Option F: Food and health
2. Food systems and spread of diseases
● One detailed example of a vector-borne disease and one detailed example
of a water-borne disease
Vector-Borne Disease - Malaria:
What is malaria and how does it spread?
● Malaria is an infectious disease spread by the mosquito, the vector for the
malaria parasite, which thrives in tropical areas (~32°C) in stagnant water,
estuaries or densely populated agricultural regions
● Symptoms of malaria appear 10-15 days after bite (including fever, tiredness,
vomiting, and headaches, death in severe cases)
● Africa is home to 93% of malaria deaths, and malaria is considered a disease of
poverty
Malaria is a life-threatening disease for humans caused by the plasmodium parasite and transmitted to
people via the bite of the female Anopheles mosquito.
Here are some key facts about malaria:
● In 2015, 95 countries and territories had ongoing malaria transmission.
● About 3.2 billion people – almost half the world’s population – are at risk of malaria.
● Malaria is preventable and curable and increased efforts are dramatically reducing the malaria
burden in many places.
● Between 2000 and 2015, malaria incidence among populations at risk (the rate of new cases) fell by
37 per cent globally. At the same time, malaria death rates in populations at risk fell by 60 per cent
globally among all age groups and by 65 per cent among children under ve.
● Sub-Saharan Africa carries a disproportionately high share of the global malaria burden. In 2015 the
region suffered 88 per cent of malaria cases and 90 per cent of malaria deaths
What factors enable the spread (diffusion) of malaria?
● Human factors
○ Urbanisation/population growth
■ Creation of mosquito breeding sites (garbage dumps, tires,
discarded containers)
■ High population density, allows for rapid spread of disease
○ Low educational levels
■ Failure to receive adequate guidance regarding prevention and
dosage and as such, fail to adhere to prescription
■ Improper use of drugs results in adaptation of resistance in
mosquitoes
○ Economic status
■ Malaria is easily treatable and preventable if funds are present, so
disease is concentrated on the poor
● Geographical factors
○ Climate
■ Concentrated on tropical areas as mosquitos can only survive in
said areas
Landforms
■ Malaria is found only around rivers or other bodies of water as
other parts of the country can be quite dry
■ Transmission is reduced due to lack of proper breeding sites for
mosquitos
Environmental preferences
The malarial parasite (plasmodium) thrives in the humid tropics where a minimum temperature of
20°C allows it complete its life cycle. The mosquito is a primary host and the human is secondary. The
mosquito’s ideal environment is stagnant water, estuaries, deltas and irrigation channels. These are
usually found in densely populated agricultural regions. The disease is often triggered by natural
events such as cyclones and ooding or by human conicts such as war, which often results in refugees.
They are likely to live in temporary camps with inadequate drainage (open sewers), which are ideal
breeding grounds for the mosquito.
○
The cost of treating malaria
Global nancing for malaria control increased from an estimated $960 million in 2005 to $2.5 billion in
2014. Malaria interventions led to health service savings of $900 million in sub-Saharan Africa between
2001 and 2014, owing to the reduced number of cases. The direct cost of malaria to individual
households includes medication, doctors’ fees and preventative measures such as bed nets, which
help to reduce transmission. Infected individuals are unable to work, which can reduce family incomes
during the attacks.
The symptoms of malaria
The rst symptoms – fever, headache, chills and vomiting – appear seven days after the mosquito bite,
and they may be mild at rst and difcult to recognize as malaria. If not treated within 24 hours, malaria
can progress to severe illness, often leading to death.
Children with severe malaria frequently develop one or more of the following symptoms: severe
anaemia, respiratory distress in relation to metabolic acidosis, or cerebral malaria. In adults,
multi-organ involvement is also frequent. In malaria-endemic areas, people may develop partial
immunity, allowing asymptomatic infections to occur.
Who is at risk?
Some population groups are at considerably higher risk of contracting malaria and developing severe
disease than others. These include infants, children under ve years of age, pregnant women and
patients with HIV/AIDS, as well as non-immune migrants, mobile populations and travellers. National
malaria control programmes need to take special measures to protect these population groups from
malaria infection, taking into consideration their specic circumstances.
Transmission
In most cases, malaria is transmitted through the bites of female Anopheles mosquitoes. There are
more than 400 different species of Anopheles mosquito; around 30 are malaria vectors of major
importance.
All the important vector species bite between dusk and dawn. The intensity of transmission depends
on factors related to the parasite, the vector, the human host and the environment.
