Ebola response in Sierra Leone: The impact on children

Abstract

SummaryThe West African Ebola virus disease (EVD) outbreak is the largest ever seen, with over 28,000 cases and 11,300 deaths since early 2014. The magnitude of the outbreak has tested fragile governmental health systems and non-governmental organizations (NGOs) to their limit. Here we discuss the outbreak in the Western Area of Sierra Leone, the shape of the local response and the impact the response had on caring for children suspected of having contracted EVD. Challenges encountered in providing clinical care to children whilst working in the “Red Zone” where risk of EVD is considered to be highest, wearing full personal protective equipment are detailed. Suggestions and recommendations both for further research and for operational improvement in the future are made, with particular reference as to how a response could be more child-focused.

Ebola Virus Disease in Children, Sierra Leone, 2014–2015

“…Samples were transported to specialist laboratories, which were usually off-site. Patients testing negative for EVD were discharged home or admitted to a routine (non-Ebola) hospital bed ( Figure 1 ) ( 8 ). Patients testing positive were transferred to an ETC coordinated by the WAERC.…”

“…The OICC was set up to care for children with substantial Ebola virus exposure (usually a first-degree relative with confirmed EVD) and without relatives to care for them during the 21-day incubation period. Figure reproduced from ( 8 ) (Creative Commons License). EHU, Ebola holding unit; EVD, Ebola virus disease; OICC, observational interim care center.…”

“…At the height of the outbreak, laboratory, ambulance, and bed capacities were overwhelmed, leading to substantial delays throughout the pathway, limited provision of clinical care, and long transfer distances ( 7 , 8 ). As the response scaled up, delays shortened and transfer distances decreased as more ETCs opened locally ( 7 , 8 ). These changing health systems factors possibly affected death and are amenable to modification in future outbreaks.…”

Development of a Pediatric Ebola Predictive Score, Sierra Leone1

“…During admission, however, EVD-negative patients risked exposure to EVD, raising concerns that EHUs could act as amplification sites for infection ( 3 – 7 ). Children, many of whom were unaccompanied, were particularly vulnerable, and, because EHUs were overstretched, supervision to minimize the risk of cross-infection was challenging ( 4 , 8 ). …”

Ebola virus disease in children: towards a better clinical picture and improved management

“…Some papers on the clinical features of EVD in children described several cases of hypoglycaemia. 3,4 It would have been useful to measure the blood glucose concentrations in children in this study to understand the importance of hypoglycaemia in children with confusion and thus to improve the management of patients in ETCs.…”