what factors contribute to the spread of ebola
Pan Afr Med J. 2015; 22(Suppl 1): 9.
The impact of traditional and religious practices on the spread of Ebola in Westward Africa: time for a strategic shift
Angellar Manguvo
1Section of Medical Education Support Services, School of Medicine, University of Missouri-Kansas City, USA
Benford Mafuvadze
2Department of Pathology, University of Kansas Medical Center, United states
Received 2015 January 24; Accepted 2015 Mar 29.
Keywords: Ebola, traditional and religious practices, traditional leaders, spiritual healers
Commentary
The current Ebola viral affliction outbreak in West Africa, affecting communities in Guinea, Liberia, and Sierra Leone with contained cases in Nigeria, Mali, and Senegal, is the largest known outbreak since the discovery of the virus in 1976. Several factors including the emergence of the illness in highly populated urban areas, poor health facilities, and a general lack of awareness of the affliction among affected communities perpetuated the spread of the affliction. In addition, researchers [1–4] agree that the widespread embracing of certain traditional and religious practices among West African communities had tremendous negative effects on the spreading of the disease. In concurrence, the World Wellness Organization (WHO) [five] contents that about 60% of all Ebola cases reported in Guinea can be linked to traditional burial practices.
Scientifically-based methods of combatting the spread of highly infectious diseases like Ebola are normally preferred, with very little considerations given to the bear upon of traditional and religious practices on preventive measures [6]. Even so, recent trends in Westward Africa have demonstrated that the use of scientific methods alone without a holistic consideration of other contextual factors is non sufficient to control the disease. For example, an analysis of media reports and contempo studies [7] in Westward Africa reveals notable resistance against prescribed scientific means of combating the transmission of Ebola in some affected communities. While there is no single explanation for this kind of resistance, every bit this is a very complex social phenomenon, the influence of religious and cultural behavior cannot be denied. It is, thus, important that we recognize the bear on that traditional and religious practices can accept on health promotion interventions. It is also important that we admit ethnic and cultural diversity among communities. For example, in Liberia, in that location are at least 16 major ethnic and cultural groups; each described by a specific language and associated traditions and customs [eight]. Understanding these ethno-social dynamics should help policy-makers with formulation of affliction prevention approaches that are culturally tolerated by affected communities.
Given the challenges faced with ongoing efforts to contain the spread of Ebola that arise as a upshot of incompatibilities betwixt some religious and cultural practices and prescribed scientific methods, it is high time we explore ways in which traditional and religious structures can be effectively implored in combatting the spread of Ebola. Dealing with cultural and religious problems negatively affecting Ebola transmission prevention programs requires flexibility and adaptability from governments, wellness officials, and the people in affected communities. Equally Alexander et al. [9] argue, a consideration of traditional and religious practices is critical to our understanding of transmission dynamics and subsequent control of highly infectious diseases. In this paper, nosotros identified notable religious and traditional practices in West Africa that potentially contribute to the spread of Ebola and exacerbate the current outbreak. Our proposed strategies call for deliberate targeting of leaders of traditional and religious institutions in customs-directed programs for preventive measures. As custodians of the solar day-to-twenty-four hours cultural values, traditional and religious leaders command more respect and authority in their communities than unfamiliar trained health personnel, who can be easily be viewed equally having suspicious agendas.
The Impact of religion and tradition on transmission of Ebola
Perceived Causation of Diseases and Death: adherence to prescribed preventive measures by people in affected communities is central to a desirable result in the fight against Ebola. A general lack of agreement of affliction etiology tin, even so, negatively influence level of adherence to preventive measures [10]. In the Due west African context, diseases and expiry are generally perceived equally a culmination of natural and metaphysical causes [11]. Metaphysical causes entail the spiritual realm such as witchcraft and punishment from God or bequeathed spirits for breaking taboos and diverse forms of transgressions [xi]. Undoubtedly, this line of thinking can potentially make information technology difficult for ordinary people in affected communities to fully understand the cause of Ebola-related deaths as a viral infection.
