Ebola virus disease research paper

Ebolavirus disease research paper

Ebolavirus is currently considered to be one of the most belligerentcontagious agents in the world. Ebola virus can cause highly fatalhemorrhagic fever syndrome in both human and non-human victims andthus leading to death within a very short time. The name &quotEbola&quotwas adopted from the Ebola River in the Democratic Republic of Congo.Death occurs after 1 to 2 weeks from infection and is characterizedby severe bleeding from all body orifices and multiple organfailures. Together with an average mortality rate of 53%, it is oneof the most feared infectious diseases as there is no licensedvaccine or cure (CDC2016,a).Ebola virus is transmitted by Bats and once a person has beeninfected, he or she can pass it to others through secretions, organs,and blood. After an infection, an individual exhibit signs likediarrhea, vomiting, fever, headache, and hair loss, and can progressto hemorrhaging. Although there is no cure for the disease, there arevarious preventive measures that can be adopted to ensure safetyagainst the virus. This research paper will describe the causativeagent, route of entry and signs and symptoms of Ebola virus.Additionally, it will discuss its mode of transmission, resulting incomplications and the community Health Concerns attributed to thedisease. Lastly, the discussion will incorporate some of theprevention options, evidence of racial disparities in Ebola cases andthe long-term consequences of the disease.

Historyof Ebola

Ebolawas first discovered in the year 1976 in Yambuku, Zaire, and Nzara inSudan. During this outbreak, it had infected 318 people and 284people the DRC and Sudan respectively (CDC2016,b). In Zaire, the Ebola strain had a record mortality rate of 53%while the Sudan version had a death rate of 83%. Despite theextensive research conducted by teams of scientists all over theworld, the investigation failed to identify the disease reservoir.The subsequent appearances of the virus were in Virginia, Mindanaoand Reston where a species of Old World monkeys imported from thePhilippines tested positive for the virus. However, the animal’shandlers in contact with the monkeys never developed the disease.Another case of the virus was in 1994, CoteD’Ivoire (West Africa)where a female ethnologist was infected by the disease whenconducting a necropsy on a chimpanzee. Almost every year after 2000,there have been cases reported in African nations mostly those inWest and Central Africa. The 2014 Ebola outbreak had over 28,000infected cases and over 11,000 of those patients died. The countriesthat have had numerous cases of Ebola include the Democratic Republicof Congo (formerly known as Zaire), Congo, Sudan, Gabon, Uganda andSouth Africa (Hageman et al. 2016).

Ebolain animals

Ebolais mainly transmitted by Fruits bats of the family Pteropodidae. Theyare thought to be the natural host of the Ebola virus. Once a singleperson has acquired the virus, it is transmitted to others throughcontact with secretions, organs, and blood of animals or peopleinfected with Ebola. Another source of infections are animals such asmonkey, gorillas, forest antelopes, porcupines or chimpanzees(Nanclareset al. 2016).

CausativeAgent

TheEbola virus is a member of the Filoviridae family. Five known Ebolavirus species are of medical significance. They are ZaireEbola virus(ZEBOV), BundibugyoEbola virus(BEBOV, TaïForest Ebola virus(TEBOV), and SudanEbola virus(SEBOV)) and lastly Restonvirus(REBOV) that only develops disease to non-human primates (NHPs)(Broadhurst, Brooks &amp Pollock, 2016).

Ebolavirus natural reservoirs are still unknown. It is also important tonote that all the virus species except the REBOV are found only inAfrica, and this could be the reason why the majority of the casesoccur in the continent. The Restonvirus specieswas first discovered in Virginia at Reston Town in 1990 and was namedafter the town. In the United States, research indicating how thedisease reached Virginia showed that it could have been introduced bymacaques, which are species of Old World monkeys imported from thePhilippines. Later in 2008, pigs from a farm near Manilla,Philippines also tested positive for REBOV (WHO2014).

Pathogenicity

Regardingpathogenicity of Ebola viruses, there is a difference between the onecaused by REBOV and those from other viruses. For instance, the SEBOVand ZEBOV strains have a higher virulence and their fatality ratesare high (CDC, 2016, b). However, the REBOV has low pathogenicity oris nonpathogenic to humans. This conclusion is based on the fact theanimal handlers who attended to the monkeys in Reston or the pigs inManilla developed the antibodies to the REBOV but remained in theasymptomatic stage.

