The indirect effects of Ebola to the health system in Sierra Leone

A.J. van Duinen1,2, A. Erikson3,4, A.M. Ekström3, K. Brolin3,4, H.A. Bolkan1,2,5

1Surgery, St Olav Hospital, Trondheim, Norway, 2CapaCare, Trondheim, Norway,3Centre for Research on Health Care in Disasters , Karolinska Institutet, Stockholm, Sweden,

4Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden,5Norwegian University of Science and Technology, Trondheim, Norway

BackgroundDuring the current Ebola Viral Disease (EVD) outbreak, over 27,000 people have been infected and more than 11,000 people have died of the disease. Sierra Leone, with over 8,500 confirmed cases is the most affected country. Although the common efforts to fight the virus have shown to be effective, the effect of the outbreak to the already weak health system is disastrous. Death among healthcare workers and the fear of contracting EVD, has increased the mismatch between healthcare needs and the availability of human resources. The scale of such indirect effects on health facility function is unknown. The aim of this survey is to explore EVD´s effect on number of admissions before and after the start of the EVD epidemic.

MethodsBetween September 2014 and May 2015, 21 Community Health Officers, collected weekly retrospective data from the inpatient admissions books. Data was retrieved from all facilities that were known to provide major surgeries. The study period was before (2014 week 1 to 19) and during (2014 week 20 to 2015 week 20) the onset of the EVD outbreak in Sierra Leone.

ResultsFrom the 57 identified healthcare facilities, data from 42 was (almost) complete. Facilities were organized in three categories: governmental (19), private-non-profit (7) and private-for-profit (16).On average, 1788 patients were admitted weekly before the EVD onset and 1071 after, an overall reduction of 40.1%. This decrease was even higher (54.9%) during the peak of the epidemic (week 46-49 2014).The reduction in admissions was more severe in the private-for-profit sector (60.6%) compared to the private-non-profit (46.1%) and governmental (33.8%) sector. The areas most affected were Southern province (45.1%), Western Area (39.7%), Northern province (38.8%), while Eastern area had a reduction of 36.0%. In addition, the decrease in admissions was more distinct for males (43.9%) than for females (37.0%). Over the last months there is a slight increase in admissions visible.

ConclusionAs a consequence of the current EVD epidemic, the number of admissions has decreased with 40.1% in Sierra Leone. The reduction is not equal among the different sectors, areas and patient sex. This reduction most likely reflects the collateral damage to the health system. Patients´ fear of contracting Ebola, mistrust in the healthcare system and the high number affected health workers are likely contributing factors. Although there is some increase in admissions, it is far less then the situation before the Ebola outbreak. Investment in human resources is essential to re-establish the Sierra Leonean healthcare system after the EVD epidemic. www.capacare.org

Figure 2 – Admissions (by sex)

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Figure 1 – Admissions (by area)

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Figure 2 – Admissions (by sector)