Ebola Outbreak In West Africa Research Articles

Assessing the Concepts and Designs of 58 Mobile Apps for the Management of the 2014-2015 West Africa Ebola Outbreak: Systematic Review.

BackgroundThe use of mobile phone information technology (IT) in the health sector has received much attention especially during the 2014-2015 Ebola virus disease (EVD) outbreak. mHealth can be attributed to a major improvement in EVD control, but there lacks an overview of what kinds of tools were available and used based on the functionalities they offer.ObjectiveWe aimed to conduct a systematic review of mHealth tools in the context of the recent EVD outbreak to identify the most promising approaches and guide further mHealth developments for infectious disease control.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched for all reports on mHealth tools developed in the context of the 2014-2015 EVD outbreak published between January 1, 2014 and December 31, 2015 on Google Scholar, MEDLINE, CAB s (Global Health), POPLINE, and Web of Science in any language using the search strategy: (“outbreak” OR “epidemic”) AND (“mobile phone” OR “smartphone” OR “smart phone” OR “mobile phone” OR “tablet” OR “mHealth”) AND (“Ebola” OR ”EVD” OR “VHF” OR “Ebola virus disease” OR “viral hemorrhagic fever”) AND (“2014” OR “2015”). The relevant publications were selected by 2 independent reviewers who applied a standardized data extraction form on the tools’ functionalities.ResultsWe identified 1220 publications through the search strategy, of which 6.31% (77/1220) were original publications reporting on 58 specific mHealth tools in the context of the EVD outbreak. Of these, 62% (34/55) offered functionalities for surveillance, 22% (10/45) for case management, 18% (7/38) for contact tracing, and 6% (3/51) for laboratory data management. Only 3 tools, namely Community Care, Sense Ebola Followup, and Surveillance and Outbreak Response Management and Analysis System supported all four of these functionalities.ConclusionsAmong the 58 identified tools related to EVD management in 2014 and 2015, only 3 appeared to contain all 4 key functionalities relevant for the response to EVD outbreaks and may be most promising for further development.

Community-informed research on malaria in pregnancy in Monrovia, Liberia: a grounded theory study

BackgroundLiberia is a West African country that needs substantial investment to strengthen its National Malaria Control Programme (NMCP), which was disrupted during the 2014–2016 Ebola epidemic. As elsewhere, Liberian pregnant women are especially vulnerable to malaria. Understanding prevention and treatment-seeking behaviours among the population is crucial to strategize context-specific and women-centred actions, including locally-led malaria research, to improve women’s demand, access and use of NMCP strategies against malaria in pregnancy.MethodsIn 2016, after the Ebola crisis, a qualitative inquiry was conducted in Monrovia to explore populations’ insights on the aetiology, prevention and therapeutics of malaria, as well as the community and health workers’ perceptions on the utility of malaria research for pregnant women. In-depth interviews and focus group discussions were conducted among pregnant women, traditional community representatives and hospital staff (n = 38), using a feminist interpretation of grounded theory.ResultsThe narratives indicate that some Liberians believed in elements other than mosquito bites as causes of malaria; many had a low malaria risk perception and disliked current effective prevention methods, such as insecticide-treated nets; and some would resort to traditional medicine and spiritual care to cure malaria. Access to clinic-based malaria care for pregnant women was reportedly hindered by lack of financial means, by unofficial user fees requested by healthcare workers, and by male partners’ preference for traditional medicine. The participants suggested that malaria research in Liberia could help to design evidence-based education to change current malaria prevention, diagnostic and treatment-seeking attitudes, and to develop more acceptable prevention technologies.ConclusionPoverty, insufficient education on malaria, corruption, and poor trust in healthcare establishment are structural factors that may play a greater role than local traditional beliefs in deterring Liberians from seeking, accessing and using government-endorsed malaria control strategies. To increase access to and uptake of preventive and biomedical care by pregnant women, future malaria research must be informed by people’s expressed needs and constructed meanings and values on health, ill health and healthcare.

