Ebola Virus Outbreak in Africa

Abstract

Ebola is one of the most dangerous conditions in the world today. Once it outbreaks, it spreads fast when individuals contact bodily fluids from the infected individuals. The condition has a short incubation period (two days) in which the person starts to exhibit the symptoms that include fever, vomiting, diarrhea, and headaches. The virus affects the functions of important body organs, including the liver and the kidney, which are likely to lead to death sooner. Handling people infected with the virus requires absolute protection to ensure that one does not contact any fluids from the person with the condition. There is no proven vaccine or treatment for Ebola now, but it is possible to increase the survival of a person by giving them fluids occasionally. The current nature of the condition and the threat it poses to the world requires further research to introduce preventive measures and treatment in the future.

 

Introduction

Ebola is a relatively new condition that was first heard in 1976. Then, three hundred and eighteen people showed the symptoms of the condition, of which two hundred and eighty succumbed to the condition. The case of 1976 was unique in that many people that got the condition after the initial cases got it in the hospital. At the time, it was common practice in the region for nurses to use one syringe for injections in the region because of the dire healthcare problems. According to Vidal, of all the three hundred and eighteen people treated for the uncommon condition only five syringes were used (176). The isolated causative was named Ebola after a small river near the villages these cases were reported in Zaire. The strange condition and its spread among people in the villages led to the revelation that it was spread when people were exposed to bodily fluids of another person. Other outbreaks or Ebola were experienced in 1995, 2000, 2001, 3007, and 2014. The latest case of 2014 was concerning because the Centers for Disease Control estimates that more than 17,000 people were infected, and more than ten thousand died (1). Additionally, the condition spread in all continents, which made people think that it would be an apocalypse. Ebola spreads through bodily fluids and its incubation period is between two and twenty-one days. The major symptoms associated with the condition include chills, chest pains, shortness of breath, headache, confusion, coma, vomiting, diarrhea, and severe abdominal pains. Many questions arise regarding the outbreak of Ebola in Africa because these scenarios have become common in the recent years and have severe fatalities.

Literature Review

Background. Ebola has a short history for it was not reported until 1976. It is in the classification of filoviruses and is thought to be a common illness among wild animals in the rain forests around Central and Western Africa. The relation between animals and Ebola started in 1969 when German vaccine workers got the Marburg viral condition that they acquired from infected monkeys got from Congo. Marburg and Ebola viruses belong to the same class, filoviruses, and have the same clinical manifestations (World Health Organization 1). When a disease with a strange causative agent was reported in Zaire and Sudan in 1976, some scientists related the two and noted that the symptoms were similar. The fast spread of the condition in Zaire around the Ebola River astonished many scientists and health professionals, which encouraged them to perform epidemiological studies there. Scientists successfully isolated a singular RNA virus that was named after the place it affected many people in Zaire (Feldmann and Geisbert 849).

There was no other incidence of Ebola until 1994 when an ethnologist who had worked in Tai forest in Côte d’Ivoire exhibited the symptoms atypical to those of the viral disease. Further research indicated that the ethnologist had done necropsy on an infected chimpanzee (Centers for Disease Control 1). In the same year, 1994, there was an Ebola outbreak in Gabon, which killed at least 30 people. In the following three years, cases of Ebola were reported in South Africa, Zaire, United States, and Russia. Further outbreaks were reported in Uganda, the Democratic Republic of the Congo, Gabon, Sudan, and Russia between 2000 and 2004. In these outbreaks, the fatality rate was between 53 and 100% (Centers for Disease Control 1). There were outbreaks of the viral disease again between 2007 and 2009 in Democratic Republic of the Congo, Uganda, and the Philippines (Centers for Disease Control 1). Other outbreaks occurred between 2011 and 2013 in the Democratic Republic of the Congo and Uganda. From March 2014, an Ebola outbreak was reported in Liberia, which soon spread to other countries, including Guinea, Nigeria, Senegal, Sierra Leon, Mali, Spain, United States, Italy, and United Kingdom (Centers for Disease Control 1). Estimates for the infected individuals stand at twenty-eight thousand with more than ten thousand deaths.

