Management of malaria in children with fever in rural Sierra Leone in relation to the 2014–2015 Ebola outbreak

Moses, Francis; Tamang, David; Denisiuk, Olga; Dumbuya, Umaru; Hann, Katrina; Zachariah, Rony

doi:10.5588/pha.16.0085

Cited by 6 publications

(8 citation statements)

References 13 publications

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“…6 Sixteen studies were conducted, and are assembled here for this special issue. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Through the study of routine data the performance of a wide range of programmes was assessed before, during and after the outbreak. These studies present data from mother and child health care services, the human immunodeficiency virus (HIV), tuberculosis, vaccination, malaria, malnutrition and non-communicable diseases programmes.…”

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confidence: 99%

What was the effect of the West African Ebola outbreak on health programme performance, and did programmes recover?

Decroo

Fitzpatrick

Amone

2017

public health action

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The West African Ebola virus disease (EVD) outbreak was the largest in history. The vast majority of cases were reported in Guinea, Sierra Leone and Liberia. Altogether, 28 646 people were infected and 11 323 died. 1 One of the explanations for the extent of the outbreak was the lack of response of local health systems. These health systems were incapable of responding adequately to the outbreak due to a lack of human resources, information, research, supply of medical products, financing and governance. 2 The devastating effect of the Ebola outbreak stretched far beyond the number of Ebola cases, and resulted in the deterioration of the provision and utilisation of routine health care. On the one hand the EVD outbreak compromised the functioning of the health system, due to the deaths of many health care workers and the closure of health facilities, 3,4 while at the same time communities had little trust in the capacity of providers to secure safe health care. In Ebola-affected communities many individuals feared to seek care, even for curable conditions. 4,5 The manner in which the provision and utilisation of programmes were affected by the outbreak was difficult to monitor during the outbreak response, given the state of emergency. All the attention of national and international health care providers was focused on limiting further spread of EVD, and reducing mortality in infected patients. We therefore studied in retrospect the effect of the Ebola outbreak on health system performance. Two Structured Operational Research Training Initiative (SORT IT) courses were organised, one in Liberia and one in Sierra Leone. The participants, the first authors of the manuscripts included in this supplement, were involved in the local health programmes during the Ebola outbreak. Course participation was defined as successful if the participant submitted a scientific manuscript to a peer-reviewed journal by the end of the course. 6 Sixteen studies were conducted, and are assembled here for this special issue. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Through the study of routine data the performance of a wide range of programmes was assessed before, during and after the outbreak. These studies present data from mother and child health care services, the human immunodeficiency virus (HIV), tuberculosis, vaccination, malaria, malnutrition and non-communicable diseases programmes. In addition, infection prevention monitoring, community health worker programme and performance-based financing are included.The different studies illustrate how service delivery and utilisation of most programmes dropped significantly during the Ebola outbreak. The greater the area affected, the sharper the decline, and the longer it took for performance to recover to pre-Ebola levels. The level of programme performance pre-Ebola also affected recovery post-Ebola. For example, in Liberia the already struggling immunisation programme was further weakened during the outbreak and took significant time to recover post-Ebola. 19 Ne...

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confidence: 99%

What was the effect of the West African Ebola outbreak on health programme performance, and did programmes recover?

Decroo

Fitzpatrick

Amone

2017

public health action

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“…This was a cross-sectional study using routine program data. The setting has been previously described 1 . The study population included all children under five with fever who presented to 68 primary healthcare units.…”

Section: Methodsmentioning

confidence: 99%

“…A cross-sectional study conducted in 2017 1 involving 68 primary health facilities in Koinadugu district of rural Sierra Leone compared the management of children with fever for malaria for a period before, during and after the Ebola outbreak. There were two key findings.…”

Section: Introductionmentioning

confidence: 99%

Malaria management in children with fever in rural Sierra Leone. Has anything changed after the Ebola outbreak?

