• Case-study: A retrospective assessment of transmission of Ebola virus disease (EVD) through a rural Sierra Leonean community and the impact on mortality and health seeking behaviours.

      Duncombe, Jennifer; Caleo, Grazia; Mills, Clair; Passmore, Charlotte; Kremer, Ronald; Lokuge, Kamalini; Greig, Jane; Lamin, Manjo; MSF-OCA (2018-07)
      OBJECTIVES 2.1. PRIMARY OBJECTIVES  To provide a comprehensive description of mortality and transmission of EVD and the community response to EVD in one rural Sierra Leonean community in Kailahun District throughout the course of an outbreak. 2.2. SECONDARY OBJECTIVES 1. Describe the transmission and associated morbidity and mortality of EVD within the village throughout the course of the outbreak, with particular attention to the period prior to the MSF Ebola Management Centre (EMC) opening in Kailahun district (May-June 2014) and the period during which it was receiving cases from the village under study (July-November 2014). 2. Estimate overall and cause-specific mortality (EVD and non-EVD) in under-5 and 5 and older populations within the study village 3. Estimate the secondary cases due to Ebola in quarantined and non-quarantined households. 4. Document the broader impact of the Ebola virus outbreak on health-seeking behaviours and disease outcomes in general, including changes in access to healthcare, illness beliefs and perceptions of healthcare providers. 5. Determine level and factors associated with access and uptake of MSF EMC services within affected households.
    • Maternal and child health care seeking behaviour: a household survey and interview study in an urban and rural area of Sierra Leone, 2016

      Elston, James; Snag, Sibylle; Kazungu, Donald Sonne; Jimissa, A; Caleo, Grazia; Danis, Kostas; Lokuge, Kamalini; Black, Benjamin; Gray, Nell; MSF-OCA (2018-07)
      To describe health seeking behaviour during pregnancy, for childbirth and in children under the age of five years, and to identify barriers to accessing and receiving healthcare services at the time of the study and since the start of the Ebola outbreak in an urban and rural area of Tonkolili District. 2.2 PRIMARY OBJECTIVES 1. To estimate utilisation of health facilities by women for childbirth in Magburaka town and Yoni chiefdom since the start of the Ebola outbreak ; 2. To estimate utilisation of healthcare services by children aged <5 years in Magburaka town and Yoni chiefdom during their most recent febrile illness within the three month period preceding the day of the survey. 3. To identify and describe factors influencing utilisation of health services and delays in seeking and receiving adequate healthcare during pregnancy and for childbirth 4. To identify and describe factors influencing utilisation of health services and delays in seeking and receiving adequate healthcare for febrile illness in children aged <5 years
    • Research Protocol - Inpatient signs and symptoms and factors associated with death among children aged ≤5 years admitted to two Ebola Management Centres in Sierra Leone, 2014: a retrospective cohort study

      Shah, Tejshri; Caleo, Grazia; Lokuge, Kamalini (2015-12-16)
      1. To describe the source case for children 2. To describe the viral load at presentation 3. To document the intervals between symptom onset and presentation for those who die and those who survive 4. To describe early symptoms of Ebola virus disease 5. To assess the association between risk factors and death
    • Research Protocol - Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study

