DD SG3- Ebola in Liberia, Sierra Leone, Guinea 2014-16

prevalence

total number of people in a population who have a disease or health condition at a certain point in time

incidence

number of new cases of a disease in a population during a specific time period

where and when did the outbreak start?

Dec 2013 with the death of a 2 year old boy in Meliandou (small village) in SE Guinea

countries affected

Guinea

Liberia

Sierra Leone

(UK had 2 cases after 2 volunteer nurses returned but were detected at the airport + put on drug trials + survived)

how did ebola spread + pattern of the outbreak

spread through direct contact with bodily fluids of infected people or infected fruit bats or contaminated objects (contagious diffusion)

disease spread with population movement between villages + cities(e.g. attending funerals) + across the porous borders into Sierra Leone + Liberia (spread outwards but remained highest at source) (expansion diffusion)

environmental factors causing the outbreak

fruit bats are host for ebola virus. contact with blood or bodily fluids led to ebola in human population

forest location of outbreak- SE Guinea village surrounded by bat habitat

tropical wet + dry climate- lots of forest food for bats in wet seasons, but in dry seasons, bats move closer to villages to look for food, increasing contact between bats + humans

climate change- dry season exaggerated, followed by abundance of rainfall + more fruit coincided with outbreak

human factors causing the outbreak

mobile population- migrant workers e.g. miners working in deforested areas returned to the city so spread in urban areas- civil war lead to a displaced population in unhealthy slums- 70% in Freetown (Sierra Leone) live in USS

deforestation + mining- humans came in close contact with bats

poverty- hunted for bat meat- free source of food. LIDCs had basic access to healthcare + sanitation facilities e.g. Liberia only has 1 doctor for every 100,000 people

civil war in Sierra Leone in 1991 + 2002 meant healthcare systems had collapsed

cultural practices- e.g. social greetings of hugging + hand shaking. funeral ritual of touching + kissing the body (e.g. one funeral lead to over 365 ebola cases)

Socio-economic impacts

Agriculture

Economic decline

Children + education

Reduced access to healthcare

Road blocks + quarantine checkpoints

stigma

Socio-economic impacts- agriculrure

40% of farms were abandoned in Sierra Leone (fear of infection)

Rice crops shortages caused 30% increase in prices in Sierra Leone

25% of households struggled to afford high food prices (food insecurity) = more hunger = lower ability to farm = lower household income (PFL)

80% of Sierra Leone’s population are farmers

Outbreak = lower productivity

Socio-economic impacts- economic decline

Loss of tourism

Businesses closed

Neighbouring countries closed borders so loss of trade

Farmers unable to sell produce

Liberia is the poorest country + suffered the biggest GDP losses = 11% of GDP

Sierra Leone = 4% loss of GDP = less devastating as richer of 3 countries but still LIDC

Direct + indirect costs

Guinea = 1.5% loss of GDP

Socio-economic impacts- children + education

10,000 children lost one or both parents to ebola in West Africa- 8,000 of these children were from Sierra Leone

7-8 months of school closures

5 million children across the 3 countries had their education affected by school closures- on re-opening, temps of children taken before entry

Less likely to return to school = long-term poverty

Some relatives refused to take in children = emotionally affected

Socio-economic impacts- reduced access to healthcare

Hospitals prioritised ebola so other diseases were neglected

500 health workers infected + 300 died = weakened long-term healthcare

Socio-economic impacts- road blocks + quarantine checkpoints

Restricted movements made socio-economic impacts worse e.g. farmers couldn’t sell at market = food shortages + economic decline, access to healthcare worsened as many hospitals are in cities so people have to travel from villages

Socio-economic impacts- stigma

Survivors rejected by families + community, faced threats of violence, lost incomes, hid symptoms + avoided healthcare workers

Direct responses used by gov and international agencies to mitigate the disease + respond to the outbreak

Ebola Treatment Units (ETUs)

Personal Protective Equipment (PPE)

Dead body management teams

Banning bat consumption

How were Ebola Treatment Units (ETUs) used as a direct response

Set up by NGOs such as Red Cross + MSF

Visitors not allowed

PPE worn

MSF deployed 3,900 medical staff

How was Personal Protective Equipment (PPE) used as a direct response

WHO recommended people in patients room should wear PPE (e.g. masks, gloves etc.)

How were dead body management teams used as a direct response

Red Cross followed procedure recommended by WHO = spray body with chlorine, place in at least 2 body bags + anything which touched body was burnt or buried as well as cremating the body

How was banning bat consumption used as a direct response

Officials in Guinea banned consumption + sales of bats after outbreak in region

Indirect responses used by gov + internationa agencies to mitigate against the disease and respond to the outbreak

Community awareness

Schools closed + careful reopening

National state of emergency

Contact tracing

Temperature screening

How was community awareness used as an indirect response

Educated on Ebola by NGO volunteers + locally educated people (task forces) e.g. posters, street drama (for illiterate). A song ‘Ebola is Real’ also released. Taught to ‘protect yourself, family + community’

How was school closures + careful reopening used as an indirect response

Closed for 8 months + reopened when there were safety measures

How were national state of emergencies used as an indirect response

All 3 governments declared state of emergency

Guinea = army enforcing travel restrictions through roadblocks

Liberia = night-time curfew enforced by troops + placed the capital, Monrovia, under quarantine

How was contact tracing used as an indirect response

Used to identify, monitor + treat new ebola cases quickly for anyone who came in direct contact

Contacts were watched for signs of illness for 21 days

How was temperature screening used as an indirect response

For air passengers arriving in UK + USA + asking questions about their health

Some countries banned flights from ebola affected countries

WHO response in March 2014

Activated Global Outbreak Alert + Response Network (GOARN)

Set up response roadmap reports where scientists looked at causes of the disease + the response required to control it

WHO response in August 2014

Declared ebola as a Public Health Emergency of International Concern (PHEIC) coordinating a global response = extra staff, tighter border checks + more donor funding

Direct strategies implemented by the WHO

‘70-70-60’ target launched in early 2014 = 70% of ebola patients put in isolation hospitals or ETUs, 70% of bodies done as safe burials within 60 days

Advised health workers follow strict protocols e.g. must wear PPE, have regular health checks + be trained in strict dead body-handling protocols

Encouraged internationa donations + NGOs to fund the setting up of ETUs

Indirect strategies implemented by the WHO

Deployed medical experts + health workers to support affected West African countries. They helped with more laboratories for rapid diagnosis, epidemiological mapping + contact tracing to reduce transmission

Advised the gov on public information campaigns to tackle fear, rumours + mistrust

Improved cross-border coordination between the gov of the 3 countries e.g. to share data on case numbers, set up checkpoints to take temp of people crossing the border, ensure contact tracing teams communicated across the border

Strategies used by the Red Cross

Raised £8.8 million to help tackle ebola in Sierra Leone

Trained over 1,600 local volunteers to support the ebola response

Educated 2.8 million people through dama events, text messages + door-to-door visits

Carried out contact tracing for 49,000 people

Trained teams to conduct safe burials, handling 78% of ebola related deaths, reducing further spread

Set up a 60-bed treatment centre in Kenema

Evidence that strategies have been effective