Ebola, jobs and economic activity in Liberia

Impact of Ebola epidemics on the daily operation of existing systems in Eastern Democratic Republic of the Congo: a brief review

AIMS

to provide insights into the recent Ebola virus disease (EVD) outbreaks on different aspects of daily life in the Democratic Republic of the Congo and propose possible solutions.

METHODS

We collected information regarding the effects of EVD outbreaks on existing systems in the eastern part of the Democratic Republic of the Congo (DRC). We searched the PubMed database using the terms "impact effect Ebola outbreak system", "Management Ebola Poor Resources Settings", "Health Economic Challenges Ebola" and "Economic impact Ebola systems." Only studies focusing on epidemiology, diagnostics, sequencing, vaccination, therapeutics, ecology, work force, governance, healthcare provision and health system, and social, political, and economic aspects were considered. The search included the electronic archives of EVD outbreak reports from government and partners.

RESULTS

EVD outbreaks negatively impacts the functions of countries. The disruption in activities is proportional to the magnitude of the epidemic and slows down the transport of goods, decreases the region's tourist appeal, and increases 'brain drain'. Most low- and medium-income countries, such as the DRC, do not have a long-term holistic emergency plan for unexpected situations or sufficient resources to adequately implement countermeasures against EVD outbreaks. Although the DRC has acquired sufficient expertise in diagnostics, genomic sequencing, administration of vaccines and therapeutics, clinical trials, and research activities, deployment, operation, and maintenance of these expertise and associated tools remains a concern.

LIMITATIONS

Despite the data search extension, additional reports addressing issues related to social aspects of EVD outbreaks in DRC were not retrieved.

CONCLUSION

National leadership has not yet taken the lead in strategic, operational, or financial aspects. Therefore, national leaders should double their efforts and awareness to encourage local fundraising, sufficient budget al.location, infrastructure construction, equipment provision, and staff training, to effectively support a holistic approach in response to outbreaks, providing effective results, and all types of research activities.

The economic burden of Ebola virus disease: a review and recommendations for analysis

BACKGROUND

Ebola virus disease (EVD) continues to be a major public health threat globally, particularly in the low-and-middle-income countries (LMICs) of Africa. The social and economic burdens of EVD are substantial and have triggered extensive research into prevention and control. We aim to highlight the impact and economic implications, identify research gaps, and offer recommendations for future economic studies pertaining to EVD.

METHOD

We conducted a comprehensive librarian-led search in PubMed/Medline, Embase, Google Scholar, EconLit and Scopus for economic evaluations of EVD. After study selection and data extraction, findings on the impact and economics of EVD were synthesized using a narrative approach, while identifying gaps, and recommending critical areas for future EVD economic studies.

RESULTS

The economic evaluations focused on the burden of illness, vaccine cost-effectiveness, willingness-to-pay for a vaccine, EVD funding, and preparedness costs. The estimated economic impact of the 2014 EVD outbreak in Guinea, Liberia, and Sierra Leone across studies ranged from $30 billion to $50 billion. Facility construction and modification emerged as significant cost drivers for preparedness. The EVD vaccine demonstrated cost-effectiveness in a dynamic transmission model; resulting in an incremental cost-effectiveness ratio of about $96 per additional disability adjusted life year averted. Individuals exhibited greater willingness to be vaccinated if it incurred no personal cost, with a minority willing to pay about $1 for the vaccine.

CONCLUSIONS

The severe impact of EVD puts pressure on governments and the international community for better resource utilization and re-allocation. Several technical and methodological issues related to economic evaluation of EVD remain to be addressed, especially for LMICs. We recommend conducting cost-of-sequelae and cost-of-distribution analyses in addition to adapting existing economic analytical methods to EVD. Characteristics of the affected regions should be considered to provide evidence-based economic plans and economic-evaluation of mitigations that enhance resource allocation for prevention and treatment.

