title: Community-centered responses to Ebola in urban Liberia: the view from below.
abstract: BACKGROUND
  The West African Ebola epidemic has demonstrated that the existing range of medical and epidemiological responses to emerging disease outbreaks is insufficient, especially in post-conflict contexts with exceedingly poor healthcare infrastructures. In this context, community-based responses have proven vital for containing Ebola virus disease (EVD) and shifting the epidemic curve. Despite a surge in interest in local innovations that effectively contained the epidemic, the mechanisms for community-based response remain unclear. This study provides baseline information on community-based epidemic control priorities and identifies innovative local strategies for containing EVD in Liberia.
  
  
  RESULTS
  This study was conducted in September 2014 in 15 communities in Monrovia and Montserrado County, Liberia--one of the epicenters of the Ebola outbreak. Findings from 15 focus group discussions with 386 community leaders identified strategies being undertaken and recommendations for what a community-based response to Ebola should look like under then-existing conditions. Data were collected on the following topics: prevention, surveillance, care-giving, community-based treatment and support, networks and hotlines, response teams, Ebola treatment units (ETUs) and hospitals, the management of corpses, quarantine and isolation, orphans, memorialization, and the need for community-based training and education. Findings have been presented as community-based strategies and recommendations for (1) prevention, (2) treatment and response, and (3) community sequelae and recovery. Several models for community-based management of the current Ebola outbreak were proposed. Additional findings indicate positive attitudes towards early Ebola survivors, and the need for community-based psychosocial support.
  
  
  CONCLUSIONS
  Local communities' strategies and recommendations give insight into how urban Liberian communities contained the EVD outbreak while navigating the systemic failures of the initial state and international response. Communities in urban Liberia adapted to the epidemic using multiple coping strategies. In the absence of health, infrastructural and material supports, local people engaged in self-reliance in order to contain the epidemic at the micro-social level. These innovations were regarded as necessary, but as less desirable than a well-supported health-systems based response; and were seen as involving considerable individual, social, and public health costs, including heightened vulnerability to infection.
authors: Department of Anthropology & Center for African Studies, University of Florida, Gainesville, Florida, United States of America.
authors: Sharon Alane
authors: SA
authors: Abramowitz
authors: Department of Anthropology, Yale University, New Haven, Connecticut, United States of America.
authors: Kristen E
authors: KE
authors: McLean
authors: Department of Epidemiology & College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America.
authors: Sarah Lindley
authors: SL
authors: McKune
authors: Centre for Infectious Disease, The University of Edinburgh, Edinburgh, United Kingdom; Emerging Pathogens Institute, Gainesville, Florida, United States of America.
authors: Kevin Louis
authors: KL
authors: Bardosh
authors: Ebola Emergency-Response Program, Action Contre la Faim (ACF), Monrovia, Liberia.
authors: Mosoka
authors: M
authors: Fallah
authors: Ebola Emergency-Response Program, Action Contre la Faim (ACF), Monrovia, Liberia.
authors: Josephine
authors: J
authors: Monger
authors: Ebola Emergency-Response Program, Action Contre la Faim (ACF), Monrovia, Liberia.
authors: Kodjo
authors: K
authors: Tehoungue
authors: Focusing International, Chestnut Ridge, New York, United States of America.
authors: Patricia A
authors: PA
authors: Omidian
mesh_terms: D003140:Communicable Disease Control / Q000379:methods*; D003153:Community Health Services / Q000379:methods* / Q000458:organization & administration*; D058872:Epidemics / Q000517:prevention & control*; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology*; D006801:Humans; D007988:Liberia / Q000453:epidemiology; D011634:Public Health