The National Emergency Medical Service Role During the COVID-19 Pandemic in Sierra Leone

Caviglia, Marta; Buson, Riccardo; Pini, Sara; Jambai, Amara; Vandy, Matthew Jusu; Venturini, Francesco; Rosi, Paolo; Barone-Adesi, Francesco; Corte, Francesco Della; Ragazzoni, Luca; Putoto, Giovanni

doi:10.1017/s1049023x20001211

Cited by 10 publications

(23 citation statements)

References 3 publications

(3 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Specific ambulances were dedicated solely for COVID-19 and the rest of the fleet maintained for essential health services. 25 Rapid expansion of COVID-19 treatment beds was achieved by converting existing hospital spaces into safe treatment and isolation centres, using pre-existing infrastructure and staff and modelled on a previous Ebola response model. 26 The response also differed from the Ebola response in that COVID-19 treatment centres were all located at government hospitals, as opposed to temporary Non Governmental Organisations (NGO) separate facilities.…”

Section: Discussionmentioning

confidence: 99%

“…35 This could explain why adult medical and surgical admissions that require more out of pocket expenditure saw reductions, while services provided under the Free Healthcare Initiative 19 such as caesarean deliveries were resilient. Furthermore, as the National Emergency Medical Service ambulance system 25 is primarily intended for paediatric and maternal cases, which were unaffected from Q1 to Q2, it is possible that the protective effect of the free prehospital transport system maintained access for these populations.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The impact of the COVID-19 pandemic on hospital utilisation in Sierra Leone

et al. 2021

View full text Add to dashboard Cite

IntroductionThe COVID-19 pandemic has adversely affected health systems in many countries, but little is known about effects on health systems in sub-Saharan Africa. This study examines the effects of COVID-19 on hospital utilisation in a sub-Saharan country, Sierra Leone.MethodsMixed-methods study using longitudinal nationwide hospital data (admissions, operations, deliveries and referrals) and qualitative interviews with healthcare workers and patients. Hospital data were compared across quarters (Q) in 2020, with day 1 of Q2 representing the start of the pandemic in Sierra Leone. Admissions are reported in total and disaggregated by sex, service (surgical, medical, maternity and paediatric) and hospital type (government or private non-profit). Referrals in 2020 were compared with 2019 to assess whether any changes were the result of seasonality. Comparisons were performed using Student’s t-test. Qualitative data were analysed using thematic analysis.ResultsFrom Q1 to Q2, weekly mean hospital admissions decreased by 14.7% (p=0.005). Larger decreases were seen in male 18.8% than female 12.5% admissions. The largest decreases were in surgical admissions, a 49.8% decrease (p<0.001) and medical admissions, a 28.7% decrease (p=0.002). Paediatric and maternity admissions did not significantly change. Total operations decreased by 13.9% (p<0.001), while caesarean sections and facility-based deliveries showed significant increases: 12.7% (p=0.014) and 7.5% (p=0.03), respectively. In Q3, total admissions remained 13.2% lower (p<0.001) than Q1. Mean weekly referrals were lower in Q2 and Q3 of 2020 compared with 2019, suggesting findings were unlikely to be seasonal. Qualitative analysis identified both supply-side factors, prioritisation of essential services, introduction of COVID-19 services and pausing elective care, and demand-side factors, fear of nosocomial infection and financial hardship.ConclusionThe study demonstrated a decrease in hospital utilisation during COVID-19, the decrease is less than reported in other countries during COVID-19 and less than reported during the Ebola epidemic.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The impact of the COVID-19 pandemic on hospital utilisation in Sierra Leone

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Case definition-based screening at the front gate of hospitals with linkage to hospital isolation units, provided further delineation between COVID-19 and non-COVID-19 care. Specific ambulances were dedicated solely for COVID-19 and the rest of the fleet maintained for essential health services(25). Rapid expansion of COVID-19 treatment beds was achieved by converting existing hospital spaces into safe treatment and isolation centres, using pre-existing infrastructure and staff and modelled on a previous Ebola response model(26).…”

Section: Discussionmentioning

confidence: 99%

“…This could explain why adult medical and surgical admissions, that require more out of pocket expenditure, saw reductions whilst services provided under the Free Health Care Initiative(36) such as caesarean deliveries, were resilient. Furthermore, as the national ambulance service(25) is primarily intended for paediatric and maternal cases, which were unaffected from Q1-Q2, it is possible that the protective effect of free pre-hospital transport system maintained access for these populations.…”

Section: Discussionmentioning

confidence: 99%

The impact of the COVID-19 pandemic on health service utilisation in Sierra Leone

