Interrupting Ebola Transmission in Liberia Through Community-Based Initiatives
Authors: Mosoka Fallah, Bernice Dahn, Tolbert G. Nyenswah, Moses Massaquoi, Laura A. Skrip, Dan Yamin, Martial Ndeffo Mbah, Netty Joe, Siedoh Freeman, Thomas Harris, Zinnah Benson, Alison P. Galvani
Journal: Annals of Internal Medicine (2016)

Ideas and Opinions1 March 2016Interrupting Ebola Transmission in Liberia Through Community-Based InitiativesMosoka Fallah, PhD, MPH, Bernice Dahn, MD, MPH, Tolbert G. Nyenswah, Esq, MPH, Moses Massaquoi, MD, MPH, Laura A. Skrip, MPH, Dan Yamin, PhD, Martial Ndeffo Mbah, PhD, Netty Joe, MD, Siedoh Freeman, MD, Thomas Harris, BA, Zinnah Benson, BBA, and Alison P. Galvani, PhDMosoka Fallah, PhD, MPHFrom the Ministry of Health, Community-Based Initiative, United Nations Development Programme, and A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, and Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut., Bernice Dahn, MD, MPHFrom the Ministry of Health, Community-Based Initiative, United Nations Development Programme, and A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, and Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut., Tolbert G. Nyenswah, Esq, MPHFrom the Ministry of Health, Community-Based Initiative, United Nations Development Programme, and A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, and Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut., Moses Massaquoi, MD, MPHFrom the Ministry of Health, Community-Based Initiative, United Nations Development Programme, and A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, and Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut., Laura A. Skrip, MPHFrom the Ministry of Health, Community-Based Initiative, United Nations Development Programme, and A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, and Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut., Dan Yamin, PhDFrom the Ministry of Health, Community-Based Initiative, United Nations Development Programme, and A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, and Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut., Martial Ndeffo Mbah, PhDFrom the Ministry of Health, Community-Based Initiative, United Nations Development Programme, and A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, and Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut., Netty Joe, MDFrom the Ministry of Health, Community-Based Initiative, United Nations Development Programme, and A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, and Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut., Siedoh Freeman, MDFrom the Ministry of Health, Community-Based Initiative, United Nations Development Programme, and A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, and Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut., Thomas Harris, BAFrom the Ministry of Health, Community-Based Initiative, United Nations Development Programme, and A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, and Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut., Zinnah Benson, BBAFrom the Ministry of Health, Community-Based Initiative, United Nations Development Programme, and A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, and Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut., and Alison P. Galvani, PhDFrom the Ministry of Health, Community-Based Initiative, United Nations Development Programme, and A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, and Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-1464 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail On 6 March 2014, Ebola virus disease spread from Guinea to Liberia, sparking an unprecedented outbreak. At the peak of the epidemic in western Africa, Liberia was the most affected country (1). Despite its extraordinary resource constraints—per capita gross domestic product is much lower than that of Guinea or Sierra Leone (2)—Liberia's steep epidemic trajectory was reversed several weeks before that of those countries. This article details the community-based initiative (CBI) that was instrumental to the shift in transmission dynamics.In the design of public health strategies, organizational and cultural sensitivity, as well as an awareness of infrastructure constraints, are ...References1. Centers for Disease Control and Prevention. Ebola (Ebola Virus Disease), 2014 West Africa Outbreak, Case Counts: Previous case counts 3/25/2014-present. 2015. Accessed at www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/previous-case-counts.html on 29 May 2015. Google Scholar2. The World Bank. Data: Liberia. 2015. Accessed at http://data.worldbank.org/country/liberia on 31 May 2015. Google Scholar3. Dunn F. Social determinants in tropical disease.. In: Warren K, Mahmoud A, eds. Tropical and Geographical Medicine. New York: McGraw-Hill; 1985. Google Scholar4. Hewlett BS, Amola RP. Cultural contexts of Ebola in northern Uganda. Emerg Infect Dis. 2003;9:1242-8. [PMID: 14609458] CrossrefMedlineGoogle Scholar5. Liberia Institute of Statistics and Geo-Information Services. 2008 national population and housing census: final results. May 2009. Accessed at www.emansion.gov.lr/doc/Population_by_County.pdf on 31 May 2015. Google Scholar6. Liljas P. Liberia's West Point slum reels from the nightmare of Ebola. Time. 22 August 2014. Accessed at http://time.com/3158244/liberia-west-point-slum-ebola-disease-quarantine on 15 May 2015. Google Scholar7. Yamin D, Gertler S, Ndeffo-Mbah ML, Skrip LA, Fallah M, Nyenswah TG, et al. Effect of Ebola progression on transmission and control in Liberia. Ann Intern Med. 2015;162:11-7. [PMID: 25347321]. doi:10.7326/M14-2255 LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Mosoka Fallah, PhD, MPH; Bernice Dahn, MD, MPH; Tolbert G. Nyenswah, Esq, MPH; Moses Massaquoi, MD, MPH; Laura A. Skrip, MPH; Dan Yamin, PhD; Martial Ndeffo Mbah, PhD; Netty Joe, MD; Siedoh Freeman, MD; Thomas Harris, BA; Zinnah Benson, BBA; Alison P. Galvani, PhDAffiliations: From the Ministry of Health, Community-Based Initiative, United Nations Development Programme, and A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, and Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut.Acknowledgment: The authors thank Tom Snyder and Tom Murray for their development of a mobile application to collect active surveillance data and the thousands of community workers who came together to implement CBIs.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1464.Corresponding Author: Mosoka Fallah, PhD, MPH, PO Box 10-9009, 1000 Monrovia 10, Liberia; e-mail, mfallah1969@gmail.com.Current Author Addresses: Drs. Fallah, Dahn, and Massaquoi; Mr. Nyenswah; Mr. Harris; Ms. Joe; Ms. Freeman; and Ms. Benson: PO Box 10-9009, 1000 Monrovia 10, Liberia.Drs. Yamin, Ndeffo Mbah, and Galvani and Ms. Skrip: 135 College Street, Suite 200, New Haven, CT 06520.Author Contributions: Conception and design: M. Fallah, B. Dahn, T.G. Nyenswah, L.A. Skrip, D. Yamin, M. Ndeffo Mbah, S. Freeman, T. Harris.Analysis and interpretation of the data: T.G. Nyenswah, L.A. Skrip, T. Harris.Drafting of the article: M. Fallah, T.G. Nyenswah, L.A. Skrip, D. Yamin, A.P. Galvani.Critical revision of the article for important intellectual content: D. Yamin, M. Ndeffo Mbah, A.P. Galvani.Final approval of the article: M. Fallah, T.G. Nyenswah, L.A. Skrip, D. Yamin, M. Ndeffo Mbah, A.P. Galvani.Provision of study materials or patients: T.G. Nyenswah.Obtaining of funding: Z. Benson.Administrative, technical, or logistic support: N. Joe, S. Freeman, M. Massaquoi, T. Harris, Z. Benson.Collection and assembly of data: S. Freeman, T. Harris.This article was published online first at www.annals.org on 5 January 2016. 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