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Published on: September 27, 2014
The Effect of Community-Based Prevention and Care on Ebola Transmission in Sierra Leone
Paul Pronyk1, Braeden Rogers1, Sylvia Lee1
1Paul Pronyk, Braeden Rogers, Mickey Chopra, David Hipgrave, and Peter Salama are with UNICEF Headquarters, New York, NY. Paul Pronyk is also with the School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. Sylvia Lee, Aarunima Bhatnagar, Yaron Wolman, and Roeland Monasch are with UNICEF Sierra Leone, Freetown. Adam Kucharski is with Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England.
Objectives:
To examine the acceptability, use, effects on early isolation, and contribution to Ebola virus disease (EVD) transmission of Community Care Centers (CCCs), which were rapidly deployed in Sierra Leone during an accelerated phase of the 2014-2015 EVD epidemic.
Methods:
Focus group discussions, triads, and key informant interviews assessed acceptability of the CCCs. Facility registers, structured questionnaires, and laboratory records documented use, admission, and case identification. We estimated transmission effects by comparing time between symptom onset and isolation at CCCs relative to other facilities with the national Viral Hemorrhagic Fever data set.
Results:
Between November 2014 and January 2015, 46 CCCs were operational. Over 13 epidemic weeks, 6129 patients were triaged identifying 719 (12%) EVD suspects. Community acceptance was high despite initial mistrust. Nearly all patients presented to CCCs outside the national alert system. Isolation of EVD suspects within 4 days of symptoms was higher in CCCs compared with other facilities (85% vs 49%; odds ratio = 6.0; 95% confidence interval = 4.0, 9.1), contributing to a 13% to 32% reduction in the EVD reproduction number (Ro).
Conclusions:
Community-based approaches to prevention and care can reduce Ebola transmission.
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