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Military-style operation helping defeat Ebola

A military-style operation to fight Ebola in Sierra Leone has helped to dramatically reduce new cases, in what health officials say is a major step towards defeating the deadly disease.

Polity reports that since it was launched about one month ago, the operation has doubled the number of ambulances for patients in the densely populated west of Sierra Leone, the worst-affected country where more than 3,000 people have died. Police halt vehicles at checkpoints in the tumble-down streets to check temperatures, while posters proclaim in the local Krio language: "Togeda we go stop ebola."

Aid workers also report success in changing behaviour in rural areas, notably discouraging people from burial rituals involving direct contact with the dead – a major source of transmission.

As a result, transmission of the haemorrhagic fever has slowed sharply in the West African country, which has recorded more than 10,000 cases since May. There were just 184 new cases in the week to 11 January – the lowest in five months. This has prompted President Ernest Bai Koroma to say he believes his government – helped by the nearly 800 British soldiers and more than $450m in foreign aid – can stamp out Sierra Leone's last case by the end of March.

But, the report says, some health specialists and aid workers are more cautious. They hope the success in Freetown and its environs is a big step towards beating the epidemic now that Liberia and Guinea also appear to have stabilised, but are wary of calling the end of an outbreak that last April seemed to wane in Guinea, only to return ferociously.

The Ebola centre has noted pockets of resistance in the capital, which officials attribute to mistrust of authorities due to the weak response before the surge. "The challenge is this last small group of people who aren't changing their behaviour," said Joanna Reid, head of Britain's Department for International Development in Sierra Leone. "That's the last mile."

David Heymann, head of Britain's Chatham House Centre on Global Health Security, said both current success and future progress is largely due to communication. "They've finally got strong communication … probably through traditional leaders and others who are helping communities understand how to prevent transmission. From my past experience with outbreaks, when communities learn how to communicate the risks and how to prevent infection, the outbreak stops – it's as simple as that."

In a positive sign, the percentage of corpses picked up by burial teams around Freetown testing positive for Ebola has dropped below 10%, from 30% before the surge, as families report suspected cases for treatment earlier.
But, the report notes, there is still much to be done. There is not yet a central database of Ebola contacts and there are only nine contacts for each Ebola case, versus an average of 10-15 for Liberia. And even if contacts are established, officials often get lost searching a country with no postcodes and where street numbers are often not sequential.

"We are getting there," said Karline Kleijer, operations manager for Medicins Sans Frontieres in Sierra Leone. "Major steps have been made, but we still have a long way to go."

[link url="http://www.polity.org.za/article/ebola-end-game-in-sight-as-new-cases-fall-sharply-in-sierra-leone-2015-01-21"]Full Polity report[/link]

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