Ebola Management Centre Proximity Associated With Reduced Delays of Healthcare of Ebola Virus Disease (EVD) Patients, Tonkolili, Sierra Leone, 2014-15

Hdl Handle:
http://hdl.handle.net/10144/618911
Title:
Ebola Management Centre Proximity Associated With Reduced Delays of Healthcare of Ebola Virus Disease (EVD) Patients, Tonkolili, Sierra Leone, 2014-15
Authors:
Theocharopoulos, G; Danis, K; Greig, J; Hoffmann, A; De Valk, H; Jimissa, A; Tejan, S; Sankoh, M; Kleijer, K; Turner, W; Achar, J; Duncombe, J; Lokuge, K; Gayton, I; Broeder, R; Kremer, R; Caleo, G
Journal:
PloS One
Abstract:
Between August-December 2014, Ebola Virus Disease (EVD) patients from Tonkolili District were referred for care to two Médecins Sans Frontières (MSF) Ebola Management Centres (EMCs) outside the district (distant EMCs). In December 2014, MSF opened an EMC in Tonkolili District (district EMC). We examined the effect of opening a district-based EMC on time to admission and number of suspect cases dead on arrival (DOA), and identified factors associated with fatality in EVD patients, residents in Tonkolili District. Residents of Tonkolili district who presented between 12 September 2014 and 23 February 2015 to the district EMC and the two distant EMCs were identified from EMC line-lists. EVD cases were confirmed by a positive Ebola PCR test. We calculated time to admission since the onset of symptoms, case-fatality and adjusted Risk Ratios (aRR) using Binomial regression. Of 249 confirmed Ebola cases, 206 (83%) were admitted to the distant EMCs and 43 (17%) to the district EMC. Of them 110 (45%) have died. Confirmed cases dead on arrival (n = 10) were observed only in the distant EMCs. The median time from symptom onset to admission was 6 days (IQR 4,8) in distant EMCs and 3 days (IQR 2,7) in the district EMC (p<0.001). Cases were 2.0 (95%CI 1.4-2.9) times more likely to have delayed admission (>3 days after symptom onset) in the distant compared with the district EMC, but were less likely (aRR = 0.8; 95%CI 0.6-1.0) to have a high viral load (cycle threshold ≤22). A fatal outcome was associated with a high viral load (aRR 2.6; 95%CI 1.8-3.6) and vomiting at first presentation (aRR 1.4; 95%CI 1.0-2.0). The opening of a district EMC was associated with earlier admission of cases to appropriate care facilities, an essential component of reducing EVD transmission. High viral load and vomiting at admission predicted fatality. Healthcare providers should consider the location of EMCs to ensure equitable access during Ebola outbreaks.
Publisher:
Public Library of Science
Issue Date:
1-May-2017
URI:
http://hdl.handle.net/10144/618911
DOI:
10.1371/journal.pone.0176692
PubMed ID:
28459838
Submitted date:
2017-05-08
Language:
en
ISSN:
1932-6203
Appears in Collections:
Other Diseases

Full metadata record

DC FieldValue Language
dc.contributor.authorTheocharopoulos, Gen
dc.contributor.authorDanis, Ken
dc.contributor.authorGreig, Jen
dc.contributor.authorHoffmann, Aen
dc.contributor.authorDe Valk, Hen
dc.contributor.authorJimissa, Aen
dc.contributor.authorTejan, Sen
dc.contributor.authorSankoh, Men
dc.contributor.authorKleijer, Ken
dc.contributor.authorTurner, Wen
dc.contributor.authorAchar, Jen
dc.contributor.authorDuncombe, Jen
dc.contributor.authorLokuge, Ken
dc.contributor.authorGayton, Ien
dc.contributor.authorBroeder, Ren
dc.contributor.authorKremer, Ren
dc.contributor.authorCaleo, Gen
dc.date.accessioned2017-05-08T18:20:48Z-
dc.date.available2017-05-08T18:20:48Z-
dc.date.issued2017-05-01-
dc.date.submitted2017-05-08-
dc.identifier.citationEbola Management Centre Proximity Associated With Reduced Delays of Healthcare of Ebola Virus Disease (EVD) Patients, Tonkolili, Sierra Leone, 2014-15, 2014-15. 2017, 12 (5):e0176692 PLoS ONEen
dc.identifier.issn1932-6203-
dc.identifier.pmid28459838-
dc.identifier.doi10.1371/journal.pone.0176692-
dc.identifier.urihttp://hdl.handle.net/10144/618911-
dc.description.abstractBetween August-December 2014, Ebola Virus Disease (EVD) patients from Tonkolili District were referred for care to two Médecins Sans Frontières (MSF) Ebola Management Centres (EMCs) outside the district (distant EMCs). In December 2014, MSF opened an EMC in Tonkolili District (district EMC). We examined the effect of opening a district-based EMC on time to admission and number of suspect cases dead on arrival (DOA), and identified factors associated with fatality in EVD patients, residents in Tonkolili District. Residents of Tonkolili district who presented between 12 September 2014 and 23 February 2015 to the district EMC and the two distant EMCs were identified from EMC line-lists. EVD cases were confirmed by a positive Ebola PCR test. We calculated time to admission since the onset of symptoms, case-fatality and adjusted Risk Ratios (aRR) using Binomial regression. Of 249 confirmed Ebola cases, 206 (83%) were admitted to the distant EMCs and 43 (17%) to the district EMC. Of them 110 (45%) have died. Confirmed cases dead on arrival (n = 10) were observed only in the distant EMCs. The median time from symptom onset to admission was 6 days (IQR 4,8) in distant EMCs and 3 days (IQR 2,7) in the district EMC (p<0.001). Cases were 2.0 (95%CI 1.4-2.9) times more likely to have delayed admission (>3 days after symptom onset) in the distant compared with the district EMC, but were less likely (aRR = 0.8; 95%CI 0.6-1.0) to have a high viral load (cycle threshold ≤22). A fatal outcome was associated with a high viral load (aRR 2.6; 95%CI 1.8-3.6) and vomiting at first presentation (aRR 1.4; 95%CI 1.0-2.0). The opening of a district EMC was associated with earlier admission of cases to appropriate care facilities, an essential component of reducing EVD transmission. High viral load and vomiting at admission predicted fatality. Healthcare providers should consider the location of EMCs to ensure equitable access during Ebola outbreaks.en
dc.language.isoenen
dc.publisherPublic Library of Scienceen
dc.rightsPublished by Public Library of Science, [url]http://www.plosone.org/[/url] Archived on this site by Open Access permissionen
dc.titleEbola Management Centre Proximity Associated With Reduced Delays of Healthcare of Ebola Virus Disease (EVD) Patients, Tonkolili, Sierra Leone, 2014-15en
dc.identifier.journalPloS Oneen

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