title: Challenges in controlling the Ebola outbreak in two prefectures in Guinea: why did communities continue to resist?
abstract: BACKGROUND
  The Ebola outbreak emerged in a remote corner of Guinea in December 2013, and spread into Liberia and Sierra Leone in the context of weak health systems. In this paper, we report on the main challenges faced by frontline health services and by communities including their perceptions and views on the current Ebola response in the Prefectures of Coyah and Forecariah in Guinea.
  
  
  METHODS
  A cross-sectional study was conducted in December 2014 using mixed approaches: (i) Desk review; (ii) Interviews; and (iii) Direct observation.
  
  
  RESULTS
  Almost one year after the beginning of the Ebola virus disease outbreak in West Africa, the perceptions of stakeholders and the observed reality were that the level of preparedness in the two health districts was low. The study identified poor coordination mechanisms, inadequate training of human resources and lack of equipment and supplies to field teams and health facilities as key elements that affected the response. The situation was worsened by the inadequate communication strategy, misconceptions around the disease, ignorance of local culture and customs and lack of involvement of local communities in the control strategies, within the context of poor socioeconomic development. As a result distrust developed between communities and those seeking to control the epidemic and largely contributed to the reluctance of the communities to participate and contribute to the effort.
  
  
  CONCLUSIONS
  There is a need to rethink the way disease control interventions in the context of an emergency such as Ebola virus disease are designed, planned and implemented in low income countries.
authors.affiliation: Amref Health Africa Headquarters, International Training Centre, P O Box 27691-00506, Nairobi, Kenya.
authors.forename: Sylla
authors.initials: S
authors.lastname: Thiam
authors.affiliation: Centre de Formation et de Recherche de Maferinyah, Forecariah, Guinea; Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Delamou
authors.affiliation: Amref Health Africa, Conakry, Guinea.
authors.forename: Soriba
authors.initials: S
authors.lastname: Camara
authors.affiliation: Amref Health Africa Headquarters, International Training Centre, P O Box 27691-00506, Nairobi, Kenya.
authors.forename: Jane
authors.initials: J
authors.lastname: Carter
authors.affiliation: Centre de Formation et de Recherche de Maferinyah, Forecariah, Guinea.
authors.forename: Eugene Kaman
authors.initials: EK
authors.lastname: Lama
authors.affiliation: Amref Health Africa West Africa Regional Office, Dakar, Senegal.
authors.forename: Bara
authors.initials: B
authors.lastname: Ndiaye
authors.affiliation: Amref Health Africa Headquarters, International Training Centre, P O Box 27691-00506, Nairobi, Kenya.
authors.forename: Josephat
authors.initials: J
authors.lastname: Nyagero
authors.affiliation: Amref Health Africa Headquarters, International Training Centre, P O Box 27691-00506, Nairobi, Kenya.
authors.forename: John
authors.initials: J
authors.lastname: Nduba
authors.affiliation: Amref Health Africa West Africa Regional Office, Dakar, Senegal.
authors.forename: Mor
authors.initials: M
authors.lastname: Ngom
mesh_terms: D003142:Communication; D003256:Community Participation / Q000523:psychology*; D003430:Cross-Sectional Studies; D003625:Data Collection; D003695:Delivery of Health Care / Q000458:organization & administration*; D003906:Developing Countries; D004196:Disease Outbreaks / Q000517:prevention & control*; D016701:Guinea / Q000453:epidemiology; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D012959:Socioeconomic Factors
keywords: Ebola outbreak; communication; community perception; community resistance