Ecology. The fact that Ebola outbreaks occur in one region (Central and West Africa) raises questions about whether there are specific factors that enhance the development of the viral disease. According to Ealy and Dehlinger, the equatorial forests of Central and Western Africa present the necessary ecological requirements to harbor Ebola virus (6). This is through a specific link between animals and human beings living there. The virus exists as a Zoonosis in some mammals, mostly thought rainforest bats, and have the ability to infect animals. There are suggestions that animals, mostly primates in these forests contact the bat feaces on fruits, which mostly led to infection. When human beings encounter the infected animals, they automatically get the infection. People in the rainy forests of Central and Western Africa usually take bush meat, which increases their chances of becoming infected, especially if they take meat from infected animals. Although this is the commonly thought perspective, there are suggestions that not all bats are reservoirs for the Ebola virus (Ealy and Dehlinger 6).

Understanding how Ebola outbreaks occur is more complicated than just considering the infection cycle of animals and human beings. According to Ealy and Dehlinger, Ebola outbreaks occur at certain times only (8). They are of the perception that climatic changes increase the chances of Ebola outbreak. Their studies indicate that there were abrupt climatic changes when Ebola outbreaks occurred between 1981 and 2000. Ealy and Dehlinger indicate that there were sudden changes in climate from dry to wet conditions (8). In such cases, few trees produce fruits that are common to the primates and bats. These animals are likely to interact in their quests to search for food, which increases the chances of infection. The infected animals pass the viral disease to humans when the later hunt for bush meat or when doing physiological studies.

On the same, there are suggestions that the changing landscapes in Africa are also playing a role in Ebola outbreak. Aron and Patz state that deforestation, which is common in these parts of Africa, is to blame for the Ebola outbreak (172). They believe that forests offer protection against animal diseases, for example, Ebola and other common animal diseases. When human beings encroach on the forests, they increase the chances of interacting with the wild animals. Such scenarios increase the chances of getting common animal infections. According to Aron and Patz, the Ebola outbreak of the 1990s in Zaire was because of increased deforestation (172). They warn that continued deforestation will lead to even worse and complex animal-related diseases in the future. Scientists are confident that there are many unknown microorganisms in these dense forests and interaction with human beings could be disastrous. The main challenge is devising sustainable ways to regulate deforestation considering that the population in these regions is growing very fast, among the highest in the world, which increases the need to cultivate further into the forests to get enough food (Aron and Patz).

Poor nursing practices and cultural beliefs. Nursing practices in Central and Western Africa are poor compared to those of the developing and developed nations. Magil and colleagues state that nursing practices in Africa are extremely poor, especially in the rural regions where most of the Ebola outbreaks started (332). Most nurses and doctors in the rural health care facilities are quick to prescribe medicine without confirmation of the condition a person is suffering from. In the Ebola outbreaks in Zaire in 1976 and Ivory Coast in 1994, the medics in the healthcare facilities treated the patients for malaria. Although the patients exhibited such symptoms, it is always important to confirm the condition before prescription (Magil et al. 332). Smith states that the cases of Ebola outbreak in Central and West Africa are not unique because they are all the same (19). He states that the nurses and doctors in the rural facilities have a tendency of using syringes to serve many people. They also do not understand the importance o f sterilization, which they rarely do when they are serving patients.

Cultural practices also play an important role in the spread of Ebola in Central and West Africa. According to the World Health Organization, the burial and funeral rites in these regions are strange in many ways (1). Most tribes in the region have a tendency of using the water used to wash corpses before burial for anointing individuals. Some individuals even bath in such waters with the aim of getting blessings from the dead person. Many communities in the region also believe that a dead person deserves compassionate care before they are buried. These communities disregard death and continue treating the corpse specially, for example, sleeping next to it, washing it, and even dressing it. If the dead person died of Ebola, all the individuals that encounter the waters used to wash them or touch the body in preparation for the burial are likely to get Ebola (World Health Organization 1). Although the communities understand the risks that come with such practices, most are unwilling to stop these cultural practices, which increase the chances of Ebola spread. There are suggestions that these cultural practices are the greatest contributors of the spread of Ebola in Central and Western Africa (Alexander et al; Nielsen et al. 20)

Shortage of healthcare workers. These two things would dictate the containment of Ebola before it becomes an outbreak. In the regions that Ebola is common, there is shortage of healthcare workers. Naicker, Plange-rule, Tutt, and Eastwood claim that healthcare systems in most African countries are wanting because there are fewer healthcare workers (S1-60). In these countries, the number of doctors and nurses serving the population is below the World Health Organization requirement that at least two doctors should serve a population if ten thousand individuals. The problem is magnified in countries like Liberia and Sierra Leone that have had a share of Civil war (World Health Organization 1).   The shortage of healthcare workers is mostly because of immigration, whereby, most go to the developed countries where there are more opportunities for career growth. In most African countries, the healthcare workers lack postgraduate programs that would advance their career (Naicker, Plange-rule, Tutt, and Eastwood S1-62). In addition, the salaries in the developed countries are an attraction to many healthcare professionals from the developing nations.

