Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2018 Kono Members' Perceptions of Burial Practices and the Spread of Ebola Virus Disease Comfort Kenyeh Panda Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Medicine and Health Sciences Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Comfort K. Panda has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. John Oswald, Committee Chairperson, Public Health Faculty Dr. Daniel Okenu, Committee Member, Public Health Faculty Dr. Kim Sanders, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2018 Abstract Kono Members’ Perceptions of Burial Practices and the Spread of Ebola Virus Disease by Comfort K. Panda MSN, South University, 2011 BSN, Columbia Union College, 2008 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University November 2018 Abstract Sierra Leone was heavily affected by the West African Ebola virus disease (EVD) epidemic from 2013 to 2016. Ongoing EVD transmission during the epidemic was connected to several factors including unsafe traditional burial practices. This phenomenological qualitative study addressed Kono members’ perceived knowledge, attitudes, and beliefs regarding how burial practices influenced EVD transmission. Rosenstock’s health belief model provided the framework for the study. The participants purposefully selected from various religions and professions were interviewed individually and in focus group settings. Similar phrases and comments were identified from the interview responses resulted which resulted in the following 5 main themes: (a) Kono community leaders and public health workers were cognizant of important EVD issues, but there was a knowledge deficit among Konos about EVD and its mode of transmission; (b) although customary burial rituals were temporarily banned from 2014 to 2016, they were practiced among the Konos to promote culture-driven dignity and respect for the dead; (c) many Konos harbored grudges and mistrusted government officials and public health workers; (d) infrastructural deficits were a barrier to health care as private and public sectors lacked training and equipment to mitigate the 2013- 2016 EVD outbreak; and (e) participants were willing to adopt safer burial practices if EVD outbreaks were to reemerge. These findings indicated that EVD transmission was connected to unsafe burial practices. Findings may be used to improve community engagement and public health outreach efforts to promote safer burial practices, especially during periods of infectious disease outbreaks. Kono Members’ Perceptions of Burial Practices and the Spread of Ebola Virus Disease by Comfort K. Panda MSN, South University, 2011 BSN, Columbia Union College, 2008 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University November 2018 Dedication This dissertation is dedicated to the memory of my loving father, Sundima Kenneth Williams, who believed in me and who had so much passion for education that he encouraged me from an early age to seek and attain my maximum potential. His last wish for me was that I never stop learning till I achieve a doctorate. To Dad, you can rest in peace, as your wish has come true. To my adopted mother, the late Pastor Shirley Jean Nicholson, you were an inspiration to me and loved me unconditionally. May you rest in perfect peace. To my beloved husband, Osman Panda; children, Solomon, Adama, Amadu, and Isata; son-in-law, Wulah Cooper; and sisters, Elizabeth Tucker and Stella Smith, I thank you all so much for your unwavering support and sacrifices. I love you all so much. I also would like to dedicate this work to my beloved mother, Madam Isata Williams, who instilled so much hard work and determination in me to pursue this degree. Mom, you are the best mom in the entire world. Acknowledgments I express my sincere gratitude to Dr. John Oswald for academic support, Dr. Daniel Okenu for methodology support, and Dr. Joseph L. Malone for manuscript writing advice. I am also very grateful to the study participants in Kono District who participated in the interview. Specifically, I recognize the unsung heroics of many public health workers and community leaders in Kono, including several who participated in the qualitative survey and those who helped contain the 2013-2016 EVD epidemic. Most importantly, I thank those who continue to work in the Kono community monitoring and increasing the surveillance watch for any future EVD epidemics. Table of Contents List of Figures ......................................................................................................................v Chapter 1: Introduction to the Study ..............................................................................1 Background ....................................................................................................................1 Problem Statement .........................................................................................................5 Purpose of the Study ......................................................................................................8 Research Questions ........................................................................................................9 Conceptual Framework for the Study ..........................................................................10 Nature of the Study ......................................................................................................13 Definitions....................................................................................................................15 Assumptions .................................................................................................................17 Scope and Delimitations ..............................................................................................18 Limitations ...................................................................................................................18 Significance..................................................................................................................20 Significance to Practice......................................................................................... 21 Significance to Theory .......................................................................................... 22 Significance of Social Change .............................................................................. 22 Summary ......................................................................................................................23 Chapter 2: Literature Review .............................................................................................24 Literature Search Strategy............................................................................................25 Conceptual Framework ................................................................................................26 Literature Review Related to Key Variables and Concepts .........................................31 i Ebola Epidemic in Sierra Leone and Health Care ................................................ 35 Contributing Factors to the Rapid Spread of the Ebola Virus .............................. 37 Distrust of the Government and the Health Care Systems ................................... 39 Role of Anthropology to Control the Ebola Virus Disease .................................. 41 Assessment of Cemetery and Burial Practices ...................................................... 42 Communication Approaches ................................................................................. 44 Health Care System Collapse and Spread of the Ebola Virus .............................. 45 Community Resistance and Rumors ..................................................................... 46 Social Insecurity and Spread of the Ebola Virus .................................................. 51 Food Insecurities Due to the Ebola Virus Epidemic ............................................. 52 Linking Burial Practices to the Spread of the Ebola Virus ................................... 53 Summary and Conclusion ............................................................................................56 Chapter 3: Research Method ..............................................................................................58 Research Design and Rationale ...................................................................................58 Research Questions ......................................................................................................60 Role of the Researcher .................................................................................................60 Methodology ................................................................................................................62