Global Bioheroes: clinical research and new vaccines for health security

ABSTRACTIn the pursuit of ‘global health security’, some governments advocate deployment of pharmaceuticals to combat deadly infectious diseases wherever they emerge. Following the Ebola outbreak in West Africa, attention has turned to other emerging diseases and future pharmaceutical solutions. There is growing support for enabling faster clinical research to make new vaccines available sooner. Research on experimental vaccines must ordinarily be consistent with ethical principles designed to protect human research participants. However, where a target disease is framed in security terms, it could be argued that an extraordinary response is required: exposing research participants to more risk in order to accelerate research and enable more lives to be saved pharmaceutically. This article assesses two scenarios of security-oriented research. The scenario envisaged by the Coalition for Epidemic Preparedness Innovations (CEPI) is the propelling of vaccine research through to the stage of human safety-testing before a natural outbreak of the relevant disease. Efficacy and effectiveness tests are then able to be conducted once an outbreak begins. In a hypothetical second scenario, pre-outbreak vaccine research undertaken for the sake of health security would also include efficacy-testing. This would involve the exposure to pathogenic microorganisms of healthy volunteers (‘global bioheroes’) from around the world.

The Economic and Social Burden of the 2014 Ebola Outbreak in West Africa

The 2014 Ebola virus disease (EVD) outbreak in West Africa was more devastating than all previous EVD outbreaks combined; however, many estimates of its economic burden did not capture its significant social costs. This study aimed to review all currently available estimates, identify social components missed by these estimates, and generate a comprehensive cost of the 2014 EVD outbreak. We conducted a systematic review of the grey (reports produced by nonprofit or nongovernmental organizations, government, or industry) and published literature to identify current estimates of the burden of the outbreak. Based on the findings of this review, we identified 6 key areas absent or underestimated from previous estimates and calculated the underestimated social costs using estimates from the literature and extrapolation. Current estimates of the economic burden of the outbreak range from $2.8 to $32.6 billion in lost gross domestic product. We estimated the comprehensive economic and social burden from the 2014 EVD outbreak to be $53.19 billion (2014 USD). The most significant component, $18.8 billion, was deaths from non-Ebola causes. A more complete understanding of the burden of the 2014 EVD outbreak underscores the value of interventions that can mitigate or reduce the severity of future outbreaks.

Tracking health seeking behavior during an Ebola outbreak via mobile phones and SMS

The recent Ebola outbreak in West Africa was an exemplar for the need to rapidly measure population-level health-seeking behaviors, in order to understand healthcare utilization during emergency situations. Taking advantage of the high prevalence of mobile phones, we deployed a national SMS-poll and collected data about individual-level health and health-seeking behavior throughout the outbreak from 6694 individuals from March to June 2015 in Liberia. Using propensity score matching to generate balanced subsamples, we compared outcomes in our survey to those from a recent household survey (the 2013 Liberian Demographic Health Survey). We found that the matched subgroups had similar patterns of delivery location in aggregate, and utilizing data on the date of birth, we were able to show that facility-based deliveries were significantly decreased during, compared to after the outbreak (p < 0.05) consistent with findings from retrospective studies using healthcare-based data. Directly assessing behaviors from individuals via SMS also enabled the measurement of public and private sector facility utilization separately, which has been a challenge in other studies in countries including Liberia which rely mainly on government sources of data. In doing so, our data suggest that public facility-based deliveries returned to baseline values after the outbreak. Thus, we demonstrate that with the appropriate methodological approach to account for different population denominators, data sourced via mobile tools such as SMS polling could serve as an important low-cost complement to existing data collection strategies especially in situations where higher-frequency data than can be feasibly obtained through surveys is useful.

Structural basis for broad neutralization of ebolaviruses\xa0by an antibody targeting the glycoprotein fusion loop

The severity of the 2014–2016 ebolavirus outbreak in West Africa expedited clinical development of therapeutics and vaccines though the countermeasures on hand were largely monospecific and lacked efficacy against other ebolavirus species that previously emerged. Recent studies indicate that ebolavirus glycoprotein (GP) fusion loops are targets for cross-protective antibodies. Here we report the 3.72 Å resolution crystal structure of one such cross-protective antibody, CA45, bound to the ectodomain of Ebola virus (EBOV) GP. The CA45 epitope spans multiple faces of the fusion loop stem, across both GP1 and GP2 subunits, with ~68% of residues identical across > 99.5% of known ebolavirus isolates. Extensive antibody interactions within a pan-ebolavirus small-molecule inhibitor binding cavity on GP define this cavity as a novel site of immune vulnerability. The structure elucidates broad ebolavirus neutralization through a highly conserved epitope on GP and further enables rational design and development of broadly protective vaccines and therapeutics.

And Ghana was scared: Media Representations of the Risk of an Ebola Outbreak in Ghana.

