Social pathways for Ebola virus disease in rural Sierra Leone, and some implications for containment

Abstract

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 cross sectional 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.

Fig 1. Confirmed Ebola cases by district.

Ministry of Health and Sanitation, Situation Report 17 December 2014 (S1 Dataset and S2 Dataset). Figure plots all confirmed Ebola cases by district as of 17 December 2014, and main rivers and roads.

Fig 2. Case study villages.

Figure plots case study villages, and main rivers and roads. S1 Dataset.

Fig 3. A,B: Trust and seeking help by type of institution.

ABC Household Survey (S3 Dataset), 2200 respondents in 117. The graph plots mean response and 95% confidence interval upper and lower bound. Panel A asks respondents “How much do you trust [institution]? “, responses are on a five point scale ranging from “Not at all” to “Completely”. For Panel B, respondents are asked “If you were in trouble, would you go to these people for help?”, responses are on a three point scale ranging “No never” to “Definitely”.

Fig 4. a-d: Village dependencies, migration for marriage, work and education.

Figure (a) plots village social, economic and political dependencies. Source: Community Survey (S4 Dataset) in 91 villages in Eastern Sierra Leone in Malema, Makpele, Nomo, Gaura, Tunkia, Koya and Barri Chiefdoms. Map plots the village dependencies as indicated in a community focus group meeting with arrows going to the location the village depends on socially, economically and politically. Figure (b)-(d) use Household Survey (S5 Dataset) under 2460 respondents in 187 villages. Figure plots the migration patterns (origin and destination) for six randomly selected villages for household members who left the household for marriage, work or education during 2000–2010. In total we recorded data on 4208 migration decisions. Of these, 20% are for marriage, 36% are for attending school and 17% to work elsewhere. Work migration is for trading, mining, labourer for cash crop production and urbanisation. Location of Kenema is approximate.

Fig 5. a-c: Distance to Chiefdom headquarters town.

Source: Figure plots the distance frequencies to the Chiefdom headquarter towns for villages with an Agri-Business Center (Panel A (S3 Dataset), villages without an Agri-Business center (Panel B, (S3 Dataset)) and villages around the GRNP (Panel C, Household Survey (S5 Dataset)).