By Dyan Mazurana and the STOP Spillover Sierra Leone Country Team
Here we look at the wild meat trade in Sierra Leone to understand how people’s gender identities and gendered roles and responsibilities can put them at heightened risk of contracting Ebola and other viral hemorrhagic fevers.
Introduction
Paying attention to gender helps us better understand who is at heightened risk of zoonotic spillover, where, when and why, and what we can do to reduce their exposure risks. The U.S. Centers for Disease Control and Prevention found that contact with animal bodily fluids (e.g. feces, urine, blood, saliva, and intestinal components) can lead to zoonotic spillover because these fluids can contain a high viral load if an animal is infected. People who are part of the wild meat value chain come in contact with animal bodily fluids every day, and therefore are at a high risk of zoonotic spillover, amplification and spread.
During the West Africa Ebola outbreak in 2014-16, with 28,000 reported cases and over 11,000 deaths, the Ebola virus is suspected to have started from zoonotic spillover from fruit bats to a child in Guinea, and then spread through human-to-human contact. Hunting and trading wild meat was banned in Sierra Leone during the outbreak. By-laws and risk communication efforts caused consumers to be afraid of eating wild meat, decreasing demand for it. Once the Ebola epidemic ended, by-laws and education efforts also ended, and the wild meat markets were back in business.
The Sierra Leone team from the Strategies to Prevent Spillover (STOP Spillover) project, funded by the United States Agency for International Development (USAID), conducted a study on the wild meat value chain and risks of zoonotic spillover in Kenema District. Research focused on wild animals known or suspected as Ebola and other zoonotic virus reservoirs or incidental hosts that are part of the wild meat market, including fruit bats, duikers, pangolin and non-human primates. The STOP Spillover team conducted research in four chiefdoms around Gola Rainforest National Park in eastern Sierra Leone. Two forest-edge communities were selected in each chiefdom where active wild meat hunting, trade, and consumption happen. The main wild meat market in Kenema town was also included in the study. The STOP Spillover team used a gender-informed study design to interview 304 people, including hunters (all men), women married to hunters (who process and sell wild meat), wholesale and retail wild meat traders and processors (mostly women), wild meat consumers (both women and men), traditional Chiefs (all men), traditional healers (mostly men), and health workers (both men and women).
Who Is at Risk, When, and Why
Researchers identified three groups of people who have an increased risk due to their exposure to wild animals’ body fluids: 1) young men (18‒35) who hunt and transport wild meat; 2) women working in the wild meat market who butcher and process wild meat to sell; and 3) customers—both women and men—who come to purchase the meat for themselves and their families and friends to eat.
For generations, people in many rural and urban communities in Sierra Leone have eaten wild meat as their primary source of protein. People use all parts of the wild animals except for the feces. Men eat wild meat more frequently than women, including the animal head because men are considered the head of the family. Liver is mixed with rice and given to children because women believe it promotes growth. Although most wild meat consumed is hunted, dead animals are seen as a gift from God and most communities will eat them. Wild meat is used for medicinal purposes, particularly for treating or protecting ill children. Wild meat is also an important part of initiation processes into the Poro and Bondo secret societies. Some people use wild meat in rituals and sacrifices for their ancestors.
In the past, it was mostly adult men that hunted wild animals to feed their families and generate additional income to pay school fees and purchase household goods. Today, male youth are the primary hunters of wild animals, which they sell for profit. For both the adult men and male youth, the sale of meat is a major source of income for their households. The men who hunt animals and women who sell the wild meat use the money they earn to pay for school fees, medicine, clothing and other foodstuffs.
The wild meat value chain starts with young men who hunt wild animals. Once the animals are killed or captured, motorbike riders, again predominantly male youth, transport the animals or meat to local or larger urban markets for sale. Sometimes the animals or meat are sold to local middlemen traders. At the market, women buy the meat or animals from motorbike riders or traders, and kill the animals and process the meat. Women sell wild animals in pieces or cook the meat in soups and sauces for immediate resale. Women are the primary customers at both the local and larger urban market, for purchasing raw wild meat. These predominantly women customers further process and consume the meat at home, or cook the meat into soup or other foods and sell it for income. Adult men are the primary consumers of processed and cooked meat that is sold in the market, both grilled and in soups.
Hunters, traders, processors, and transporters all come into physical contact with wild meat urine, feces, and blood. Some hunters are bitten during hunting. Processors and hunters reported that when they accidentally cut themselves with knives when processing wild meat or if they get bit by animals, they use salt, lime, or herbs as remedies to stop the bleeding. A few reported going to a hospital for severe injuries. Processors said that blood splashes on them when butchering wild animals. Depending on the season, the frequency of contact with wild meat ranged from every day, to once or twice a week, to twice a month.
