Cultural Contexts of Ebola in Northern Uganda

guidelines for the control of Ebola hemor-rhagic fever (EHF) indicate that understanding local views and responses to an outbreak is essential. However, few studies with such information exist. Thus, we used qualitative and quantitative methods to determine how local residents of Gulu, Uganda, viewed and responded to the 2000–2001 outbreak of EHF. Results indicated that Acholi people used at least three explanatory models to explain and respond to the outbreak; indigenous epidemic control measures were often implemented and were consistent with those being promoted by healthcare workers; and some cultural practices amplified the outbreak (e.g., burial practices). However, most persons were willing to modify and work with national and international healthcare workers. M any emerging disease specialists are sensitive to and acknowledge the potential importance of social science in disease control, but seldom is this perspective considered when organizing response efforts. In part, this situation exists because so little research in this area has been conducted. The special issue on Ebola in The Journal of Infectious Diseases (1) does not include any articles on the behavioral aspects of the disease. However, World Health Organization (WHO) technical guidelines for responding to Ebola hemorrhagic fever (EHF) state that, in conducting epidemiologic surveillance, " Special attention must be given to the actual perception of the outbreak by the community. In particular, specific cultural elements and local beliefs must be taken into account to ensure proper messages, confidence, and close cooperation of the community " (2). We describe the first systematic sociocultural study of an outbreak of EHF. The outbreak occurred in several locations in northern Uganda in 2000 to 2001. We conducted this research in villages and neighborhoods in and around Gulu during the last month of the outbreak. The field study aimed to: 1) describe local explanatory models of EHF; 2) provide understanding of topics of concern to WHO (i.e., burial practices, patients' fear of going to the hospital, the role of traditional healers in disease transmission); and 3) identify local and international beliefs and practices that enhanced or were detrimental to the control of EHF. An " explanatory model " refers to a person's or culture's explanations and predictions regarding a particular illness. Some of the questions asked when trying to understand an explanatory model include: How do persons refer to the ill-ness? How do they explain it (i.e., cause)? What do they see as appropriate treatments? What do they do …