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developed countries have been leaning toward cremation, a number of countries in the developing world still adhere to their traditional funerary rituals. In the mountains of Tibet, where wood is too scarce for cremation and the ground is too rocky and frozen for burial, it is common to practice ‘sky (celestial) burial’ [2, 5, 6]. A death professional, called a rogyapa, removes the flesh of the body, crushes the bones, and then mixes them with yak butter or milk to attract vultures to consume the entirety of the remains [2]. Tibetans believe that sky burial is a virtuous gift of returning the body to nature in an honorable, generous way by feeding the vultures [6]. In a remote region of Tana Toraja in Indonesia, people sleep with the body in the same bed and change the dead’s clothes every day. For ritualistic Torajan funerals, the corpse lies in a traditional Torajan mini-house carried atop the shoulders of 35 young men [2]. A pig and a sacrificial buffalo are brought by a different family, with the expectation that they will be repaid by the bereaved family for their funerals in the future [2, 7, 8]. For a three-day funeral, at least seven buffaloes are slaughtered, which is the same as the cost of three to four houses in Toraja [7]. Torajans do not consider the body truly dead until the sacrifice of the animals [2, 7]. Harris stated, “As Mary is to Christians the mother of God, the cow to Hindus is the mother of life” [9]. Likewise, witchcraft, sorcery, and other superstitions are deeply rooted in funerals in Africa. West Africans believe that supernatural forces can interrupt normative transitioning of the soul to the afterlife [10]. Mourners at the funeral believe that ancestral spirits can influence the living, so they talk directly to the deceased to ask for a smooth transition to the afterlife in the future [10]. Nichter [11] argued that ethnophysiology—the study of perceptions of health and medicine in a different culture—should be considered to treat disease in an ethno-tailored manner. It is understandable that every culture wants to respect the dead through over-expenditure or hopes to cement the connection between this world and the next. However, traditional burial practices can lead to the spread of infectious disease. In sub-Saharan Africa, traditional funerary rituals are deeply rooted and positioned in African cultures. In Madagascar, the Malagasy people perform a funerary tradition called ‘Famadihana’ rewrapping the bodies of their ancestors in fresh clothes and dancing with the dead around the tomb to upbeat music. Although it has not been scientifically proven, mass media has nonetheless reported that this sacred ritual could spread plague in Madagascar [12]. From August 1 to November 22 in 2017, 2,348 confirmed, probable, or suspected cases of pneumonic, bubonic, septicemic, or unspecified plague were reported, along with 202 deaths, in Madagascar [13]. One of the public health response measures advised by the World Health Organization (WHO) is to provide information regarding infection control practices for burial rituals [13]. In Uganda, three cases of Marburg were reported in 2017, and all of the afflicted died [14]. The virus was presumed to be spread by traditional burial ceremonies [14]. Journal of Health and Social Sciences 2020; 5,1:073-090 The Italian Journal for Interdisciplinary Health and Social Development 76 During the unprecedented Ebola outbreak in West Africa of 2014–2016, villagers’ resistance to the use of burial teams to protect their family members seriously exacerbated the spread of the disease. This Ebola outbreak claimed 11,310 lives in Guinea, Liberia, and Sierra Leone [15], more than all other previous Ebola outbreaks combined. The Ebola virus can be transmitted even after the infected person dies, when bodily fluids from the deceased permeate the broken skin or mucous membranes of those handling the bodies [16]. The virus can also survive for a few days on body surfaces as well as on sheets contaminated with bodily fluids [16]. Demiryürek et al. indicated that the infectious pathogens of Mycobacterium tuberculosis, hepatitis B and C, and HIV survive in cadavers even after embalming and suggested that specific safety guidelines are necessary for cadaver handlers to avoid accidental disease transmission [17]. The long period of pathogen viability extends far beyond the time when bereaved families claim a body for funeral services, which involve the opening of caskets that could be contaminated from contact with the body [18]. Human remains can become serious public health threats if they are infected with highly lethal contagious pathogens that are resistant to environmental alterations or have very high concentrations [19]. During the 2014–2016 Ebola outbreak in West Africa, the greatest risk was from lethal pathogens on the bodies, and improper burial practices may have contributed to the ongoing transmission of the Ebola virus [19]. According to the WHO, 60% of all Ebola cases in Guinea were linked to traditional burial practices [20]. In addition, organizations involved in the Ebola response in Sierra Leone claimed that 70% of newly infected cases stemmed from funerary rituals that involved touching the bodies of those who had died from Ebola [21]. The WHO staff and Guinean health officials conducted retrospective studies to find the origin of the 2014–2016 Ebola epidemic; the index case was
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