The shortage of healthcare staff in the developing nations is likely to affect the rural regions more. According to Soucat, Scheffler, and Ghebreyesus, there is a wide variation in the distribution of healthcare works in these countries, whereby, most prefer to be within regions where the wealthy people live (137). Most of the healthcare professionals live in the large urban centers where they are likely to make a good living. There is a consideration that there is no money in the rural areas, which is true. Most people in rural Africa live in abject poverty, which is the discouraging factor for the healthcare professionals. Considering that most people in Africa live in the rural areas, the number of healthcare workers there is required to serve a population that beyond the World Health Organization by far (Naicker et al S1-63). Another issue that comes up in the rural regions is the unwillingness of the people there to use the modern medical services. In regions like the Central and Western Africa, most people still appreciate medicine men and traditional herbs as the ultimate cure (World Health Organization 1). Even when the people in the rural regions notice unusual diseases, like the symptoms of Ebola, they believe in their traditional doctors.

Poorly equipped facilities. The healthcare facilities in most African countries are poorly equipped even for the basic equipments. Facts on File Incorporated states that most African healthcare facilities have little supplies, which leads to poor sterilization of equipment, re-use of some of the equipment for example, syringes (46). In some cases, healthcare facilities lack important supplies, which prompt them to ask the patients to go purchase their own equipment for use. These conditions are ripe for an outbreak like Ebola. In fact, most of the Ebola outbreaks in Central and Western Africa have been because of insufficient supplies in the local healthcare facilities. Poor disease surveillance adds to the problem as Tambo and colleagues state (2). In these regions, most healthcare professionals lack the knowledge to differentiate between diseases. In most of the outbreaks, healthcare professionals are quick to treat the condition based on the symptoms they see in a patient rather than do tests to determine the exact cause of the ailment. This is partly due to the poor surveillance knowledge and lack of equipment in the facilities, especially in the rural Africa (Tambo, Ugwu, and Ngogang 2).

Under these conditions, the healthcare professionals are likely to contact the bodily fluids from the patients, which put them at risk of contracting dangerous diseases. McGill states that most healthcare workers in Central and Western Africa risk their lives when saving others (1). On example of such a person is Khan, who was a physician at a small government hospital in Sierra Leon. In his quest to save lives, Khan contracted Ebla and passed later on (McGill 1). The major issue of concern in this case is the fact that these individuals lacked protective gear when handling patients exhibiting symptoms that resemble those of Ebola. The healthcare professionals like Khan, who are committed to do their work diligently, end up dying from such a disease. McGill is convinced that hundreds of doctors and nurses pass when they contract such a condition when there is a large outbreak (3). The World Health Organization admitted that many healthcare professionals working in Liberia and Sierra Leon contracted Ebola virus.

Poor infrastructure. This is one of the largest problems in Central and Western Africa. The countries that experience Ebola outbreaks have extremely poor infrastructure. This is a challenge because it makes it practically impossible to launch a quick response in the case of Ebola outbreak (World Health Organization 1). The problem of poor infrastructure is common in the countries affected by Ebola epidemic, for example, Liberia and Sierra Leon that were in a civil war. Although peace has prevailed in these countries in the recent past, their infrastructure is yet to catch up. These are among the poorest nations on earth and depend on international assistance for most projects. Considering their situation, most of the donation is for provision of basic amenities, including food. The poor infrastructure makes it very challenging for healthcare officials and international organizations to access the rural regions, where most of the Ebola outbreaks start (World Health Organization 1). In addition, the healthcare infrastructure is also very poor and there are fewer healthcare institutions, especially in the rural regions and slums. The few facilities in such regions do not have the required equipment to address cases of strange illnesses like Ebola. They lack proper laboratories, which increases the chances of treating the wrong condition, malaria mostly instead of Ebola because the two have similar symptoms.   