Routeof Entry

Researchsuggest that Ebola virus enters the body through insect bites,scratches or any opening in the skin that usually act as a barrieragainst infection. The virus has also been known to enter throughmucous membranes in the eyes, nose, and mouth. There have been casesof Ebola virus being detected in semen of infected patients. However,there has been no conclusive evidence to suggest that the virus caninvade the body through sexual intercourse. The CDC recommends,however, that safe sex as a way of managing the disease (CDC 2016,a).

Symptoms:prodromal, second, fetal, effects

Thevirus is usually not contagious after infection until the patient issymptomatic. The incubation period of the virus ranges from 2 to 21days depending on the patient`s immune system (Broadhurst, Brooks &ampPollock, 2016). The prodromal period is usually brief, and at thisstage, early detection can help in its management. Initial symptomsof Ebola include sudden joint pains, headache, fatigue, and sorethroat as is seen in any tropical fever like malaria, dengue orinfluenza. Other rare symptoms are chest pains, sore throats, andhiccups. Some people have also complained about swallowing andbreathing problems that also occur in the prodromal phase. Vomiting,diarrhea, appetite loss and severe weight loss are also commongastrointestinal problems that come with Ebola. Patients may alsodevelop a maculopapular rash between 5-7 days. Around 40- 50% of thepatients bleed from puncture sites and mucous membranes like thenose, vagina, gums and the gastrointestinal tract (Team, 2014).Symptomsof impaired kidney and liver function are also common.

Thebleeding phase of the Ebola virus begins around the 5th-7thday after initial symptoms. At this stage, the patients may displaysubcutaneous bleeding, reddening of the eyes and bloody vomit. Hemorrhagic fever is an indication that Ebola patient`s prognosis isgetting worse and blood loss can cause death. Ebola patients oftendie from severe bleeding complications and multiple organ failures.In most Ebola cases, patients show signs of coagulation defectsincluding impaired clotting (Team, 2014). In the later stages of theEbola virus, patients develop thrombocytopenia which interferes withprothrombin time and activated partial thromboplastin time.Therefore, the patient’s blood will not clot and bleed from anypuncture site, or mucosal sites will require medical interventionuntil the patient recovers or dies.

Hematologicalchanges in the patients are lymphopenia and leukopenia. Patients arealso diagnosed with an increase in liver enzymes and decrease in theneutrophil count. If the patient does not recover, death can occur asa result of multiple organ dysfunction syndromes, and this can happenwithin 7 to 16 days after first symptoms. The Ebola virus isextremely dangerous, and it is difficult for the patients to recoverfrom the virus because it deteriorates the patient`s immune system,resulting in a weak defense system to fight off the infection. In onestudy on Ebola, abnormal bleedings occurred in almost 20% of thepatients and later stages of the disease. In recent years, Ebola hasbeen associated with high death rates due to its hemorrhagic fevercomplications. SEBOV and ZEBOV have been the cause of hemorrhagicfever outbreaks in the Zaire and Sudan region over the past 30 years(Towner et al. 2008).

Pregnantwomen that are infected with The Ebola virus may present with severegenital bleeding. Pregnant women may develop symptoms such as fever,asthenia, conjunctivitis, shock, anorexia and much more. Researchhas indicated that spontaneous abortion is widespread in pregnantwomen infected with the Ebola virus (Bausch &amp Schwarz, 2014).However, clinical diagnosis of the hemorrhagic fever in pregnantpatients might be difficult due to the presence of similar bleedingcomplications like placenta previa that are common in pregnant women.

Modeof Transmission

Ebolaspreads from one person to another through close and direct contactwith an infected individual’s blood or bodily fluids such as breastmilk, saliva, sweat, urine, vomit, feces, and semen. The virus canalso be transmitted indirectly through items that have been taintedby the virus such as needles or syringes (Bausch &amp Schwarz,2014). Bedding and clothing are also fomites for the transmission ofthe Ebola virus. The virus can survive for several hours oninanimate objects and can survive in body fluids for several days atroom temperature. Recent research has also suggested that sexualtransmission may be possible as samples of semen from infected maleshave tested positive for the virus (Maganga, Kapetshi, Berthet,Ilunga, Kabange, Kingebeni &amp Cabore, 2014).