A Resilience Analysis of a Medical Mask Supply Chain during the COVID-19 Pandemic: A Simulation Modeling Approach

The COVID-19 pandemic has caused severe consequences such as long-term disruptions and ripple effects on regional and global supply chains. In this paper, firstly, we design simulation models using AnyLogistix to investigate and predict the pandemic’s short-term and long-term disruptions on a medical mask supply chain. Then, the Green Field Analysis experiments are used to locate the backup facilities and optimize their inventory levels. Finally, risk analysis experiments are carried out to verify the resilience of the redesigned mask supply chain. Our major research findings include the following. First, when the pandemic spreads to the downstream of the supply chain, the duration of the downstream facilities disruption plays a critical role in the supply chain operation and performance. Second, adding backup facilities and optimizing their inventory levels are effective in responding to the pandemic. Overall, this paper provides insights for predicting the impacts of the pandemic on the medical mask supply chain. The results of this study can be used to redesign a medical mask supply chain to be more resilient and flexible.

Impact of COVID-19 pandemic on African indigenous vegetables value chain in Kenya

Background

African indigenous vegetables are important for food security and nutrition, and income of the poor farm households. In the era of COVID-19, they are critical for boosting people’s immunity. Unfortunately, both production of and trade in these vegetables is likely to be severely affected by the pandemic.

Methods

This study examined potential effects of COVID-19 pandemic on production and trade of African indigenous vegetables using a cross-sectional survey of 244 farmers and 246 traders from different regions in Kenya.

Results

COVID-19 has a negative impact on production and trading of AIVs in Kenya. Findings indicate that 75% of the farmers are experiencing declining production due to reduced access to input, farm labour and output market. Secondly, about 98% of the traders have recorded a drop in sales volumes due to containment measures implemented by the government and personal safety precautions. In particular, farmers’ production and traders’ sales volumes declined by 39 and 65%, respectively, during the first phase of the pandemic.

Conclusion

The findings indicate that the sub-sector requires targeted interventions which may include input support, careful reopening and control of the open-air markets, reduced taxation and facilitated access to urban markets.

Epidemics, pandemics, and social conflict: Lessons from the past and possible scenarios for COVID-19

Since COVID-19 broke out, there has been renewed interest in understanding the economic and social dynamics of historical and more recent epidemics and pandemics, from the plagues of Antiquity to modern-day outbreaks like Ebola. These events can have significant impacts on the interplay between poverty and social cohesion, i.e. how different groups in society interact and cooperate to survive and prosper. To that effect, this paper provides a theory-driven overview of how social responses to past epidemics and pandemics were determined by the epidemiological and non-epidemiological characteristics of these outbreaks, with a particular focus on the conditions giving rise to scapegoating and persecution of minority groups, including migrants. We discuss existing theories as well as historical and quantitative studies, and highlight the cases where epidemics and pandemics may lead to milder or more severe forms of scapegoating. Finally, we conclude with a summary of priorities for future research on epidemics, pandemics and social conflict and discuss the possible effects and policy implications of COVID-19.

Execution and viable applications of face shield "a safeguard" against viral infections of cross-protection studies: A comprehensive review

Face shield are the unmistakable plastic gatekeepers secures eyes and face, simpler to wear and a group of specialists state face shields may supplant masks as an increasingly agreeable and progressively successful obstacle to COVID-19. Face shields are useful in stopping respiratory droplets from speading from the wearer to others. The droplets, which come into contact with the shield, are quickly spread over a large area, both transversely and vertically, over the shield, but with a shrinking concentration of droplets, as opposed to face masks, which appear to slide under the nose of the wearer or, worse, collapse entirely off the shield. Hence, a face- shield can be considered as personal protective equipment (PPE), which is a first line of resistance, utilized by the clinicians and forefront health workers for protection against the infectious body fluid and aerosols. Face-shields are mainly fabricated using polycarbonate material, because of their excellent optical transparency in UVA-visible-IR spectrum and mechanical properties. The goal of this article is to provide researchers working in the same area, as well as health and industrial staff, with a detailed analysis of the usage of face shields against bioaerosols and the need for personal security. The reviews main focus on the background of the face shield, provide assistance in the selection, its design and structure, applications, advantages and disadvantages. Lastly, people's view about the usage of face shield as it becomes an essential part of human beings like an accomplice during this current pandemic situation.

