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, 64 (1), 20-7

Improving Burial Practices and Cemetery Management During an Ebola Virus Disease Epidemic - Sierra Leone, 2014

Improving Burial Practices and Cemetery Management During an Ebola Virus Disease Epidemic - Sierra Leone, 2014

Carrie F Nielsen et al. MMWR Morb Mortal Wkly Rep.

Abstract

As of January 3, 2015, Ebola virus disease (Ebola) has killed more than 2,500 persons in Sierra Leone since the epidemic began there in May 2014. Ebola virus is transmitted principally by direct physical contact with an infected person or their body fluids during the later stages of illness or after death. Contact with the bodies and fluids of persons who have died of Ebola is especially common in West Africa, where family and community members often touch and wash the body of the deceased in preparation for funerals. These cultural practices have been a route of Ebola transmission. In September 2014, CDC, in collaboration with the Sierra Leone Ministry of Health and Sanitation (MOH), assessed burial practices, cemetery management, and adherence to practices recommended to reduce the risk for Ebola virus transmission. The assessment was conducted by directly observing burials and cemetery operations in three high-incidence districts. In addition, a community assessment was conducted to assess the acceptability to the population of safe, nontraditional burial practices and cemetery management intended to reduce the risk for Ebola virus transmission. This report summarizes the results of these assessments, which found that 1) there were not enough burial teams to manage the number of reported deaths, 2) Ebola surveillance, swab collection, and burial team responses to a dead body alert were not coordinated, 3) systematic procedures for testing and reporting of Ebola laboratory results for dead bodies were lacking, 4) cemetery space and management were inadequate, and 5) safe burial practices, as initially implemented, were not well accepted by communities. These findings were used to inform the development of a national standard operating procedure (SOP) for safe, dignified medical burials, released on October 1. A second, national-level, assessment was conducted during October 10-15 to assess burial team practices and training and resource needs for SOP implementation across all 14 districts in Sierra Leone. The national-level assessment confirmed that burial practices, challenges, and needs at the national level were similar to those found during the assessment conducted in the three districts. Recommendations based on the assessments included 1) district-level trainings on the components of the SOP and 2) rapid deployment across the 14 districts of additional trained burial teams supplied with adequate personal protective equipment (PPE), other equipment (e.g., chlorine, chlorine sprayers, body bags, and shovels), and vehicles. Although these assessments were conducted very early on in the response, during October-December national implementation of the SOP and recommendations might have made dignified burial safer and increased community support for these practices; an evaluation of this observation is planned.

Figures

FIGURE 1
FIGURE 1
Cumulative number of confirmed Ebola virus disease (Ebola) cases, by district — Sierra Leone, September 21–October 4, 2014 Sources: Sierra Leone Ministry of Health and Sanitation and International Federation of Red Cross and Red Crescent Societies.
FIGURE 2
FIGURE 2
A burial team preparing to collect another body and transport it in the back of truck along with eight other bodies that had already been collected — Sierra Leone, September 2014
FIGURE 3
FIGURE 3
Unmarked graves in an Ebola burial section of a cemetery — Sierra Leone, September 2014
FIGURE 4
FIGURE 4
Dead bodies, personal protective equipment, and medical waste buried together in unmarked graves at an unsafe depth of <2 meters — Sierra Leone, September 2014
FIGURE 5
FIGURE 5
A burial team preparing to wrap a body in a Muslim shroud, illustrating the incorporation of a dignified component of a standard operating procedure for safe, dignified medical burial — Sierra Leone, October 2014

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References

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