The potential risk components and prevention measures of the Ebola virus disease outbreak in Liberia: An in-depth interview with the health workers and stakeholders


Ebola virus disease
risk components
prevention measure
public health

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Stephens, M. T., Juniastuti, Sulistiawati, & Dossen, P. C. (2024). The potential risk components and prevention measures of the Ebola virus disease outbreak in Liberia: An in-depth interview with the health workers and stakeholders. Belitung Nursing Journal, 10(1), 67–77.
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Accepted for publication: 2024-01-13
Peer reviewed: Yes

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Background: The Ebola virus, a highly infectious and deadly pathogen, has posed a significant public health threat in West Africa for several decades. Liberia is one of the most severely affected countries. Healthcare personnel, including nurses, are on the front lines of patient care, and their perspectives are invaluable in understanding the challenges that arise during outbreaks, especially in implementing prevention measures.

Objective: This study aimed to explore the potential risk components and prevention measures of the Ebola virus disease (EVD).

Methods: This study used an exploratory descriptive qualitative design. Five stakeholders, ten doctors and five nurses who had suffered from EVD during the outbreak in Liberia participated in semi-structured interviews to provide their experience and comprehensive perspectives on EVD. Data were collected from February 2022-August 2023. NVivo 12 plus was used for inductive thematic analysis.

Results: Six themes and several subthemes emerged: 1) transmission modes (body contact, body fluid, sexual intercourse, traditional burial), 2) funeral attendance (traditional practices and crowded gatherings), 3) community-led prevention (promoting good hygiene practices, increasing awareness, contact tracing, and surveillance), 4) Ebola virus vaccine (false sense of security, potential side effects, and limited data), 5) challenges in implementing prevention measures (inadequate health infrastructures, difficulty of tracing infected people, lack of resources, and cultural-social barriers), 6) Liberia’s health systems (a weak, underfunded, fragile health infrastructure, lack of health facilities and shortage of health workers).

Conclusion: Several potential risk components contributing to the EVD outbreak should be a public concern. Strengthening the current healthcare system supported by local community and international aid providers (multidisciplinary teams) is needed to anticipate behavioral problems and to improve the efficacy of the prevention measures appropriate to the conditions in Liberia. Accordingly, the nurses’ compliance with the recommended prevention practices is necessary.


Copyright (c) 2024 Moses Tende Stephens, Juniastuti, Sulistiawati, Peter Chilaque Dossen

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Declaration of Conflicting Interest

There are no conflicts of interest to disclose.




We thank the participants for their cooperation and support during data collection, as well as thank the Rector of Universitas Airlangga, Mohammad Nasih, for his prestigious global scholarship (Airlangga Development Scholarship) and the directors of JFK Hospital and Redemption Hospital, Monrovia, Liberia, for giving permission to obtain the data of samples.

Authors’ Contributions

Conceptualization and design: Moses Tende Stephens, Junistuti, Sulistiawati, Peter Chalaqual Dossen.

Data curation: Moses Tende Stephens, Juniastuti.

Formal analysis: Moses Tende Stephens, Juniastuti, Sulistiawati, Peter Chalaqual Dossen.

Investigation: Moses Tende Stephens and Peter Chalaqual Dossen.

Methodology: Moses Tende Stephens, Juniastuti, Sulistiawati, Peter Chilaque Dossen.

Writing – original draft: Moses Tende Stephens, Juniastuti.

Writing – review & editing: Juniastuti, Sulistiawati.

Supervision: Juniastuti, Sulistiwati.

Data Availability

Due to the nature of this research, participants of this study did not provide consent for their data to be shared publicly, so supporting data is not available.

Declaration of Use of AI in Scientific Writing

There is nothing to declare.


Abo, S. M. C. (2020). Modelling the daily risk of Ebola in the presence and absence of a potential vaccine. Infectious Disease Modelling, 5, 905-917.

Abramowitz, S. A., Hipgrave, D. B., Witchard, A., & Heymann, D. L. (2018). Lessons from the West Africa Ebola epidemic: A systematic review of epidemiological and social and behavioral science research priorities. The Journal of Infectious Diseases, 218(11), 1730-1738.

Agnandji, S. T., & Loembe, M. M. (2022). Ebola vaccines for mass immunisation in affected regions. The Lancet Infectious Diseases, 22(1), 8-10.

Akbarialiabad, H., Shidhaye, R., Shidhaye, P., Cuijpers, P., Weaver, M. R., Bahrololoom, M., Kiburi, S., Njuguna, I. N., Taghrir, M. H., & Kumar, M. (2022). Protocol: Impact of major disease outbreaks in the third millennium on adolescent and youth sexual and reproductive health and rights in low and/or middle-income countries: A systematic scoping review protocol. BMJ Open, 12(3), e051216.

