National survey of Ebola-related knowledge, attitudes and practices before the outbreak peak in Sierra Leone: August 2014

Abstract

BackgroundThe 2014–2015 Ebola epidemic in West Africa was the largest ever to occur. In the early phases, little was known about public knowledge, attitudes and practices (KAP) relating to Ebola virus disease (Ebola). Data were needed to develop evidence-driven strategies to address gaps in knowledge and practice.MethodsIn August 2014, we conducted interviews with 1413 randomly selected respondents from 9 out of 14 districts in Sierra Leone using multistage cluster sampling. Where suitable, Ebola-related KAP questions were adapted from other internationally validated questionnaires related to infectious diseases.ResultsAll respondents were aware of Ebola. When asked unprompted, 60% of respondents could correctly cite fever, diarrhoea and vomiting as signs/symptoms of Ebola. A majority of respondents knew that avoiding infected blood and bodily fluids (87%) and contact with an infected corpse (85%) could prevent Ebola. However, there were also widespread misconceptions such as the belief that Ebola can be prevented by washing with salt and hot water (41%). Almost everyone interviewed (95%) expressed at least one discriminatory attitude towards Ebola survivors. Unprompted, self-reported actions taken to avoid Ebola infection included handwashing with soap (66%) and avoiding physical contact with patients with suspected Ebola (40%).ConclusionThree months into the 2014 Ebola outbreak in Sierra Leone, our findings suggest there was high awareness of the disease but misconceptions and discriminatory attitudes toward survivors remained common. These findings directly informed the development of a national social mobilisation strategy and demonstrated the importance of KAP assessment early in an epidemic.

An assessment of Ebola-related stigma and its association with informal healthcare utilisation among Ebola survivors in Sierra Leone: a cross-sectional study

“…Our finding may be explained by the fact that adherence to local bylaws to prevent stigma and discrimination by the community was more prevalent in rural areas compared to urban areas [59]. Also, previously identified urban-rural community differences in knowledge and perception of, and attitude towards, EVD may also explain our finding [60]. Our study also revealed that EVD survivors who are unemployed were more likely to be socially isolated by their communities than their counterparts who were employed.…”

Knowledge, Attitudes and Practices towards Ebola Virus Disease among Participants in an Ebola Vaccine Trial in Dakar, Senegal

“…The knowledge of the reservoir of EVD was very high in our study as well as that of Jalloh & al. [10] unlike what was reported in Uganda [9]. The main sources of transmission found in our study but also in others, were monkeys and bats [9,19].…”

“…The level of knowledge of vaccine trial participants regarding the main modes of transmission of EVD was very low as previously demonstrated in the same area [13] and also elsewhere [14,15]. Some misconceptions are persistent such as transmission by air or by bank notes and had already been highlighted in other studies [10,11,13,[15][16][17].…”

“…During this period, many commercials were broadcast and messages delivered on symptoms and preventive measures of EVD. This is another testimony that television or radio are the preferential channels for health information in our regions [9][10][11] unlike the USA where the main source of information was internet [12]. Interposal communication at work or in the neighbouring was another important source of information; however the quality of this information was not certified.…”

Arguing from Ignorance

“…Indicators of ignorance about health are easy to find. Jalloh et al (2017) interviewed 1413 randomly selected respondents from 9 out of 14 districts in Sierra Leone about their knowledge of Ebola three months into the 2014 outbreak. Only 42% of respondents linked Ebola to a virus.…”