Country Example: Ethiopia
●
●
●
●
●
5 mil cases a year, 70k deaths a year
Transmission peaks bi-annually during harvesting seasons (large migrations from
highlands to lowlands for agricultural work)
Lack of communications technology to communicate information on the epidemic
Changes from rain-fed agriculture to large scale irrigation agriculture increases
river damming for hydroelectricity and increases stagnant water
○ Irrigated crops eg. cotton and sugarcane require lots of water and warm
tropical temperatures increases breeding of malaria vectors
Impacts:
○ reduction in productivity of adult workforce and ability of children to attend
school (Ethiopia highly dependent on labour-intensive agricultural sector)
○ An overwhelmed healthcare sector lacking in skills, resources and staff
training
○ Loss of investment & tourism (tourists reluctant to visit)
What barriers, treatment & prevention strategies exist?
● Prevention
○ Vector control by long-lasting insecticide-treated mosquito nets and indoor
residual spraying
■ sleeping under a bed net reduces child mortality by as much as
20%
■ Nets reduce the overall lifespan of mosquitoes, limiting further
transmission
○ Spraying with insecticides (DDT), fully effective when >80% of houses in
targeted areas are sprayed
○ Environmental management, favoured in Ethiopia (destroying breeding
sites, digging proper toilets to prevent water accumulation)
○ Increased govt primary health care initiatives, introducing up to 30,000
HCW by 2009
○ Rapid diagnostic tests to distinguish between non-malarial fevers
○ Drug treatment (quinine and recently chloroquine)
Prevention
Vector control is the main way to prevent and reduce malaria transmission, as recommended by the
WHO.
Two forms of vector control
– insecticide-treated mosquito nets and indoor residual spraying – are
effective in a wide range of circumstances. If coverage of vector control interventions within a specic
area is high enough, then a measure of protection will be conferred across the community.
Long-lasting insecticidal nets (LLINs) are the preferred form of insecticide-treated mosquito nets (ITNs)
for public health programmes. In most settings, WHO recommends LLIN coverage for all people at risk
of malaria. The most cost-effective way to achieve this is by providing LLINs free of charge, to ensure
equal access for all. In parallel, effective behaviour change communication strategies are required to
ensure that all people at risk of malaria sleep under an LLIN every night, and that the net is properly
maintained.
Indoor residual spraying (IRS) with insecticides, including DDT, is a powerful way to rapidly reduce
malaria transmission. Its full potential is realized when at least 80 per cent of houses in targeted areas
are sprayed. In some settings, multiple spray rounds are needed to protect the population for the
entire malaria season.
Antimalarial medicines can also be used to prevent malaria. For travellers, malaria can be prevented
through chemoprophylaxis, which suppresses the blood stage of malaria infections, thereby
preventing malarial disease.
●
Barriers
○ Antimalarial drug and insecticide resistance mean more combinations of
drugs need to be developed
○ Insecticide nets and cheap drugs require routine monitoring
Insecticide resistance
Vector control is highly dependent on the use of pyrethroids, the only class of insecticides currently
recommended for ITNs or LLINs. In recent years, mosquito resistance to pyrethroids has emerged in
many countries. In some areas, resistance to all four classes of insecticides used for public health has
been detected. Fortunately, this resistance has only rarely been associated with decreased efcacy of
LLINs, which continue to provide a substantial level of protection in most settings. Rotational use of
different classes of insecticides for IRS is recommended as one approach to manage insecticide
resistance.
To ensure a timely and coordinated global response to the threat of insecticide resistance, the WHO
worked with a wide range of stakeholders to develop the “Global Plan for Insecticide Resistance
Management in Malaria Vectors (GPIRM)”, which was released in May 2012.
Diagnosis and treatment
Early diagnosis and treatment of malaria reduces disease and prevents deaths. It also contributes to
reducing malaria transmission. The best available treatment, particularly for P. falciparum malaria, is
artemisininbased combination therapy (ACT).
Antimalarial drug resistance
Resistance to antimalarial medicines is a recurring problem. Resistance of P. falciparum to previous
generations of medicines, such as chloroquine and sulfadoxine-pyrimethamine (SP), became
widespread in the 1970s and 1980s, undermining malaria control efforts and reversing gains in child
survival.
The WHO recommends the routine monitoring of antimalarial drug resistance, and supports countries
to strengthen their efforts in this important area of work.