Ali, E., Benedetti, G., Van den Bergh, R., Halford, A., Bawo, L., Massaquoi, M., Bellizzi, S., & Maes, P. (2020). Distribution of household disinfection kits during the 2014-2015 Ebola virus outbreak in Monrovia, Liberia: the MSF experience. PLoS Neglected Tropical Diseases, 14(9), e0008539.

Appiah-Sakyi, K., Mohan, M., & Konje, J. C. (2021). Ebola infection in pregnancy, an ongoing challenge for both the global health expert and the pregnant woman—A review. European Journal of Obstetrics & Gynecology and Reproductive Biology, 258, 111-117.

Arthur, R. F., Horng, L. M., Tandanpolie, A. F., Gilstad, J. R., Tantum, L. K., & Luby, S. P. (2023). The lasting influence of Ebola: A qualitative study of community-level behaviors, trust, and perceptions three years after the 2014-16 Ebola epidemic in Liberia. BMC Public Health, 23, 682.

Arthur, R. R. (2002). Ebola in Africa-discoveries in the past decade. Eurosurveillance, 7(3), 33-36.

Aspers, P., & Corte, U. (2019). What is qualitative in qualitative research. Qualitative Sociology, 42, 139-160.

Bebell, L. M., Oduyebo, T., & Riley, L. E. (2017). Ebola virus disease and pregnancy: A review of the current knowledge of Ebola virus pathogenesis, maternal, and neonatal outcomes. Birth Defects Research, 109(5), 353-362.

Bingham, A. J., & Witkowsky, P. (2021). Deductive and inductive approaches to qualitative data analysis. In C. Vanover, P. Mihas, & J. Saldana (Eds.), Analyzing and interpreting qualitative data: After the interview (pp. 133-146). SAGE Publications.

Bisimwa, P., Biamba, C., Aborode, A. T., Cakwira, H., & Akilimali, A. (2022). Ebola virus disease outbreak in the Democratic Republic of the Congo: A mini-review. Annals of Medicine and Surgery, 104213.

Brainard, J., Hooper, L., Pond, K., Edmunds, K., & Hunter, P. R. (2016). Risk factors for transmission of Ebola or Marburg virus disease: A systematic review and meta-analysis. International Journal of Epidemiology, 45(1), 102-116.

Brown, J. F., Dye, J. M., Tozay, S., Jeh-Mulbah, G., Wohl, D. A., Fischer 2nd, W. A., Cunningham, C. K., Rowe, K., Zacharias, P., & van Hasselt, J. (2018). Anti–Ebola virus antibody levels in convalescent plasma and viral load after plasma infusion in patients with Ebola virus disease. The Journal of Infectious Diseases, 218(4), 555-562.

Carter, R. J., Idriss, A., Widdowson, M.-A., Samai, M., Schrag, S. J., Legardy-Williams, J. K., Estivariz, C. F., Callis, A., Carr, W., & Webber, W. (2018). Implementing a multisite clinical trial in the midst of an Ebola outbreak: Lessons learned from the Sierra Leone trial to introduce a vaccine against Ebola. The Journal of Infectious Diseases, 217(suppl_1), S16-S23.

Casey, M. L., Nguyen, D. T., Idriss, B., Bennett, S., Dunn, A., & Martin, S. (2015). Potential exposure to Ebola virus from body fluids due to ambulance compartment permeability in Sierra Leone. Prehospital and Disaster Medicine, 30(6), 625-627.

Dokubo, E. K., Wendland, A., Mate, S. E., Ladner, J. T., Hamblion, E. L., Raftery, P., Blackley, D. J., Laney, A. S., Mahmoud, N., & Wayne-Davies, G. (2018). Persistence of Ebola virus after the end of widespread transmission in Liberia: An outbreak report. The Lancet Infectious Diseases, 18(9), 1015-1024.

Fallah, M. P., Skrip, L. A., Dahn, B. T., Nyenswah, T. G., Flumo, H., Glayweon, M., Lorseh, T. L., Kaler, S. G., Higgs, E. S., & Galvani, A. P. (2016). Pregnancy outcomes in Liberian women who conceived after recovery from Ebola virus disease. The Lancet Global Health, 4(10), e678-e679.

Furuse, Y., Fallah, M., Oshitani, H., Kituyi, L., Mahmoud, N., Musa, E., Gasasira, A., Nyenswah, T., Dahn, B., & Bawo, L. (2017). Analysis of patient data from laboratories during the Ebola virus disease outbreak in Liberia, April 2014 to March 2015. PLoS Neglected Tropical Diseases, 11(7), e0005804.