Furthermore, W Africa is abode to some of the globe's fastest-growing Islamic and Christian communities. Both the Bible and the Koran abound with verses and suras that dwell on causality of infectious diseases. For example, normally cited verses include Deuteronomy 28 verses 20-22 where information technology is stated that, equally a consequence of various transgressions, God strikes people with diseases, fever, and inflammation. Others have falsely cited the occurrence of Ebola as God-inflicted punishment for indulgence in activities like adultery and homosexuality [12]. The way people conceptualize the etiology of a affliction generally dictates their response to it. Given that in some affected communities in West Africa, Ebola is linked to the metaphysical realm, it is not surprising that diviners and spiritual healers are often consulted for treatment. In view of the potential influence of etiological beliefs on people'south response to prevention and treatment, an agreement of beliefs of the people in affected communities on causes of Ebola is pivotal in mitigating the negative bear on of such beliefs on the transmission of the disease.
Traditional and Spiritual Healing: while modernistic wellness care based on Western medicine is now considered the norm in Africa, several communities in Westward Africa still rely heavily on traditional medical practices. According to WHO [13], nigh 70-80% of the population in some West African countries depend on traditional medicine. Every bit noted by Wonacott [14], traditional healers are often more highly regarded than those who promote unfamiliar forms of wellness care. Whereas traditional medicine can have a positive role in health care, some ethno-medical behavior and practices, as discussed earlier, can also have of import negative impact on health outcomes and, most importantly, pathogen transmission pathways. For instance, studies on the current Ebola outbreak in West Africa revealed that several traditional and spiritual healers falsely claimed to have the capability to cure Ebola [3]. One reported instance was the employment of warm salt baths and table salt drinks provided by traditional and spiritual healers as a preventive measure from contracting the highly communicable diseases [3]. A previous study by Hewlett and Hewlett [15] reported similar claims by traditional healers in Uganda who were making incisions into people's bodies and rubbing herbal medicine in. Given that human-to-human transfer of Ebola occurs from direct contact with body fluids of the infected, information technology is not surprising that several people including traditional healers themselves reportedly got infected through these practices. By falsely claiming adequacy to treat and rid patients of Ebola, traditional healers are often called to nourish to severely sick patients. Without proper protective resource to cater for the sick Ebola patients, information technology is not surprising that nearly of the traditional healers frequently end up contracting the disease themselves and passing it to their other patients. It is with this recognition that Guinea'south caput of Ebola Response Team had to dissuade a delegation of traditional healers confronting using their formula for fighting the lethal virus [fourteen].
The media has also reported of several organized religion healers who prayed for Ebola victims and not only ended up contracting the diseases themselves simply passing the affliction to other people [xvi]. For example, it was reported that several loftier-ranking members of a church contracted and died from Ebola later on they participated in a healing prayer session in which they laid hands on the body of a sick person [17]. Most churches have since abolished this practice of laying hands on the sick every bit a mensurate to prevent the spread of the disease. Both Christian and Islamic leaders can, thus, play a pregnant role in educating their institutional members on the importance of strict adherence to preventive measures for combatting the spread of Ebola.
Overall, reports of attempts to cure Ebola through traditional and spiritual means highlight the demand for increased cooperation betwixt traditional healers, spiritual healers, and trained wellness personnel. We advise that awareness programs specifically targeting traditional and spiritual healers in affected communities and all high risk areas exist launched once an outbreak of Ebola has been reported. Without fully agreement the etiology, pathogenesis, transmission vehicles, every bit well as signs and symptoms of the disease, it becomes difficult for traditional and spiritual healers to distinguish potential Ebola patients from patients with other conditions that they can cure. Furthermore, without proper understanding of the disease, traditional and spiritual healers are often sources of simulated information and myths to the general public particularly in remote rural areas where there is limited access to information through electronic and print media. We further propose that traditional and spiritual healers form regional and national associations through which regular collaborative workshops with wellness professionals tin be organized with the ultimate goal of creating a mutual agreement. Such programs will not merely help reduce the spread of Ebola but will likewise be of import in dealing with several other wellness issues. Recent reports that some traditional healers in Sierra Leone openly best-selling their ignorance of the Ebola virus and called on other healers to append healing activities until they are given adequate training [i] show a willingness to embrace modern scientific noesis. Trained traditional healers can, thus, potentially be used as personnel to railroad train other traditional and spiritual healers and dispel myths on the etiology, pathogenesis, transmission, likewise every bit prevention of Ebola.
