The Role of Community Beliefs and Practices on the Spread of Ebola in Uganda, September 2022

Abstract

AbstractBackgroundTraditional community beliefs and cultural practices can facilitate the spread of ebolaviruses during outbreaks. On September 20, 2022, Uganda declared a Sudan Virus Disease (SVD) outbreak after a case was confirmed in Mubende District. During September–November 2022, the outbreak spread to eight additional districts. We investigated the role of community beliefs and practices in the spread of SUDV in Uganda in 2022.MethodsA qualitative study was conducted in Mubende, Kassanda, and Kyegegwa districts in February 2023. We conducted nine focus group discussions (FGDs) and six key informant interviews (KIIs). FGDs included SVD survivors, household members of SVD patients, traditional healers, religious leaders, and community leaders. Key informants included community, political, and religious leaders, traditional healers, and health workers. We asked about community beliefs and practices to understand if and how they contributed to the spread of SUDV. Interviews were recorded, translated, transcribed, and analyzed thematically.ResultsFrequently-reported themes included beliefs that the community deaths, later found to be due to SVD, were the result of witchcraft or poisoning. Key informants reported that SVD patients frequently consulted traditional healers or spiritual leaders before seeking formal healthcare or visited them after formal healthcare failed to improve their health conditions. They also noted that traditional healers treated patients with signs and symptoms of SVD without protective measures. Additional themes included religious leaders conducting laying-on-of-hands prayers for SVD patients and symptomatic contacts, SVD patients and their symptomatic contacts hiding in friends’ homes, and exhumation of SVD patients originally buried in safe and dignified burials, to enable traditional burials.ConclusionVaried community beliefs and cultural practices likely promoted SVD outbreak spread during the 2022 outbreak in Uganda. Controlling ebolavirus outbreaks in Uganda could be aided by the involvement of formal public health systems, traditional healers, and religious leaders. Community engagement during inter-epidemic periods could aid in the effective management of future outbreaks in Uganda by identifying socially acceptable and scientifically supported alternatives for infection control.