Stopping Marburg requires bucking Angolan customs

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April 19, 2005 (CIDRAP News) – Healthcare workers battling the worst outbreak of the lethal Marburg virus are facing cultural barriers that have hampered prevention efforts in Uige Province in northern Angola.

The death toll had reached 235 people, with 500 people under surveillance following possible exposure to the virus, according to Angola's Health Ministry and the World Health Organization (WHO), as reported by Agence France-Presse (AFP) on Apr 17.

There is no cure for Marburg, a fast-developing hemorrhagic fever that has killed about 90% of its victims in this outbreak. That's why health authorities are emphasizing preventive efforts, some of which run counter to Angolan traditions.

Aid workers are making progress in persuading Angolans to greet one another with bows and curtsies instead of handshakes and hugs, Reuters reported today. However, authorities remain concerned that people are avoiding the provincial hospital's isolation ward, which is seen as the key to stopping transmission.

In one example reported by the New York Times today, a pregnant woman who was close to term was taken to the isolation unit Apr 16. She escaped by car within an hour. She had tested positive for the virus.

"I hope she dies before she has the baby," Enzo Pisani, a doctor with an Italian aid group, told the newspaper. "She could infect 20 people" in the course of delivery.

Officials can't force people to stay in the isolation ward, WHO spokesman Dave Daigle told Reuters. If patients opt to stay at home, "We have to tell relatives how to care for them in the safest way possible."

Keeping people from touching infected bodies is another key to preventing Marburg's spread, yet it's a challenge in a country where funeral traditions call for washing the body and kissing it goodbye, news services reported.

Healthcare workers have sought to enlist traditional healers and leaders to tell Angolans about the infectious hazards posed by such funeral practices, Reuters reported.

On Apr 17, three WHO doctors in Uige disinfected the body of a 1-year-old girl who had died of Marburg, and also cleaned her family's home, the Times reported. Pierre Formenty, one of the doctors who prepared the girl for the funeral, described the process as building trust.

"We can stop an outbreak like this in two or three weeks if the people trust us and cooperate with us," Formenty told the Times. "We are fighting the battle of the disease, but first we have to win the battle of the heart, and the battle of the funeral."

Angolan officials have said the outbreak is coming under control, but international aid workers have not confirmed that conclusion, Reuters reported.

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