Methodology

Research design. To understand Ebola outbreak better, this study interviewed medical professionals in one of the major hospitals in the country. Although these professionals are here, they have a lot of knowledge on factors that could increase the chances of outbreak of Ebola in Africa. The study used cost effective methods, interviews and questionnaires, to get this information. To make it easy for the medical staff, they were informed beforehand what was being done and the objective. In addition, we understood that these individuals are usually busy and we structured the interviews during their free time as per their convenience.

Sample. The medical staff selected was from the infectious diseases department, but the individual participants were randomly selected. The idea behind this selection was the perception that the medical staff in this department had more knowledge on diseases like Ebola. Some of them were studying the patterns of the condition with the objective of understanding it better. After the interviews, they were given questionnaires to fill. The questionnaire had open-end questions that were easy to fill and took a short time to complete. In total, twenty individuals filled the questionnaire and one, the head of the Infectious Diseases Department was interviewed.

Data collection.

Interview

(Appendix one)

Questionnaire

(Appendix two)

Results

Of all the people that filled the questionnaires, there is an agreement that Ebola tends to outbreak from one region only. They further agree that cultural practices and poor infrastructure in the regions influence the spread of the condition. Another factor most of the staffs agree on is that healthcare workers are at risk of contracting Ebola easily, especially when handling people with the condition. Additionally, there is an agreement that no person or country is safe from Ebola. The factors that were contentious are that it is possible to contain Ebola and that there is a shortage of healthcare workers in central and Western Africa.

 

Questionnaire results chart

1 Ebola outbreaks in one region
2 Risk factors are preventable
3 Cultural practices influence the spread of Ebola.
4 Poor healthcare and road infrastructure increase the spread of Ebola.
5 Healthcare professionals are at risk of contracting Ebola.
6 There is a shortage of healthcare workers in Central and West Africa.
7 It is possible to contain Ebola.
8 No person or state is safe from Ebola

Table indicating the factors tabulated in the bar chart

General sentiments from the questionnaire

Discussion

It is clear that Ebola outbreak in Africa is a problem that concerns many people across the world. The recent outbreak proved that the viral disease could spread across the world in a short period and deliver disastrous consequences on the people. The question that arises is why the condition outbreaks in one region only. Many studies have shown that there are many reasons that Ebola outbreaks are mostly reported in the Central and West Africa. On the top of the list is the ongoing practice by the people in these regions. They are used to bush meat, through which they are infected. Studies by Ealy and Dehlinger indicate that wild animals eaten by the people living near rainforests in Central and West Africa are likely to get infected from bats, which are thought to be the hosts for the Ebola virus (6). The conditions that make this possible are the abrupt climatic changes, which increase the chances of bats and wild animals interacting. In such times, there is food shortage yet bats and most of the wild primates share food sources, especially wild fruits. The interaction between these animals increases the chances of the primates being infected.

The infected primates are likely to be in close contact with human beings in the region. This is facilitated by the fact that deforestation in the region is taking place at a fast rate. According to Aron and Patz, the cutting down of the forests reduces the distance between wild animals and human beings, thereby increasing the chances of the later of being infected by Ebola and other infectious diseases. This factor is a challenge to address because there are no other sustainable solutions for settling the increasing population. In addition, the forests provide fertile lands for farming, which seems to be the only way to guarantee food security in these countries. In this case, the governments of the region have no option but to allow people to continue with the deforestation process.

Other challenges that increase the chances of Ebola outbreak are poor infrastructure, few healthcare professionals, lack of good surveillance methods, and ill-equipped healthcare facilities. All these factors are related and they all increase the spread of Ebola in the case of an outbreak. When a single case of Ebola is reported in the rural regions, the healthcare staffs working in the healthcare facilities are likely to misdiagnose Ebola. History indicates that most of the professionals think the symptoms the patients show are those of malaria and give medicine to cure that. They do not have good laboratories and do not have to test the patient to determine the condition. In addition, they are likely to share the equipment used by such a patient with other patients, which increases the chances of spreading. When the patients’ symptoms worsen, the healthcare professionals do not have the necessary resources at hand to transport the patients to better healthcare facilities in the major cities. Even if they have such resources, the road networks and infrastructure are terrible, which makes it a challenge for such quests. The lack of equipment also poses a risk to the healthcare professionals, who are likely to encounter the bodily fluids of the infected individuals. Some studies indicate that healthcare professionals are infected with Ebola in their quests to save the ailing individuals.