Surveillance
Surveillance entails tracking the disease and taking action based on the data received. Malaria
eradication is dened as the permanent reduction to zero of the worldwide incidence of malaria
infection as a result of deliberate efforts. Once eradication has been achieved, intervention measures
are no longer needed.
In countries with high or moderate rates of malaria transmission, national malaria control
programmes aim to maximize the reduction of malaria cases and deaths.
Vaccines against malaria
There are currently no licensed vaccines against malaria or any other human parasite. Clinical trials
are currently being held, and it is expected that there will be a vaccine by 2020. In October 2015, two
WHO advisory groups recommended pilot implementations of RTS, S/AS01 (a malaria vaccine) in a
limited number of African countries.
The WHO strategy
The WHO Global Technical Strategy for Malaria 2016–30 – adopted by the World Health Assembly in
May 2015 – provides a technical framework for all malaria-endemic countries. It is intended to guide
and support regional and country programmes as they work towards malaria control and elimination.
The strategy sets ambitious but achievable global targets, including:
● reducing malaria incidence by at least 90 per cent by 2030
● reducing malaria mortality rates by at least 90 per cent by 2030
● eliminating malaria in at least 35 countries by 2030
● preventing a resurgence of malaria in all countries that are malaria-free
Water-Borne Disease - Cholera:
What is cholera and how does it spread?
● Acute diarrheal disease (vibrio cholerae) transmitted through oral routes (water,
food); often found in estuary ecology
● It strikes in pandemics in LICs and NICs (newly industrialised countries), and can
easily be brought to other countries through network/relocation diffusion.
● There are 3-5 mil cases annually, killing 100,000, but reported cases only
represent 5-10% of actual cases
● Symptoms include large amounts of watery diarrhea, vomiting and muscle
cramps, dehydration and death if left untreated
Cholera is an infection of the small intestine caused by the bacterium Vibrio cholerae. There are
several strains of the bacterium, some causing worse symptoms than others. It is a waterborne
disease, although it can also be transmitted by contaminated food.
For cholera outbreaks to occur, there must be two conditions:
1. There must be signicant breaches of water sanitation leading to contamination by the bacterium
Vibrio cholerae
2. Cholera must be present in the population. This infection is mostly asymptomatic or causes mild
gastroenteritis. However, about 5 per cent of infected persons develop severe dehydration and acute
diarrhoea, which can kill within hours.
There are 28,000–142,000 deaths from cholera every year. Even those who are symptom-free can carry
the bacteria in their faeces and the disease is easily transmitted if sanitation arrangements are
inadequate.
What factors enable the spread (diffusion) of cholera?
● Social
○ Hunger present in a population leads to weakened immune systems,
making it easier to be infected
○ A lack of sanitation and food safety practices increase the risk of
transmission
○ High living density in urban areas & rapid urbanisation
○ Low diffusion of education (particularly regarding health & proper
treatment of disease)
● Economic
○
●
●
Corruption prevents sanitation and medical supplies to reach those in
need
Environmental
○ Irrigation and water insecurity in the area (epidemics begin during the end
of the dry season when people are forced to accumulate at fewer water
resources)
Political
○ Difficulty of access to rural areas to conduct government censuses
Risk factors
Transmission of Vibrio cholerae is relatively easy in areas of poor housing and inadequate sanitation. It
is particularly the curse of displaced populations living in overcrowded camps. Children under ve are
particularly vulnerable.
The transmission of Vibrio cholerae Open-air defecation or leaking sewers
Country Example: Ethiopia
● deaths of 684 people and infection of nearly 60,000 others in less than a year
(2007)
● 33,000 cases of cholera and 776 deaths (2017)
● Forced migration due to drought and below average rains (as a result of the El
Niño event)
● Most prevalent in refugee camps with poor infrastructure and crowded conditions
● The WFP (World Food Programme) needed $268 million to provide food
assistance in Ethiopia from Jan 2017 until July
What barriers, treatment & prevention strategies exist?
● Treatment: reducing deaths
○ Rehydrating patients and replacing electrolytes lost through vomiting and
feces
○ Emphasising chlorinated, boiled water for use during oral rehydration,
food preparation, hand washing, and cleaning
● Prevention: preventing new cases
○ Intensive public education, environmental sanitation campaigns (eg.
education programmes about latrine safety)
○ Surveillance, allowing healthcare personnel to detect cases early and to
assess size, density of outbreak to distribute resources
○ Assembling a response team to fully cover all aspects of disease
identification, treatment & recovery - lab techs to identify symptoms,
environmental health experts to identify causes, creating stockpiles of oral
rehydration salts
Cholera symptoms
Infection of the small intestine
Water abstracted for domestic use
Contaminated water used for washing hands Vibrio cholerae in stream
Vibrio cholerae in faeces
Clinical treatment
● Prompt administration of oral rehydration therapy is sufcient to treat 80 per cent of patients.
