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Social pathways for Ebola Virus Disease in rural Sierra Leone, and some implications for containment
Paul Richards¹*, Joseph Amara¹, Mariane C Ferme², Prince Kamara¹, Esther Mokuwa¹, Amara Idara Sheriff¹, Roland Suluku¹, and Maarten Voors³
1 Njala University, Sierra Leone
2 University of California, Berkeley, United States of America
3 Wageningen University, The Netherlands
*Corresponding author: email@example.com.
The current outbreak of Ebola Virus Disease in Upper West Africa is the largest ever recorded. Molecular evidence suggests spread has been almost exclusively through human-to-human contact. Social factors are thus clearly important to understand the epidemic and ways in which it might be stopped, but these factors have so far been little analyzed. The present paper focuses on Sierra Leone, and provides data on the least understood part of the epidemic – the largely undocumented spread of Ebola in rural areas. Various forms of social networking in rural communities and their relevance for understanding pathways of transmission are described. Particular attention is paid to the relationship between marriage, funerals and land tenure. Funerals are known to be a high-risk factor for infection. It is suggested that more than a shift in awareness of risks will be needed to change local patterns of behavior, especially in regard to funerals, since these are central to the consolidation of community ties. A concluding discussion relates the information presented to plans for halting the disease. Local consultation and access are seen as major challenges to be addressed.
Competing Interests: The authors have declared that no competing interests exist.
Funding: International Initiative for Impact Evaluation (3ie) through the Global Development Network (GDN) grant #TW1.1042 to MV and PR, http://www.3ieimpact.org/en/ UK Economic and Social Research Council (ESRC) grant # ES/J017620/1 to MV and PR, http://www.esrc.ac.uk/ National Science Foundation, grant # 1430959 to MF, http://www.nsf.gov FAO and Irish Aid funds to EM and PR, http://www.fao.org/home/en/ https://www.irishaid.ie/The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright: © 2014 Richards et al. This is an open-access manuscript distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
The present outbreak of Ebola Virus Disease (EVD) in Upper West Africa is the worst ever recorded. Currently (late September 2014) it has a case doubling rate of three weeks, and shows no signs of coming under control. The international community is alarmed, and resources are being rushed to the region to try and stem further spread. The epidemic is an outbreak of the Zaire strain of the virus, previously associated with death rates of up to 90 per cent. Death rates in the Upper West African outbreak average 70 percent (WHO 2014)
The epidemic has been traced to a single index case – the infection of a 2 year-old boy in the village of Meliandou, in the Republic of Guinea (Baize et al 2014, Bausch and Schwarz 2014). Previous outbreaks of the disease have occurred in remote forest edge communities, and have been associated with hunting and eating of bush meat. This scenario appears not to be appropriate for the present epidemic. Human-to-human transmission appears to be the main if not sole source of infection.
In this paper we offer some data and observations relating to the Sierra Leone epidemic (Figure 1). If human-to-human contact is the main mode of transmission attention needs to be paid to underlying social factors. The paper is divided into three sections. A case-study based scenario for the spread of EVD in Sierra Leone is described (based on interviews and direct observation by two Njala-based authors of the present paper, RS and JA), and proposes greater attention should be paid to rural buffers for the disease. We then identify and explain the role of processes related to marriage, land and burials significant for spread of the disease. A concluding discussion considers what assistance might be necessary if rural communities are to reduce current transmission rates.