In Liberia, contact tracing key to curtailing Ebola’s spread

MONROVIA, Liberia – Although there are signs the Ebola outbreak in Liberia is slowing, the fight against the disease remains an uphill battle. Underlying problems with the health system continue to impede public health responses, and rumours are discouraging people from seeking help. To extend the reach of health workers and calm fears about the outbreak, UNFPA is playing a key role in contact tracing and disease surveillance efforts.

As of 7 November, 6,619 cases of Ebola had been identified in Liberia, 2,766 of which ended in death, according to the World Health Organization. Ebola can be spread once an infected person begins to exhibit symptoms; this can take place at any point within the disease’s 21-day incubation period.

UNFPA is working with Liberia’s Ministry of Health and Social Welfare and a variety of local and international partners to implement and scale up contact tracing – a key weapon in the fight against Ebola. Contact tracers are trained to find everyone who has been in contact with an infected person, and then monitor their health for the full incubation period.

A contact tracer speaks to a community member following a reported Ebola death in the area. Photo credit: UNFPA Liberia

Tracers may even go door-to-door to gather information about possible contacts and to raise awareness about how to prevent transmission of the disease.

When a suspected case is identified, officials are notified and a team from the health ministry evacuates the patient for testing and treatment.

Taking on Ebola denial

Ebola denial remains a problem in Liberia, discouraging infected persons from seeking proper care. Without isolation and treatment, the illness can quickly spread.

“Our job as contact tracers has been made difficult by community members’ entrenched denial and or lack of knowledge about the Ebola disease,” said Francis Cooper, who has seen conspiracy theories take hold in the community where he works. “Some community members see us as spies for the Ministry of Health who are trying to limit their movement and intrude in their personal affairs.”

“One of the greatest contributors to the high transmission rate are patients staying at home, where they can infect multiple family members,” said Ibrahim Sesay, a UNFPA data specialist in Liberia.

“The best intervention is to help communities manage patients in a manner that avoids further infection – through education and training of community volunteers,” Ms. Sesay said.

UNFPA is working to make sure communities are closely involved in the planning of contact training and in the recruitment of contact tracers. This process helps raise awareness within affected communities about how the disease works and how to combat it.

“Initially, it was difficult for community members to accept us into their homes. But people are getting to understand the situation,” said Kadiatu Koneh, a contact tracer. “The crucial aspect of our task is building a rapport with community members.”

Scaling up

Contact tracers are currently monitoring thousands of potential contacts. On 29 October, the Government of Liberia reported that 6,823 contacts had been monitored on that day alone. But there 7,220 contacts have been identified, meaning more resources and trained personnel are required.

There are currently 200 UNFPA-supported contact tracers working in two counties of Liberia, and this number is set to increase to about 6,500 in at least the remaining 13 counties.

And the UN Mission for Ebola Emergency Response is set to supply 3,300 mobile phones to help contact tracers rapidly communicate information to the health ministry and other partners in the response.