Disease Control and Ebola in West Africa: A Qualitative Evidence Synthesis

Aims: The West African Ebola Virus Disease (EVD) outbreak of 2014-2016 was the most disastrous EVD epidemic in history. During this outbreak, many disease control measures ranging from health communication to safe burial practices faced resistance, hindering control of the virus. Using a qualitative systematic review method, we aimed to investigate the latter phenomenon, whilst also providing unique theoretical insights which could help inform future responses to EVD outbreaks. Methods: Following both Cochrane and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidance related to systematic searching and sorting, five key databases were searched between May 2021 and February 2022 for peer-reviewed published qualitative literature centred on the outbreak (Medline, Embase, PubMed, Scopus and Cumulative Index of Nursing and Allied Health Literature (CINAHL)), with 412 papers being collected. In supplementing the database searches, up until April 2022 handsearching was also conducted. Following abstract and full text screening by multiple reviewers, 35 papers were identified for inclusion. In determining study rigour, the Critical Appraisal Skills Programme (CASP) checklist was used, after which data was extracted and thematically coded. Coded data was then synthesised in accordance with the protocol set out by Thomas and Hardon. Findings: Regarding geographical context, most fieldwork underpinning included studies was conducted within Western Urban Area in Sierra Leone, suggesting that some geographical discrepancy exists within the literature base. Study quality was generally good, although some issues were identified regarding researcher reflexivity, ethical procedures and data analysis. Following thematic synthesis, it was found that beliefs and/or practices relating to distrust, fear, socio-cultural considerations and denial hindered engagement with control measures. By contrast, experiencing the virus first-hand and engaging with survivors prompted the uptake of such measures. Building from these findings, we then proposed an amendment to Barry Hewlett’s Evolutionary Cultural Anthropology (ECA) framework, shedding light on the determinants of such beliefs and/or practices. Conclusion: Our review provides a systematic mapping of which beliefs and/or practices either promoted or hindered response efforts during the outbreak, as well as an authentic and holistic way of understanding why such beliefs and/or practices emerged, by synthesising Hewlett’s ECA framework with our findings. Drawing on our cross-contextual analysis, health professionals throughout West Africa and beyond could use this work in further reflecting on and guiding the implementation of control measures prior or during future EVD outbreaks.