{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T09:32:33Z","timestamp":1790501553669,"version":"4.1.0"},"reference-count":31,"publisher":"BMJ","issue":"3","funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["1504"],"award-info":[{"award-number":["1504"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2016,9,26]]},"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In Sierra Leone, over 4000 individuals survived Ebola since the outbreak began in 2014. Because Ebola survivorship was largely unprecedented prior to this outbreak, little is known about survivor experiences during and post illness.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>To assess survivors' experiences and attitudes related to Ebola, 28 in-depth interviews and short quantitative surveys with survivors from all four geographic regions of Sierra Leone were conducted in May 2015.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Survivor experiences, emotions and attitudes changed over time as they moved from disease onset to treatment, discharge and life post-discharge. Survivors mentioned experiencing acute fear and depression when they fell ill. Only half reported positive experiences in holding centres but nearly all were positive about their treatment centre experiences. Survivor euphoria on discharge was followed by concerns about their financial situation and future. While all reported supportive attitudes from family members, about a third described discrimination and stigma from their communities. Over a third became unemployed, especially those previously engaged in petty trade. Survivor knowledge about sexual transmission risk reflected counselling messages. Many expressed altruistic motivations for abstinence or condom use. In addition, survivors were strongly motivated to help end Ebola and to improve the healthcare system. Key recommendations from survivors included improved counselling in holding centres and long-term government support for survivors, including opportunities for participation in Ebola response efforts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Survivors face myriad economic, social and health challenges. Addressing survivor concerns, including the discrimination they face, could facilitate their reintegration into communities and their contributions to future Ebola responses.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2016-000108","type":"journal-article","created":{"date-parts":[[2016,11,18]],"date-time":"2016-11-18T22:00:30Z","timestamp":1479506430000},"page":"e000108","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":43,"title":["\u2018Once there is life, there is hope\u2019 Ebola survivors' experiences, behaviours and attitudes in Sierra Leone, 2015"],"prefix":"10.1136","volume":"1","author":[{"given":"Emilie","family":"Karafillakis","sequence":"first","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed F","family":"Jalloh","sequence":"additional","affiliation":[{"name":"FOCUS 1000, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azizeh","family":"Nuriddin","sequence":"additional","affiliation":[{"name":"US Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi J","family":"Larson","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmy","family":"Whitworth","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelley","family":"Lees","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy M","family":"Hageman","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Sengeh","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, FOCUS 1000, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad B","family":"Jalloh","sequence":"additional","affiliation":[{"name":"FOCUS 1000, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Bunnell","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dianna D","family":"Carroll","sequence":"additional","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Morgan","sequence":"additional","affiliation":[{"name":"US Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,11,18]]},"reference":[{"key":"2025072915225281000_1.3.e000108.1","first-page":"230","article-title":"Medical anthropology and Ebola in Congo: cultural models and humanistic care","volume":"98","author":"Hewlett","year":"2005","journal-title":"Bull Soc Pathol Exot"},{"key":"2025072915225281000_1.3.e000108.2","first-page":"853","article-title":"[Epidemics and related cultural factors for Ebola hemorrhagic fever in Gabon]","volume":"48","author":"Kunii","year":"2001","journal-title":"Nihon Koshu Eisei Zasshi"},{"key":"2025072915225281000_1.3.e000108.3","unstructured":"WHO Afro. Statement on the end of the Ebola outbreak in Sierra Leone 2015. http:\/\/www.afro.who.int\/en\/sierra-leone\/press-materials\/item\/8140-statement-on-the-end-of-the-ebola-outbreak-in-sierra-leone.html"},{"key":"2025072915225281000_1.3.e000108.4","unstructured":"UK Parliament. Ebola: responses to a public health emergency 2016. http:\/\/www.publications.parliament.uk\/pa\/cm201516\/cmselect\/cmintdev\/338\/33804.htm"},{"key":"2025072915225281000_1.3.e000108.5","unstructured":"Sierra Leone National Ebola Response Centre. Lessons learned from the response to the Ebola birus Disease outbreak in Sierra Leone\u2014May 2014 to November 2015 Summary Report. Freetown: Government of Sierra Leone, 2015."