Effects of the West Africa Ebola Virus Disease on Health-Care Utilization – A Systematic Review

Abstract

Significant efforts were invested in halting the recent Ebola virus disease outbreak in West Africa. Now, studies are emerging on the magnitude of the indirect health effects of the outbreak in the affected countries, and the aim of this study is to systematically assess the results of these publications. The methodology for this review adhered to the Prisma guidelines for systematic reviews. A total of 3354 articles were identified for screening, and while 117 articles were read in full, 22 studies were included in the final review. Utilization of maternal health services decreased during the outbreak. The number of cesarean sections and facility-based deliveries declined and followed a similar pattern in Guinea, Liberia, and Sierra Leone. A change in the utilization of antenatal and postnatal care and family planning services was also seen, as well as a drop in utilization of children’s health services, especially in terms of vaccination coverage. In addition, the uptake of HIV/AIDS and malaria services, general hospital admissions, and major surgeries decreased as well. Interestingly, it was the uptake of health service provision by the population that decreased, rather than the volume of health service provision. Estimates from the various studies suggest that non-Ebola morbidity and mortality have increased after the onset of the outbreak in Sierra Leone, Guinea, and Liberia. Reproductive, maternal, and child health services were especially affected, and the decrease in facility deliveries, cesarean sections, and volume of antenatal and postnatal care visits might have significant adverse effects on maternal and newborn health. The impact of Ebola stretches far beyond Ebola cases and deaths. This review indicates that indirect health service effects are substantial and both short and long term, and highlights the importance of support to maintain routine health service delivery and the maintenance of vaccination programs as well as preventative and curative malaria programs, both in general but especially in times of a disaster.

Family Planning During and After the West African Ebola Crisis

“…), other studies have identified Ebola stigma and fear and suspicion of healthcare providers as barriers to service utilization during and following the Ebola crisis (Barden-O'Fallon et al 2015). In fact, a systematic review of the effects of the West Africa Ebola crisis on health care utilization proposed that that while there were disruptions in service delivery across the affected countries, "to a large extent, it was not health service provision that failed, but rather the uptake of health services by the population that decreased after the onset of the Ebola outbreak" (Brolin Ribacke et al 2016). The dramatic declines in service provision seen in Liberia, which experienced fewer cases of Ebola, may illustrate the power of this fear and stigma in reducing utilization of health care services, including family planning, during the crisis.…”

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.…”

A quantitative framework to define the end of an outbreak: application to Ebola Virus Disease

“…Declaring the end of an outbreak (EO) is a critical programmatic step in outbreak response. Any infectious disease outbreak can be devastating for affected populations and areas as alongside burden from infections and mortality, the outbreak status of a region or a country can influence other vital sectors such as: social, economic, political, and security (1)(2)(3). In defining the EO, it is crucial to consider the risk of cases arising in the future using objective quantitative methods.…”