{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:55:08Z","timestamp":1792457708123,"version":"4.5.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0009576","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,7,26]],"date-time":"2021-07-26T00:00:00Z","timestamp":1627257600000}}],"reference-count":68,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2021,7,14]],"date-time":"2021-07-14T00:00:00Z","timestamp":1626220800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"national institute of allergy and infectious diseases","doi-asserted-by":"publisher","award":["AI104621"],"award-info":[{"award-number":["AI104621"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"national institute of allergy and infectious diseases","doi-asserted-by":"publisher","award":["AI114855"],"award-info":[{"award-number":["AI114855"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"national institute of allergy and infectious diseases","doi-asserted-by":"publisher","award":["AI115754"],"award-info":[{"award-number":["AI115754"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"national institute of allergy and infectious diseases","doi-asserted-by":"publisher","award":["1U19AI135995"],"award-info":[{"award-number":["1U19AI135995"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"national institute of allergy and infectious diseases","doi-asserted-by":"publisher","award":["1U01AI15181201"],"award-info":[{"award-number":["1U01AI15181201"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005492","name":"Stanford University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100005492","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The West African Ebola epidemic of 2013\u20132016 killed nearly 4,000 Sierra Leoneans and devastated health infrastructure across West Africa. Changes in health seeking behavior (HSB) during the outbreak resulted in dramatic underreporting and substantial declines in hospital presentations to public health facilities, resulting in an estimated tens of thousands of additional maternal, infant, and adult deaths per year. Sierra Leone\u2019s Kenema District, a major Ebola hotspot, is also endemic for Lassa fever (LF), another often-fatal hemorrhagic disease. Here we assess the impact of the West African Ebola epidemic on health seeking behaviors with respect to presentations to the Kenema Government Hospital (KGH) Lassa Ward, which serves as the primary health care referral center for suspected Lassa fever cases in the Eastern Province of Sierra Leone.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology\/Principal findings<\/jats:title>\n<jats:p>Presentation frequencies for suspected Lassa fever presenting to KGH or one of its referral centers from 2011\u20132019 were analyzed to consider the potential impact of the West African Ebola epidemic on presentation patterns. There was a significant decline in suspected LF cases presenting to KGH following the epidemic, and a lower percentage of subjects were admitted to the KGH Lassa Ward following the epidemic. To assess general HSB, a questionnaire was developed and administered to 200 residents from 8 villages in Kenema District. Among 194 completed interviews, 151 (78%) of respondents stated they felt hospitals were safer post-epidemic with no significant differences noted among subjects according to religious background, age, gender, or education. However, 37 (19%) subjects reported decreased attendance at hospitals since the epidemic, which suggests that trust in the healthcare system has not fully rebounded. Cost was identified as a major deterrent to seeking healthcare.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions\/Significance<\/jats:title>\n<jats:p>Analysis of patient demographic data suggests that fewer individuals sought care for Lassa fever and other febrile illnesses in Kenema District after the West African Ebola epidemic. Re-establishing trust in health care services will require efforts beyond rebuilding infrastructure and require concerted efforts to rebuild the trust of local residents who may be wary of seeking healthcare post epidemic.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0009576","type":"journal-article","created":{"date-parts":[[2021,7,14]],"date-time":"2021-07-14T17:48:47Z","timestamp":1626284927000},"page":"e0009576","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Health seeking behavior after the 2013\u201316 Ebola epidemic: Lassa fever as a metric of persistent changes in Kenema District, Sierra Leone"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4578-4502","authenticated-orcid":true,"given":"Mikaela 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S.","family":"Schieffelin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3941-3772","authenticated-orcid":true,"given":"Jeffrey G.","family":"Shaffer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4329-0795","authenticated-orcid":true,"given":"Donald S.","family":"Grant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,7,14]]},"reference":[{"key":"pntd.0009576.ref001","article-title":"Epidemiology and Management of the 2013\u201316 West African Ebola Outbreak","author":"ML Boisen","year":"2016","journal-title":"Annual review of virology"},{"key":"pntd.0009576.ref002","article-title":"An Outbreak of Ebola Virus Disease in the Lassa Fever Zone","author":"A Goba","year":"2016","journal-title":"J Infect 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Branco","year":"2011","journal-title":"Virology journal"},{"issue":"12","key":"pntd.0009576.ref036","doi-asserted-by":"crossref","first-page":"1971","DOI":"10.3201\/eid1212.060812","article-title":"Mastomys natalensis and Lassa fever, West Africa","volume":"12","author":"E Lecompte","year":"2006","journal-title":"Emerg Infect Dis"},{"key":"pntd.0009576.ref037","doi-asserted-by":"crossref","first-page":"25280","DOI":"10.1038\/srep25280","article-title":"New Hosts of The Lassa Virus","volume":"6","author":"A Olayemi","year":"2016","journal-title":"Scientific reports"},{"issue":"1775","key":"pntd.0009576.ref038","doi-asserted-by":"crossref","first-page":"20180268","DOI":"10.1098\/rstb.2018.0268","article-title":"Quantifying the seasonal drivers of transmission for Lassa fever in Nigeria","volume":"374","author":"AR Akhmetzhanov","year":"2019","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"key":"pntd.0009576.ref039","article-title":"Fifty years of Imported Lassa Fever-A Systematic Review of Primary and Secondary cases","author":"T Wolf","year":"2020","journal-title":"Journal of travel medicine"},{"issue":"4","key":"pntd.0009576.ref040","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/j.cell.2015.07.020","article-title":"Clinical Sequencing Uncovers Origins and Evolution of Lassa Virus","volume":"162","author":"KG Andersen","year":"2015","journal-title":"Cell"},{"key":"pntd.0009576.ref041","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1186\/1743-422X-8-404","article-title":"Lassa hemorrhagic fever in a late term pregnancy from northern Sierra Leone with a positive maternal outcome: case report","volume":"8","author":"LM Branco","year":"2011","journal-title":"Virol J"},{"key":"pntd.0009576.ref042","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1186\/1743-422X-8-314","article-title":"Capacity building permitting comprehensive monitoring of a severe case of Lassa hemorrhagic fever in Sierra Leone with a positive outcome: case 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system for Lassa fever in Sierra Leone: Approach, implementation, and challenges","volume":"14","author":"JG Shaffer","year":"2019","journal-title":"PloS one"},{"issue":"Suppl 2","key":"pntd.0009576.ref047","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1111\/j.1863-2378.2012.01469.x","article-title":"Lassa fever in West Africa: evidence for an expanded region of endemicity","volume":"59","author":"N Sogoba","year":"2012","journal-title":"Zoonoses and public health"},{"issue":"6422","key":"pntd.0009576.ref048","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1126\/science.aau9343","article-title":"Metagenomic sequencing at the epicenter of the Nigeria 2018 Lassa fever outbreak","volume":"363","author":"LE Kafetzopoulou","year":"2019","journal-title":"Science"},{"issue":"18","key":"pntd.0009576.ref049","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1056\/NEJMoa1804498","article-title":"Genomic Analysis of Lassa Virus during an Increase in Cases in Nigeria 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Lassa fever in Nigeria, Benin, Togo, Germany and USA. European Centre for Diseases Prevention and Control."},{"key":"pntd.0009576.ref052","author":"SS LEONE","year":"2015","journal-title":"Population and Housing Census SUMMARY OF FINAL RESULTS PLANNING A BETTER FUTURE"},{"key":"pntd.0009576.ref053","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1752-1505-8-11","article-title":"A window of opportunity for reform in post-conflict settings? 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