Ebola and Indirect Effects on Health Service Function in Sierra Leone

Abstract

Background: The indirect effects of the Ebola epidemic on health service function may be significant but is not known. The aim of this study was to quantify to what extent admission rates and surgery has changed at health facilities providing such care in Sierra Leone during the time of the Ebola epidemic. Methods: Weekly data on facility inpatient admissions and surgery from admission and surgical theatre register books were retrospectively retrieved during September and October. 21 Community Health Officers enrolled in a surgical task-shifting program personally visited the facilities. The study period was January 6 (week 2) to October 12, (week 41) 2014. Results: Data was retrieved from 40 out of 55 facilities. A total of 62,257 admissions and 12,124 major surgeries were registered for the study period. Total admissions in the week of the first Ebola case were 2,006, median 40 (IQR 20-76) compared to 883, median 12 (IQR 4-30) on the last week of the study. This equals a 70% drop in median number of admissions (p=0.005) between May and October. Total number of major surgeries fell from 342, median 6 (IQR 2-14) to 231, median 3 (IQR 0-6) in the same period, equal 50% reduction in median number of major surgeries (p=0.014). Conclusions: Inpatient health services have been severely affected by the Ebola outbreak. The dramatic documented decline in facility inpatient admissions and major surgery is likely to be an underestimation. Reestablishing such care is urgent and must be a priority.

Increase in acute malnutrition in children following the 2014–2015 Ebola outbreak in rural Sierra Leone

“…Declines in facility-based screening for malnutrition during the outbreak were consistent with patterns observed in services for maternal health, malaria and hospital admissions across the three most affected countries. 3,6,7,14 Such declines were partly due to community perceptions of and fears about contracting EVD at health facilities. 8 As the number of new EVD cases in Tonkolili fell from 12 to 5 cases/week by January 2015, and to zero cases by March 2015, facility-based screening began to increase.…”

“…4 EVD may have had an impact on the management of malnutrition in Sierra Leone, as has been reported for other services in EVD-affected countries. 3,6,7 During the outbreak in Sierra Leone, 221 health workers lost their lives, 2 funds for programmes were diverted to the EVD response, and some facilities closed or reduced their services. 3 There were reports of community members and health workers being afraid to interact due to perceived risks of infection.…”

Influence of the 2014–2015 Ebola outbreak on the vaccination of children in a rural district of Guinea

“…2 Assuring the health of children requires the provision of curative and preventive services through functional and accessible health facilities. Several West African studies have reported that the Ebola outbreak was responsible for significant disruptions to the provision of health care [3][4][5][6] and an up to four-fold increase in avoidable all-cause mortality, mostly in children aged <5 years. 7 Substantial reductions in the administration of anti-malarials have also been reported.…”

Paediatric care in relation to the 2014–2015 Ebola outbreak and general reporting of deaths in Sierra Leone

“…8 Few studies from West Africa have highlighted the detrimental effect of Ebola on the health system. One study from Sierra Leone showed a drop in surgical interventions associated with the Ebola outbreak, 9 while others have shown declines in out-patient consultations for malaria, 10 reduced attendance of reproductive health services 11 and deterioration in the quality of chronic care. 12 In Sierra Leone, malaria and respiratory infections are the most common morbidities among children aged < 5 years.…”