Offering general pediatric care during the hard times of the 2014 Ebola outbreak: looking back at how many came and how well they fared at a Médecins Sans Frontières referral hospital in rural Sierra Leone

Abstract

BackgroundIn Bo district, rural Sierra Leone, we assessed the burden of the 2014 Ebola outbreak on under-five consultations at a primary health center and the quality of care for under-15 children at a Médecins Sans Frontières (MSF) referral hospital.MethodsRetrospective cohort study, comparing a period before (May-October 2013) and during the same period of the Ebola outbreak (2014). Health worker infections occurred at the outbreak peak (October 2014), resulting in hospital closure due to fear of occupational-risk of contracting Ebola. Standardized hospital exit outcomes and case fatality were used to assess quality of care until closure.ResultsA total of 13,658 children under-five, were seen at the primary health center during 2013 compared to 8761 in 2014; a consultation decline of 36%. Of 6497 children seen in the hospital emergency room, during the outbreak, patients coming from within hospital catchment area declined with 38% and there were significantly more self-referrals (80% vs. 61%, P < 0.001). During Ebola, 23 children were dead on arrival and the proportion of children in severe clinical status (requiring urgent attention) was higher (74% during Ebola vs. 65% before, P < 0.001). Of 5,223 children with available hospital outcomes, unfavorable outcomes (combination of deaths and abandoned) were less than 15% during both periods, which is within the maximum acceptable in-house threshold set by MSF. Case fatality for severe malaria and lower respiratory tract infections (n = 3752) were similar (≤15%).ConclusionsValuable and good quality pediatric care was being provided in the pediatric hospital during the 2014 Ebola outbreak, but could not be sustained because of hospital closure. Health facility and health worker safety should be tackled as a universal requirement to try to avoid a déjà-vu.

Health Systems and Services During COVID-19: Lessons and Evidence From Previous Crises: A Rapid Scoping Review to Inform the United Nations Research Roadmap for the COVID-19 Recovery

“…In India, a cross-sectional survey among PHC facilities during COVID-19 reported that PHC facilities are constrained due to their weak infrastructure (eg, limited physical space, inadequate ventilation, suboptimal infection prevention, and control measures) 33 (#747, Type V). Similarly, provision of pediatric primary care could not be sustained throughout the EVD outbreak in Sierra Leone due to hospital closure and HCW infections 71 (#425, Type II). Effective primary care mental health services in low-resource settings can be challenging, as demonstrated in Liberia post-EVD 72 (#95, Type IV).…”

The impact of the Ebola epidemics on children’s rights: a scoping review

“…11, 35) Disability, Basic Health and Welfare Right to the best possible health and to healthcare (Art. 24) Disrupted health service access; [ 27 , 30–38 , 57 ] except for some rural districts less affected by Ebola, utilization of primary care remained robust despite the outbreak; [ 39 ] Unavailability of medication; [ 30 , 65 ] Worsening of children and maternal health care quality; [ 26 , 31 , 33 , 35–37 , 40–43 , 55 , 65 ] Lack of child-centered health services; [ 25 , 27 , 30 , 40 ] High EVD mortality rate, especially in very young children (<12 months of age); [ 25 , 30 ] Exacerbation in overall infant, child and maternal mortality (specifically in teenage girls); [ 25 , 26 , 30 , 35 , 42 , 43 , 55 , 57 , 64 ] Worsening of common diseases’ management; [ 27 , 28 , 34 , 40 , 44 , 45 , 55 , 64 , 65 , 75 ] Increased risk of malnutrition and undernutrition; [ 55 , 57 , …”

Effective interventions to ensure MCH (Maternal and Child Health) services during pandemic related health emergencies (Zika, Ebola, and COVID-19): A systematic review

“…A decline of 46% - 83.8% in pediatric ED admission was demonstrated at the pediatric ED during the COVID-19 pandemic [ 51 , 55 , 56 , 58 – 60 ]. A 36% decline in under-5 children consultation was reported during the Ebola outbreak at the primary healthcare level [ 61 ].…”