Complications

Immunesystems vary among individuals. There are those who recover fromEbola virus without complications, but with some patients, outcomesare at times fatal. The Ebola virus presents with symptoms ofdiarrhea, vomiting, fever, headache and hair loss, and can progressto hemorrhaging, meningoencephalitis, seizures, coma and even death. Other complications of the Ebola virus include fatigue, jaundice,hair loss, confusion, joint problems, sensory changes and liver andeye inflammation. Its complications can last from weeks to months. Deadly complications include multiple organ (lungs, kidney, andliver) failure, sepsis, coma, shock and severe hemorrhaging (Quartey,2014).

Manysurvivors of Ebola pandemics in Africa have reported long-termillnesses that affect the neurological and musculoskeletal systems.Survivors have also reported recurrent hepatitis, myelitis, prolongedhair loss, psychosis, and uveitis. Eyes of Ebola patient tend to moveabnormally, and they also complain of inflammation of the organ.Reported neurological conditions are hearing loss, memory loss,headaches, weakness, fatigue, and depression. Musculoskeletalproblems include muscle pain, irregular reflexes, and tremors.

Researchfindings suggest some patients have also shown brain hemorrhage thusmental problems. Some of these reported conditions have made itimpossible for survivors to return to their previous places of workdue to the severity of the neurological effects. Survivors statedthat they had no prior neurological conditions however afterinfection, they found themselves incapable of the previousneurological stability ((Hageman et al. 2016)).

CommunityHealth Concerns

Educationand the engagement of community members can play a vital role inhelping to reduce the spread of Ebola. In the 2014 Ebola outbreak,affected countries in West Africa highlighted the need to better thesurveillance and health systems. They stated that such measuresshould not only be to protect the health of its citizens but also topromote global health security and cooperation. The recent outbreakof the virus called for the proper measure to be taken against thedisease due to its high mortality rates and the possible risk of aglobal outbreak of the disease. There is a need for mobilization andstrong effort towards combating future epidemics through education,surveillance, combined effort and safety (Perry et. al 2014).Therefore, it is crucial to have community health workers to assistin the disease management.

InWest Africa regions the populations in those areas wereundereducated, misinformed and did not trust the health system todeal with the outbreak. Additionally, there were inadequate reportingsystems of infected or of those who had died with the infection. Thatfacilitated the transmission from one person to another. Anotherfactor that could have facilitated the rapid transmission of thedisease in West Africa could have been their cultural practices suchas burial rituals (Hageman et al. 2016).

Inmanaging the West Africa cases, Education of the community shouldhave been the priority. Becauseof the influence of cultural beliefs, community workers also had togain the trust of community members to elicit their cooperation infollowing the safety precautions concerning caring for family membersor friends affected by the Ebola virus (Perryet. al 2014).

Inareas of West Africa where the community members were engaged andeducated, there was a notable faster containment of the virus anddevelopment of deep trust between the community and the health teamsworking on containment (Perryet. al 2014).The community workers in this zones mobilized the inhabitants, andthey assisted in the stop of the spread of the disease. Therefore,there was an immediate need for community health workers in WestAfrica to educate the members of the community on the dangers ofcoming into dealing with secretions, blood, urine, focus, organs orany other bodily fluids from infected persons (Perryet. al 2014).The community should also be made aware that inmate objects likeequipment, bedding or surfaces like floors or walls that have comeinto contact with any of the previously mentioned bodily secretionsare infectious. The community should be educated on how to handlesuspected cases of sick patients and how infectious waste should bedisposed of safely. Community trust in health workers is alsoparamount to ensure that they can be able to persuade the members toavoid cultural beliefs and practices that might lead to the spread ofthe disease. The community health workers should encourage thecommunity member to examine health safety when caring or buryingfamily members.

Communityhealth workers also play a vital role in the grounds surveillance andmobilization efforts that will help stop the spread of the pandemic.Rigorous monitoring effort that involves a thorough assessment ofcommunity members, investigation, prevention, screening and timelyreporting of possible infected community members to relevant healthauthorities will help quickly contain the virus. The effect ofcommunity workers’ active involvement was visible in Nigeria thatquickly contained the disease from spreading faster than other WestAfrican countries in the 2014 Ebola virus outbreak (Perryet. al 2014).Therefore, the relevance of community workers’ surveillance andintervention was proven to be vital in the containment of a possiblycountry-wide outbreak. Communityhealth worker and members need to develop trust and work together tostop the spread of Ebola or any other highly infectious diseases infuture outbreaks. It is only through education of the masses andtheir efforts that will bridge the gap in formal healthcare systemsand bring a stop to the spread of the virus.

