An assessment of cultural perceptions and recognition of Ebola virus disease, and its correlation with traditional burial practice in rural Guinea

Background: In the midst of the unprecedented Ebola outbreak in West Africa during 2014-2016, the humanitarian response to control the disease was hampered in part because there was a limited understanding of local traditional rituals or indigenous medicine (ethnomedicine) on the part of the responders. The Ebola outbreak claimed 11,310 lives, more than all other outbreaks combined. West African burial funeral ceremonies and surrounding rituals may have hindered interventions that included the forceful removal of the sick or dead from the community. Objective: Our objective was to understand transmission associated with traditional burial practices in rural Guinea. Through the lens of cultural and medical anthropology, this study aims to examine how knowledge of transmission might influence views on traditional burial practices, and how ethnomedical beliefs might block (or mediate) the effect of this knowledge. Method: A survey of 385 household members was administered in 2015 throughout Guinea to capture knowledge and behaviors related to Ebola. Discrete and marginal change in probability models were used to examine disease transmission knowledge on the outcome of whether respondents practice traditional burial rituals. The independent variables were knowledge about person-to-person (PTP) transmission and personal protective equipment (PPE), and the dependent binary variable was the use of traditional burial practice. Within the context of burial behavior, this study controlled for three confounders: 1. demographics (age, sex, years lived in community, ethnicity, occupation, education), 2. knowledge of Ebola etiology & symptoms, and 3. access to medical care. STATA14/MP was used. Results: Once controlling for three potential confounders (demographics, knowledge of Ebola etiology & symptoms, and access to medical care), there was no significant association between the outcome, practicing traditional burial ritual, and knowledge about PTP (person-to-person infection: 12.2 percentage points, p \u3c 0.1 by one-tail test) & PPE (5.8 percentage points, p \u3e 0.1). Conclusion: The result implies that knowledge about PTP & PPE will not necessarily lead respondents to stop traditional burial rituals. To prevent another Ebola outbreak in the future, it is essential to design a social and behavioral intervention that is specially tailored to the culture of the traditional burial ritual