● Very dehydrated cases need intravenous uids.
● Antibiotics are useful while V. cholerae is still being excreted, but prolonged treatment can lead to
antibiotic resistance – a serious problem in treating all infectious illness.
● Oral cholera vaccine (OCV) can be effective, but it is important to adopt prevention and control
measures as well.
The role of the World Health Organization
The WHO Global Task Force on cholera control works to:
● support and implement global strategies to prevent and control cholera
● provide a forum for cooperation and to strengthen a country’s capacity to prevent and control
cholera
● support research
● increase the visibility of cholera as an important global health problem
3. Stakeholders in food and health
● One case study of the issues affecting a famine-stricken country or area
Yemen & Famine
What is famine?
● A legal condition required to declare a state of emergency in a country, where
a) 20% of households in a given country face extreme food deficits
b) 30% children are acutely malnourished
c) mortality rates exceed 2 people per 10,000 population per day as a result
of food deficit
● There are currently 4 countries worldwide on the brink of famine, and $4 billion is
needed by UN to alleviate all of them, with only 14% of that amount available
from aid and donations
What is causing Yemen’s famine?
● Violent conflict
○ The Arab Spring in 2011 resulted in a power shift from an authoritarian
president (part of the Hadis)
○ As a result, a rebel Houthi Muslim movement took control of the capital
city, with Saudi Arabia and other states (backed by the US) bombing the
Houthis to try and restore the Hadis
○ The proxy war in the region has killed nearly 10,000 people since 2015,
with 2 million IDPs (internally displaced people)
○ The war escalated to an international proxy war when the US, UK &
France stepped in to lend military assistance in the form of bombings and
airstrikes to try and subdue the Houthis
○
The strategic location of Yemen neighbouring other Middle Eastern
nations enables geopolitical conflict
● Climate change
○ Yemen is naturally dry and dusty, with less than 3% of its land supporting
28 million people
○ Less rainfall means less harvest and shorter growing seasons, so minimal
(if any) food is stored for periods of crisis and people are less likely to
survive during conflict
○ Water insecurity and unsustainable resource practices and use have lead
to a depletion of Yemen’s groundwater/aquifers, further increasing the
insecurity of their minimal food production
What are the impacts of Yemen’s famine?
● Economic
○ The Yemeni economy will be unable to generate sufficient foreign
exchange, depreciating the currency and continuing to increase food
prices/inflation
○ 12,000 out of the 14,000 schools in Yemen have now shut down
● Social - a shortfall in food availability & health
○ Due to Saudi naval, land and air blockade on Yemen’s ports blocking
Iranian and international food/humanitarian aid
○ 85% of food supplies prevented from entering
○ Resurgence of preventable diseases like malaria and cholera
■ 1.26 million suspected cholera cases in the country with 1.5 million
malnourished children
○ Collapse of the health system & international aid
■ hospitals, schools, food-storage facilities targeted in bombings
■ NGO Medecins Sans Frontiers (Doctors Without Borders) had 19
personnel killed in a bombing, causing them to withdraw all
international staff in the region
■ 600 health facilities out of action due to fighting
■ 50 kilo tonnes of wheat (enough for 3.7 million people for a month)
from the World Food Programme prevented from reaching Yemeni
borders
● Environmental Degradation
○ Saudi bombings target power generation sites, causing blackouts and
impacting water supplies
○ direct & indirect pollution from destruction of infrastructure causing heavy
metals and particulates to be released into surrounding atmosphere and
water sources
Famine in Ethiopia
Social impacts:
● Ethiopia has been plagued by famines since the 16th century. In recent times, famine
struck the country in 1973 (40,000 starved in the north-east and around 55,000 died in
the Ogaden region) and between 1983 and 1985, when areas of northern Ethiopia and
Eritrea were affected in what is regarded as the country’s worst famine in a century.
Estimates of the number of deaths ranged from 400,000 to one million people. Millions of
others were made destitute. The 1983–5 famine was widely reported in the media and
received much publicity. It also led to the Band Aid and Live Aid concerts.
