Abstract
Background:Sierra Leone was severely affected by the 2014/2015 Ebola outbreak and is likely to have had longer term repercussions on the health system including on paediatric morbidity and mortality. We thus assessed under-five morbidity and mortality for malaria, acute respiratory Infections (ARI)/pneumonia, watery diarrhoea and measles during the post-Ebola period in Sierra Leone and compared this with the pre- and intra-Ebola periods. Methods:This was a retrospective cross-sectional study using program data from the District Health Information system (DHIS2) and sourced from 14 districts in Sierra Leone. It included under-five children from 1,200 health facilities country-wide. Study periods included: before (June 1 st, 2013-April 30 th, 2014); during (June 1 st, 2014-April 30 th, 2015); and after Ebola (June 1 st, 2016-April 30 th, 2017). Results:Malaria, ARI/pneumonia and diarrhoea consultations declined during Ebola but recovered to pre-Ebola levels in the post-Ebola period. During the post-Ebola period, there was a highly significant reduction in case-fatality for the first three morbidities compared to the pre-Ebola period (P<0.0001). Average number of measles cases increased from 48/month in the pre-Ebola period to 568/month (12-fold increase) post-Ebola. Although there was no difference in measles case-fatality between the pre- and post-Ebola periods, case-fatality post-Ebola was significantly lower than during Ebola (Relative Risk: 0.05, 95% confidence interval 0.02-0.15, P<0.0001). Conclusions:Consultations for under-five children at health facilities in Sierra Leone recovered to pre-Ebola levels and case-fatality for common childhood illnesses declined significantly. This is a change for the better. However, the high level of reported measles cases in the post-Ebola period indicates gaps in immune status and needs focused attention.
Highlights
In 2017, a cross-sectional study1 documented country-wide morbidity for four common childhood illnesses: malaria, acute respiratory infections (ARI)/pneumonia, watery diarrhoea and measles
The health infrastructure is tiered into tertiary hospitals, district hospitals and Peripheral Health Units (PHUs)
Measles increased during the last six months of the Ebola outbreak and this trend continued into the post-Ebola period
Summary
In 2017, a cross-sectional study documented country-wide morbidity for four common childhood illnesses: malaria, acute respiratory infections (ARI)/pneumonia, watery diarrhoea and measles. During the Ebola outbreak, health facility visits for malaria, ARI and watery diarrhoea dropped significantly nation-wide, without returning to pre-Ebola levels post-outbreak. Methods: This was a retrospective cross-sectional study using program data from the District Health Information system (DHIS2) and sourced from 14 districts in Sierra Leone It included under-five children from 1,200 health facilities country-wide. Conclusions: Consultations for under-five children at health facilities in Sierra Leone recovered to pre-Ebola levels and case-fatality for common childhood illnesses declined significantly. The high level of reported measles cases in the post-Ebola period indicates gaps in immune status and needs focused attention
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