Conclusion

Ebola presents one of the most challenging scenarios to the African continent. There are many reasons why the outbreak of this lethal viral disease keeps happening in the same region. Studies quoted in this paper indicate that poor infrastructure, climate change, deforestation, ill-equipped healthcare facilities, poor surveillance methods, and cultural practices to be the leading influencers of the spread of Ebola. All these factors are inter-related and there is a need to address them sustainable to ensure that there are no further outbreaks of the condition. In the worst-case scenario of an Ebola proved case, containment would be possible. However, the governments of these countries and the international community need to collaborate to meet these objectives.

Recommendations

Proper healthcare staff training. This is one of the strategies that can help in preventing the spread of Ebola in Central and West Africa. Studies indicate that the inability of healthcare professionals to detect Ebla symptoms is one of the leading causes of further spread. The training would include ways to differentiate Ebola from other conditions that have similar symptoms, the basic protective care, and ways of handling the people with Ebola-like symptoms. The governments in these countries should ensure that all healthcare staffs have this training regardless of whether they are based in the cities or the rural areas. The government can also perform simulated scenarios to ensure that the healthcare professionals execute such cases with absolute precision. In addition, simulated case scenarios help to prepare the health care staffs psychologically, which is important in handling such cases.

Improve infrastructure. This can play an important role in containing Ebola cases in the event of an outbreak. The first line would be ensuring that the healthcare facilities have the right equipment to handle Ebola cases. The governments of these nations should consider having well equipped hospitals in Ebola hotspots to ensure that the healthcare professionals there are likely to detect the viral disease fast. The hotspots should include regions that are near forests and places where there is a high chance of animals and human being interactions, for example, national parks. The government should also consider improving roads and other methods of transportation in the country. This helps the medical professionals to transport people suspected to have Ebola faster to advanced medical facilities. Good infrastructure can help in the containment of Ebola suspected cases faster, which would prevent further spread. Since most of the countries affected by Ebola outbreaks are poor, they can collaborate with international organizations that fund such initiatives to improve the infrastructure. It is a worth course and most institutions would be willing to fund such projects.

Awareness programs. Awareness programs can also have an impact containing the spread of Ebola. Such programs would be important in first making the people understand how some of their cultural practices increase the spread of Ebola. For example, the practice of bathing with water used to wash corpses by some communities in West Africa increases the chance of being infected, especially if the person died of Ebola. Whereas it is important to follow cultural practices and beliefs, understanding the risk can help these people look for alternative strategies of honoring their dead. The international community has helped some communities in Liberia and Sierra Leon to understand the possible effects of these practices and appreciate alternative ways.

On the same, international organizations and the local governments can collaborate to teach people about Ebola. This is important because the condition spreads in villages because the people there lack knowledge to differentiate symptoms of Ebola and other conditions. Another important thing is informing the people what they need to do in the case they suspect one of their own is infected. In such cases, the best thing is for them to call medical professionals and desist from interacting with such a person. This knowledge is likely to help villagers to collaborate in such cases, whereby, if a person suspects that they have contracted Ebola, they would stay in isolation without feeling bad until medical professionals arrive. Awareness programs can also help the villagers to desist from taking game meat. Although it is an important tradition, it is one of the things that increase the spread of Ebola. These programs can help these people to look for alternatives, to ensure that their interaction with the wild animals is minimal.

 

Works Cited

Alexander, Kathleen A., et al. “What Factors Might Have Led to the Emergence of Ebola in West Africa?” Neglected Tropical Diseases 9.6(2015): e0003652. Print.

Aron, Joan L., and Jonathan A. Patz. Ecosystem Change and Public Health: A Global Perspective. Baltimore, MD: John Hopkins University Press, 2001. Print.

Centers for Disease Control. Outbreaks Chronology: Ebola Virus Disease. CDC, 25 November 2015. Web. 27 November 2015.

Ealy, George, and Carolyn A. Dehlinger. Ebola. Burlington, MA: Jones & Bartlett Publishers, 2015. Print.

Facts on File Incorporated. Pandemics and Global Health. Philadelphia, PA: InfoBase Publishing, 2010. Print.

Feldmann, Heinz, and Thomas W. Geisbert. “Ebola Haemorrhagic Fever.” The Lancet 377.9768 (2011): 849-62. Print.

