Mobile health clinic for the medical management of clinical sequelae experienced by survivors of the 2013–2016 Ebola virus disease outbreak in Sierra Leone, West Africa

Abstract

An Ebola survivor Mobile Health Clinic (MHC) was established to implement lasting changes in communities it operates by providing effective and efficient mobile healthcare. After months of development, the MHC solution was operationalised in February 2015, aiming to provide integrated primary healthcare services to address the medical and psychosocial needs of Ebola virus (EBOV) survivors living in areas with low medical coverage. A total of 910 medical consultations for 246 EBOV survivors were performed between 7 February 2015 and 10 June 2016. Females constituted 148 (60.2%) whereas 6 (2.44%) were children under 5 years of age. The most common complication was arthralgia 185 (75.2%), headache 98 (39.8%), abdominal pain 167 (68%), myalgia 182 (73.6%), and skin disease 25 (10%). Moreover, ocular problems were diagnosed in 84 survivors (34.1%), and 60 (24.4%) suffered from psycho-trauma. Some 16 female survivors (10.8%) had miscarriages, whereas 9 (6.1%) had complaints of oligomenorrhea, 7 (4.7%) loss of sexual desire and 4 (2.7%) premature menopause. Five male survivors (5.1%) reported erectile dysfunction and 10 (10.2%) loss of sexual desire. At least 221 (89.8%) reported more than one complication. Other infectious diseases were common and no clinically relevant differences were established from haematology and clinical biochemistry laboratory results. Ibuprofen, paracetamol, anti-malaria drugs and antibiotics were the most common medicines prescribed. Community participation is critical for implantation of MHC among EBOV survivors. Future strategies for the mobile clinics should include enrolment of survivors at discharge from treatment centres with close monitoring follow-up activities, to address sequelae as they arise, to reduce the potential for development of long-term disabilities.

Post‐Ebola psychosocial experiences and coping mechanisms among Ebola survivors: a systematic review

“…Self‐stigmatisation in the form of being embarrassed by their EVD survivor status was reported in a number of studies. For instance, a cross‐sectional study conducted in northern Sierra Leone reported that 13.8% (34 out 246) of EVD survivors felt ashamed or embarrassed by their status as survivors . All 24 survivors in the study by Hugo et al .…”

“…The remaining three were cohort studies. Eighteen studies were from the 2013 to 2016 outbreak in West Africa the remaining six are from 1995 to 2012 outbreaks in Eastern Africa . Of the 24 papers, 23 were published in English and one published in French .…”

“…Appraisal of the 17 quantitative studies ( n = 17: 11 quantitative cross‐sectional, three mixed methods and three cohorts studies) shows that half (9/17, 52.9%) of the articles adequately addressed the study purpose, literature review, study design, study sample, outcome measures, intervention, data analysis, result, dropouts or exclusions, clinical importance, conclusion and limitations . Poorly reported components were research design , sample size and description , outcome measures (valid and reliable) , results and statistical significance , dropouts/exclusions and limitations . Appraisal of the qualitative studies ( n = 10: 7‐ qualitative cross‐sectional, three‐mixed methods) indicated that the following components were poorly reported data management procedure , conceptual framework , sampling strategy , threats to reliability and validity and ethical considerations .…”

“…Ebola virus disease survivors experience several psychological manifestations following their discharge from an Ebola treatment centre. Three studies measured overall psychological distress as experienced by EVD survivors. A cross‐sectional study in western Sierra Leone estimated psychological distress among EVD survivors in comparison to medical staff, logistic staff, medical students and a Chinese medical team, using the General Severity Index (GSI), Positive Symptom Total (PST) and Positive Symptom Distress Index (PSDI) .…”

“…The authors observed that an inability to concentrate (4/4, 100%) and loss of sleep over worry (3/4, 75%) were the most common psychological distress identified among the four survivors that took part in the study. Another study conducted in northern Sierra Leone between February 2015 and June 2016 reported nearly one quarter ( n = 60, 24.4%) of 246 EVD survivors suffered from at least one form of psychological distress or trauma, although the method by which psychological distress was assessed was not reported in the paper . A Liberian study, reported that EVD survivors suffered an average of 36% of the 12 psychosocial stress symptoms (PSS) vs .…”