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Trust, fear, stigma and disruptions: community perceptions and experiences during periods of low but ongoing transmission of Ebola virus disease in Sierra Leone, 2015
  1. Azizeh Nuriddin1,
  2. Mohamed F Jalloh2,
  3. Erika Meyer2,
  4. Rebecca Bunnell2,
  5. Franklin A Bio3,
  6. Mohammad B Jalloh4,
  7. Paul Sengeh3,
  8. Kathy M Hageman5,
  9. Dianna D Carroll6,
  10. Lansana Conteh7,
  11. Oliver Morgan8
  1. 1Program Performance and Evaluation Office, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  3. 3Research and Evaluation, FOCUS 1000, Freetown, Sierra Leone
  4. 4FOCUS 1000, Freetown, Sierra Leone
  5. 5Epidemiology and Strategic Information Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  6. 6National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  7. 7Health Education Division, Ministry of Health and Sanitation, Freetown, Sierra Leone
  8. 8Health Emergencies Programme, World Health Organization, Geneva, Switzerland
  1. Correspondence to Ms. Azizeh Nuriddin; irp7{at}


Social mobilisation and risk communication were essential to the 2014–2015 West African Ebola response. By March 2015, >8500 Ebola cases and 3370 Ebola deaths were confirmed in Sierra Leone. Response efforts were focused on ‘getting to zero and staying at zero’. A critical component of this plan was to deepen and sustain community engagement. Several national quantitative studies conducted during this time revealed Ebola knowledge, personal prevention practices and traditional burial procedures improved as the outbreak waned, but healthcare system challenges were also noted. Few qualitative studies have examined these combined factors, along with survivor stigma during periods of ongoing transmission. To obtain an in-depth understanding of people’s perceptions, attitudes and behaviours associated with Ebola transmission risks, 27 focus groups were conducted between April and May 2015 with adult Sierra Leonean community members on: trust in the healthcare system, interactions with Ebola survivors, impact of Ebola on lives and livelihood, and barriers and facilitators to ending the outbreak. Participants perceived that as healthcare practices and facilities improved, so did community trust. Resource management remained a noted concern. Perceptions of survivors ranged from sympathy and empathy to fear and stigmatisation. Barriers included persistent denial of ongoing Ebola transmission, secret burials and movement across porous borders. Facilitators included personal protective actions, consistent messaging and the inclusion of women and survivors in the response. Understanding community experiences during the devastating Ebola epidemic provides practical lessons for engaging similar communities in risk communication and social mobilisation during future outbreaks and public health emergencies.

  • community
  • ebola
  • epidemic
  • outbreak
  • Sierra Leone
  • survivors
  • West Africa

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  • Handling editor Seye Abimbola

  • Contributors AN and MFJ co-led the design, implementation, analysis and write-up of the manuscript. EM played a key role in preparing the manuscript with the lead authors and is responsible for coordinating all reviewers’ feedback. RB contributed extensively to the design of the study and instruments, and provided detailed feedback on all versions of the manuscript including reorganising themes for clarity and public health significance. OM is the principal investigator and contributed to the conceptualisation and design of the study. All authors contributed to the preparation of the manuscript and supported the interpretation of the qualitative data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The Sierra Leone Ethics and Scientific Review Committee reviewed and approved the protocol. The CDC Human Subjects Research Office also approved the project as a routine public health activity for disease control.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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