Environmental impacts:
● In 2015, the seasonal rains that usually fall between June and September in
north-eastern, central and southern Ethiopia did not arrive. According to the UN, this was
Ethiopia’s worst drought in 30 years. Around 90 per cent of cereal production is
harvested in autumn, after the summer long rainy season, and the rest at the end of
spring after the end of the short rainy season.
Political (role of government)
● These days, early-warning systems (Figure F.47) alert the government when famine
threatens, and in 2015 the government was able to respond more quickly to the crisis
than in 1983–5. There is evidence that in 2015–16 the Ethiopian government made
provision to mitigate the impact of poor harvests, such as establishing a social security
net so that poorer farmers can access funds for public works such as digging water
holes.
● The Ethiopian government pledged $192 million for emergency food and other
assistance, diverting money from projects such as road construction. The “international
community” promised a further $163 million. Aid agencies suggested that $600 million
was needed. The drought was caused by the El Niño weather system, and resulted in a
90 per cent reduction in crop yields. (economic, role of organiations)
Political factors: poor governance and state neglect.
The key factors driving the famine,then and now, include the selling off of land to international
corporations for industrial farming – that is, “land grabs”.
Another criticism was that in 1983–5 much food relief was channelled towards the military.
Social factors: The large number of refugees in Ethiopia
More than 650,000 refugees from Somalia, South Sudan, Sudan and Eritrea are in Ethiopia,
and this places a large burden on water and land resources.
Political (role of the government)
At first, some in the Ethiopian government claimed the country could handle the drought itself. In
December, they said about 10.2 million people were in need of $1.4 billion in aid, with 400,000
children severely malnourished. This is in addition to 8 million people supported by the
government safety net even before the drought.
Social impacts (role of the media):
To date, less than 50 per cent of the appeal has been met, and the worst could be yet to come.
In 2015–16 international donors were distracted by a string of humanitarian disasters around the
world, such as in Syria and South Sudan. This meant that there was much less media coverage,
and so less publicity compared with 1983–5. Events in Syria were more dramatic than the
failure of the rains, although the failure of the rains probably caused more deaths.
Role of organizations and aid
Nevertheless, a number of organizations are working in Ethiopia, including the World Food
Programme (WFP), Save the Children and the FAO. The WFP is helping to feed the refugees
and also supporting the government’s second ve-year Growth and Transformation Plan (GTP),
a school meals programme and a vulnerability and mapping unit (VAM). Save the Children
Ethiopia reported substantial livestock losses in the Afar region. It had also mobilized $100
million, while the FAO announced a $50 million plan to assist agriculture- and livestock
dependent households.
4. Future health and food security and sustainability
● One case study of attempts to tackle food insecurity
Management of European Fish Stocks
What is the issue?
● Nearly 70% of the world’s fish stocks are in need of management
○ Cod stocks in the North Sea are less than 10% of 1970 levels
● World wild food fish demand has increased from average of 9.9 kg per capita to
19 kg per capita, putting more strain on already taxed fisheries, particularly those
being fished above Maximum Sustainable Yield (MSY)
What is being done?
● Management of biotic resources of oceans in the EU under the Common
Fisheries Policy (CFP)
● Management can be input control, output control or a combination
● input controls:
○ Limiting the number of vessels in certain waters: fishing permits
○ fishing effort controls limiting capacity of vessels
○ technical measures: Small meshed nets, minimum landing size → protect
juveniles
● output controls:
○ limiting catches through total allowable catches and quotas, matching
supply to demand
○ surveillance: check landings by EU → apply penalties to overfishing and
illegal landings
○ Tariff policy: Minimum import prices → to ensure EU preference
● Development of aquaculture practices
○ Aquaculture now accounts for ~20% of fish production
○ Aims to double aquaculture in the EU by 2030
●
●
Conservation measures & environmental legislation (Marine Strategy Framework
Directive) to safeguard biodiversity surrounding the fish stocks & address human
activities (fisheries) affecting the oceans
as a result, pressure on European stocks in 2013 declined by 50%
○ While EU legislation regarding management of insecure stocks was not
enacted as quick as other countries, 74% of European fish stocks
previously fished below Maximum Sustainable Yield are currently
rebuilding successfully
● One case study of a contemporary pandemic and the lessons learned for
pandemic management in the future
Ebola & Pandemic Management
●
A pandemic is an epidemic (a sudden increase in cases above the norm of
disease outbreaks in an area) spread over countries/continents
What is ebola?
● An often fatal illness contracted through infection with the Ebola virus, transmitted
through human-to-human contact.
