A qualitative study to understand how Ebola Virus Disease affected nutrition in Sierra Leone—A food value-chain framework for improving future response strategies

Abstract

BackgroundThis study sought understand how the 2014–2016 EVD Virus Disease (EVD) outbreak impacted the nutrition sector in Sierra Leone and use findings for improving nutrition responses during future outbreaks of this magnitude.MethodologyThis qualitative study was iterative and emergent. In-depth interviews (n = 42) were conducted over two phases by purposively sampling both key informants (n = 21; government stakeholders, management staff from United Nations (UN) agencies and non-governmental organizations (NGO)), as well as community informants (n = 21; EVD survivors, health workers, community leaders) until data saturation. Multiple analysts collaborated in a team-based coding approach to identify key themes using Dedoose software. Findings are presented as both quotations and tables/figures.ResultsThe EVD outbreak effects and the related response strategies, especially movement restriction policies including 21-day quarantines, contributed to disruptions across the food value-chain in Sierra Leone. System-wide impacts were similar to those typically seen in large-scale disasters such as earthquakes. Participants described an array of direct and indirect effects on agricultural production and food storage and processing, as well as on distribution, transport, trade, and retailing. Secondary data were triangulated by interviews which described the aggregate negative effect of this outbreak on key pillars of food security, infant and young child feeding practices, and nutrition. During the humanitarian response, nutrition-specific interventions, including food assistance, were highly accepted, although sharing was reported. Despite EVD impacts across the entire food value-chain, nutrition-sensitive interventions were not central to the initial response as EVD containment and survival took priority. Culturally-appropriate social and behavior change communications were a critical response component for improving health, nutrition, and hygiene-related behaviors through community engagement.ConclusionsInfectious diseases such as EVD have far-reaching effects that impact health and nutrition through interrelated pathways. In Sierra Leone, the entire food value-chain was broken to the extent that the system-wide damage was on par with that typically resulting from large natural disasters. A food value-chain approach, at minimum, offers a foundational framework from which to position nutrition preparedness and response efforts for outbreaks in similar resource constrained settings.

Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response

“…Eleven articles from various geographical and disease contexts highlighted the psychological implications of mass quarantine as emotional distress and symptoms of mental illness. [22][23][24][25][27][28][29][30][31][32]35 Among people in or after quarantine, some experienced emotional distress, including:…”

“…annoyance, 32 anxiety, 25,29 boredom, 23,25,32 disappointment and life dissatisfaction, 24,32,35 fear of infection, 23,25,30,34 isolation, 23,25,32 . 27 Nevertheless, this result was prone to reporting bias as the survey response rate was less than one per cent; 27 confirmation of psychiatric disorders required further clinical diagnosis, on which data were not available.…”

“…33 Interviewees mentioned how community members offered emotional support and took care of orphans during the mass quarantine in the Toronto SARS epidemic and in the Liberia EVD outbreak, respectively. 23,29 Stigma and labelling may pose further psychological challenges to people under quarantine.…”

Effects of Covid-19 Pandemic on Food Security and Household Livelihoods in Kenya

“…Also, many studies have been conducted to evaluate the impact of epidemics and natural disasters on food security. Most studies posited that many households are most likely to be hit due to negative impact of epidemics on crop production, incomes, movements and food chains which increases the problem of food and nutritional insecurity throughout the world (Kodish et al, 2019;Agrilinks, 2020). For instance, the 2013-2016 Ebola outbreaks in West Africa negatively disrupted the food system and markets, primarily in Sierra Leone, Guinea, and Liberia (Gatiso et al, 2018;FAO, 2015a).…”

Methods in the Time of COVID-19: The Vital Role of Qualitative Inquiries

“…In a qualitative exploration of flu behavior during the 2009 H1N1 flu outbreak, Flowers and colleagues (2016) found that the majority of work surrounding hygiene, personal protection, and caregiving during the outbreak collided with gender inequities and unfairly burdened women, worsening gender-based inequities and women's vulnerabilities. Via focus groups, interviews, and observations with communities after the EVD outbreak in Sierra Leone, qualitative researchers found that quarantine put people in danger of starvation given preexisting food insecurities (Kodish et al, 2019). Similarly, during EVD, bushmeat bans contradicted people's experiences of safely consuming wild meat, and the criminalization of bushmeat worsened distrust between communities and outbreak workers (Bonwitt et al, 2018).…”