Funeral and Burying Practices: most communities in West Africa believe in life after death [18]. Consequently, funeral and burial practices are given a lot of significance as they are perceived as crucial steps in transitioning from the world of the living to the spiritual world [18]. Information technology is widely believed that the transition should be facilitated by the surviving relatives through funeral and burial rituals. In the effect that the deceased fails to attain the more than elevated rank of bequeathed spirit, it is believed that their spirit may render and punish the living relatives. One of the most commonly performed funeral rituals, which significantly contributes to the spread of Ebola, is the washing and cleaning of the dead body. Another reported burial practise is that of relatives of the deceased washing their easily in a common bowl after which they touch the face of the deceased in what is perceived equally a 'love touch' that cements unity between the living and bequeathed spirits [19]. In the instance of the decease of prominent people like traditional healers, it is common for people to lay over the corpse with the promise that some of the spiritual gifts will be transferred to them [nineteen]. Given that the major means of human-to-man transfer of the Ebola virus is through direct contact with infected body fluids as consistently reported in the current Ebola outbreak, the afore-mentioned funeral and burial practices inadvertently event in spreading of the disease [4]. A previous study in Uganda showed that a number of people who contracted Ebola during the 2003 outbreak potentially acquired the virus in the procedure of performing similar burial rituals [xv]. In spite of the obvious negative impact of the burial practices on the spread of Ebola, nigh West African communities, as mentioned earlier, place pregnant value on the rituals and resist adoption of alternative methods that minimize the spread of the virus such equally cremation. Against this background, the questions that arise when outbreaks of a disease like Ebola occur are: how do we brand sure that people desist from practices of getting into contact with the deceased's body?; who should monitor and ensure that people do not continue with such practices?; how do nosotros ensure proper burial of the deceased in line with cultural norms just minimizing the chances of contracting the disease?; should nosotros completely abandon cultural burying practices and enforce scientifically prescribed methods that presumably reduce the spread of the affliction?
In an effort to reduce the spread of Ebola through burying practices, WHO, in conjunction with affected governments gear up guidelines defining how bodies of Ebola victims are to be handled and afterwards buried [xx]. While the guidelines were formatted in line with current scientific noesis of the disease, it is obvious that not much attention was given to the cultural implications of some of the prescribed measures to the affected communities. Some of the measures, such as cremation, are in direct conflict with widely held views of life after death every bit previously discussed. It may sounds like shooting fish in a barrel for people in other cultures to think that people in West Africa should realize that the highly infectious nature of the disease and its high bloodshed rates crave extraordinary measures to comprise; All the same, information technology is also important to realize that some of these funeral practices span across generations and have been practiced in these communities for centuries. Moreover, in an attempt to apace dispose dead bodies and reduce spread of the illness, some 'Dead Body Management Teams', often carried out burials prior to notifying relatives of the deceased [nine]. Given the sacred obligations given to the deceased and the value placed on funeral traditions, as mentioned earlier, this created suspicion and discontentment amongst affected communities. Resultantly, in an attempt to avert having their relatives cremated or cached without their consent, some of the people did not report their deceased relatives and secretly connected with traditional burying practices and, in the process, thwarted efforts to combat the spreading of Ebola [16]. Moreover, at that place were several reports in Liberia of corpse collectors allegedly accepting bribes to provide death certificates falsely validating that the victim did not die of Ebola, allowing the funeral practices to continue [16]. In recognition of the unpopularity of cremation, the Liberian government recently called off the cremation decree and ordered the establishment of special burial plots for the deceased victims of Ebola [21]. Although WHO guidelines emphasized the need for understanding and respecting cultural practices and religious beliefs, co-ordinate to experts [7], the major challenge is for health officers to convince involved communities to desist from inherent cultural practices.
It is, therefore, our proposition that traditional leaders should be consulted in order to modify cultural rituals to levels that are constructive in prevention of disease but still culturally acceptable. Awareness campaigns specifically targeting traditional leaders such as chiefs, village headmen, and spiritual leaders should exist launched in one case an outbreak has been confirmed and in all loftier risk areas. Equally custodians and enforcers of traditional customs in society, it is easier for people to respect orders that contradict their own values when instructions are given past well-respected leaders equally compared to unfamiliar health officers. Equally evidenced in some of the affected communities, misinformed traditional leaders can hinder preventive efforts. On the other hand, well-informed traditional leaders tin potentially play crucial roles in reducing the spread of Ebola. In improver, well-informed traditional leaders can assistance with identification of people in their communities who can be trained and provided with protective equipment for burial of suspected Ebola victims in specially-designated burial areas in line with their cultural norms. In a similar manner, Christian and Islamic leaders can depict on guidelines described in the Bible and the Koran respectively, to encourage their congregants to adhere to scriptural recommendations of handling of dead bodies that minimize the wrinkle of infectious diseases. For example, the book of Numbers (Affiliate 19, Verses xi-12) describes how people were to handle themselves after touching a dead body. Similarly, in Leviticus (Chapter 21, Verses 10-12), priests were instructed not to come up in contact with any dead person probably as a way of preventing them from spreading infections to other members of the community given their prominent function in gild. Through highlighting such verses, both Christian and Islamic leaders tin play a significant role in educating their beau congregants on the importance of reducing contact with deceased bodies.
