In Kambia, northwestern Sierra Leone, Ebola transmission was halted last month. However, to be certain that no new case is being missed, WHO epidemiologists are scrutinizing reports of every death in the district.
This intense surveillance has yielded disturbing news of a different kind. Around 75% of deaths in recent months have occurred in children under 5 years of age. Most of these children died at home, never seeing a health worker or receiving treatment, succumbing not to Ebola but to the many other diseases that still end young lives in this region.
To understand why and then to find ways to encourage mothers to bring their children back to the health centres, teams of WHO epidemiologists and community engagement specialists have been speaking with small focus groups of mothers with children under 5 in chiefdoms where the child death rates are very high.
"In this district Kambia, children are dying now. We, WHO, we are not happy about that at all. This is why we have come here today. We want to know why," Aziza Sahid, a community engagement specialist, told a group of mothers in Bubuye village. Babies at their breasts, toddlers on their laps, the mothers listened with rapt attention.
“Feel free to say whatever you know,” Aziza encouraged the group.
Away from health centres for fear of Ebola
First to venture thoughts on what was going on was the Mammy Queen, Madame Musiga Kibbeh, who also runs the nearest health centre.
“The women here don’t come to the health centre, because they are afraid. The rumour among mothers is that, if they take the child to the health centre, the child will get Ebola,” she said.
Madame Kibbeh added that since the outbreak began, mothers have shunned the heath centre. “I have tried my level best to convince them, but I have not had a single patient for the past 6 months.”
When directly questioned, the other women initially said that of course they would take children who were ill to the health centre or to the hospital. However, it soon became clear it was not just fear of Ebola that is keeping them away. Lack of income to pay for unexpected charges and negative experiences, such as finding the health centre out of supplies needed to treat their children, made the women unwilling to come back, they said.
Women in other focus groups said similar things. Fear of having to use up their limited funds is keeping people whose incomes have been hard hit by a year of Ebola away from health centres, even when it might well mean the loss of a much-loved child.