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Sierra Leone

Summary: Study of Effectiveness of Community-Based EVD Prevention & Management in Bo District, Sierra Leone

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Zero Ebola-related fatalities documented among the 59,000 sponsored children and family members supported by World Vision during the outbreak.

Summary

The unprecedented Ebola Virus Disease (EVD) outbreak in West Africa was first reported in Sierra Leone in March 2014 and rapidly spread as the response to the crisis failed, revealing the faults of the region’s chronically fractured and under-resourced healthcare system. However, a review of district level EVD records indicated that no Ebola-related deaths were documented among the 59,000 World Vision-supported sponsored children and their family members. World Vision, Inc. commissioned Johns Hopkins University Bloomberg School of Public Health to determine the effectiveness of specific strategies employed by World Vision in order to increase the evidence of what works in responding to similar disease outbreaks. The study also explored differences between households containing children sponsored by World Vision that had a documented case of Ebola and households without a case of Ebola.

EVD in Sierra Leone

Sierra Leone’s fragile healthcare system is a result of a civil war that ended in 2002, which severely damaged the health infrastructure and created a cohort of young adults with little or no education. Consequently, there was a severe shortage of healthcare workers as well as weak transportation infrastructure, making it difficult to transport samples to laboratories and patients to health centers. In August 2014, the World Health Organization (WHO) declared the EVD outbreak a “public health emergency of international concern.” Due to a lack of early warning systems, Ebola spread rapidly and the country’s health system lacked the capacity to address the overwhelming number of cases.
Studies demonstrated the critical role of isolation of Ebola patients and safe burials in controlling spread of the disease. But initially approaches, particularly quarantine and body collection, were designed with lack of bottom-up community engagement, and were therefore ineffective. Designed and implemented without buy-in and input from community leaders, they failed to address key infrastructure constraints and were culturally insensitive. This resulted in general distrust among community members, and, ultimately, underutilization, and underuse of these interventions. By March 2016, WHO had documented a total of 14,124 cases of Ebola, including 3,955 deaths, in Sierra Leone— more than any other country.