Above: Kenema Hospital in Sierra Leone. Source: Wikimedia.
Article: Kodish SR, Bio F, Oemcke R, Conteh J, Beauliere JM, et al. (2019) A qualitative study to understand how Ebola Virus Disease affected nutrition in Sierra Leone—A food value-chain framework for improving future response strategies. PLOS Neglected Tropical Diseases 13(9): e0007645. https://doi.org/10.1371/journal.pntd.0007645
Of all the diseases facing humanity today, a select few seem to have transcended science and healthcare to become familiar buzzwords. Examples include cancer and AIDS, whose names, causes, and effects are commonly known. Another such example, one even more terrifying and frenzy-inducing, is Ebola.
Ebola, more properly known as Ebola virus disease or Ebola hemorrhagic fever, becomes a news headline each time an outbreak occurs. These outbreaks generally occur in Africa (the disease is named after the Ebola River in the Democratic Republic of the Congo), and are truly deadly. A major such outbreak, from 2013 to 2016 afflicted more than 28,000 people – of whom more than 11,000 died.
One of the major reasons why Ebola is so deadly is that it is very contagious, spreading easily from wild animals (usually bats) to people, and even more easily from person to person via body fluids. The dead body of a person killed by Ebola remains contagious even after death. The pictogram above, from the US Centers for Disease Control and Prevention (CDC) shows how human outbreaks of Ebola result from animal to human transmission.
Another reason for Ebola’s deadliness is that its initial symptoms are neither particularly serious nor specific to Ebola. This can lead to delayed and/or incorrect diagnoses. Even a timely and accurate diagnosis is not always a guarantee of successful treatment. This is because of the third reason for Ebola outbreaks being so destructive: the outbreak areas are usually low-income developing countries with subpar health, transportation, and other networks. Often Ebola patients die before they can be brought to a treatment center or from a lack of medical supplies.
The effects of Ebola on individuals, populations and areas are not a mystery – we have seen the devastation in outbreak after outbreak. However, research into Ebola’s effects on other facets of life and society is less common.
The West African nation of Sierra Leone was at the heart of the 2013-2016 Ebola outbreak. Economically still developing, Sierra Leone was also emerging from a brutal civil war that had already frayed its societal structures and decimated many of its institutions. The Ebola outbreak exacerbated these already existing challenges, and made difficult nearly every facet of life. As a recent article by Stephen R. Kodish and colleagues published in PLOS Neglected Tropical Diseases shows, this included the most basic of human activities: obtaining adequate food and nutrition.
The authors chose a qualitative research approach, focusing on individuals’ verbal and written accounts rather than numerical data points. They focused on key informants (government, organizational, and policy-focused individuals), and community informants (general laypersons, including Ebola survivors and health workers). Using their responses to questionnaires and interviews, specific impacts of Ebola and broad general themes linking them were identified.
The main findings in the article are summarized by the authors in the simple figure below:
The four major impacts from Ebola itself and the countermeasures adopted to try and control it are listed in the left-most column. Their collective impacts on food production, food storage and processing, food distribution/transport/trade, and food retailing are presented in the columns to the right. Please note that each of these steps, starting from food storage and processing, directly depends on the step before it (to the left).
Thus, when food production was disrupted during the Ebola outbreak, all the processes to the right were also affected. Each step by itself led to the three results in the bottom box. And multiple steps occurring at the same time or one after another led to even more of each end result (reduced food availability, reduced food access, and altered infant and young child feeding practices.
Why is this Important?
First, the qualitative methodology used by the researchers is noteworthy because it allowed them to hear, record, and analyze the actual feelings, thoughts, and observations of the people affected by the Ebola Outbreak. This allowed for more complete and nuanced data that purely numerical (or quantitative) research can sometimes miss.
Second, the research showed the long-term effects of the outbreak on food and nutrition, which continues to this day, long after the outbreak itself ended. Agricultural harm and changes to infant and young child nutrition practices brought about by or during the outbreak was not and will not be resolved quickly. These consequences of the outbreak continue to this day, and may in some cases be irreversible.
Third, Ebola is currently not managed proactively – there is no vaccination program currently, to prevent it. Thus, Ebola can be managed only after outbreaks actually occur. Since there have been two dozen outbreaks since the disease was first identified in 1976, another outbreak is simply a matter of time. Thus, having a better idea of Ebola’s long-term impact on food and nutrition will hopefully allow for better preparation so that the next outbreak’s after-effects are at least somewhat better managed.