TY - JOUR
T1 - The Effect of Ebola Virus Disease on Maternal and Child Health Services and Child Mortality in Sierra Leone, 2014–2015
T2 - Implications for COVID-19
AU - Ngo, Thi Minh Phuong
AU - Rogers, Braeden
AU - Patnaik, Rajesh
AU - Jambai, Amara
AU - Sharkey, Alyssa B.
N1 - Funding Information:
Financial support: This work was supported by the Sierra Leone Ministry of Health and Sanitation and UNICEF Sierra Leone.
Funding Information:
We thank UNICEF Sierra Leone, Ministry of Health and Sanitation, and FOCUS 1000 colleagues for their support of the design and management of the health facility surveys: Faraja Chiwile, Nathalie Daries, Shane O’Connor, Yaron Wolman, Hamjatu Khazali, Moses Cowan, Joseph Nganga Njau, Miatta Koroma, John Baimba, and Mohamed Jalloh, Paul Sengeh, and MoHS colleagues. We would also like to thank UNICEF Sierra Leone, UNICEF West and Central Africa Office, and UNICEF New York Headquarters colleagues for technical inputs: Augustin Kabano, Ngozi Kennedy, Patrick Okoth, Nathalie Diaries, Vandana Joshi, Edmund Makiu, Sylvia Lee, Abdulai Jalloh, Prabhat Kumar, Remy Mwamba, Jerome Pfaffmann, Richard Kumapley, Kumanan Rasanathan, Theresa Diaz, David Hipgrave, and Stefan Peterson. We are also thankful to the reviewers of our initial manuscript for their thoughtful comments. This work was supported by the Sierra Leone Ministry of Health and Sanitation and UNICEF Sierra Leone.
Publisher Copyright:
Copyright © 2021 by The American Society of Tropical Medicine and Hygiene.
PY - 2021/3
Y1 - 2021/3
N2 - During Sierra Leone’s 2014–2015 Ebola virus disease (EVD) epidemic, early reports warned of health system collapse and potential effects on other-cause mortality. These same warnings are reverberating during the COVID-19 pandemic. Consideration of the impacts of EVD on maternal and child health services from facility data can be instructive during COVID-19. We surveyed all peripheral healthcare units (PHUs) in Sierra Leone in October 2014 and March 2015 to assess closures, staffing, amenities, medicines, supplies, and service utilization during May 2014–January 2015 and October 2013–January 2014. We report PHU characteristics and service utilization changes for equivalent 4-month periods during the epidemic and the prior year. We present utilization changes by district and service type, and model excess child mortality. PHU closures (−8%) and staff attrition (−3%) were limited, but many facilities lacked amenities, medicines, and supplies. Utilization of preventive and scheduled services fell more than individualized, clinical care interventions, aside from malaria treatment which declined significantly. Ebola virus disease intensity in districts was weakly associated with utilization, aside from two districts that were severely affected. Modeling suggests utilization declines resulted in 6,782 excess under-five deaths (an increase of 21%) between 2014 and 2015. Ebola virus disease negatively affected service provision, but utilization declined relatively more, particularly for preventive and scheduled interventions. Although these findings are specific to Sierra Leone’s EVD epidemic, they illustrate the magnitude of possible effects in other settings due to COVID-19–induced service disruptions, where collateral impacts on child mortality from other preventable causes may far outweigh COVID-19 mortality.
AB - During Sierra Leone’s 2014–2015 Ebola virus disease (EVD) epidemic, early reports warned of health system collapse and potential effects on other-cause mortality. These same warnings are reverberating during the COVID-19 pandemic. Consideration of the impacts of EVD on maternal and child health services from facility data can be instructive during COVID-19. We surveyed all peripheral healthcare units (PHUs) in Sierra Leone in October 2014 and March 2015 to assess closures, staffing, amenities, medicines, supplies, and service utilization during May 2014–January 2015 and October 2013–January 2014. We report PHU characteristics and service utilization changes for equivalent 4-month periods during the epidemic and the prior year. We present utilization changes by district and service type, and model excess child mortality. PHU closures (−8%) and staff attrition (−3%) were limited, but many facilities lacked amenities, medicines, and supplies. Utilization of preventive and scheduled services fell more than individualized, clinical care interventions, aside from malaria treatment which declined significantly. Ebola virus disease intensity in districts was weakly associated with utilization, aside from two districts that were severely affected. Modeling suggests utilization declines resulted in 6,782 excess under-five deaths (an increase of 21%) between 2014 and 2015. Ebola virus disease negatively affected service provision, but utilization declined relatively more, particularly for preventive and scheduled interventions. Although these findings are specific to Sierra Leone’s EVD epidemic, they illustrate the magnitude of possible effects in other settings due to COVID-19–induced service disruptions, where collateral impacts on child mortality from other preventable causes may far outweigh COVID-19 mortality.
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U2 - 10.4269/ajtmh.20-0446
DO - 10.4269/ajtmh.20-0446
M3 - Article
C2 - 33399047
AN - SCOPUS:85108906645
SN - 0002-9637
VL - 104
SP - 1085
EP - 1092
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - 3
ER -