Changes in Health-Seeking Behavior Did Not Result in Increased All-Cause Mortality During the Ebola Outbreak in Western Area, Sierra Leone
Abstract
Little is known about the residual effects of the west African Ebola virus disease (Ebola) epidemic on non-Ebola mortality and health-seeking behavior in Sierra Leone. We conducted a retrospective household survey to estimate mortality and describe health-seeking behavior in Western Area, Sierra Leone, between May 25, 2014, and February 16, 2015. We used two-stage cluster sampling, selected 30 geographical sectors with probability proportional to population size, and sampled 30 households per sector. Survey teams conducted face-to-face interviews and collected information on mortality and health-seeking behavior. We calculated all-cause and Ebola-specific mortality rates and compared health-seeking behavior before and during the Ebola epidemic using χ(2) and Fisher's exact tests. Ninety-six deaths, 39 due to Ebola, were reported in 898 households. All-cause and Ebola-specific mortality rates were 0.52 (95% confidence interval [CI] = 0.29-0.76) and 0.19 (95% CI = 0.01-0.38) per 10,000 inhabitants per day, respectively. Of those households that reported a sick family member during the month before the survey, 86% (73/85) sought care at a health facility before the epidemic, compared with 58% (50/86) in February 2015 (P = 0.013). Reported self-medication increased from 4% (3/85) before the epidemic to 23% (20/86) during the epidemic (P = 0.013). Underutilization of health services and increased self-medication did not show a demonstrable effect on non-Ebola-related mortality. Nevertheless, the residual effects of outbreaks need to be taken into account for the future. Recovery efforts should focus on rebuilding both the formalized health system and the population's trust in it.PubMed ID
27458039Additional Links
http://www.ajtmh.orgLanguage
enDescription
We regret that this article is behind a paywall.ISSN
1476-1645ae974a485f413a2113503eed53cd6c53
10.4269/ajtmh.16-0295
Scopus Count
Collections
Related articles
- Cluster of Ebola Virus Disease Linked to a Single Funeral - Moyamba District, Sierra Leone, 2014.
- Authors: Curran KG, Gibson JJ, Marke D, Caulker V, Bomeh J, Redd JT, Bunga S, Brunkard J, Kilmarx PH
- Issue date: 2016 Mar 4
- Community-based reports of morbidity, mortality, and health-seeking behaviours in four Monrovia communities during the West African Ebola epidemic.
- Authors: McLean KE, Abramowitz SA, Ball JD, Monger J, Tehoungue K, McKune SL, Fallah M, Omidian PA
- Issue date: 2018 May
- The impact of active surveillance and health education on an Ebola virus disease cluster - Kono District, Sierra Leone, 2014-2015.
- Authors: Stehling-Ariza T, Rosewell A, Moiba SA, Yorpie BB, Ndomaina KD, Jimissa KS, Leidman E, Rijken DJ, Basler C, Wood J, Manso D
- Issue date: 2016 Oct 27
- Public Confidence in the Health Care System 1 Year After the Start of the Ebola Virus Disease Outbreak - Sierra Leone, July 2015.
- Authors: Li W, Jalloh MF, Bunnell R, Aki-Sawyerr Y, Conteh L, Sengeh P, Redd JT, Hersey S, Morgan O, Jalloh MB, O'Leary A, Burdette E, Hageman K
- Issue date: 2016 Jun 3
- Clinical features of suspected Ebola cases referred to the Moyamba ETC, Sierra Leone: challenges in the later stages of the 2014 outbreak.
- Authors: Arranz J, Lundeby KM, Hassan S, Zabala Fuentes LM, San José Garcés P, Haaskjold YL, Bolkan HA, Krogh KØ, Jongopi J, Mellesmo S, Jøsendal O, Øpstad Å, Svensen E, Kamara AS, Roberts DP, Stamper PD, Austin P, Moosa AJ, Marke D, Berg Å, Blomberg B, Riera M
- Issue date: 2016 Jun 22