Long-term consequences of food insecurity among Ebola virus disease-affected households after the 2013–2016 epidemic in rural communities of Kono District, Sierra Leone: A qualitative study

The 2013–2016 Ebola virus disease (EVD) epidemic caused food insecurity during and immediately following local outbreaks in Sierra Leone, but longer-term effects are less well described, particularly among households with no EVD survivors. We conducted a qualitative sub-study in July 2018 in Kono District, Sierra Leone to understand the impact of food insecurity on EVD-affected households. Using data from a community-based cohort, we compiled a list of all households, within the sampled communities in Kono District, that had at least one EVD case during the epidemic. We used purposive sampling to recruit 30 households, inclusive of 10 households with no EVD survivors, to participate in the study. The research team conducted open-ended, semi-structured interviews with the head of each household. All 30 interviews were transcribed, translated, and analyzed using comparative content analysis consistent with a grounded theory approach. Most household members were facing persistent food insecurity as direct or indirect consequences of the EVD epidemic, regardless of whether they did or did not live with EVD survivors. Three major themes emerged as drivers and/or mitigators of EVD-related food insecurity. Financial instability and physical health complications were drivers of food insecurity in the population, whereas support provided by NGOs or governmental agencies was observed as a mitigator and driver of food insecurity after its removal. Among the EVD-households reporting long-term support through jobs and educational opportunities, there was sustained mitigation of food insecurity. EVD-affected households with and without survivors continue to face food insecurity three years after the EVD epidemic. Provision of support was a mitigator of food insecurity in the short term, but its removal was a driver of food insecurity in the longer term, suggesting the need for longer-term transitional support in affected households.