Case Study in Community Medicine

At first, it was thought that these outbreaks were a single event resulting from one infected person who travelled between these two countries spreading the virus. But, as scientists did more research, it was discovered that the two outbreaks were actually caused by two genetically different viruses named Zaire ebolavirus and Sudan ebolavirus. This made the scientists to conclude that the virus originated from two distinct sources and spread independently to the different people in each of the identified spots. The Ebola outbreak in West Africa 2014-2016 started in a rural setting of southeastern Guinea and quickly spread to urban areas before crossing borders in a period of weeks. Within months, this outbreak became a global epidemic. Most of these cases were reported in Montserrado County which is the county where Monrovia, the capital city of Liberia is situated.

However, the number of Ebola virus outbreak in Liberia might have been underestimated by official reports because of three major reasons. First, at the period of intense outbreak in August 2014, Ebola Treatment Units (ETUs) were filled with patients and some were even turned away without being counted. Secondly, contact tracing of known EVD cases was not done completely throughout the outbreak and therefore there is likelihood that some cases were missed. Thirdly, communities were reluctant to send sick members to the ETUs. From 23rd may 2014 to 31st January 2015, Sierra Leone recorded a total of 17,318 cases of Ebola virus disease additionally, there were 2, 536 deaths and 886 recoveries reported among the probable and confirmed EVD cases with a final outcome. This data was obtained from the Ministry of Health and Sanitation of Sierra Leone.

The case fatality risk (CFR) and hospitalization fatality risk (HFR) which were used to characterize the severity of the infections in confirmed and probable EVD cases in Sierra Leone were estimated at 74. 2% and 68. 9% respectively. By October 2014, MSF reported an increase in the cases in the capital Conakry where one treatment center was receiving 22 patients per day. This made the government of Conakry to ban all Eid cultural celebrations. Guinea had a total of 9 Ebola Treatment Centers during the outbreak. In early January 2015, the number of new reported infections started to decline to about 50 cases per week, but kept on fluctuating. Between April and June 2015, the reported country cases per week further declined to about 20 cases per week and kept on fluctuating around this level until the end of July when a further decline was witnessed.

This led to some of the health care workers being attacked by members of the public and blood sample transported by the Red Cross impounded and taken away. Those members who did that had no education and knowledge that they could contract the disease because the sample were infected. Additionally, public health messages issued to the public triggered hopelessness and despair because they stressed that the disease was very serious and had no vaccine, treatment or cure. These messages were meant to sensitize and promote protective behaviors among the members of the public but instead they caused opposite effect. Families did not see the need to take their patients to hospitals where they would not get therapies, treatment or cure and therefore opted to care for their loved ones at home.

In Liberia, the increased bushmeat extraction from the forested region is attributed to the increased workers settlement, opening of road networks and timber extraction from the region. In a study conducted in Brazzaville, the Republic of Congo, it is estimated that 88% of the households interviewed said that they consume bushmeat. Due to the inability to get access to proteins from other sources like goats, sheep, cattle and high level of poverty, West African countries have turned to bushmeat as a commercial commodity trafficking illegally both locally and internationally. In fact, statistics show that about 5 tons of bushmeat are imported illegally every week to Europe and this is a common form of contraband that is carried out within and between African nations.

Ebola virus is vulnerable to a number of disinfectants or inactivation and can be made inactive by boiling bushmeat for 5 minutes or cooking for 60 minutes at 60 degrees Celsius. As the cases of outbreak began to decline and risks perceived to be diminishing, strict measures for personal protection went down. Protective measures in the community like keeping distance from others and frequent hand hygiene also declined. Most of those health care workers who followed safety precautions strictly when handling patients in hospitals and clinics only got infections in the community. For instance, by mid-December, MSF had more than 3,400 workers in the affected countries and out of these 27 were infected with Ebola and 13 died as a result (Chowell & Nishiura, 2014, p. Upon investigation, MSF found out that these infections were derived from the community.

This is because many people perceived hospitals as a place of death due to the high fatality rate in the health care facilities and therefore they did not seek early medical care. Some communities also resisted treatment and the fact that Ebola arose from wild animals. People had the perception that they and their ancestors had been living in the same environment for centuries, hunting the same animals in the same forests and had never heard of a disease like Ebola. This hindered health care workers from carrying out investigations. Neighborhood and Built Environment West African countries are characterized by high mobility with great numbers of people moving across the highly porous borders. Thirdly, health care professionals should continue assessing the molecular epidemiological outbreak and the available data on DNA sequence so that they can provide solid information about the means of transmission, public health complications and any other essential information.

With this information, it will be easy to contain Ebola outbreaks in future using the appropriate control measures. Fourthly, public health professionals both in the affected countries and outside should be willing to share data, modelling tools and expertise in future for rapid detection and response to the virus. Moreover, there is need for regional meetings of Health Ministers because such meetings provide avenues for policy-makers and scientists to come together and ensure that frontlines countries get the resources required for outbreak response and managing spread. Such partnerships across the African continent will help contain future epidemics. , Lewis, B. L. , Rivers, C. M. , Shaman, J. Chowell, G. and Nishiura, H. Transmission dynamics and control of Ebola virus disease (EVD): a review.