The impact of Covid-19 pandemic: A review on maritime sectors in Malaysia

The coronavirus disease 2019 or Covid-19 pandemic has affected many operations worldwide. This predicament also owes to the lockdown measures imposed by the affected countries. The total lockdown or partial lockdown devised by countries all over the world meant that most economic activities, be put on hold until the outbreak is contained. The decisions made by authorities of each affected country differs according to various factors, including the country's financial stability. This paper reviews the impact of Covid-19 pandemic on maritime sectors, specifically shipping, fisheries, maritime tourism, and oil and gas sector. The period of this study covers economic activities between the month of January towards the end of July 2020. Also discussed in this journal, is the analysis of the potential post-outbreak situation and the economic stimulus package. This paper serves as a reference for future research on this topic.

Perceived ability to comply with national COVID-19 mitigation strategies and their impact on household finances, food security, and mental well-being of medical and pharmacy students in Liberia

INTRODUCTION

From the outset of the COVID-19 pandemic, guidance from WHO has promoted social distancing, wearing face masks, frequent hand washing, and staying-at-home as measures to prevent the spread of COVID-19. For many across Africa, compliance can be difficult. The aim of this study was to 1) understand the impact of student's household's ability to comply with COVID-19 mitigation strategies, 2) identify predictors of mitigation strategy compliance, and 3) describe the impact of COVID-19 on household economics, food-security, and mental well-being.

MATERIALS AND METHODS

We conducted an email-based survey among current medical and pharmacy students of the University of Liberia College of Health Sciences between July and October 2020. The questionnaire was designed to explore their household's ability to comply with current mitigation strategies, as well as the pandemic´s impact on the student's household's finances and food security. Descriptive statistics were used to delineate demographic characteristics. Logistic regression was used to model factors associated with ability to comply with COVID-19 mitigation strategies, as well as participant's food security.

RESULTS

113 persons responded to the questionnaire. Seventy-six (67∙3%) reported income losses as a result of the pandemic, with 93 (82∙3%) reporting being "somewhat" or "very worried" about their households' finances. Seventy-seven (68∙1%) participants reported food stocks that were sufficient for one-week or less. Forty (35%) participants reported eating less preferred foods or skipping meals in the past week. Overall, 20 participants (19∙4%) had a positive depression screen.

CONCLUSIONS

Study participants showed mixed results in being able to adhere to national COVID-19 mitigation strategies, with household level stressors experienced around finances and food security. Until Liberia has access to vaccinations for most of its citizens, COVID-19 response measures need to provide social protections that address basic needs (shelter, clothing and food), and which specifically targets food insecurity. Preventative interventions for mental health problems must be incorporated into Liberia's response to the pandemic.

Haloculture: A system to mitigate the negative impacts of pandemics on the environment, society and economy, emphasizing COVID-19

COVID-19 (coronavirus disease) is a global pandemic that started in China in 2019 and has negatively affected all economic sectors of the world, including agriculture. However, according to estimates in different countries, agriculture has suffered less than other sectors such as construction, industry and tourism, so agricultural development can be a good option to compensate for the economic damage caused to other sectors. The quality of available water and soil resources for agricultural development is not only limited, but is also decreasing incrementally, so the use of saline and unconventional soil and water resources is inevitable. Biosaline agriculture or haloculture is a system in which highly saline water and soil resources are used sustainably for the economic production of agricultural crops. It seems that in the current situation of the world (with COVID-19's impact on agriculture on the one hand and the quantitative and qualitative decline of freshwater and soil on the other), haloculture with a re-reading of territorial capabilities has good potential to provide a part of human food supply. In this review article, the potential of haloculture to offset the adverse impacts of the pandemic is analyzed from five perspectives: increasing the area under cultivation, using unconventional water, stabilizing dust centers, increasing the body's immune resistance, and reducing losses in agribusiness due to the coronavirus. Overall, haloculture is an essential system, which COVID-19 has accelerated in the agricultural sector.