Treatment

Varioustreatments and vaccines are undergoing trials. However, they have notbeen approved by the FDA (Perryet. al 2014).Thereare experimental on vaccines and treatment, but they have not beenfully tested for safety or efficacy (Towner, Sealy, Khristova,Albariño, Conlan &amp Reeder et al. 2008). Thus, recuperationfrom Ebola depends on good ancillary care and the patient’s immunereplication. As a result, the symptoms and the complications of Ebolavirus are treated as they appear. Thus, the overall theme for Ebolatreatment is restorative and preventative care and damage control.The Restorative care includes fluidresuscitation to rehydrate body fluid lost as a result of diarrheaand the replacement of vital electrolytes, blood transfusions, oxygenprovision and treatment of infections(CDC 2016).

Preventivecare involves the measures taken to contain the spread of the virus.These measures include proper hand washing, surveillance, and the useof personal protective equipment by persons dealing with possiblyinfected patients or equipment, and ease and fast access tohealthcare services. The most efficient way of managing the virus isby putting in place faster responses to the disease. For this tooccur, surveillance is vital in the fight against this virus and willensure that the infected persons start treatment due to earlydiscovery (Towner,Sealy, Khristova, Albariño, Conlan &amp Reeder et al. 2008).According to Perry (2016), the Ebola outbreak indicated the need forthe low-income countries to build better healthcare systems andsurveillance programs that will prevent future outbreaks fromspreading.

Preventionstrategies

Ebolahas been known to spread in healthcare settings and it is importantto use universal precautions for infectious diseases as well asproper hand sanitization practice during care for patients to avoidcontacting the disease. Treating the Ebola disease requires firstisolation of the patient to avoid spreading the disease to otheruninfected patients followed by handling the patient with personalprotective equipment (PPE).

Personalprotect equipment

Properdecontamination and disposal of the used personal protectiveequipment are vital in preventing the spread of the virus (Hageman etal. 2016). Cleaners of the isolation wards where Ebola patients arekept must also use special precaution and always wear PPEs to avoidcontracting the illness. Use of bleach that kills most virusesincluding the Ebola virus is recommended when cleaning. Ebola cannotbe transmitted via food, water or air. However, sneezing and coughingof patients can release heavily laden virus droplets that can serveas a mode of transmission.

Training

Thepatients who survive the infection and start recovering are stillhighly contagious even within 21 to 42 days after the symptomsdisappear. Special care should also be practiced when disposing ofpatients` bodies after they succumb to Ebola. The virus remainsactive in bodily fluids and secretion for several days. Therefore,improper handling of the body might result in contracting thedisease. People have contracted the disease after touching the bodyof the diseased during burials of individuals who died of Ebola(Hageman et al., 2016).

Ina certain study, it was also noted that even after some men weretreated and recovered from the virus, traces of infections were stillfound in their semen. It is also likely that Ebola can remain in thesemen for 70 to 90 days (Metanat,2015).Standard protocols are required to be put in place by the healthcaresystems dictating how health personnel should deal with infectedpeople and avoid contracting the disease. It is highly recommendedthat every medical personnel wear a proper gown, special goggles,masks, and gloves before handling any patients in an outbreak zone.This PPE will ensure that there is no part of the worker`s skin isexposed to the patient. Member of the community should also betrained on observing possible symptoms of the disease andappropriately handle infected members before they are moved tohealthcare centers.

Isolation

Despitethe proper use of PPE, training of personnel and proper disposal ofinfected waste, the most effect way of stopping and outbreak beforeit reaches epidemics status is by isolation of infected patients.Isolation will prevent the spread of the disease from one person toanother through direct contact or indirectly through innate objects.Well described standard procedures should be created and the healthpersonnel trained on implementation (WorldOrganisation for Animal Health (WHO), 2016).The procedure should what a community member should do once they finda person is infected. For example, transportation of the patient tothe nearest facility and how the patient should be treated once theyreach the healthcare facility.

Quarantinemay also be necessary to avoid getting any members of the communityfrom coming into contact with possible infected patients. Quarantineis also essential for controlling the movement of people betweenoutbreak zones. Travelers from regions of an outbreak should beisolated for some time (usually the disease`s incubation period) toensure that they are not sick despite looking uninfected (Metanat,2015).