IntroductionThe 2014 Ebola virus outbreak in parts of West Africa marked the 25th occurrence of the disease since its discovery in 1976. While earlier outbreaks in Central and Eastern Africa had limited geographical extension and little media coverage, news media interest in the 2014 epidemic was remarkably high. In countries like Ghana, where the risk of imported infection was estimated to be among the highest, news coverage for the epidemic proliferated. This study aimed to describe and analyze the central themes which characterized media representations of the risk of Ebola outbreak in Ghana.MethodA quantitative content analysis (CA) was employed to study news media reportage of the risk of Ebola outbreak in Ghana. Two daily newspapers, the Daily Graphic and Today were sampled. An online search for Ebola news stories in the selected newspapers was conducted, and all hits with Ebola downloaded and screened. A total of 332 articles were retrieved and 156 articles met the inclusion criteria. Three independent coders carried out the coding using identical story analysis form.ResultsIn the course of the 2014 Ebola epidemic in parts of West Africa, the Daily Graphic and Today newspapers in Ghana published 332 stories about the epidemic. Of this number, the study analyzed 156 news articles which met the inclusion criteria. The analysis found that, media coverage for the risk of Ebola outbreak in Ghana reflected nine salient themes: concerns about the Ghana’s preparedness, support for Ghana’s preparation, public education on Ebola virus, assurances on Ghana’s readiness, suspected cases of Ebola, effects of Ebola, critique of Ebola risk handling, Misinformation and other.ConclusionAnalysis of news media coverage for the threat of Ebola outbreak in Ghana revealed nine important themes. These themes, contributed to an understanding of the broad impact of the recent Ebola outbreak on various sectors of the population.

Citizens, dependents, sons of the soil

The impact of biomedicine and biomedical technologies on identity and sociality has long been the focus of medical anthropology. In this article we revisit these debates in a discussion of how unprecedented encounters with biomedicine during the West African Ebola outbreak have featured in Sierra Leoneans’ understandings of citizenship and belonging, using the case study of an Ebola vaccine trial taking place in Kambia District (EBOVAC Salone). Analysing our ethnographic material in conversation with a historical analysis of notions of belonging and citizenship, we show how participation in a vaccine trial in a moment of crisis allowed people to tell stories about themselves as political subjects and to situate themselves in a conversation about the nature of citizenship that both pre-dates and post-dates the epidemic.

Causes and Effects of Occupational Risk for Healthcare Workers on the Maternity Ward of a Tanzanian Hospital

In the Rukwa region of Tanzania, healthcare providers often work in very low-resource environments that lack equipment and the tools needed for patient care. Additionally, resources for protecting the healthcare workers from occupational exposure to infectious diseases is also often lacking. Against the background of the 2014–2015 Ebola outbreak in West Africa and continued resource scarcity in the Mawingu Regional Hospital, healthcare workers explained the effects of a lack of certainty about women's HIV status and a lack of personal protective equipment. On the maternity ward, the nurse-midwives worked in an environment that was high risk but also nearly entirely outside their control. When health administrators at the institutional level did not demonstrate care for their employees—what I term institutional care—the nurses reported higher levels of concern and fatalism regarding their potential to contract HIV or Hepatitis. This article introduces the concept of “institutional care” as a key component ...

Representing Ebola: Culture, Law, and Public Discourse about the 2013–2015 West African Ebola Outbreak

Book Review| September 01 2018 Representing Ebola: Culture, Law, and Public Discourse about the 2013–2015 West African Ebola Outbreak Representing Ebola: Culture, Law, and Public Discourse about the 2013–2015 West African Ebola Outbreak. By Marouf A. Hasian Jr. Lanham, MD: Fairleigh Dickson University Press, 2016; pp. v + 251. $85.00 cloth. Skye de Saint Felix Skye de Saint Felix University of Arkansas–Fayetteville Search for other works by this author on: This Site Google Rhetoric and Public Affairs (2018) 21 (3): 551–554. https://doi.org/10.14321/rhetpublaffa.21.3.0551 Cite Icon Cite Share Icon Share Facebook Twitter LinkedIn MailTo Permissions Search Site Citation Skye de Saint Felix; Representing Ebola: Culture, Law, and Public Discourse about the 2013–2015 West African Ebola Outbreak. Rhetoric and Public Affairs 1 September 2018; 21 (3): 551–554. doi: https://doi.org/10.14321/rhetpublaffa.21.3.0551 Download citation file: Zotero Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All Scholarly Publishing CollectiveMichigan State University PressRhetoric and Public Affairs Search Advanced Search The text of this article is only available as a PDF. © 2018 Michigan State University Board of Trustees2018 Article PDF first page preview Close Modal You do not currently have access to this content.