Sesay¹,

Denisiuk

Hann

et al. 2019

F1000Res

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Background: Sierra Leone is one of the highest malaria burden countries in the world and was severely affected by the 2014-15 Ebola outbreak. As fever is a common symptom of both malaria and Ebola, it might have affected the management of fever in children. Among under-fives in Koinadugu district, Sierra Leone, we determined fever cases that had malaria diagnostic testing and treated with Artemisinin-based Combination Therapy (ACT) during pre-Ebola, intra-Ebola and post-Ebola periods. Methods: The study population included all children under five with fever who presented to 68 primary healthcare facilities in Koinadugu district. Malaria management was in line with national guidelines. All individuals presenting with fever should be subjected to a malaria diagnostic test, which may involve a Rapid Diagnostic Test (RDT) or microscopy. Only confirmed malaria cases should receive ACTs. The study spanned pre-Ebola (June 1, 2013 – April 30, 2014), intra-Ebola (June 1, 2014 – April 30, 2015) and post-Ebola (June 1, 2016 – April 30 ,2017) periods. Data were sourced directly from routine morbidity registers available at each health facility. Results: In the 68 health facilities, fever cases increased from 43,245 pre-Ebola to 74,367 post-Ebola (1.7-fold increase). Diagnosed malaria ranged between 66% and 75%. Only 47% of malaria cases were treated during Ebola. ACT use was 95% pre-Ebola, 99% intra-Ebola and dropped to 71% post-Ebola. Post-Ebola, an average of 40 (59%) facilities had monthly stock-outs of ACT (range 28-45). Conclusion: What has changed since the Ebola outbreak is the increased utilisation of services for malaria. However, ACT stockouts are of concern, and this requires attention in order to ensure compliance with national malaria treatment guidelines.

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“…Weak health systems are adversely impacted during global public health emergencies, such as Ebola and COVID-19, leading to disruptions in service provision, supply chain, and health-seeking behaviour [ 6 , 7 ]. During the Ebola outbreak 2014–2015 in Sierra Leone, pre-existing gaps in reporting and service delivery worsened [ 8 ], and changes to service delivery had a lasting impact on access in neighbouring Liberia [ 9 ]. Although access to ACT is essential, multiple factors influence the effectiveness of treatment, including the efficacy of ACT regimens, targeted testing and treatment, and patient (or caregiver) adherence to treatment [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with access and adherence to artemisinin‐based combination therapy (ACT) for children under five: a secondary analysis of a national survey in Sierra Leone

Banek

Webb

Doogue

et al. 2021

Malar J

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Background Access and adherence to artemisinin-based combination therapy (ACT) are key challenges to effective malaria treatment. A secondary analysis of the Sierra Leone malaria Knowledge, Attitudes, and Practices (mKAP) survey was conducted to investigate access and adherence to ACT for the treatment of fever in children under-five. Methods The mKAP was a nationally representative, two-stage cluster-sample survey, conducted in 2012. Thirty primary sampling units per district were randomly selected using probability proportionate to size, based on national census estimates; 14 households were subsequently randomly selected and enrolled per sampling unit. The analysis was restricted to children under-five with fever in the past two weeks. Factors associated with access and adherence were assessed using multivariate logistic regression. Results Of 5169 enrolled households, 1456 reported at least one child under-five with fever in the past two weeks. Of the 1641 children from these households, 982 (59.8%) received any treatment for fever and were analysed for access to ACT; 469 (47.6%) received ACT and 466 were analysed for treatment adherence. Only 222 (47.4%) febrile children received ACT and completed 3-day treatment. In an adjusted analysis, factors associated with ACT access included knowledge of ACT (odds ratio [OR] 2.78, 95% CI 2.02–3.80; p < 0.001), knowledge of insecticide-treated nets (ITNs) (OR 1.84, 95% CI 1.29–2.63; p = 0.001), source of care (public health facility vs. other; OR 1.86, 95% CI 1.27–2.72, p = 0.001), geographic region (East vs. West; OR 2.30, 95% CI 1.20–4.44; p = 0.025), and age (24–59 vs. 0–23 months; OR 1.45, 95% CI 1.07–1.96; p = 0.016). The only factor associated with ACT adherence was time to treatment; children treated within 24 h were less likely to adhere (OR 0.55, 95% CI 0.34–0.89; p = 0.015). Conclusions In 2012, access and adherence to ACT remained low in Sierra Leone. Knowledge of ACT and ITNs, and seeking care in the public sector, were most strongly associated with ACT access. National surveys provide important information on anti-malarial access and could be expanded to measure treatment adherence.

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Management of malaria in children with fever in rural Sierra Leone in relation to the 2014–2015 Ebola outbreak

Cited by 6 publications

References 13 publications

What was the effect of the West African Ebola outbreak on health programme performance, and did programmes recover?

What was the effect of the West African Ebola outbreak on health programme performance, and did programmes recover?

Malaria management in children with fever in rural Sierra Leone. Has anything changed after the Ebola outbreak?

Factors associated with access and adherence to artemisinin‐based combination therapy (ACT) for children under five: a secondary analysis of a national survey in Sierra Leone

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