Community-based reports of morbidity, mortality, and health-seeking behaviours in four Monrovia communities during the West African Ebola epidemic

ABSTRACT

The goal of this study was to assess morbidity, mortality, and health-seeking behaviours during the 2014 Ebola outbreak in Monrovia, Liberia. This study examined commonly reported symptoms of illness, pre-clinical diagnostic practices, typical healthcare-seeking strategies, and health resources available to populations, in order to identify salient needs and gaps in healthcare that would inform local emergency response efforts. Semi-structured interviews were conducted with household members in four Monrovia neighbourhoods. Researchers used a multi-stage cluster approach to recruit participants. Within 555 households sampled, 505 individuals were reported sick (69%) or recently sick (38%) or deceased (7%). Common self-diagnoses included malaria, hypertension, influenza, typhoid, and Ebola. The most cited health-seeking strategy was to purchase medications from the private sector. Respondents also obtained healthcare from community members known to have medical experience. Findings suggest that non-formal healthcare systems played an important role in managing morbidity during the West African Ebola virus disease (EVD) outbreak. Lay community members engaged in complex assessments of health symptoms and sought biomedical care at rates perhaps higher than anticipated during the response. This study highlights how informal networks of healthcare providers can play an important role in preventing and curbing future emerging disease outbreaks.

KEYWORDS:

• Community-based response
• Ebola virus disease (EVD)
• morbidity
• health-seeking behaviour
• Liberia

Acknowledgements

We are grateful to the World Health Organization (WHO), and especially to Alex Ntale Gasasira – WHO Representative for Liberia, and the Government of Liberia for making this study possible. We also want to acknowledge the RAs contracted by the WHO to assist with data collection: Momo M. Kpehe, Theresa Weah, Theophilus Sieka, Konah L. Kennedy, Romel Blamo, Clementia G. Forh, Jesse S. Colendo, and Edvida B. Davis. We also very much appreciate the support of the Ebola Anthropology Initiative and the Ebola Response Anthropology Platform. Finally, we would like to thank the University of Florida International Center’s Global Health Council, the Center for African Studies at the University of Florida, the Health in Africa Working Group and the Ebola Research Group at the University of Florida. A special thanks also goes to Juliet Bedford, Julianne Weis, Nell Gray, Kristen Childers-Buschle, and Kerrie Thornhill from Anthrologica (www.anthrologica.com) for their assistance with the cleaning and coding of data presented in this article. All conclusions and opinions are those of the authors and do not reflect the official position of the WHO or Anthrologica.

Disclosure statement

There are no potential conflicts of interest reported by authors.

Additional information

Funding

The authors would like to acknowledge the World Health Organization (WHO) for funding this medical anthropology study of the Ebola Virus Disease (EVD) outbreak in Liberia, West Africa.