Appendix A. Situation Analysis

Ebola Context

© 2007 Bizimungu Kisakye, Courtesy of Photoshare

© 2007 Bizimungu Kisakye, Courtesy of Photoshare

faviconThe current outbreak in West Africa (first cases reported in March 2014) is the largest and most complex outbreak since Ebola was first discovered in 1976. There have been more cases and deaths in this outbreak than in all others combined. It has also spread between countries, starting in Guinea then spreading across land borders to Sierra Leone and Liberia, by air to Nigeria, and by land to Senegal and Mali. The most severely affected countries—Guinea, Sierra Leone and Liberia—have very weak health systems lacking in human and infrastructural resources, having only recently emerged from long periods of conflict and instability. On August 8, 2014, the WHO Director-General declared this outbreak a Public Health Emergency of International Concern.

A separate, unrelated Ebola outbreak began in Boende, Equateur, an isolated part of the Democratic Republic of Congo.

While KAP studies and other research efforts are still ongoing in the three primary Ebola countries, as of this writing (December 2014), a sample of the preliminary data from Liberia, Guinea and Sierra Leone shows that:

Rumors, misconceptions or inaccurate knowledge of Ebola transmission persist and there is a lack of trust of both national and foreign government assistance

Fear and panic lead to stigma and reduced health-seeking and substandard care practices.

Fear of death, of health care workers and of the disease by frontline HWs lead to either suboptimal care for patients or substandard implementation of protective measures.

Lack of understanding about Ebola is coupled with denial, mistrust and rejection of proposed public health interventions arising from misinterpretation of the cause of the new disease.

Public health interventions to reduce the spread of the disease (e.g., early isolation, no care for sick person, safe burials) are seen as highly intrusive and go against social/cultural patterns, which makes interventions difficult to accept.

There is a lack of experienced health care workers and capacities for rapid response.

There is high exposure to Ebola through household care and customary burial procedures.

There are close community ties and movement within and across borders, leading to difficulties in tracing and following up of contacts for the three countries.

Audience and Communication Analysis

Decisions affecting Ebola prevention and treatment are made at various levels: the individual, family, and community level; the health system level; and the society or policy level. It is helpful to look at the factors affecting Ebola prevention and treatment behaviors at each of these levels separately. Many sources were consulted to provide this global Ebola situation analysis.

Individual, Family, and Community Level

Common reasons for unsafe practices related to Ebola transmission are listed in the following table.

Harmful practice Common reasons for it
Unsafe burial practices
  • Religious and traditional beliefs in preparing the dead body for burial, including one or a combination of washing, touching, kissing and dressing bodies
  • Extreme aversion to cremation based on religious/traditional beliefs and customs
Close contact with bodily fluids of a sick Ebola patient
  • Lack of knowledge about Ebola transmission and how to protect oneself and others from Ebola
  • Rumors and misconceptions about Ebola transmission and protection
  • Denial of Ebola
  • Avoidance of Ebola Treatment Units (ETUs) or other health facilities due to fear of never leaving, fear of cremation, leading to improper home care of Ebola patients by CHWs and family members
  • Lack of knowledge about the handling of items used by someone who was sick or died from Ebola
  • Distrust of government and foreign assistance, including protection and treatment messages and services
  • Lack of knowledge about unsafe transportation (e.g., taxis that have carried people sick with Ebola)
Poor hygiene and sanitation practices
  • Lack of knowledge about proper hygiene and sanitation as protection from Ebola
  • Lack of water, soap or chlorine
Avoidance of ETUs or other health facilities
  • Fear of never coming out or seeing family members again
  • Distrust of government and foreign assistance, including protection and treatment messages and services
  • Fear of getting Ebola at a health facility, if accessed for reasons other than Ebola
Stigma of Ebola survivors and HWs
  • Fear that they will get Ebola from them
  • For the survivors: initial belief that one couldn’t survive Ebola, so survivors seen as ghosts
Improper handling of Ebola patients by health care workers
  • Lack of proper training and/or knowledge about safety procedures (e.g., removing PPE)
  • Fatigue due to working too many hours, leading to mistakes
  • Misdiagnosis of Ebola and belief that early signs and symptoms are the result of malaria or typhoid fever
Eating bushmeat
  • Lack of knowledge about transmission of Ebola through the slaughter and preparation of bushmeat
  • Traditional practices and cultural preferences for bushmeat


Communication Strategy Guidance

View guidance on how and why to conduct a situation analysis.

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