Research

Seriousattention and capital should be invested towards studying the diseaseand discovering a cure or a vaccine (WorldOrganisation for Animal Health (WHO), 2016).The natural reservoirs should also be discovered as until thathappens, cases of Ebola will continue to occur all over Africa. Incase the natural reservoirs are the bats, then precaution should beundertaken when handling them or visiting their natural habitats likecaves. A strategy to treat the bats should also be created to ensurethat the virus is eradicated. Since the virus is currently said to betransmitted to man through handling potentially infectious animals,research should be undertaken on the rain forest animals to discoverhow the virus affects them. Hunters and Butchers who handle wildanimals’ carcasses should be trained on how recognized potentiallyinfected animals to avoid contracting the disease. Africa’s medicalsystems are also required to be developed to handle possibleoutbreaks with standard protocols on handling Ebola taught to allmedical personnel.

Culture

Inmany ways, African traditional cultures have assisted the spread ofthe disease. For further outbreaks to be avoided, cultures andpractices that promote the spread of the virus must be changed orstopped (WorldOrganisation for Animal Health (WHO), 2016).This is not going to be an easy task as some cultural traditions havedeep roots into the beliefs of the people. However, with theeducation of the public on the risks of their traditions aiding thespread of the virus, change will be possible. The education will beundertaken by specially trained community health workers and grassroot leaders whom the people trust. Burial traditions that mightrequire the body to be placed in the house of the deceased should bediscouraged. Traditions that may also require the physical touchingof the deceased body or personal effects must be avoided as this willjust spread disease. Simple actions like handshakes, hugging orkissing during times of a possible outbreak should be discouragedwith people informed of the risks of contracting the disease. It isonly with reduction of person to person contact that the outbreakswill be contained before reaching epidemic status (Hageman et al.2016).

LongTerm Consequences

Economiceffects

Thepast Ebola outbreaks in Africa have had adverse effects on thefinancial status of the regions. For example, Guinea in West Africahad a 4.5% decline in the agricultural sectors during the 2014outbreak because farmers had lost their lives and the survivors wereless productive (World Bank 2016). People are forced to leaveoutbreak areas where their homes and businesses are to avoid gettinginfected. This act has a devastating effect on the economy as peopleare no longer able to work and generate income. Ebola virus survivorsare also not productive with some having joint pains, chronicdiseases and neurological complications after the infection (Perry,Dhillon, Liu, Chitnis, Panjabi &amp Palazuelos, et al. 2016). Mostare not able to return to their previous careers.

Psychologicaleffect

Psychologicaleffects are always present in areas ravaged by an outbreak. Thesurvivors of the virus who were infected suffer isolation from therest of the community because of fear of infection. Those close tothe survivors such as family or relatives are also treated in thesame way. This stigmatization leads to long-term psychologicalconsequences such as depression and sadness among the survivors andtheir families. Also, the families mostly children of deceasedpatients are faced with many challenges. For example, the 2014 Ebolaoutbreak left about 16,600 children orphaned. The fate of Ebolaorphans is often unknown and some may never have access to qualityeducation and will live in poverty (Hageman et al. 2016).

Racialdisparity

Althoughthe majority of the case have been reported in Africans countries, noresearch has affirmed that the disease is more prevalent amongcertain races. The virus is widespread in Africa due to the largeforested areas with various non-human primates and the suspectedreservoirs of the virus: bats. The fact that the disease can affectany person irrespective their race with several American whitedoctors infected during their time in West Africa does not change themisconception in some that Africans carry the disease (Quartey,2014). This misconception might create racial disparity.

Conclusion

Ebolais a highly infectious virus with high recorded mortality ratesattributed to three of the four viral strains. The name &quotEbola&quotwas adopted from the Ebola River in the Democratic Republic of Congoand first cases recorded in two villages Nzara in Sudan and Yambuku,in the Democratic Republic of Congo. Since then, the disease hasclaimed thousands of lives in Africa and across the world. Ebola ismainly transmitted by Fruits bats of the family Pteropodidae. Once asingle person has acquired the virus, it is transmitted to othersthrough secretions, organs, and blood of animals or people infectedwith Ebola. The disease currently has no cure or vaccine and patientsare treated for the systems as they display them. Patients whosurvive the illness are followed by long-term complications such asrecurrent hepatitis, neurological disordered and eye complications.Preventive care, training, and community education are the key topreventing further outbreaks. Reporting of any possible infectedindividuals and rapid quarantine of the zone are effective strategiesthat will contain the virus thus managing it before it reaches anepidemic status.

