{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:30:42Z","timestamp":1765758642069,"version":"3.48.0"},"reference-count":39,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T00:00:00Z","timestamp":1620777600000},"content-version":"unspecified","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006090","name":"Center for Global Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006090","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,4,20]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To understand the barriers contributing to the more than threefold decline in the number of deaths (of all causes) reported to a national toll free telephone line (1-1-7) after the 2014\u20132016 Ebola outbreak ended in Sierra Leone and explore opportunities for improving routine death reporting as part of a nationwide mortality surveillance system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>An exploratory qualitative assessment comprising 32 in-depth interviews (16 in Kenema district and 16 in Western Area). All interviews were audio-recorded, transcribed and analysed using qualitative content analysis to identify themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Participants were selected from urban and rural communities in two districts that experienced varying levels of Ebola cases during the outbreak. All interviews were conducted in August 2017 in the post-Ebola-outbreak context in Sierra Leone when the Sierra Leone Ministry of Health and Sanitation was continuing to mandate reporting of all deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Family members of deceased persons whose deaths were not reported to the 1-1-7 system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Death reporting barriers were driven by the lack of awareness to report all deaths, lack of services linked to reporting, negative experiences from the Ebola outbreak including prohibition of traditional burial rituals, perception that inevitable deaths do not need to be reported and situations where prompt burials may be needed. Facilitators of future willingness to report deaths were largely influenced by the perceived communicability and severity of the disease, unexplained circumstances of the death that need investigation and the potential to leverage existing death notification practices through local leaders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Social mobilisation and risk communication efforts are needed to help the public understand the importance and benefits of sustained and ongoing death reporting after an Ebola outbreak. Localised practices for informal death notification through community leaders could be integrated into the formal reporting system to capture community-based deaths that may otherwise be missed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-042976","type":"journal-article","created":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T05:45:39Z","timestamp":1620884739000},"page":"e042976","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Barriers and facilitators to reporting deaths following Ebola surveillance in Sierra Leone: implications for sustainable mortality surveillance based on an exploratory qualitative assessment"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7206-8042","authenticated-orcid":false,"given":"Mohamed F","family":"Jalloh","sequence":"first","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"},{"name":"Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Kinsman","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Epidemiology and Global Health, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Conteh","sequence":"additional","affiliation":[{"name":"Independent Consultant, Freetown, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reinhard","family":"Kaiser","sequence":"additional","affiliation":[{"name":"Sierra Leone Country Office, U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amara","family":"Jambai","sequence":"additional","affiliation":[{"name":"Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna Mia","family":"Ekstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca E","family":"Bunnell","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9226-6441","authenticated-orcid":false,"given":"Helena","family":"Nordenstedt","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,5,13]]},"reference":[{"key":"2025121300243006000_11.5.e042976.1","article-title":"Understanding the emergence of Ebola virus disease in Sierra Leone: Stalking the virus in the threatening wake of emergence","volume":"7","author":"Wauquier","year":"2015","journal-title":"PLoS Curr"},{"key":"2025121300243006000_11.5.e042976.2","unstructured":"World Health Organization . 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