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Glob Public Health. 2018 May;13(5):528-544. doi: 10.1080/17441692.2016.1208262. Epub 2016 Jul 27.

Community-based reports of morbidity, mortality, and health-seeking behaviours in four Monrovia communities during the West African Ebola epidemic.

Author information

a Department of Anthropology , Yale University , New Haven , CT , USA.
b Department of Anthropology , Rutgers, The State University of New Jersey , East Brunswick , NJ , USA.
c Department of Epidemiology & Emerging Pathogens Institute , University of Florida , Gainesville , FL , USA.
d United Nations Development Programme & Mother Patern College of Health Sciences (MPCHS) , Monrovia , Liberia.
e World Health Organization & A. M. Dogliotti College of Medicine (AMDCM), University of Liberia , Monrovia , Liberia.
f Department of Epidemiology, College of Public Health and Health Professions , University of Florida , Gainesville , FL , USA.
g Emergency Operations Center, Ministry of Health , Partnership for Research on Ebola Virus in Liberia (PREVAIL) & A. M. Dogliotti College of Medicine (AMDCM), University of Liberia , Monrovia , Liberia.
h Focusing Initiatives International, Chestnut Ridge , New York , NY , USA.


The goal of this study was to assess morbidity, mortality, and health-seeking behaviours during the 2014 Ebola outbreak in Monrovia, Liberia. This study examined commonly reported symptoms of illness, pre-clinical diagnostic practices, typical healthcare-seeking strategies, and health resources available to populations, in order to identify salient needs and gaps in healthcare that would inform local emergency response efforts. Semi-structured interviews were conducted with household members in four Monrovia neighbourhoods. Researchers used a multi-stage cluster approach to recruit participants. Within 555 households sampled, 505 individuals were reported sick (69%) or recently sick (38%) or deceased (7%). Common self-diagnoses included malaria, hypertension, influenza, typhoid, and Ebola. The most cited health-seeking strategy was to purchase medications from the private sector. Respondents also obtained healthcare from community members known to have medical experience. Findings suggest that non-formal healthcare systems played an important role in managing morbidity during the West African Ebola virus disease (EVD) outbreak. Lay community members engaged in complex assessments of health symptoms and sought biomedical care at rates perhaps higher than anticipated during the response. This study highlights how informal networks of healthcare providers can play an important role in preventing and curbing future emerging disease outbreaks.


Community-based response; Ebola virus disease (EVD); Liberia; health-seeking behaviour; morbidity

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