Abstract
During the initial phase of the 2014–2016 Ebola virus disease (EVD) outbreak in Monrovia, Liberia, all hospitals’ isolation capacities were overwhelmed by the sheer caseload. As a stop-gap measure to halt transmission, Medecins sans Frontieres (MSF) distributed household disinfection kits to those who were at high risk of EVD contamination. The kit contained chlorine and personal protective materials to be used for the care of a sick person or the handling of a dead body. This intervention was novel and controversial for MSF. This paper shed the light on this experience of distribution in Monrovia and assess if kits were properly used by recipients. Targeted distribution was conducted to those at high risk of EVD (relatives of confirmed EVD cases) and health staff. Mass distributions were also conducted to households in the most EVD affected urban districts. A health promotion strategy focused on the purpose and use of the kit was integrated into the distribution. Follow-up phone calls to recipients were conducted to enquire about the use of the kit. Overall, 65,609 kits were distributed between September and November 2014. A total of 1,386 recipients were reached by phone. A total of 60 cases of sickness and/or death occurred in households who received a kit. The majority of these (46, 10%) were in households of relatives of confirmed EVD cases. Overall, usage of the kits was documented in 56 out of 60 affected households. Out of the 1322 households that did not experience sickness and/or death after the distribution, 583 (44%) made use of elements of the kit, mainly (94%) chlorine for hand-washing. At the peak of an EVD outbreak, the distribution of household disinfection kits was feasible and kits were appropriately used by the majority of recipients. In similar circumstances in the future, the intervention should be considered.
Highlights
The West Africa Ebola Virus Disease (EVD) outbreak in 2014–2016 was the first and so far only EVD outbreak to affect several major urban areas
Medecins Sans Frontières (MSF) was one of the first international organisations responding to the EVD outbreak in the overcrowded urban context of Monrovia
Even while MSF was setting up its largest-ever Ebola Treatment Centre (ETC), ELWA3, it found itself in the unprecedented situation of having to send ill patients home, as there was nowhere they could be isolated [4,5]
Summary
The West Africa Ebola Virus Disease (EVD) outbreak in 2014–2016 was the first and so far only EVD outbreak to affect several major urban areas. Liberia was one of the worst affected countries, with the capital Monrovia seeing a rapid spiralling of EVD cases from August 2014 onwards. By the end of the outbreak in Liberia, in June 2016, 10,678 EVD cases had been declared, and 4810 deaths had occurred [1,2]. Medecins Sans Frontières (MSF) was one of the first international organisations responding to the EVD outbreak in the overcrowded urban context of Monrovia. The MSF outbreak management strategy incorporates case isolation, contact tracing, outreach activities, safe burials, health promotion, and psycho-social support [3], though MSF does not necessarily perform each of these activities itself. In the initial phase of the outbreak in Monrovia (August 2014), the health system failed as all hospitals’ isolation capacities were overwhelmed by the sheer caseload.
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