Sevalie

Youkee

et al. 2021

Preprint

View full text Add to dashboard Cite

Introduction: The COVID-19 pandemic has adversely affected health systems in many countries, but little is known about effects on health systems in sub-Saharan Africa. This study examines the effects of COVID-19 on health service utilisation in a sub-Saharan country, Sierra Leone. Methods: Mixed-methods study using longitudinal nationwide hospital data (admissions, operations, deliveries and referrals), and qualitative interviews with healthcare workers and patients. Hospital data were compared across Quarters (Q) in 2020, with day 1 of Q2 representing the start of the pandemic in Sierra Leone. Admissions are reported in total and disaggregated by sex, service (surgical, medical, maternity, paediatric), and hospital type (government or private not for profit). Referrals in 2020 were compared with 2019, to assess whether any changes were the result of seasonality. Comparisons were performed using students t test. Qualitative data were analysed using thematic analysis. Results: From Q1-Q2, weekly mean hospital admissions decreased by 14.7% (p=0.005). Larger decreases were seen in male 18.8%, than female 12.5% admissions. The largest decreases were in surgical admissions, a 49.8 % decrease (p<0.001) and medical admissions, a 28.7% decrease (p=0.002). Paediatric and maternity admissions did not significantly change. Total operations decreased by 13.9% (p<0.001), whilst caesarean sections and facility-based deliveries showed significant increases, 12.7 % (p=0.014) and 7.5% (p=0.03) respectively. In Q3 total admissions remained 13.2% lower (p<0.001) than Q1. Mean weekly referrals were lower in Q2 and Q3 of 2020 compared to 2019, suggesting findings were unlikely to be seasonal. Qualitative analysis identified both supply-side factors, prioritisation of essential services, introduction of COVID-19 services and pausing elective care, and demand-side factors, fear of nosocomial infection and financial hardship. Conclusion: The study demonstrated a decrease in health service utilisation during Covid-19, the decrease is less than in other countries during COVID-19 and less than reported during the Ebola epidemic.

show abstract

“…Located on the west coast of Africa, Sierra Leone, being one of the most undeveloped countries in the world, has a particularly vulnerable public health system ( 4 , 5 ). Even though Sierra Leone reacted quickly to the threat of COVID-19, implementing policies to contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ( 6 ), COVID-19 emerged as a serious public health challenge due to the weak health system, poverty, cultural norms, and limited medical resources ( 7 , 8 ) [e.g., a single ventilator was available for the whole population of Sierra Leone in the initial stage of the COVID-19 pandemic ( 1 )], which led to significant health concerns and socioeconomic issues. A related study showed that people lost their jobs and had difficulty providing food for their families as a consequence of COVID-19 lockdowns ( 1 ).…”

Section: Introductionmentioning

confidence: 99%

Epidemiological Trends of Coronavirus Disease 2019 in Sierra Leone From March 2020 to October 2021

Liu

Gao²,

Xue³

et al. 2022

Front. Public Health

View full text Add to dashboard Cite

Coronavirus disease 2019 (COVID-19), a serious public health challenge the world over, has led to significant health concerns in Sierra Leone. In the present study, epidemic indices, such as the number of cases, positivity rate, reproduction rate (R0), case fatality rate (CFR), age, and sex, were used to characterize the epidemiological trends of COVID-19. As of October 31, 2021, a total of 6,398 cases and 121 related deaths had been confirmed. The total number of COVID-19 reverse transcription polymerase chain reaction (RT-PCR) tests conducted to October 31, 2021, was 249,534, and the average positivity rate was 2.56%. Three waves of COVID-19 were recorded, occurring during weeks 15–46 in 2020 (2,369 cases), week 47 in 2020 to week 16 in 2021 (1,665 cases), and weeks 17–43 in 2021 (2,364 cases), respectively. Remarkably, there was no increase in the numbers of confirmed COVID-19 cases despite rising test numbers throughout the three waves. Moreover, three high R0 values were observed before each wave. The number of positive cases significantly correlated with positive numbers of international arrivals (P < 0.01), deaths (P < 0.01), and the positivity rate of tested samples (P < 0.01). Moreover, all of the deaths occurred during the peak of the three waves. Our results indicate that there was a low level of COVID-19 epidemic in Sierra Leone and that COVID-19's introduction led to local transmission. It is vital to fight against the spread of SARS-CoV-2 from the source of origin by strengthening testing and management of people entering the country. Our findings will provide important clues for expanding sample screening and will contribute to the reasonable allocation of medical resources.

show abstract

The National Emergency Medical Service Role During the COVID-19 Pandemic in Sierra Leone

Cited by 10 publications

References 3 publications

The impact of the COVID-19 pandemic on hospital utilisation in Sierra Leone

The impact of the COVID-19 pandemic on hospital utilisation in Sierra Leone

The impact of the COVID-19 pandemic on health service utilisation in Sierra Leone

Epidemiological Trends of Coronavirus Disease 2019 in Sierra Leone From March 2020 to October 2021

Contact Info

Product

Resources

About