Topical evolution patterns and temporal trends of microblogs on public health emergencies

PurposeThe purpose of this paper is to identify salient topic categories and outline their evolution patterns and temporal trends in microblogs on a public health emergency across different stages. Comparisons were also examined to reveal the similarities and differences between those patterns and trends on microblog platforms of different languages and from different nations.Design/methodology/approachA total of 459,266 microblog entries about the Ebola outbreak in West Africa in 2014 on Twitter and Weibo were collected for nine months after the inception of the outbreak. Topics were detected by the latent Dirichlet allocation model and classified into several categories. The daily tweets were analyzed with the self-organizing map technique and labeled with the most salient topics. The investigated time span was divided into three stages, and the most salient topic categories were identified for each stage.FindingsIn total, 14 salient topic categories were identified in microblogs about the Ebola outbreak and were summarized as increasing, decreasing, fluctuating or ephemeral types. The topical evolution patterns of microblogs and temporal trends for topic categories vary on different microblog platforms. Twitter users were keen on the dynamics of the Ebola outbreak, such as status description, secondary events and so forth, while Weibo users focused on background knowledge of Ebola and precautions.Originality/valueThis study revealed evolution patterns and temporal trends of microblog topics on a public health emergency. The findings can help administrators of public health emergencies and microblog communities work together to better satisfy information needs and physical demands by the public when public health emergencies are in progress.

Experiences and challenges in the health protection of medical teams in the Chinese Ebola treatment center, Liberia: a qualitative study

BackgroundHealth care workers are at the frontline in the fight against infectious disease, and as a result are at a high risk of infection. During the 2014–2015 Ebola outbreak in West Africa, many health care workers contracted Ebola, some fatally. However, no members of the Chinese Anti-Ebola medical team, deployed to provide vital medical care in Liberia were infected. This study aims to understand how this zero infection rate was achieved.MethodsData was collected through 15 in-depth interviews with participants from the People’s Liberation Army of China medical team which operated the Chinese Ebola Treatment Center from October 2014 to January 2015 in Liberia. Data were analysed using systematic framework analysis.ResultsThis study found numerous bio-psycho-socio-behavioural risk factors that directly or indirectly threatened the health of the medical team working in the Chinese Ebola Treatment Center. These factors included social and emotional stress caused by: (1) the disruption of family and social networks; (2) adapting to a different culture; (3) and anxiety over social and political unrest in Liberia. Exposure to Ebola from patients and local co-workers, and the incorrect use of personal protective equipment due to fatigue was another major risk factor. Other risk factors identified were: (1) shortage of supplies; (2) lack of trained health personnel; (3) exposure to contaminated food and water; (4) and long working hours. Comprehensive efforts were taken throughout the mission to mitigate these factors. Every measure was taken to prevent the medical team’s exposure to the Ebola virus, and to provide the medical team with safe, comfortable working and living environments. There were many challenges in maintaining the health safety of the team, such as the limited capability of the emergency command system (the standardized approach to the command, control, and coordination of an emergency response), and the lack of comprehensive international protocols for dealing with emerging infectious disease pandemics.ConclusionsThe comprehensive and multidisciplinary measures employed to protect the health of the medical team proved successful even in Liberia’s resource-limited setting. The global health community can learn valuable lessons from this experience which could improve the safety of health care workers in future emergencies. These lessons include: establishing capable command systems; implementing effective coordination mechanisms; providing adequate equipment; providing training for medical teams; investing in the development of global health professionals; and improving research on ways to protect health care workers.

Managing emerging transnational public health security threats: lessons learned from the 2014 West African Ebola outbreak

BackgroundPandemics pose significant security/stability risks to nations with fragile infrastructures. We evaluated characteristics of the 2014 West African Ebola outbreak to elucidate lessons learned for managing transnational public health security threats.MethodsWe used publically available data to compare demographic and outbreak-specific data for Guinea, Sierra Leone, and Liberia, including key indicator data by the World Health Organization. Pearson correlation statistics were calculated to compare country-level infrastructure characteristics with outbreak size and duration.ResultsHospital bed density was inversely correlated with longer EVD outbreak duration (r = − 0.99). Country-specific funding amount allocations were more likely associated with number of incident cases than the population at-risk or infrastructure needs. Key indicators demonstrating challenges for Guinea included: number of unsafe burials, percent of EVD-positive samples, and days between symptom onset and case hospitalization. Sierra Leone’s primary key indicator was the number of districts with ≥1 security incident. Liberia controlled their outbreak before much of the key-indicator data were collected.ConclusionMany of the country-level factors, particularly the WHO key indicators were associated with controlling the epidemic. The infrastructure of countries affected by communicable diseases should be assessed by international political and public health leaders.

