The limited body of research on Ebola suggests that, among survivors and their families, there are substantial impacts of infection on social and demographic outcomes, yet little is known about this topic. The 2014-15 Ebola epidemic was by far the most severe in history, with over 28,000 reported cases in Guinea, Liberia and Sierra Leone, and more than 10,000 survivors. Among survivors, the impact of Ebola infection extended beyond just physical health; the consequences range from the psychological (depression, anxiety, guilt) to demographic and social (marital dissolution, migration, stigma), many of which are likely to be long-lasting. However, to date, very little research has examined the impact of Ebola on social and demographic outcomes- both for survivors, as well as their families- and the existing research has important limitations. The vast majority of research on social and demographic impacts of Ebola infection is qualitative and uses convenience samples. Several topics have not been examined, like the longer-term impacts of Ebola infection, factors promoting recovery and resilience after infection among survivors, and indirect impact of Ebola infection on households. This proposed research will be the first population-based quantitative study on the impacts of Ebola infection on social and demographic outcomes. We seek to collect data for three populations in Sierra Leone: individuals who (1) were infected with Ebola but survived (the infected), (2) had a household member who died from Ebola (the affected), and (3) were neither infected or had a household member die from Ebola infection (neither infected nor affected).
The Specific Aims for this study therefore include: SA #1: To examine the consequences of Ebola infection on demographic and social outcomes, such as marriage, fertility, migration, and mental and physical health; and social outcomes, such as views towards health facilities, perceptions of mortality, social interactions and networks. To accomplish this goal, we will compare these outcomes between Ebola survivors and those who were not infected in the same communities in Sierra Leone, while controlling for characteristics that differ between these groups and may impact the outcomes of interest. SA #2: Among Ebola survivors, to identify coping mechanisms that promoted resilience and recovery after Ebola infection. Among Ebola survivors, we will identify those who more effectively recovered from Ebola, and identify characteristics that are associated with effective recovery. Several aspects of recovery will be measured, including health and well-being, economic status, and social capital. SA #3: To measure the indirect impacts of Ebola infection on households and families. To do so, we will compare sociodemographic outcomes between households affected by Ebola and those who were neither infected nor affected by Ebola.
With the growing threat of infectious diseases such as SARS, MERS, Ebola, and Zika, the consequence of and recovery from an epidemic is an increasingly important issue for public health. This proposed research will be the first population-based quantitative study on the impacts of Ebola infection on social and demographic outcomes. We seek to examine the direct and indirect impacts of Ebola infection on demographic and social outcomes, and identify factors that promote recovery from Ebola infection in Sierra Leone.
