A Qualitative Study Exploring Perceived Impacts of Ebola on Nutrition in Sierra Leone – a Food Value-chain Framework for Improving Future Response Strategies (OR21-07-19)

•to explore how and through what multi-level pathways the Ebola outbreak impacted the nutrition sector in Sierra Leone•to investigate the barriers and facilitating factors to implementing effective response strategies during the nutrition response•to develop an improved preparedness and nutrition response framework for consideration during future outbreaks of this nature. This qualitative study had an iterative and emergent design. In-depth interviews (n = 42) were conducted over two phases by purposively sampling both key informants (n = 21; government stakeholders, management staff from United Nations agencies and non-governmental organizations (NGO), and informants (n = 21; community members, Ebola survivors, front-line workers) until data saturation was reached. Multiple analysts worked collaboratively in a team-based coding approach to identify key themes and sub-themes using Dedoose software. Findings are presented as both salient quotations and tables/figures to illustrate the results. The Ebola outbreak and related response strategies, especially movement restriction policies, disrupted nearly every aspect of the food value-chain in Sierra Leone. Through production, storage and processing, distribution, transport and trade, and retailing, salient themes emerged across interviews with Government, United Nations, and NGO stakeholders, as well as community-level participants about the serious effects of the outbreak on food and nutrition. Data suggest that the effects of the outbreak had an aggregate negative effect on key pillars of food security as well as infant and young child feeding practices. Food-based response efforts were highly accepted, although sharing and selling of food assistance was reported by front-line workers and community members alike. Infectious diseases such as Ebola have far-reaching effects that are not just directly bio-medical in nature but also indirectly impacting health through the entire food value-chain from agriculture agricultural disruption to individual nutritional status. A food value-chain approach therefore may offer a viable framework from which to position nutrition preparedness and response efforts for infectious disease outbreaks in other similar food insecure settings. UNICEF West and Central Africa Regional Bureau. ▪