Social Pathways for Ebola Virus Disease in Rural Sierra Leone, and Some Implications for Containment

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.当前在西非上部地区暴发的埃博拉病毒病（Ebola Virus Disease）是有记录以来规模最大的一次疫情。分子生物学证据显示，此次疫情的传播几乎完全依托人际接触实现。因此，社会因素对于解析本次疫情及其防控路径具有关键意义，但目前针对此类因素的研究分析仍较为匮乏。本研究聚焦塞拉利昂，提供了本次疫情中最不为人所认知的环节——埃博拉在农村地区大范围未被记录的传播情况——的横断面数据。本文阐述了农村社区中的各类社交网络形式，及其对于理解病毒传播路径的关联价值。研究特别关注了婚姻、丧葬活动与土地保有制之间的内在关联。已知丧葬活动是病毒感染的高风险因素。研究表明，仅依靠提升风险认知不足以改变当地民众的行为模式，尤其是在丧葬活动方面——因为丧葬活动是巩固社区纽带的核心环节。结语部分将本文所呈现的研究信息与疫情防控计划相结合展开探讨。本地协商与信息获取被视为亟待解决的核心挑战。