Effect of a safe and dignified burial intervention on Ebola virus transmission in the eastern Democratic Republic of the Congo, 2018–19: a propensity score analysis
Safe and dignified burial (SDB) is a pillar of the response to epidemics of Ebola virus disease and other diseases caused by pathogens transmissible through contact with corpses. A large epidemic of Ebola virus disease affected eastern Democratic Republic (DR) of Congo during 2018–20, throughout which the DR Congo Red Cross and local authorities, with support from the International Federation of Red Cross and Red Crescent Societies, provided SDB services. This propensity score analysis aimed to estimate the effect of SDB performance on the transmission of Ebola virus during this epidemic. The method is used here to retrospectively evaluate a real-life intervention that could not be allocated randomly.
SDB timeliness and successfulness were associated with respective reductions of 7% and 40% in incidence across adjacent time windows, and with decreases in the log reproduction number. A dose–response relationship with SDB successfulness was apparent for both transmission outcomes. Transmission decreased below the epidemic extinction thresholds when more than around 40% of SDBs were successful.
The SDB service was associated with a substantial and plausibly causal reduction in the transmission of Ebola virus during the 2018–19 epidemic in eastern DR Congo.
Building on SDB previous analyses, there is strong evidence that, in addition to improving communities’ experience and engagement with the wider response to Ebola virus disease, SDB can make a crucial contribution to controlling transmission, potentially ending epidemics if timeliness and coverage are high. This intervention should therefore be among the priority response actions for future and similar outbreaks involving Ebola virus and other pathogens that have a risk of infection from dead bodies.
This research is linked to the R2HC funded study: Evaluation of community-based Ebola control interventions in the DRC.