Facilitators and Barriers to Community Acceptance of Safe, Dignified Medical Burials in the Context of an Ebola Epidemic, Sierra Leone, 2014

Abstract

Sierra Leone was heavily affected by the Ebola epidemic, with over 14,000 total cases. Given that corpses of people who have died from Ebola are highly infectious and given the extremely high risk of Ebola transmission associated with direct contact with bodies of people who have died of Ebola, community acceptance of safe, dignified medical burials was one of the important components of efforts to stop the Ebola epidemic in Sierra Leone. Information on barriers and facilitators for community acceptance of safe, dignified medical burials is limited. A rapid qualitative assessment using focus group discussions (FGDs) explored community knowledge, attitudes, and practices towards safe and dignified burials in seven chiefdoms in Bo District, Sierra Leone. In total, 63 FGDs were conducted among three groups: women >25 years of age, men >25 years of age, and young adults 19–25 years of age. In addition to concerns about breaking cultural traditions, barriers to safe burial acceptance included concerns by family members about being able to view the burial, perceptions that bodies were improperly handled, and fear that stigma may occur if a family member receives a safe, dignified medical burial. Participants suggested that providing opportunities for community members to participate in safe and dignified burials would improve community acceptance.

Acknowledgments

The authors acknowledge the Bo District Social Mobilization Team, Sierra Leone; CDC Sierra Leone Ebola Response Team; Mohamad Jalloh, FOCUS 1000, Sierra Leone; Darren Hertz, International Rescue Committee; Mutale Mumba, World Health Organization; Barbara Knust, Division of High-Consequences Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Alicia Anderson, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Carrie Nielsen, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.