      Shah, Tejshri; Greig, Jane; van der Plas, LM; Achar, J; Caleo, Grazia; Squire, James Sylvester; Turay, AS; Joshy, G; D’Este, C; Banks, E; et al. (2016-07)
      Background Médecins Sans Frontières (MSF) opened Ebola management centres (EMCs) in Sierra Leone in Kailahun in June, 2014, and Bo in September, 2014. Case fatality in the west African Ebola virus disease epidemic has been highest in children younger than 5 years. Clinical data on outcomes can provide important evidence to guide future management. However, such data on children are scarce and disaggregated clinical data across all ages in this epidemic have focussed on symptoms reported on arrival at treatment facilities, rather than symptoms and signs observed during admission. We aimed to describe the clinical characteristics of children aged 5 years and younger admitted to the MSF EMCs in Bo and Kailahun, and any associations between these characteristics and mortality. Methods In a retrospective cohort study, we included data from children aged 5 years and younger with laboratory-confirmed Ebola virus disease admitted to EMCs between June and December, 2014. We described epidemiological, demographic, and clinical characteristics and viral load (measured using Ebola virus cycle thresholds [Ct]), and assessed their association with death using Cox regression modelling. Findings We included 91 children in analysis; 52 died (57·1%). Case fatality was higher in children aged less than 2 years (76·5% [26/34]) than those aged 2–5 years (45·6% [26/57]; adjusted HR 3·5 [95% CI 1·5–8·5]) and in those with high (Ct<25) versus low (Ct≥25) viral load (81·8% [18/22] vs 45·9% [28/61], respectively; adjusted HR 9·2 [95% CI 3·8–22·5]). Symptoms observed during admission included: weakness 74·7% (68); fever 70·8% (63/89); distress 63·7% (58); loss of appetite 60·4% (55); diarrhoea 59·3% (54); and cough 52·7% (48). At admission, 25% (19/76) of children were afebrile. Signs significantly associated with death were fever, vomiting, and diarrhoea. Hiccups, bleeding, and confusion were observed only in children who died. Interpretation This description of the clinical features of Ebola virus disease over the duration of illness in children aged 5 years and younger shows symptoms associated with death and a high prevalence of distress, with implications for clinical management. Collection and analysis of age-specific data on Ebola is very important to ensure that the specific vulnerabilities of children are addressed.
    • Retrospective population-based mortality survey in an urban and rural area of Sierra Leone, 2015

      Caleo, Grazia; Kardamanidis, Katina; Broeder, Rob; Belava, Jaroslava; Kremer, Ronald; Lokuge, Kamalini; Greig, Jane; Turay; Saffa, Gbessay; MSF-OCA (2018-07)
      2. Objectives 2.1. Primary objectives The Primary objective of the survey is to:  Estimate mortality in a sample of the population in the urban and rural area of Bo District from the approximate start of the Ebola outbreak in Sierra Leone (mid May 2014) until the day of the survey. 2.2. Secondary objectives  Estimate overall and cause-specific mortality (EVD and non-EVD) in children under the age of 5 years, and the population aged 5 years and older within the study area, with particular attention to the period prior to the MSF Ebola Management Centre (EMC) opening in Bo district (19 September 2014) and the period during which it was receiving cases from the district (last confirmed case exited 26 January 2015);  Estimate overall and cause-specific mortality (EVD and non-EVD) in quarantined and non-quarantined households; and contact-traced and non-contact-traced households;  Describe health seeking behaviour in terms of whether health care was sought, where health care was sought and whether access to health care was possible.
    • Review of MSF-OCA surveillance and alert response in Freetown during the Ebola outbreak: lessons learned and challenges

      West, Kim; Greig, Jane; Lokuge, Kamalini; Caleo, Grazia; Stringer, Beverley; Korr, Gerit Solveig; MSF-OCA (2018-07)
      Aim: To reduce suffering, morbidity and mortality by containing and reducing the spread of Ebola Virus Disease (EVD), while preserving human dignity for the affected population in Sierra Leone. Purpose: To reduce and ultimately eliminate the transmission of EVD in a defined catchment population in Freetown. Objectives: • Provide epidemiological technical support to intensify surveillance, supervision of the alert response and enhanced case investigation in the defined area. • Assess and respond to current gaps in infection prevention and control, water and sanitation, and triage in health facilities within the defined area. • Assess community social mobilisation, health promotion, contact tracing and quarantine interventions in the defined area and respond to any gaps through advocacy towards the relevant pillar/organization and/or through direct MSF intervention. • Prioritise MSF and health staff safety & biosecurity at all times • Medical (non-Ebola) and humanitarian needs of the population are monitored, recorded, analysed and responded to through advocacy or MSF action.