Stopping Ebola, re-starting lives: arresting infection and mitigating the impact of EVD The Sierra Leone Ministry of Health reported 5,524 confirmed cases of Ebola in Sierra Leone as of 25th November 2014, although the number of unreported cases is thought to be much higher.  The number of confirmed Ebola fatalities is 1,397, giving an average death rate of 25 percent .  Effective awareness raising to produce behaviour change is essential to address the high rate of transmission. The majority of Sierra Leoneans have access to information about Ebola, and attitudes have changed since the beginning of the outbreak as to whether or not the disease ‘exists.’ However, cultural practices, involving direct contact with the sick and deceased persist and there is a mistrust of the healthcare system. With religion deeply engrained into Sierra Leonean way of life, many fully trust religious leaders, traditionalist healers or ‘secret society’ chiefs to provide healthcare or burial practises.  Ebola prevention messaging through religious and spiritual leaders is crucial to gaining the support of local communities and buy in and adherence to the messaging. affected by Ebola.  
The Focus 1000 KAP survey findings: Of people surveyed, 96% reported holding some discriminatory attitude towards people with suspected or having (had) Ebola, while 76% indicated they would not welcome someone back into their community after they recovered from Ebola.  While such attitudes persist, they present an obstacle to individuals adopting correct practise, therefore impeding efforts to reduce transmission rates.  In addition, only 39% of the respondents were able to identify three means of prevention and rejected three misconceptions. The study found that nearly everyone would like to receive additional information on prevention of EVD and treatment options. By increasing this knowledge through interventions such as this proposal, the likelihood of individuals to adopt the promoted prevention and medical seeking behaviours will raise. The survey recommendations highlighted the need to address common misconceptions through inter-personal engagement at grassroots level.  A study by Richards et al. (2014) on Social Pathways for EVD indicates that the engagement of local opinion leaders is crucial to transfer this knowledge, to help change attitudes and to provide assistance to individuals. However data also suggest that the household members and extended families should be targeted directly as the family is the most trusted source of reliable assistance. Taken this into account the project will use a mixture of information transmission through faith leaders as well as through community-led strategies involving community structures and peers.  Male and female traditional and faith leaders, including inter-religious groups, will be targeted for training as community mobilisers due to their role in presiding over burials and ability to influence attitudes, perceptions and behaviour change amongst the community.  Women with leadership roles within faith structures will also be specifically targeted. These will include Muslim ‘Mami Queens’ who are chair ladies of mosques and influential women pastors or other religious leaders. Women, girls and traditional healers will also be targeted for sensitisation by faith leaders as they are the traditional care givers for sick people.  This will include focus groups with women groups/associations in mosques and churches, community level women’s organizations, and collaboration with district level women’s umbrella organizations.  This is particularly important as a way of mitigating some of the cultural constraints in communication expected in between Muslim faith leaders and female congregants. Young people are another important group as they can easily distort and pass wrong information albeit unintentionally, and have been leaders of many of the attacks on health workers, surveillance and burial teams that were seen early on in the outbreak; however they will be mobilized in this program to propagate correct information in communities and be leaders for behaviour change, if engaged effectively.