Human Polyclonal Antibodies Produced by Transchromosomal Cattle Provide Partial Protection Against Lethal Zaire Ebolavirus Challenge in Rhesus Macaques.

Antibody therapy has been used to treat a variety of diseases and the success of ZMapp and other monoclonal antibody-based therapies during the 2014-2016 West African Ebola outbreak has shown this countermeasure can be a successful therapy for Ebola hemorrhagic fever. This study utilized transchromosomal bovines (TcB) vaccinated with a DNA plasmid encoding Ebola virus glycoprotein sequence to produce human polyclonal antibodies directed against Ebola virus glycoprotein. When administered 1 day postinfection, these TcB polyclonal antibodies provided partial protection and resulted in a 50% survival rate following a lethal challenge of Ebola virus Makona in rhesus macaques.

Antiviral Compounds from Myxobacteria.

Viral infections including human immunodeficiency virus (HIV), cytomegalovirus (CMV), hepatitis B virus (HBV), and hepatitis C virus (HCV) pose an ongoing threat to human health due to the lack of effective therapeutic agents. The re-emergence of old viral diseases such as the recent Ebola outbreaks in West Africa represents a global public health issue. Drug resistance and toxicity to target cells are the major challenges for the current antiviral agents. Therefore, there is a need for identifying agents with novel modes of action and improved efficacy. Viral-based illnesses are further aggravated by co-infections, such as an HIV patient co-infected with HBV or HCV. The drugs used to treat or manage HIV tend to increase the pathogenesis of HBV and HCV. Hence, novel antiviral drug candidates should ideally have broad-spectrum activity and no negative drug-drug interactions. Myxobacteria are in the focus of this review since they produce numerous structurally and functionally unique bioactive compounds, which have only recently been screened for antiviral effects. This research has already led to some interesting findings, including the discovery of several candidate compounds with broad-spectrum antiviral activity. The present review looks at myxobacteria-derived antiviral secondary metabolites.

What treating Ebola means for pandemic influenza.

Almost all new treatments being developed for the next influenza pandemic target the virus. During the Ebola crisis in West Africa, patients were treated with an inexpensive generic statin/angiotensin receptor blocker combination that appeared to greatly improve survival. These drugs target the host response, not the virus, and probably reverse endothelial dysfunction. Scientists and health officials have shown little interest in this idea. Yet, during the early months of the next pandemic, vaccines will be unavailable and treatment options will be limited. Physicians should be prepared to undertake clinical trials of widely available generic drugs to determine whether they improve survival in patients with seasonal influenza, other emerging virus diseases, and other forms of acute critical illness. Public health officials should give these studies their strong support. If successful, they will suggest a ‘bottom up’ approach to patient care that could be implemented worldwide on the first pandemic day.

Green grabs and rural development: How sustainable is biofuel production in post-war Sierra Leone?

In Sub-Saharan Africa, now dubbed the ‘Green OPEC’ of the global bioenergy economy, biofuels have been hailed as a ‘new profitability frontier’ that will provide ‘win-win’ outcomes and deliver development to poor communities. Yet, in an era of economic recession and soaring food prices, their ‘sustainability’ has been at the centre of controversy. This paper focuses on the case of Sierra Leone, where in 2008, a Swiss bioenergy company ushered in the largest foreign direct investment since the end of the country’s civil war. Although recently set back by the catastrophic impacts of the Ebola crisis, there continues to be much support for the government’s strategy to secure foreign direct investment in biofuels production in agriculturally rich regions of the country. Bioenergy proponents believe that such investments will transform rural areas, in light of the fact that Sierra Leone has over the last decade been consistently ranked as one of the poorest in the world, facing food insecurity, high unemployment and entrenched poverty. But land access and control remain central to debates around biofuels and development, particularly for poor rural people living in project areas. This paper explores the perceptions of a wide range of project stakeholders, many of whom have differing interpretations of what biofuel sustainability entails. The paper concludes by reflecting on the implications this may have for the present post-Ebola environment, where evolving policy discussions on land investment and ‘green’ development continue to assume a key part of the government’s recovery trajectory.