According to male hunters, clothes contaminated by spilled fluids from wild animals are worn for less than an hour or for up to seven hours, depending on the distance from the place of hunting to the place of sale or home. Women processors reported washing wild animal fluids and feces off and changing their clothes once they finish processing the meat. Some women processors reported washing their hands with soap and water after working with wild meat. Very few people reported using gloves when processing wild meat.
Most hunters believe that Ebola does not come from wild animals, so they do not think they need any protection when handling wild animals. Most respondents believed that there was no risk to handling wild meat, and therefore they do not use any protection while working with it.
The riskiest part of the wild meat value chain is wild meat processing by hunters’ wives or processors at the market, who are mainly women. Wild meat processing involves burning hair from the meat using fire, washing the meat in water, removing internal organs, and cutting the meat into smaller pieces for cooking or selling. Hunters’ wives and meat processors at the market perform these tasks with their bare hands using regular clothes. Butchering tables and tools are not disinfected after processing, placing traders and consumers at risk.
Reasons for the limited use of personal protective equipment (PPE)—face masks/shields, boots, aprons, and gloves—include low risk perception, traditional customs, beliefs and practices, and economic factors. There are no biosafety practices or food safety laws promoted or enforced in local markets that facilitate PPE use.
Gender-Informed Interventions to Reduce Spillover Risk
To reduce potential spillover risks for hunters’ wives, meat processors, and consumers, there is a need to use effective biosafety materials. Unlike hunters, female and male meat processors are aware of the need to use protective gear, and they perceive potential risks in their work. However, they worry about the affordability and availability of appropriate protective gear. Testing different gear to explore their cost and benefits in reducing exposure to wild meat contaminants could help wild meat processors make appropriate decisions about which gear to use.
Testing biosafety equipment should be coupled with targeted behavior change communication efforts focused on handwashing and hygiene during meat processing. A formative research study conducted by the STOP Spillover team showed the importance of involving local leaders, traditional societies and community health workers in efforts to promote risk reduction practices and behaviors.
Most consumers in markets touch wild meat with their bare hands and smell it before selecting the piece of meat they prefer. Customers rarely wash their hands after touching the meat. This practice places the consumer at risk of infection, that they may take to their homes and amplify. Interventions are needed that target zoonotic disease spillover risks from consumers who touch meat with their bare hands. Interventions could include: discouraging touching wild meat by consumers, promoting the use of forceps to pick up meat, and covering wild meat with transparent plastic or selling it from closed plastic containers. Meat pieces can be pre-cut and pre-wrapped so that consumers do not touch the meat.
Wild meat is mainly transported by young men using motorcycles, who often carry the meat together with other items, other livestock and domestic animals and people, putting the rider and passengers at risk of spillover and amplification of zoonotic diseases. Motorcycle riders need to use gloves to prevent touching dead meat with their bare hands while packaging the meat. Transporters have multiple contacts with dead meat. Transporters should use sealed containers during transport to prevent spillage of animal liquid onto riders and passengers. Riders should also consider not carrying both wild meat and people at the same time.
The study found very poor sanitary conditions in the main urban market. There is no running water, poor garbage disposal practices, poor hygiene practices, no hand-washing station, tables are not covered to facilitate cleaning, tables and utensils are not disinfected, and liquid waste is thrown indiscriminately into nearby streams. The poor sanitary state of the market coupled with poor hygiene practices by traders and poor waste disposal practices makes it a potential high-risk point for zoonotic spillover. To address these issues, market actors should cover tables to facilitate disinfection, and tables should be cleaned regularly using disinfectant. Handwashing stations for traders and consumers need to be made available at the market. Regular garbage collection to remove wild meat waste from the market is needed. Storage pits to safely dispose of liquid waste generated from the market would improve hygiene and biosafety.
To effect systemic change in local market practices, it is important to ensure effective multisectoral collaboration with various stakeholders including the water sector, the Local Council Administration (LGA), the wildlife unit of the Ministry of Agriculture, the Ministry of Health and Sanitation, and the trader’s union. A systemic, multisectoral approach is required to improve the governance and management of the wild meat market, improve waste management systems and hygiene practices, and promote compliance with policies designed to protect producers and consumers. Market-based structural interventions should be integrated with well designed social and behavior change (SBC) efforts and communication interventions to promote and facilitate the adoption of these measures, and incentivize sustained compliance.
Finally, all of these approaches need to be implemented using a gender lens, with a clear understanding of the roles and risks to young men who hunt and transport wild animals, to women who butcher, cook and sell wild animals in the market, and to wild meat consumers (more often men than women). Both the interventions themselves and the social behavior change approaches needed to accompany them must be crafted in ways that respond to the beliefs and cultural context in which each intervention will be implemented, including the gender norms and patterns that guide risk related behaviors.
