment and survival took priority. Culturally-appropriate social and behavior change communications were a critical response component for improving health, nutrition, and hygiene-related behaviors through community engagement. CONCLUSIONS: Infectious diseases such as EVD have far-reaching effects that impact health and nutrition through interrelated pathways. In Sierra Leone, the entire food value-chain was broken to the extent that the system-wide damage was on par with that typically resulting from large natural disasters. A food value-chain approach, at minimum, offers a foundational framework from which to position nutrition preparedness and response efforts for outbreaks in similar resource constrained settings.
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Altruistic attitudes during mass quarantine were reported in three studies.
“In contrast, altruistic attitudes during mass quarantine were reported in three studies.”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [29]
Survivors of EVD in Sierra Leone experienced rejection from food sellers.
“One study mentioned that survivors of EVD in Sierra Leone experienced rejection from food sellers.29”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [29]
Interviewees mentioned community members offered emotional support and took care of orphans during mass quarantine in the Toronto SARS epidemic and Liberia EVD outbreak.
“Interviewees mentioned how community members offered emotional support and took care of orphans during the mass quarantine in the Toronto SARS epidemic and in the Liberia EVD outbreak, respectively.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 [29]
Eleven articles highlighted the psychological implications of mass quarantine as emotional distress and symptoms of mental illness.
“Eleven articles from various geographical and disease contexts highlighted the psychological implications of mass quarantine as emotional distress and symptoms of mental illness.22–25,27–32,35”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [29]
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 [29]
Interviewees in Sierra Leone worried about their own food stock, whereas some Canadians were concerned about how others in economic difficulties preserved food under movement restrictions.
“Regarding food storage, interviewees in Sierra Leone worried about their own food stock,29 whereas some Canadians were concerned about how others in economic difficulties preserved food under movement restrictions.23”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [29]
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 [29]
One study identified that because the quarantine period overlapped with the harvest season, workers and farmers could not travel to their field for harvesting agricultural products, which created downstream effects on the food system.
“One study identified that, because the quarantine period overlapped with the harvest season, workers and farmers could not travel to their filed for harvesting agricultural products, which then created downstream effects on the food system.29”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [29]
A qualitative study reported that residents in Sierra Leone during the EVD outbreak were unable to work due to village-based quarantine, which further impacted labour force supply and the agricultural cycle.
“A qualitative study reported that residents in Sierra Leone during the EVD outbreak were unable to work due to village-based quarantine, which further impacted labour force supply and the agricultural cycle.29”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [29]
Kodish et al. indicated that decreased production of grains and reduced mobility of traders interrupted the domestic and international flow of agriculture trade.
“They indicated that decreased production of grains and reduced mobility of traders interrupted the domestic and international flow of agriculture trade.”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [29]
Three studies reported that travel bans during mass quarantine might impact agricultural production, leisure business and tourism.
“Three studies reported that travel bans during mass quarantine might impact agricultural production, leisure business and tourism.22,26,29”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [29]
Loss of income following unemployment was the key consequence raised in qualitative research on the SARS and EVD outbreak.
“Loss of income following unemployment was the key consequence raised in qualitative research on the SARS and 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 [29]
Their results highlighted the interconnectivity between the business economy and employment.
“Their results highlighted the interconnectivity between the business economy and employment.”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [29]
Kodish et al. underlined a drastic shift in public health priorities, as EVD management entirely replaced existing nutrition screening programmes at the beginning of the outbreak.
“Kodish et al.29 underlined a drastic shift in public health priorities, as EVD management entirely replaced existing nutrition screening programmes at the beginning of the outbreak.”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [29]
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 [29]
They underscored that the reported reduction in malnutrition screenings resulted from movement restrictions under quarantine, behaviour changes in service users due to lack of trust and resource competition between the EVD outbreak management and humanitarian nutrition programmes.
“They underscored that the reported reduction in malnutrition screenings resulted from movement restrictions under quarantine, behaviour changes in service users due to lack of trust and resource competition between the EVD outbreak management and humanitarian nutrition programmes, both of which were vital to survival.”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [29]
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 [29]
Mass quarantine undermines public trust in governments.
“Our results highlight the unintended and negative impacts of mass quarantine, including reinforcing stigma against social minorities,31 aggravating misinformation31,46 and undermining public trust in governments.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 [29]
Altruism was identified as a positive consequence from research on the EVD and SARS outbreaks.
“In contrast to negative implications, altruism was identified as a positive consequence from research on the EVD and SARS outbreaks.23,29,33”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [29]
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 [29]
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 [29]
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West African food system resilience
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Crafting a resilient and sustainable future amid major crises
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Emerging ethical challenges in researching vulnerable groups during the COVID-19
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Food as a transmitter of viruses: A review
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The Effects of Cultural Factors on Food Assistance After Disaster: A Scoping Review
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Self-citation
- Authors
- Kodish, S. R., Bio, F., Oemcke, R., Conteh, J., Beauliere, J. M., Pyne-Bailey, S., Rohner, F., Ngnie-Teta, I., Jalloh, M. B., & Wirth, J. P.
- Affiliations
- Ministry of Health and Sanitation (SL)
- Corresponding author
- Kodish, Stephen R.
- Venue
- PLOS Neglected Tropical Diseases
- Publisher
- Public Library of Science (PLoS)
- Published
- 2019-09-10
- Volume
- 13
- Issue
- 9
- Pages
- e0007645
- ISSN
- 1935-2727 (ISSN-L)
- 1935-2735
- PMC
- PMC6736239
- OpenAlex
- W2973140134
- Cited by
- 44
- References
- 48
- Citations by year
- 2026: 1 · 2025: 5 · 2023: 7 · 2022: 7 · 2021: 13 · 2020: 11
- FWCI
- 5.88
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS neglected tropical diseases (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- UNICEF
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Health Professions › Emergency Medical Services › Disaster Response and Management
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Outbreaks Research
- Keywords
- Ebola virus disease, 2014-2016 Ebola outbreak, food value chains, food security, nutrition, humanitarian response, infant and young child feeding, nutrition-sensitive interventions, nutrition-specific interventions, food aid, social and behavior change communication, epidemic preparedness, Sierra Leone
- MeSH terms
- Crop Production, Child, Preschool, Disease Outbreaks, Food Supply, Food-Processing Industry, Humans, Infant, Nutritional Status, Quarantine, Sierra Leone, Hemorrhagic Fever, Ebola, Ebolavirus, Qualitative Research
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