Magil, Alan J., G. Thomas Strickland, James H. Maguire, Edward T Ryan, and Tom Solomon. Hunter’s Tropical Medicine and Emerging Infectious Disease. London, England: Elsevier Health Sciences, 2012. Print.

McGill, Natalie. “Health workers put themselves at risk for Ebola while saving lives: Shortage of staff, supplies a concern.” The Nation’s Health October 44.8(2014) 1-16. Print.

Naicker, Saraladevi, Jacob Plange-rule, Roger C. Tutt, and John B. Eastwood. “Shortage of healthcare workers in developing countries—Africa.” Ethnicity & Disease 19.1(2009): S1-60-S1-64.

Nielsen, Carrie F et al. “Improving Burial Practices and Cemetery Management During an Ebola Virus Disease Epidemic — Sierra Leone, 2014”. Weekly 64.1(2015): 20-27. Print.

Smith, Tara C. Ebola. Philadelphia, PA: InfoBase Publishing, 2009. Print.

Soucat, Agnes, Richard Scheffler, and Tedros Ghebreyesus. The Labor Market for Health Workers in Africa: A New Look at the Crisis. Washington, DC: World Bank Publications.

Tambo, Ernest, Emmanuel Chidiebere Ugwu, and Jeane Yonkeu Ngogang. “Need of Surveillance Response Systems to Combat Ebola Outbreaks and Other Emerging Infectious Diseases in African Countries.” Infectious Diseases of Poverty 3 (2014): 29.

Vidal, Yinka. How to Prevent the Spread of Ebola: Effective Strategies to Reduce Hospital Acquired Infections. St Louis, MO: Lara Publications Inc, 2015. Print.

World Health Organization. Factors that contributed to undetected spread of the Ebola virus and impeded rapid containment. WHO, January 2015. Web. 27 November 2015.

World Health Organization. Marburg haemorrhagic fever. WHO, November 2012. Web. 27 November 2015.

 

Appendices

Appendix one

Interview (Mr X; Head of Infectious Diseases Department).

Interviewer: What is Ebola?

Mr. X: It is a hemorrhagic fever with disastrous consequences.

 

Interviewer: When did you hear of Ebola?

Mr. X: I first heard about it when in college. It was disturbing to know its fatality rate.

 

Interviewer: Who is at risks of contracting Ebola?

Mr. X: Every person is at risk. If you look at the recent case, normal people and health care staff contracted the condition.

 

Interviewer: Why do you think it starts in the same region?

Mr. X: The region faces many challenges, including poor infrastructure, lack of enough healthcare staff, poor healthcare facilities, poor surveillance systems, and weird cultural practices, which enhance the spread of the viral disease.

 

Interviewer: What do you think are the risk factors?

Mr. X: deforestation, taking bush meat, and the recent revelation that climate change has an effect

 

Interviewer: Do you think the government of this region can help eradicate the menace?

Mr. X: Yes, they can. The first thing they need to do is engage in intense awareness campaigns to teach people about the condition, the risk factors, and preventive measures. The governments can also recruit healthcare staffs and pay them well to ensure that they are prepared for any eventuality. In addition, the governments can collaborate with international organizations like the World Health Organization for the same purpose.

Interviewer: What do you think will stop the spread of Ebola in the region?

Mr. X: understanding of the risk factors, government involvement, and improvement of infrastructure, including roads and hospitals

 

Interviewer: Are we safe from Ebola?

Mr. X: Unfortunately, we are not. The recent outbreak spread to all continents, which is an indication that no person or country is safe from the viral condition.

 

Interviewer: Do you think there can be a cure for the condition?

Mr. X: definitely. The major challenge about Ebola is that it is a relatively new disease and it is evolving. However, the advancements in technology will help us get cure on time. Already, there is a vaccine on clinical trial.

 

Appendix two

Demographic Data

Gender            _______________________

Occupation      _______________________

Age                 _______________________

Questionnaire

Strongly Agree Agree Neutral Disagree Strongly Disagree
1.Ebola outbreaks in one region
2. Risk factors are preventable
3. Cultural practices influence the spread of Ebola.
4. Poor healthcare and road infrastructure increase the spread of Ebola.  

 

5. Healthcare professionals are at risk of contracting Ebola.
6. There is a shortage of healthcare workers in Central and West Africa.
7. It is possible to contain Ebola.
8. No person or state is safe from Ebola.

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