},{"key":"2025072915225281000_1.3.e000108.6","unstructured":"Organization WH. Ebola Situation Report\u201430 March 2016. http:\/\/apps.who.int\/ebola\/current-situation\/ebola-situation-report-30-march-2016"},{"key":"2025072915225281000_1.3.e000108.7","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1586\/14787210.2015.1079128","article-title":"Post-Ebola virus disease syndrome: what do we know?","volume":"13","author":"Carod-Artal","year":"2015","journal-title":"Expert Rev Anti Infect Ther"},{"key":"2025072915225281000_1.3.e000108.8","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ453"},{"key":"2025072915225281000_1.3.e000108.9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1500306"},{"key":"2025072915225281000_1.3.e000108.10","unstructured":"Follow-up Study on Public Knowledge, Attitudes, and Practices Relating to EVD Prevention and Medical Care. (KAP 4 Preliminary Findings) Ministry of Health, Sierra Leone.CDC. Focus1000. http:\/\/focus1000.org\/index.php\/downloads-resources\/send\/4-ebola-kap-study\/32-kap-4-preliminary-findings"},{"key":"2025072915225281000_1.3.e000108.11","first-page":"1205","article-title":"Support services for survivors of Ebola virus disease\u2014Sierra Leone, 2014","volume":"63","author":"Lee-Kwan","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025072915225281000_1.3.e000108.12","unstructured":"FOCUS 1000, US Centers for Disease Control and Prevention, UNICEF. Follow-up study on public knowledge, attitudes, and practices relating to Ebola virus disease prevention and medical care in Sierra Leone (Ebola KAP-2), Final Report. Freetown, Sierra Leone: FOCUS 1000, 2014."},{"key":"2025072915225281000_1.3.e000108.13","unstructured":"FOCUS 1000, US Centers for Disease Control and Prevention, UNICEF. Study on public knowledge, attitudes, and practices relating to Ebola virus disease prevention and medical care in Sierra Leone (Ebola KAP-3), Final Report. Freetown, Sierra Leone: Focus 1000, 2014. http:\/\/reliefweb.int\/sites\/reliefweb.int\/files\/resources\/Ebola-Virus-Disease-National-KAP-Study-Final-Report_-final.pdf"},{"key":"2025072915225281000_1.3.e000108.14","unstructured":"FOCUS 1000, US Centers for Disease Control and Prevention, UNICEF. Follow-up study on public knowledge, attitudes, and practices relating to Ebola virus disease prevention and medical care in Sierra Leone (Ebola KAP-4), Preliminary Report. Freetown, Sierra Leone: FOCUS 1000, 2015."},{"key":"2025072915225281000_1.3.e000108.15","unstructured":"UNICEF. Sierra Leone Ebola Situation Report, 2015."},{"key":"2025072915225281000_1.3.e000108.16","unstructured":"World Health Organization. Ebola outbreak to recovery: Sierra Leone progress report. Sierra Leone: WHO, 29 Jan 2015. https:\/\/www.unicef.org\/appeals\/files\/UNICEF_Sierra_Leone_EVD_Weekly_SitRep_29_January_2015.pdf"},{"key":"2025072915225281000_1.3.e000108.17","unstructured":"Statistics Sierra Leone, ICF International. Sierra Leone Demographic and Health Survey 2013. Freetown, Sierra Leone. Rockville, Maryland, USA: SSL and ICF International, 2014."},{"key":"2025072915225281000_1.3.e000108.18","doi-asserted-by":"crossref","unstructured":"Deen GF , Knust B , Broutet N , et al . Ebola RNA persistence in semen of Ebola virus disease survivors \u2013 preliminary report. N Engl J Med 2015. doi:10.1056\/NEJMoa1511410 doi:10.1056\/NEJMoa1511410","DOI":"10.1056\/NEJMoa1511410"},{"key":"2025072915225281000_1.3.e000108.19","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1509773"},{"key":"2025072915225281000_1.3.e000108.20","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.15.030215"},{"key":"2025072915225281000_1.3.e000108.21","first-page":"1207","article-title":"Reintegration of Ebola survivors into their communities\u2014Firestone District, Liberia, 2014","volume":"63","author":"Arwady","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025072915225281000_1.3.e000108.22","unstructured":"Partners in Health. Sierra Leone. http:\/\/www.pih.org\/country\/sierra-leone"},{"key":"2025072915225281000_1.3.e000108.23","unstructured":"World Health Organization. WHO meeting on survivors of Ebola virus disease: clinical care of survivors, 3\u20134 August 2015 Meeting report. Freetown: WHO, 2015."},{"key":"2025072915225281000_1.3.e000108.24","unstructured":"UNDP. Livelihood skills and mothly stipends for ebola survivors Freetown, 2016. http:\/\/www.sl.undp.org\/content\/sierraleone\/en\/home\/presscenter\/pressreleases\/2016\/06\/21\/livelihood-skills-and-monthly-stipends-for-ebola-survivors.html"},{"key":"2025072915225281000_1.3.e000108.25","doi-asserted-by":"crossref","first-page":"e0003706","DOI":"10.1371\/journal.pntd.0003706","article-title":"Community-centered responses to Ebola in urban Liberia: the view from below","volume":"9","author":"Abramowitz","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"2025072915225281000_1.3.e000108.26","doi-asserted-by":"crossref","unstructured":"Johnson O , Youkee D , Brown CS , et al . Ebola holding units at government hospitals in Sierra Leone: evidence for a flexible and effective model for safe isolation, early treatment initiation, hospital safety and health system functioning. BMJ Glob Health 2016;1:e000030. doi:10.1136\/bmjgh-2016-000030doi:10.1136\/bmjgh-2016-000030","DOI":"10.1136\/bmjgh-2016-000030"},{"key":"2025072915225281000_1.3.e000108.27","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2015-205002"},{"key":"2025072915225281000_1.3.e000108.28","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyu233"},{"key":"2025072915225281000_1.3.e000108.29","doi-asserted-by":"publisher","DOI":"10.1038\/516323a"},{"key":"2025072915225281000_1.3.e000108.30","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/dav003"},{"key":"2025072915225281000_1.3.e000108.31","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-3156.1998.00322.x"}],"container-title":["BMJ Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjgh-2016-000108","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T22:22:58Z","timestamp":1753827778000},"score":1,"resource":{"primary":{"URL":"https:\/\/gh.bmj.com\/lookup\/doi\/10.1136\/bmjgh-2016-000108"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,11]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2016,11,18]]},"published-print":{"date-parts":[[2016,11]]}},"alternative-id":["10.1136\/bmjgh-2016-000108"],"URL":"https:\/\/doi.org\/10.1136\/bmjgh-2016-000108","relation":{},"ISSN":["2059-7908"],"issn-type":[{"value":"2059-7908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,11]]}}}