Fears and misperceptions of the Ebola Response System during the 2014-2015 outbreak in Sierra Leone

To decrease the severity of epidemics in countries with under-developed health system capacity to control outbreaks, lessons can be drawn from the Ebola outbreak inWest Africa. This is the first study, to our knowledge, to use qualitative research methods to understand community members’ perceptions of using the Ebola response system during the outbreak in Sierra Leone.We conducted this study in two of the most populous districts during a time when there were still a high number of Ebola-related fatalities, and the Ebola response system had been scaled up. While national household surveys demonstrated high levels of intent to use the response system at the time, epidemiological reports suggested that there were delays in seeking testing and treatment. Our use of semi-structured in-depth interviews, as well as an ethnographer with experience in Sierra Leone, enhanced our ability to elicit people’s fears and misperceptions. Concerns about the response system clustered around three key themes: fears of calling the national hotline, negative perceptions of the chlorine spray, and misperceptions about the Ebola laboratory test and the need to re-test. These fears and misperceptions likely delayed people from seeking care. Our results lend support to the argument that trust in the public health response system was integral to citizens’ use of the system.We make several recommendations for how trust could have been enhanced during the Ebola outbreak. Protocols for future outbreaks should incorporate dynamic and qualitative research both to understand perceptions of the response system and to use these data to informa more effective response.