Community health workers during the Ebola outbreak in Guinea, Liberia, and Sierra Leone

BackgroundThe role of community health workers (CHWs) in the West Africa Ebola outbreak has been highlighted to advocate for increasing numbers of CHWs globally to build resilience, strengthen health systems, and provide emergency response capacity. However, the roles CHWs played, the challenges they faced, and their effectiveness during the outbreak are not well documented. This study assessed the impact of Ebola on community-based maternal, newborn, and child health (MNCH) services, documented the contribution of CHWs and other community-based actors to the Ebola response, and identified lessons learned to strengthen resilience in future emergencies.MethodsThis mixed methods study was conducted in Guinea, Liberia, and Sierra Leone, with data collected in four Ebola-affected districts of each country. Qualitative data were collected through in-depth interviews and focus group discussions with stakeholders at national, district, and community levels. Quantitative program data were used to assess trends in delivery of community-based MNCH services.ResultsThere was a sharp decline in MNCH service provision due to weak service delivery, confusion over policy, and the overwhelming nature of the outbreak. However, many CHWs remained active in their communities and were willing to continue providing services. When CHWs received clear directives and were supported, service provision rebounded. Although CHWs faced mistrust and hostility from community members because of their linkages to health facilities, the relationship between CHWs and communities proved resilient over time, and CHWs were more effectively able to carry out Ebola-related activities than outsiders. Traditional birth attendants, community health committees, community leaders, and traditional healers also played important roles, despite a lack of formal engagement or support. Service delivery weaknesses, especially related to supply chain and supervision, limited the effectiveness of community health services before, during, and after the outbreak.ConclusionsCHWs and other community-level actors played important roles during the Ebola outbreak. However, maintenance of primary care services and the Ebola response were hampered because community actors were engaged late in the response and did not receive sufficient support. In the future, communities should be placed at the forefront of emergency preparedness and response plans and they must be adequately supported to strengthen service delivery.

Development of Mobile Laboratory for Viral Hemorrhagic Fever Detection in Africa.

A mobile laboratory transportable on commercial flights was developed to enable local response to viral hemorrhagic fever outbreaks. The development progressed from use of mobile real-time reverse-transcription polymerase chain reaction to mobile real-time recombinase polymerase amplification. In this study, we describe various stages of the mobile laboratory development. A brief overview of mobile laboratory deployments, which culminated in the first on-site detection of Ebola virus disease (EVD) in March 2014, and their successful use in a campaign to roll back EVD cases in Conakry in the West Africa Ebola virus outbreak are described. The developed mobile laboratory successfully enabled local teams to perform rapid disgnostic testing for viral hemorrhagic fever.

'When Ebola enters a home, a family, a community': A qualitative study of population perspectives on Ebola control measures in rural and urban areas of Sierra Leone.

BackgroundDuring the West Africa Ebola outbreak, cultural practices have been described as hindering response efforts. The acceptance of control measures improved during the outbreak, but little is known about how and why this occurred. We conducted a qualitative study in two administrative districts of Sierra Leone to understand Ebola survivor, community, and health worker perspectives on Ebola control measures. We aimed to gain an understanding of community interactions with the Ebola response to inform future intervention strategies.Methodology/Principal findingsParticipants (25 survivors, 24 community members, and 16 health workers) were recruited purposively. A flexible participatory method gathered data through field notes and in-depth, topic-led interviews. These were analysed thematically with NVivo10© by open coding, constant comparison, and the principles of grounded theory. The primary theme, ‘when Ebola is real’, centred on denial, knowledge, and acceptance. Ebola was denied until it was experienced or observed first-hand and thus health promotion was more effective if undertaken by those directly exposed to Ebola rather than by mass media communication. Factors that enabled acceptance and engagement with control measures included: access to good, proximate care and prevention activities; seeing that people can survive infection; and the co-option of trusted or influential local leadership, with bylaws implemented by community leaders being strongly respected. All participants noted that dignity, respect, and compassion were key components of effective control measures.ConclusionsSuccessful control approaches need strong community leadership, with the aim of achieving collective understanding between communities and health workers. Health promotion for communities at risk is best conducted through people who have had close interaction with or who have survived Ebola as opposed to reliance on broad mass communication strategies.