The Effect of Community-Based Prevention and Care on Ebola Transmission in Sierra Leone.

Journal Article (Journal Article)


To examine the acceptability, use, effects on early isolation, and contribution to Ebola virus disease (EVD) transmission of Community Care Centers (CCCs), which were rapidly deployed in Sierra Leone during an accelerated phase of the 2014-2015 EVD epidemic.


Focus group discussions, triads, and key informant interviews assessed acceptability of the CCCs. Facility registers, structured questionnaires, and laboratory records documented use, admission, and case identification. We estimated transmission effects by comparing time between symptom onset and isolation at CCCs relative to other facilities with the national Viral Hemorrhagic Fever data set.


Between November 2014 and January 2015, 46 CCCs were operational. Over 13 epidemic weeks, 6129 patients were triaged identifying 719 (12%) EVD suspects. Community acceptance was high despite initial mistrust. Nearly all patients presented to CCCs outside the national alert system. Isolation of EVD suspects within 4 days of symptoms was higher in CCCs compared with other facilities (85% vs 49%; odds ratio = 6.0; 95% confidence interval = 4.0, 9.1), contributing to a 13% to 32% reduction in the EVD reproduction number (Ro).


Community-based approaches to prevention and care can reduce Ebola transmission.

Full Text

Duke Authors

Cited Authors

  • Pronyk, P; Rogers, B; Lee, S; Bhatnagar, A; Wolman, Y; Monasch, R; Hipgrave, D; Salama, P; Kucharski, A; Chopra, M; UNICEF Sierra Leone Ebola Response Team,

Published Date

  • April 2016

Published In

Volume / Issue

  • 106 / 4

Start / End Page

  • 727 - 732

PubMed ID

  • 26890176

Pubmed Central ID

  • PMC4816080

Electronic International Standard Serial Number (EISSN)

  • 1541-0048

International Standard Serial Number (ISSN)

  • 0090-0036

Digital Object Identifier (DOI)

  • 10.2105/ajph.2015.303020


  • eng