title: Mathematical assessment of the effect of traditional beliefs and customs on the transmission dynamics of the 2014 Ebola outbreaks.
abstract: BACKGROUND
  Ebola is one of the most virulent human viral diseases, with a case fatality ratio between 25% to 90%. The 2014 West African outbreaks are the largest and worst in history. There is no specific treatment or effective/safe vaccine against the disease. Hence, control efforts are restricted to basic public health preventive (non-pharmaceutical) measures. Such efforts are undermined by traditional/cultural belief systems and customs, characterized by general mistrust and skepticism against government efforts to combat the disease. This study assesses the roles of traditional customs and public healthcare systems on the disease spread.
  
  
  METHODS
  A mathematical model is designed and used to assess population-level impact of basic non-pharmaceutical control measures on the 2014 Ebola outbreaks. The model incorporates the effects of traditional belief systems and customs, along with disease transmission within health-care settings and by Ebola-deceased individuals. A sensitivity analysis is performed to determine model parameters that most affect disease transmission. The model is parameterized using data from Guinea, one of the three Ebola-stricken countries. Numerical simulations are performed and the parameters that drive disease transmission, with or without basic public health control measures, determined. Three effectiveness levels of such basic measures are considered.
  
  
  RESULTS
  The distribution of the basic reproduction number ([Formula: see text]) for Guinea (in the absence of basic control measures) is such that [Formula: see text], for the case when the belief systems do not result in more unreported Ebola cases. When such systems inhibit control efforts, the distribution increases to [Formula: see text]. The total Ebola cases are contributed by Ebola-deceased individuals (22%), symptomatic individuals in the early (33%) and latter (45%) infection stages. A significant reduction of new Ebola cases can be achieved by increasing health-care workers' daily shifts from 8 to 24 hours, limiting hospital visitation to 1 hour and educating the populace to abandon detrimental traditional/cultural belief systems.
  
  
  CONCLUSIONS
  The 2014 outbreaks are controllable using a moderately-effective basic public health intervention strategy alone. A much higher (>50%) disease burden would have been recorded in the absence of such intervention. 2000 Mathematics Subject Classifications 92B05, 93A30, 93C15.
authors.affiliation: Department of Mathematics and Statistics, Austin Peay State University, Clarksville, 37044, TN, USA. fbagusto@gmail.com.
authors.forename: Folashade B
authors.initials: FB
authors.lastname: Agusto
authors.affiliation: Department of Mathematics, Lehigh University, Bethlehem, 18015, PA, USA. ewungkems@gmail.com.
authors.forename: Miranda I
authors.initials: MI
authors.lastname: Teboh-Ewungkem
authors.affiliation: Simon A. Levin Mathematical, Computational and Modeling Sciences Center, Arizona State University, Tempe, 85287-1904, AZ, USA. agumel@asu.edu.|School of Mathematical and Natural Sciences, Arizona State University, Phoenix, 85069-7100, AZ, USA. agumel@asu.edu.
authors.forename: Abba B
authors.initials: AB
authors.lastname: Gumel
mesh_terms: D003469:Culture; D004196:Disease Outbreaks; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D008962:Models, Theoretical; D011634:Public Health / Q000379:methods*