Admissions and surgery as indicators of hospital functions in Sierra Leone during the west-African Ebola outbreak

Abstract

BackgroundIn an attempt to assess the effects of the Ebola viral disease (EVD) on hospital functions in Sierra Leone, the aim of this study was to evaluate changes in provisions of surgery and non-Ebola admissions during the first year of the EVD outbreak.MethodsAll hospitals in Sierra Leone known to perform inpatient surgery were assessed for non-Ebola admissions, volume of surgery, caesarean deliveries and inguinal hernia repairs between January 2014 and May 2015, which was a total of 72 weeks. Accumulated weekly data were gathered from readily available hospital records at bi-weekly visits during the peak of the outbreak from September 2014 to May 2015. The Mann-Whitney U test was used to compare weekly median admissions during the first year of the EVD outbreak, with the 20 weeks before the outbreak, and weekly median volume of surgeries performed during the first year of the EVD outbreak with identical weeks of 2012. The manuscript is prepared according to the STROBE checklist for cross-sectional studies.ResultsOf the 42 hospitals identified, 40 had available data for 94% (2719/2880) of the weeks. There was a 51% decrease in weekly median non-Ebola admissions and 41% fewer weekly median surgeries performed compared with the 20 weeks before the outbreak (admission) and 2012 (volume of surgery). Governmental hospitals experienced a smaller reduction in non-Ebola admissions (45% versus 60%) and surgeries (31% versus 53%) compared to private non-profit hospitals. Governmental hospitals realized an increased volume of cesarean deliveries by 45% during the EVD outbreak, thereby absorbing the 43% reduction observed in the private non-profit hospitals.ConclusionsBoth non-Ebola admissions and surgeries were severely reduced during the EVD outbreak. In addition to responding to the EVD outbreak, governmental hospitals were able to maintain certain core health systems functions. Volume of surgery is a promising indicator of hospital functions that should be further explored.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3666-9) contains supplementary material, which is available to authorized users.

”For this one, let me take the risk”: why surgical staff continued to perform caesarean sections during the 2014–2016 Ebola epidemic in Sierra Leone

“…In comparison, it is remarkable that at least one of our study participants even lied to the family about performing surgery. These intrinsic motivations might explain the remarkable productivity demonstrated by surgical care providers in Sierra Leone during EVD 22…”

“…Ethical issues arise from allocating scarce resources on data collection during a crisis as well as retrospectively researching a disaster overcome. More transparent and continuous reporting by aid agencies have been suggested feasible solutions 22 60. Evaluations might run the risk of lending too little agency to the frontline workers involved in the EVD response.…”

“…Despite these challenges, a study found that public hospitals in Sierra Leone unexpectedly maintained or even increased CS volumes during the EVD outbreak 22. While most studies focus on the negative impact of healthcare provision following the EVD outbreak, there is a need to increase the knowledge about successful examples of resilience 23…”

Assessing the need for surgical treatments in Sierra Leone

“…Hernia repairs are the most commonly general surgical procedure performed in Sierra Leone (4). Non-emergent surgical procedures decreased dramatically during EVD outbreak (46). This may have contributed to an increased backlog of hernia repairs performed, thus contributing to an increased prevalence compared with before the outbreak.…”

“…At the time inflow and outflow are equal, it will maintain a constant maximal fluid level within the funnel. The accuracy and reliability of the device seems adequate for detecting LUTS or voiding dysfunction (46).…”