Indirect Effects of Ebola Virus Disease Epidemics on Health Systems in the Democratic Republic of the Congo, Guinea, Sierra Leone and Liberia: A Scoping Review Supplemented with Expert Interviews

Abstract

Ebola Virus Disease (EVD) epidemics have been extensively documented and have received large scientific and public attention since 1976. Until July 2022, 16 countries worldwide had reported at least one case of EVD, resulting in 43 epidemics. Most of the epidemics occurred in the Democratic Republic of Congo (DRC) but the largest epidemic occurred from 2014–2016 in Guinea, Sierra Leone and Liberia in West Africa. The indirect effects of EVD epidemics on these countries’ health systems, i.e., the consequences beyond infected patients and deaths immediately related to EVD, can be significant. The objective of this review was to map and measure the indirect effects of the EVD epidemics on the health systems of DRC, Guinea, Sierra Leone and Liberia and, from thereon, draw lessons for strengthening their resilience vis-à-vis future EVD outbreaks and other similar health emergencies. A scoping review of published articles from the PubMed database and gray literature was conducted. It was supplemented by interviews with experts. Eighty-six articles were included in this review. The results were structured based on WHO’s six building blocks of a health system. During the EVD outbreaks, several healthcare services and activities were disrupted. A significant decline in indicators of curative care utilization, immunization levels and disease control activities was noticeable. Shortages of health personnel, poor health data management, insufficient funding and shortages of essential drugs characterized the epidemics that occurred in the above-mentioned countries. The public health authorities had virtually lost their leadership in the management of an EVD response. Governance was characterized by the development of a range of new initiatives to ensure adequate response. The results of this review highlight the need for countries to invest in and strengthen their health systems, through the continuous reinforcement of the building blocks, even if there is no imminent risk of an epidemic.

A Framework for Assessing the Impact of Outbreak Response Immunization Programs

“…A large body of studies exist which investigate the impacts of Ebola on health systems [27,28]; however, the reported metrics are highly varied and reported with low frequency, with the most reported measure being the change in visits to health care facilities during an outbreak. We were unable to find health system impact data for set of searched VPDs other than Ebola, which indicates that it may be difficult to estimate the impacts of other pathogens.…”

Ebola outbreak in DRC and Uganda; an East African public health concern

“…Furthermore, countries should conduct surveys to find out the level of acceptability of Ebola vaccines and also set up strategies to improve community participation in EVD control activities. 22,24 The governments should help in reducing the risk of wildlife-tohuman transmission through contact with infected fruit bats or monkeys/great apes and consumption of their raw meat by enacting relevant regulations in place to check these practices. The availability of PPE and IPC supplies to manage sick patients and for decontamination should be optimally ensured and provided for by the government.…”

“…More so, countries should invest in and strengthen their health systems, as this approach strengthens the building blocks, even if there is no imminent risk of an epidemic and reducing the impact should there be an outbreak. Furthermore, countries should conduct surveys to find out the level of acceptability of Ebola vaccines and also set up strategies to improve community participation in EVD control activities 22,24 …”

“…Furthermore, countries should conduct surveys to find out the level of acceptability of Ebola vaccines and also set up strategies to improve community participation in EVD control activities. 22 , 24 …”

Evaluation of Short-Term Effects of Anti-Malaria Drugs on Haematology and Serum Electrolytes in Rats

“…While antimalarial drugs have proven to be effective in combating malaria, they can also have various side effects on the human body. These side effects may range from mild symptoms such as nausea, headaches, and dizziness, to more severe complications affecting vital organs and body systems (Mulenga-Cilundika et al, 2020, Nnamonu et al, 2020.…”