● Extremely prevalent 2014-2016 in Liberia, Sierra Leone, Guinea
● Epidemiology: transmitted through human-to-human contact & infected wild
animals; through bodily fluids, organs etc of infected persons (blood, dead
bodies, sweat etc)
● Symptoms: 8-10 days incubation highly flu-like (fever, fatigue, muscle pains),
extreme escalation in the 2-3 days after (internal bleeding, vomiting, diarrhea)
What was the temporal & spatial dispersal of ebola?
● began in Guinea 2013 after a boy died at a regional trading point from contracting
the virus from a bat
● boy’s family became infected & died, disease spread to other villages when
people travelled
● traditional burial practices in West African culture involves evacuating the body of
bowels, food etc., making the spread of the disease extremely prevalent in this
region
● Proper cases were not reported until March 2014 as it is tradition for sick
relatives to be cared for at home in West Africa
● 28,657 total reports of infection, of which 11,325 died (a high mortality rate of
39.5%)
● The disease spread to the slums of capital cities, causing rapid spikes in number
of cases per day
What role did social marginalisation play in this pandemic?
● Social Marginalisation: an extreme tension between communities due to lack of
awareness about how the disease spreads and infects others
●
●
●
The borders & markets between Liberia and neighbouring countries have closed,
even though cross-border trade and relationships are vital for border economies
and building trust
Survivors & their quarantined families completely shunned within communities
due to fear of infection
The role of local governments was key in minimising stigma - an organisation
called District Platforms for Dialogue (DPD) educated villagers about ebola in the
local dialect
○ forums and discussions were facilitated by DPD, with town chiefs, women
leaders and healthcare workers in attendance to remind communities of
life before ebola
How can social media be used to manage pandemics?
● Organisation ‘Africa Stop Ebola’ used well-respected public figures with social
weight & music to perform a song in French and other local languages
● Local media portrayal of the pandemic contrasts with Western media, who were
very slow to report on initial outbreak
○ reporting in US only began after an American who travelled to Liberia
returned home to the US and fell ill in 2014; widespread European
reporting only after a volunteer Spanish nurse fell ill
● Note the social media penetration is 14% in Africa vs. 66% in NA and 54% in
Europe, meaning the media isn’t always accessible to the majority of the
population and thus its effectiveness in dealing with or reporting news about the
ebola pandemic can be limited in certain areas
● Newspaper media coverage is crucial to frame pandemics in the right light
○ The ebola pandemic was initially framed as localised African crisis
○ Media coverage transitioned to focusing on danger to Western countries
rather than humanitarian disaster in Africa
■ This limited donations for medical equipment & travel of volunteer
health workers
● Human interest stories shown to be effective at humanising the crisis
● Amplified panic on social media micro-posts can be used to detect real time
emergence of crises through the use of semantic data mining
How can ebola be controlled and treated?
● By diagnosing, tracing and isolating contact of every single Ebola patient to
prevent new chains of transmission was necessary to fully contain the disease
● The use of chlorine concentrate to treat food, water, clothes etc
● Biosecure Emergency Care Units for Outbreaks (cubes) cost $USD17,000 but
allow workers to administer care externally, and for families to communicate with
patients without risk of contamination
How can ebola be prevented?
● Household prevention kits containing soap, chlorine, masks etc distributed by
WHO, UNICEF
●
educating public on transmission, using personal protection equipment
effectively, ebola transmission campaigns aired on radio & television
● ensuring free treatment in isolated regions is essential for early detection &
eradication
What are the barriers to prevention?
● Fear amongst locals and communities
○ There was a great fear amongst locals who didn’t understand ebola and
the treatment process of never seeing loved ones again - family members
that were ill were taken away by healthcare workers in hazmat suits &
masks; they often didn’t return alive due to the high prevalence of disease
○ Pervasive messaging spread among communities that ebola has no cure
due to the high death toll, when in reality treatment and containment is
possible given proper resources
● poor infrastructure & communication, cultural beliefs
● Ebola suspect’s dilemma
○ The early symptoms of ebola are extremely similar to malaria, a common
and preventable disease also found on the African continent
○ A person suffering from these symptoms either has malaria & will likely
survive if they get malaria medication, but if they have ebola and go
without treatment, they will die and likely infect others
○ Patients have a choice whether to go to an ebola treatment centre or not the probability of dying can be seen in the following graphic:
○
○
overall mortality risk for staying at home vs treatment is 35% to 40%.
suspects can maximise chance of survival by staying at home, but risk
becoming sub spreaders of the virus