References

CDC.(2016, a).&nbspAboutEbola Hemorrhagic Fever| Ebola Hemorrhagic Fever | Cdc.gov.Retrieved from http://www.cdc.gov/vhf/ebola/about.html

WorldOrganisation for Animal Health (WHO). 2016Ebolavirus disease.Retrieved from http://www.who.int/mediacentre/factsheets/fs103/en/

Hageman,J., Hazim, C., Wilson, K., Malpiedi, P., Gupta, N., &amp Bennett, S.et al. (2016). Infection Prevention and Control for Ebola in HealthCare Settings — West Africa and the United States.MMWRSupplements,&nbsp65(3),50-56. http://dx.doi.org/10.15585/mmwr.su6503a8

UNICEF.(2016).&nbsp Theimpact of Ebola.Retrieved fromhttp://www.unicef.org/emergencies/ebola/75941_76129.html

Metanat,P. (2015). Prevention of Ebola.&nbspInternationalJournal of Infection,&nbsp2(3).http://dx.doi.org/10.17795/iji27220

Fever|CDC.(2016).Ebola Virus Disease| Ebola Hemorrhagic&nbspRetrieved2016, fromhttp://www.cdc.gov/vhf/ebola/outbreaks/history/chronology.html

Perry,H., Dhillon, R., Liu, A., Chitnis, K., Panjabi, R., &amp Palazuelos,D. et al. (2016). Community health worker programs after the2013–2016 Ebola outbreak.&nbspBulletinof the World Health Organization,&nbsp94(7),551-553. http://dx.doi.org/10.2471/blt.15.164020

Quartey,K. (2014).&nbspEbola`sRacial Disparity – FPIF.&nbspForeignPolicy in Focus.Retrieved 8 November 2016, fromhttp://fpif.org/ebolas-racial-disparity/

Towner,J., Sealy, T., Khristova, M., Albariño, C., Conlan, S., &ampReeder, S. et al. (2008). Newly Discovered Ebola Virus Associatedwith Hemorrhagic Fever Outbreak in Uganda.&nbspPlosPathog,4(11),e1000212. http://dx.doi.org/10.1371/journal.ppat.1000212

CDC.(2016, b).&nbspCdc.gov.Transmission| Ebola Hemorrhagic FeverRetrieved from https://www.cdc.gov/vhf/ebola/transmission/

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Maganga,G. D., Kapetshi, J., Berthet, N., Kebela Ilunga, B., Kabange, F.,Mbala Kingebeni, P., &amp Cabore, J. (2014). Ebola virus disease inthe Democratic Republic of Congo.&nbspNewEngland Journal of Medicine,&nbsp371(22),2083-2091.

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Appendix

Atable with the chronological order of Ebola outbreaks in Africa fromthe first reported case of 1976 to 2012 (&quotOutbreaks Chronology:Ebola Virus Disease| Ebola Hemorrhagic Fever | CDC,&quot 2016).

Year

Country

Ebolavirus species

Cases

Deaths

Case fatality

2012

The Democratic Republic of Congo

Bundibugyo

57

29

51%

2012

Uganda

Sudan

7

4

57%

2012

Uganda

Sudan

24

17

71%

2011

Uganda

Sudan

1

1

100%

2008

The Democratic Republic of Congo

Zaire

32

14

44%

2007

Uganda

Bundibugyo

149

37

25%

2007

The Democratic Republic of Congo

Zaire

264

187

71%

2005

Congo

Zaire

12

10

83%

2004

Sudan

Sudan

17

7

41%

2003 (Nov-Dec)

Congo

Zaire

35

29

83%

2003 (Jan-Apr)

Congo

Zaire

143

128

90%

2001-2002

Congo

Zaire

59

44

75%

2001-2002

Gabon

Zaire

65

53

82%

2000

Uganda

Sudan

425

224

53%

1996

South Africa (ex-Gabon)

Zaire

1

1

100%

1996 (Jul-Dec)

Gabon

Zaire

60

45

75%

1996 (Jan-Apr)

Gabon

Zaire

31

21

68%

1995

The Democratic Republic of Congo

Zaire

315

254

81%

1994

Cote d`Ivoire

Taï Forest

1

0

0%

1994

Gabon

Zaire

52

31

60%

1979

Sudan

Sudan

34

22

65%

1977

The Democratic Republic of Congo

Zaire

1

1

100%

1976

Sudan

Sudan

284

151

53%

1976

The Democratic Republic of Congo

Zaire

318

280

88%