Fusch, P. I., & Ness, L. R. (2015). Are we there yet? Data saturation in qualitative research. Qualitative Report, 20(9), 1408-1416.

Hunter, D., McCallum, J., & Howes, D. (2019). Defining exploratory-descriptive qualitative (EDQ) research and considering its application to healthcare. Journal of Nursing and Health Care, 4(1).

International Ebola Response Team, Agua-Agum, J., Ariyarajah, A., Aylward, B., Bawo, L., Bilivogui, P., Blake, I. M., Brennan, R. J., Cawthorne, A., & Cleary, E. (2016). Exposure patterns driving Ebola transmission in West Africa: a retrospective observational study. PLoS Medicine, 13(11), e1002170.

Kobayashi, M., Beer, K. D., Bjork, A., Chatham-Stephens, K., Cherry, C. C., Arzoaquoi, S., Frank, W., Kumeh, O., Sieka, J., & Yeiah, A. (2015). Community knowledge, attitudes, and practices regarding Ebola virus disease—five counties, Liberia, September–October, 2014. Morbidity and Mortality Weekly Report, 64(26), 714-718.

Koepsell, S. A., Fitts, E. C., & Roback, J. D. (2023). Revisiting Ebola: Lessons learned from the 2014–2015. Transfusion, 63(2), 427-429.

Korstjens, I., & Moser, A. (2018). Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. European Journal of General Practice, 24(1), 120-124.

Lévy, Y., Lane, C., Piot, P., Beavogui, A. H., Kieh, M., Leigh, B., Doumbia, S., D'Ortenzio, E., Lévy-Marchal, C., & Pierson, J. (2018). Prevention of Ebola virus disease through vaccination: Where we are in 2018. The Lancet, 392(10149), 787-790.

MacNeil, A., & Rollin, P. E. (2012). Ebola and Marburg hemorrhagic fevers: Neglected tropical diseases? PLoS Neglected Tropical Diseases, 6(6), e1546.

Malik, S., Kishore, S., Nag, S., Dhasmana, A., Preetam, S., Mitra, O., León-Figueroa, D. A., Mohanty, A., Chattu, V. K., & Assefi, M. (2023). Ebola virus disease vaccines: Development, current perspectives & challenges. Vaccines, 11(2), 268.

Matlock, A. M., Gutierrez, D., Wallen, G., & Hastings, C. (2015). Providing nursing care to Ebola patients on the national stage: The National Institutes of Health experience. Nursing Outlook, 63(1), 21-24.

Mbala-Kingebeni, P., Pratt, C., Mutafali-Ruffin, M., Pauthner, M. G., Bile, F., Nkuba-Ndaye, A., Black, A., Kinganda-Lusamaki, E., Faye, M., & Aziza, A. (2021). Ebola virus transmission initiated by relapse of systemic Ebola virus disease. New England Journal of Medicine, 384(13), 1240-1247.

Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16(1), 1609406917733847.

Paillard-Borg, S., Holmgren, J., Saaristo, P., & von Strauss, E. (2020). Nurses in an Ebola viral hemorrhagic fever outbreak: Facing and preparing for psychosocial challenges. SAGE Open, 10(2), 2158244020920658.

Reichler, M. R., Bangura, J., Bruden, D., Keimbe, C., Duffy, N., Thomas, H., Knust, B., Farmar, I., Nichols, E., & Jambai, A. (2018). Household transmission of Ebola virus: Risks and preventive factors, Freetown, Sierra Leone, 2015. The Journal of Infectious Diseases, 218(5), 757-767.

Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing & Health, 23(4), 334-340.<334::AID-NUR9>3.0.CO;2-G

Selvaraj, S. A., Lee, K. E., Harrell, M., Ivanov, I., & Allegranzi, B. (2018). Infection rates and risk factors for infection among health workers during Ebola and Marburg virus outbreaks: A systematic review. The Journal of Infectious Diseases, 218(suppl_5), S679-S689.

Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349-357.

WHO Ebola Response Team. (2014). Ebola virus disease in West Africa—the first 9 months of the epidemic and forward projections. New England Journal of Medicine, 371(16), 1481-1495.

Wiratsudakul, A., Triampo, W., Laosiritaworn, Y., & Modchang, C. (2016). A one-year effective reproduction number of the 2014–2015 Ebola outbreaks in the widespread West African countries and quantitative evaluation of air travel restriction measure. Travel Medicine and Infectious Disease, 14(5), 481-488.

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