Decision
The current Ebola outbreak in West Africa clearly demonstrates that scientifically proven methods of combating the transmission of infectious diseases, if non culturally and religiously acceptable to a customs, are likely to be resisted and rendered less effective. There is, thus, a demand to investigate and align preventative measures with cultural norms and values of affected communities. Where there are incompatibilities between religious and cultural practices and prescribed scientific preventive measures, there is a need to widely consult and interact with traditional and religious leaders. We propose that, for effectiveness of community-based preventive programs, traditional leaders should be engaged and assigned important roles in monitoring and implementation of preventive measures against the spread of Ebola.
One of the major challenges faced with the current Ebola outbreak is lack of mutual trust and understanding between health officials and affected communities. The mistrust was especially worsened when burials were sometimes implemented without relatives' consent. The rapid burial of deceased without notification of relatives resulted in a belief that medical professionals were keeping the corpses for nefarious purposes. In a similar outbreak in Uganda in 2003, such mistrust was exacerbated when rumors circulated that some Westerners were buying human torso parts [xv]. Fostering mutual trust between health officials and affected communities is the ultimate key to success of scientific measures aimed at combatting the spread of the disease. Without this mutual trust, adherence to preventive measures is probable to be compromised and, every bit witnessed in some communities, health official were even attacked and barred from executing their duties. The inclusion of traditional and spiritual leaders and trained people fatigued from affected communities in leadership positions is likely to meliorate understanding and adherence to preventive measures. Every bit Alexander et al. [9] argue, near people in West African communities often wait to traditional leaders for advice in times of catastrophic strikes; as such, traditional and spiritual leaders tin can have a significant influence on constructive implementation of preventive measures against the spread of Ebola.
There is a likelihood that widespread Ebola vaccination campaigns will be launched in the nigh future. Previous polio vaccination campaigns in Nigeria were boycotted by some communities amidst rumors that the vaccine contained infertility drugs, caused polio-myelitis, and spread HIV and AIDS, in add-on to varied religious reasons [22]. Information technology is, thus, probable that the success of Ebola vaccination campaigns in W Africa volition, to a big extent, depend on the direct involvement of traditional and religious leaders. We farther identified the demand for awareness campaigns specifically targeting traditional and spiritual healers. Given the religious and cultural beliefs of some people in West Africa, it is hard to effectively control spread of Ebola without the support of traditional and spiritual healers. It is encouraging to note that a recent written report by Umeora [3] shows that some traditional and spiritual healers and leaders accept shown some willingness to interact with health officials in mobilizing communities for effective prevention of the spread of Ebola. Effigy ane, summarizes our proposition that awareness campaigns specifically targeting traditional leaders, traditional and spiritual healers, and other influential community leaders should be launched in all loftier risky areas for effective implementation of Ebola awareness and preventive measures. As highlighted in this paper, it is crucial to consult leaders of traditional and religious institutions and collaborate with them at all stages of Ebola prevention campaigns peculiarly those that are incompatible with cultural and religious practices.
Proposed approach to dealing with traditional and religious issues impacting preventive measures in Ebola affected areas. Once an outbreak is confirmed or suspected, apart from making all wellness personnel (physicians, nurses, assistants et cetera), awareness campaigns specifically targeting traditional and religious leaders (chiefs, village headmen, church pastors, mosque imams), equally well as traditional and spiritual healers should be launched. These groups of people should so collaborate in educating, implementation and monitoring of prescribed preventive measures. Traditional leaders should identify people under their jurisdiction that will be trained and aid in carrying out community-based preventive programs such equally burial of deceased bodies
Acknowledgments
Thanks to John Kaldor for assisting with the French translation of the abstract.
Competing interests
The authors declare no competing interests.
Authors' contributions
Both authors did literature search and wrote parts of the initial manuscripts. In improver, they both edited and approved the final manuscript
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709130/
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