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an 18-month-old boy from the remote village of Meliandou in Guinea, who came into contact with wild animals in his backyard and died on December 28, 2013 [22]. Meliandou, where only 31 households existed at that time, is located in Guéckédou Prefecture, a forest region destroyed by foreign mining and timber operations [22]. The forest loss drove more than 80% of infected wild animals into human settlements [22]. The boy’s immediate family and those who treated them at a hospital in Guéckédou, including midwives, traditional healers, and staff, also fell sick and died during the second week of January 2014 [22]. The boy’s extended family members who attended funerals or took care of ill relatives developed a similar illness and died the following week [22]. A pattern of unprotected exposure and continued funerals spread the disease further, and it ended up affecting three countries in West Africa: Guinea, Liberia, and Sierra Leone. The aim of this research was to understand the history, importance, and social context of Africans’ traditional burial rituals to see why the initial Ebola-control interventions set up by various stakeholders in West Africa faced a backlash from the local population. With a focus on the aid workers’ efforts to ensure dignified and safe burials, this study emphasized the integration of theoretical culturally tailored interventions and models to prevent and control future Ebola outbreaks by understanding how Africans’ funerary rituals could coexist with humanitarian aid efforts. METHODS A narrative literature review was conducted. Among public health-related abstract and citation databases, four electronic databases—PubMed, Medline, Web of Science, and Scopus—were used to search for and review the relevant literature. A date range was open to all years, up to 2017 to include a historical aspect of Africans’ funerary rituals and 2014– 2016 Ebola outbreak in West Africa. Related articles from a variety of disciplines, such as public health, sociology, anthropology, politics, and history were considered. The language was not restricted to a particular language, but the majority of selected references were Journal of Health and Social Sciences 2020; 5,1:073-090 The Italian Journal for Interdisciplinary Health and Social Development 77 written in English. The search strategy for four electronic databases consisted of the combination of four major categories: the region (Africa), infectious disease (Ebolavirus), traditional behavior (funeral rites), and social and behavioral interventions (health services and communication). The search was initially conducted in PubMed, using the following Medical Subject Headings (MeSH) terms, such as ‘Africa’, ‘Ebolavirus’, ‘communicable diseases’, ‘funeral rites’, ‘burial’, ‘cemeteries’, ‘embalming’, ‘mortuary practice’, ‘social behavior’, ‘health services’, ‘delivery of health care’, and ‘communication’. Then, relevant MeSH terms and keywords searchable in article titles or abstracts were added to expand the scope of a search. After searching in PubMed, the same approach to keyword searching was applied in the other three databases, Medline, Web of Science, and Scopus. The full search strategy for the identification of articles in the databases is described in Supplement 1. Additionally, a manual search of Google Scholar and websites was conducted to review additional research articles, gray literature, reports, online news, and Youtube videos published by Discovery and National Geographic. This study concerned all African regions and countries to comprehensively understand traditional burial practices linked to Ebola and other infectious diseases. RESULTS Background of the afterlife: History, importance, and social context of Africans’ funerary rituals In Europe and North America, death is a private affair that is sanitized and medicalized as a result of the biomedical model of medicine [23, 24]. Africans, in contrast, consider death and life two essential components of their social world [24]. In Bushluckridge, South Africa, for example, where the HIV/ AIDS stigma is extremely high, AIDS patients and HIV-positive persons are described as being in the ‘waiting room for death’ or as ‘dead before dying’. However, bereaved families host ostentatious funerals for them that draw more than 500 attendees [25]. For Africans, death invokes fear, revulsion, and trouble [26]. For this reason, Africans want their deceased relatives to take their places alongside their ancestors through the proper performance of ritual customs with the individuals and social groups closest to the deceased [24]. They have elaborate and complex funerals with a high degree of expectation to maintain a connection with the world of the dead and their ancestors [24]. That is why Africans attend every ceremony they can, and relatives do not skimp on funeral, burial, and mourning practices. To ensure the dignity and decency of funerals, Africans make sure that a proper coffin is conveyed to the cemetery and that rituals are attended by properly dressed mourners who strongly believe in the existence of God [27]. Although having a dignified funeral with fellow Christians or Muslims has become essential for a respectable death in Africa, traditional healers still have a significant influence on villagers. Supernatural beliefs in indigenous, traditional medicine have long been central to sub-Saharan Africans’
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