Changes in Health-Seeking Behavior Did Not Result in Increased All-Cause Mortality During the Ebola Outbreak in Western Area, Sierra Leone

Abstract

Little is known about the residual effects of the west African Ebola virus disease (Ebola) epidemic on non-Ebola mortality and health-seeking behavior in Sierra Leone. We conducted a retrospective household survey to estimate mortality and describe health-seeking behavior in Western Area, Sierra Leone, between May 25, 2014, and February 16, 2015. We used two-stage cluster sampling, selected 30 geographical sectors with probability proportional to population size, and sampled 30 households per sector. Survey teams conducted face-to-face interviews and collected information on mortality and health-seeking behavior. We calculated all-cause and Ebola-specific mortality rates and compared health-seeking behavior before and during the Ebola epidemic using χ and Fisher's exact tests. Ninety-six deaths, 39 due to Ebola, were reported in 898 households. All-cause and Ebola-specific mortality rates were 0.52 (95% confidence interval [CI] = 0.29-0.76) and 0.19 (95% CI = 0.01-0.38) per 10,000 inhabitants per day, respectively. Of those households that reported a sick family member during the month before the survey, 86% (73/85) sought care at a health facility before the epidemic, compared with 58% (50/86) in February 2015 (P = 0.013). Reported self-medication increased from 4% (3/85) before the epidemic to 23% (20/86) during the epidemic (P = 0.013). Underutilization of health services and increased self-medication did not show a demonstrable effect on non-Ebola-related mortality. Nevertheless, the residual effects of outbreaks need to be taken into account for the future. Recovery efforts should focus on rebuilding both the formalized health system and the population's trust in it.

Unreported cases in the 2014-2016 Ebola epidemic: Spatiotemporal variation, and implications for estimating transmission

“…Estimates of population size in each district were taken from the 2015 census [ 23 ]. Estimates of weekly all-cause community mortality were taken from a household survey conducted in the capital district of Western Area Urban in 2015 [ 24 ]. This survey reported raw all-cause mortality of 36 deaths at home over a recall period of 267 days for 898 households, with a mean household size of 6.66 individuals.…”

Mechanistic understanding of N-glycosylation in Ebola virus glycoprotein maturation and function

“…The 2014 outbreak of Ebola hemorrhagic fever in West Africa has resulted in the deaths of over 11,000 people and represents the worst epidemic of this disease in history (1). Ebola hemorrhagic fever is caused by Ebola viruses (EBOVs), 4 members of Filoviridae, which can have a 90% rate of mortality in humans and nonhuman primates (2).…”

Rebuilding transformation strategies in post-Ebola epidemics in Africa

“…Strategic global post-EVD epidemics assistance in recovery and rebuilding programmes and activities institutionalization is imperative in improving care workforce and health commodities, access to and use of diagnostics and care delivery packages to remote rural settings [ 6 , 8 , 12 ]. Substantial success rely on improving information communication, training of field workers, care-providers and epidemiologists, leadership management and accountability, quality standards at local and national levels [ 3 , 7 , 8 ].…”

“…Although recovery is a complex process, community engagement and social mobilization activities play an important role in developing and implementing operational and transparent evidence-based rebuilding and recovery programmes [ 8 , 9 ]. Moreover, community perceptions and vision of decision makers in building comprehensive and integrated evidence-based approaches and strategies is crucial in strengthening emergency local and national health systems, psychosocial and economic recovery and management capacities imperative to public peace and security for partnership commitment and investment [ 8 , 9 , 12 ]. Understanding the local determinants can also contribute to increasing the frequency of public health needs, programs and social services delivery amongst communities and populations who are at greater risk or disease outbreak disaster.…”

“…Understanding the local determinants can also contribute to increasing the frequency of public health needs, programs and social services delivery amongst communities and populations who are at greater risk or disease outbreak disaster. Response policies and programs should be rooted within evidence-based frameworks and standards practices [ 8 , 12 ]. This should include a multidisciplinary training and workshops, interactive discussions, group work and individual/collective projects in answering some key socio-cultural and health issues and players [ 8 – 10 ].…”