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Paediatric morbidity and mortality in Sierra Leone. Have things changed after the 2014/2015 Ebola outbreak?

Tom Sesay1, Olga Denisiuk2, Rony Zachariah3

  • 1Child Health and Immunization Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone.

F1000Research
|December 11, 2020
PubMed

Insights

The Ebola outbreak impacted Sierra Leone

Area of Science:

  • Public Health
  • Epidemiology
  • Pediatric Medicine

Background:

  • The 2014/2015 Ebola outbreak severely impacted Sierra Leone's health system, with potential long-term effects on child health.
  • Assessing under-five morbidity and mortality trends for key childhood illnesses before, during, and after the Ebola epidemic is crucial for understanding health system recovery.

Purpose of the Study:

  • To evaluate trends in under-five morbidity and mortality for malaria, acute respiratory infections (ARI)/pneumonia, watery diarrhea, and measles in Sierra Leone.
  • To compare these trends between the pre-Ebola, during-Ebola, and post-Ebola periods to assess health system resilience and recovery.

Main Methods:

  • Retrospective cross-sectional study utilizing District Health Information system (DHIS2) program data.
  • Inclusion of under-five children from 1,250 health facilities across all 14 districts in Sierra Leone.
  • Analysis of data from three distinct periods: pre-Ebola (June 2013-April 2014), during Ebola (June 2014-April 2015), and post-Ebola (June 2016-April 2017).

Main Results:

  • Consultations for malaria, ARI/pneumonia, and diarrhea decreased during Ebola but returned to pre-Ebola levels post-outbreak.
  • Significant reduction in case-fatality rates for malaria, ARI/pneumonia, and diarrhea in the post-Ebola period compared to the pre-Ebola period (P<0.0001).
  • A 12-fold increase in monthly measles cases was observed in the post-Ebola period compared to the pre-Ebola period; case-fatality post-Ebola was significantly lower than during Ebola (P<0.0001).

Conclusions:

  • Under-five child consultations at Sierra Leonean health facilities have recovered to pre-Ebola levels.
  • Case-fatality rates for common childhood illnesses have significantly decreased, indicating improved health outcomes.
  • The substantial rise in measles cases post-Ebola highlights critical gaps in immunization coverage requiring targeted interventions.

Keywords:
Operational ResearchOutbreak responseSORT ITSustainable Development GoalsUniversal Health Coverage

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