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Effect of a Safe and Dignified Burial Intervention on Ebola Virus Transmission in the Eastern Democratic Republic of the Congo, 2018-2019: A Propensity Score Analysis
25 Pages Posted: 27 Nov 2023
More...Abstract
Background: Safe and dignified burial (SDB) is a pillar of the response to epidemics of Ebola Virus Disease (EVD) and other pathogens transmissible through contact with corpses. A large EVD epidemic affected the eastern Democratic Republic of the Congo (DRC) during 2018-2020. The DRC Red Cross and local authorities, with support from the International Federation of Red Cross and Red Crescent Societies, provided SDB services throughout the epidemic. We estimated the effect of SDB on Ebola virus (EBOV) transmission.
Methods: We computed two alternative outcomes by health zone and week: (i) the change in EVD incidence over adjacent three-week time windows and (ii) the effective reproduction number. We combined the proportions of timely and successful SDBs (exposures) with potential confounder variables representing epidemiological surveillance, EVD vaccination coverage, insecurity and infrastructure into propensity scores that we then used to adjust exposure-outcome models.
Findings: SDB timeliness and successfulness were associated with reductions of 23% (95%CI 12% to 32%) and 47% (95%CI 33% to 59%) across adjacent time windows, and of -0.38 (95%CI -0.70 to -0.07) and -0.72 (95%CI -1.20 to -0.25) in the reproduction number, respectively. A linear dose-response relationship with SDB successfulness was apparent for both transmission outcomes. Transmission fell below the epidemic extinction thresholds when about 50-70% of SDBs were successful.
Interpretation: The SDB service was associated with a substantial and plausibly causal reduction in transmission of EBOV. This intervention should be prioritised whenever exposure to corpses contributes to epidemic propagation.
Funding: Research for Health in Humanitarian Crises (R2HC) Programme (ref. 43670) of the Enhancing Learning and Research for Humanitarian Assistance (ELRHA) charity.
Declaration of Interest: The authors declare that they have no competing interests.
Ethical Approval: We received ethical approval from the London School of Hygiene and Tropical Medicine ethics review committee (Ref: 17762) and the University of Kinshasa (Ref: ESP/CE/264/2019). Data were anonymised before analysis, and were originally collected for routine, non-research purposes.
Keywords: Ebola, epidemic, burial, dead body, intervention, transmissibility, transmission, effect, impact, propensity score, Democratic Republic of the Congo
Suggested Citation: Suggested Citation