Abstract
BackgroundThe West Africa Ebola Virus Disease (EVD) outbreak in 2014–2016 was declared by the World Health Organization (WHO) a public health emergency of international concern. Most of the previous studies done in Sierra Leone relating to the clinical and epidemiological features of EVD during the 2014–2016 West African outbreak focused on adult EVD patients. There have been conflicting reports about the effects of EVD on children during previous outbreaks.MethodsThis is an observational retrospective analysis of medical data of all laboratory confirmed paediatric EVD patients below 15 years of age who were admitted at the 34 Military Hospital Ebola Treatment Center (ETC) in Wilberforce, Sierra Leone between June 2014 to April 2015. We analyzed the sociodemographic and clinical characteristics of paediatric EVD cases contained in case report forms that were collected by Ebola surveillance officers and clinicians at the 34 Military Hospital ETC. Both univariate and multivariate logistic regression models were used to determine the sociodemographic and clinical characteristics of paediatric EVD patients that were associated with EVD facility-based mortality.ResultsThe majority of the paediatric EVD cases in this study were female (56.1%), pupils (51.1%), and 43.2% belonged to the age group between 10 years and below 15 years. The median age of the paediatric EVD cases was 9 years (interquartile range = 4 to 11 years). Adjusting for other covariates in the model, male paediatric EVD patient (AOR = 13.4, 95% CI = [2.07–156-18], p < 0.05), EVD patient with abdominal pain (AOR = 11.0, 95% CI = [1.30–161.81], p < 0.05), vomiting (AOR = 35.7, 95% CI = [3.43–833.73], p < 0.05), signs of conjunctivitis (AOR = 17.4, 95% CI = [1.53–342.21], p < 0.05) and difficulty in breathing (AOR = 23.3, 95% CI = [1.92–713.01], p < 0.05) at the time of admission had increased odds of dying during EVD treatment.ConclusionsWe recommend the adoption of case definitions currently in vigour to cater for specific characteristics of paediatric patients. Subgroups that can be identified by applying the model developed in this study may require special attention and intensified care.
Highlights
The West Africa Ebola Virus Disease (EVD) outbreak in 2014–2016 was declared by the World Health Organization (WHO) a public health emergency of international concern
An individual’s high risk of dying as implied by our model would as a consequence justify prompt and intensified treatment, which may be a scarce resource during peak periods of an ongoing outbreak. Our study identified both epidemiological and clinical features that were associated with EVD infection, Case Fatality Rate (CFR) as well as those that are significant predictors for paediatric EVD treatment outcome
We reported that slightly more females were infected with EVD compared to males and that EVD cases below 5 years of age, as well as those cases that reported difficulty in breathing, difficulty in swallowing, signs of conjunctivitis and those with Stage 3 EVD infection at the time of admission recorded higher CFRs compared to the other paediatric EVD cases without these criteria
Summary
The West Africa Ebola Virus Disease (EVD) outbreak in 2014–2016 was declared by the World Health Organization (WHO) a public health emergency of international concern. Most of the previous studies done in Sierra Leone relating to the clinical and epidemiological features of EVD during the 2014–2016 West African outbreak focused on adult EVD patients. An EVD outbreak in West Africa which was detected in March 2014 prompted the World Health Organization (WHO) to declare it a “public health emergency of international concern” [5, 6]. Most studies relating to the clinical and epidemiological features of EVD at the time of the West African outbreak focused on adult EVD patients. Biased by the WHO case definition for a suspected Ebola case, the majority of the patients affected in Sierra Leone by the West African outbreak like others in previous ones were characterized by fever, fatigue, muscle pain, headache, and sore throat, vomiting, diarrhea, rash, kidney, liver function failure, sometimes bleeding ( to a lesser extent than previously known), and an incubation period of 2–21 days (median, 14 days) [1, 2, 5, 12]
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