Objective: The Republic of Gabon experienced epidemics of Ebola hemorrhagic fever (EHF) three times between 1994 and 1997. This study aimed at exploring cultural factors related to the outbreaks.
Methods: We collected information about EHF epidemics from the Gabon Ministry of Health, district hospitals and other facilities and conducted in-depth interviews with 20 villagers and 2 traditional healers in the village where the third epidemic occurred.
Results: All three epidemics were supposed to have direct or indirect relationship with great apes, the victims having cooked or eaten chimpanzees meat. Although the reuse of syringes and needles in hospitals which had worsened past EHF outbreaks in Sudan and Zaire did not contribute to the outbreak in Gabon, traditional practices as family members remaining close to the patient to nurse him/her, and hugging and touching the dead at funerals were suspected to be crucial sources of infection. Interviews with traditional healers revealed that traditional treatment methods as cutting a patient' skin with an unsterilized knife and applying blood to the skin were risky and might have been contributory factors in the deaths of one traditionals healer and his assistant in the third EHF outbreak. In one village where EHF had reached epidemic proportions, in-depth interviews were conducted with 2 traditional healers and 20 persons of mean age 33 (20-46) years with a sampling method of selecting every tenth household from the entrance. Even though they lived in a village suffering an EHF outbreak, only two thirds of them knew the name of the disease and about half of them could not explain what kind of disease it was. One quarter felt it was fatal and another quarter felt fearful. Three persons thought it had been due to evil spirits; others responded the mosquitoes or patient's sweat/saliva were the cause.
Conclusions: This study showed that cultural factors might be very crucial to EHF outbreaks in developing countries. Quick intervention with health education is needed to disseminate appropriate knowledge and persuade people that traditional practices could carry a high risk of infection
