July 12, 2015
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Liberians struggle to identify Ebola

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Residents of Liberia may have great awareness about Ebola transmission, but a majority are not confident about identifying symptoms of the disease, according to research published in MMWR.

“Liberia successfully achieved Ebola transmission-free status, with no new Ebola cases occurring during a 42-day period; however new Ebola cases were reported beginning June 29, 2015,” Miwako Kobayashi, MD, epidemic intelligence officer at the CDC, and colleagues wrote. “Local cultural practices and beliefs have posed challenges to disease control and, therefore, targeted, timely messages are needed to address practices and misconceptions that might hinder efforts to stop the spread of Ebola.”

CDC epidemiologists and local volunteer interviewers conducted a knowledge, attitudes and practices (KAP) survey of 609 respondents — including some Ebola survivors — from five Liberian counties from Sept. 17, 2014 to Oct. 11, 2014. Bong and Margibi counties had high incidence of Ebola with 482 and 229 cases, respectively, while Maryland, River Gee and Sinoe were considered to have low incidence with 26 combined cases, according to the researchers.

Respondents chose the preferred response to 17 questions about Ebola transmission a median of 16 times. With the exception of one question: “I can get Ebola from a healthy (asymptomatic) person,” to which 40% agreed, respondents chose the preferred response for each question at least 80.8% of the time.

Respondents from low-incidence counties (LICs) tended to score lower on questions related to Ebola transmission than those in high-incidence counties (HICs). Some of the largest discrepancies included the danger of contracting Ebola by eating bush meat (74.5% of LIC respondents agreed, which was the preferred response, compared with 85.8% of HIC respondents) and the possibility of contracting the disease via a spell or curse (34.8% of LIC respondents agreed instead of selecting the preferred response, disagree, compared with 7.4% of HIC respondents).

In terms of attitudes, only 61% of respondents indicated they would know if they experienced Ebola symptoms, and 40.5% expressed fear of Ebola survivors. While HIC and LIC respondents expressed a similar degree of difficulty in identifying symptoms, 47.8% of LIC respondents expressed fear of Ebola survivors, compared with 34.6% of HIC respondents, the researchers said.

“The Ebola KAP is believed to be the first survey that was conducted during the Ebola outbreak to assess the effectiveness of initial Ebola messaging at the community level across a wide geographical area in Liberia,” Kobayashi and colleagues wrote. “The recent recurrence of Ebola cases in Liberia highlights the continued risk for transmission in the region. Future health awareness activities, especially in Guinea and Sierra Leone where the epidemic is not fully contained, might benefit from emphasizing the signs and symptoms of Ebola, addressing fears about seeking treatment, and placing additional focus on counties and communities where incidence of Ebola is low as a preparedness measure.” – by David Jwanier

Disclosure: The researchers report no relevant financial disclosures.