Sunlight sterilized, recyclable and super hydrophobic anti-COVID laser-induced graphene mask formulation for indelible usability

The uncontrollable outbreak of the novel coronavirus (COVID-19) rapidly affected almost 230 countries across the world and territories since last year'2020 and its transmission mainly due to respiratory droplets. To fight and protect against micron dimension (~1.4 µm) corona virus the usage of disposable medical masks is one and only trivial option for patients, doctors, health employers and in fact mandatory for kids to senior citizens, as well as public places in a risky environment. Ordinary medical masks unable to self-sterilize in order to recycle for other appliances resulting further destroying impact of societies high economic and environmental costs. To minimize this global pandemic issue this proposal explores novel mechanism for further commercialization of surgical mask of photo-thermal and self-cleaning functionalization. Indeed, depositing few layer ultra-thin graphene coating onto low-melting temperature non-woven mask by tempering a dual mode laser induced mechanism. Incoming aqueous droplets are bounced off due the super-hydrophobic states were treated on the mask surface. Superficial hydrophobic surface yields an advanced safety towards approaching respiratory droplets. Due to the huge absorption coefficient capability of the sunrays activated laser-induced mask may rapidly boost temperature exceeds 85ºC under sunlight illumination, causes making the mask reusable after sunlight distillation. For SARS/coronavirus/ aerosolized bacteria, laser induced graphene mask is a recent breakthrough in superior antibacterial capacity. Furthermore, cost-effective and ultra-thin layered mask formulation recycled directly utilizes solar-driven desalination with remarkable self-exclusion performance for indelible usability. Featured review article, deals with remarkable achievements from forthcoming experimentation which may be inspired with layered mask designing by more progressive materials.

Health, economic, and social implications of COVID-19 for China's rural population

This study examines the effects of local and nationwide COVID-19 disease control measures on the health and economy of China's rural population. We conducted phone surveys with 726 randomly selected village informants across seven rural Chinese provinces in February 2020. Four villages (0.55%) reported infections, and none reported deaths. Disease control measures had been universally implemented in all sample villages. About 74% of informants reported that villagers with wage-earning jobs outside the village had stopped working due to workplace closures. A higher percentage of rural individuals could not work due to transportation, housing, and other constraints. Local governments had taken measures to reduce the impact of COVID-19. Although schools in all surveyed villages were closed, 71% of village informants reported that students were attending classes online. Overall, measures to control COVID-19 appear to have been successful in limiting disease transmission in rural communities outside the main epidemic area. Rural Chinese citizens, however, have experienced significant economic consequences from the disease control measures.

Covid-19 vs. Ebola: Impact on households and small businesses in North Kivu, Democratic Republic of Congo

In April 2020, the Eastern Democratic Republic of Congo was facing two major infectious disease outbreaks: Covid-19 and Ebola Virus Disease (EVD). We highlight large differences in the socioeconomic impact of these two outbreaks. The data come from a phone survey that we conducted in the period May-July 2020 with 637 households and 363 small firms from a megacity and two rural communes in the province of North Kivu. While 3,470 EVD cases and 2,287 EVD deaths were confirmed since August 2018, self-reported impacts of EVD on revenues, access to food and behavior were limited. In contrast, only 251 Covid-19 cases were reported as of July 22nd but respondents reported sizable effects on livelihoods, especially in the large urban hub, and in part driven by substantial job losses. Our results show that different infectious disease outbreaks can have very different effects, largely unrelated to case numbers of the disease. Moderately lethal but highly transmissible viruses such as Covid-19 can trigger a steep economic downturn, especially in areas with high economic interconnectedness, reflecting both national and international policies to contain the pandemic.

Global collaboration and social practices to mitigate impacts of COVID-19 in the world: a lived experience of infecting

COVID-19 pandemic is one of the most serious threatening conditions and the complex situation in the recent century, which shook the world. This unprecedented crisis has caused many disruptions and distractions for humans in different local and global levels. This reflexive essay aims to review challenges and opportunities originated by the Corona-virus pandemic within social groups through a moral perspective. Focusing on both negative and positive aspects would help us find the required skills and strategies to adapt to the crises and mitigate the issues based on our capacities and resources.

Income-related health inequalities associated with the coronavirus pandemic in South Africa: A decomposition analysis

BACKGROUND

The coronavirus disease 2019 (COVID-19) has resulted in an enormous dislocation of society especially in South Africa. The South African government has imposed a number of measures aimed at controlling the pandemic, chief being a nationwide lockdown. This has resulted in income loss for individuals and firms, with vulnerable populations (low earners, those in informal and precarious employment, etc.) more likely to be adversely affected through job losses and the resulting income loss. Income loss will likely result in reduced ability to access healthcare and a nutritious diet, thus adversely affecting health outcomes. Given the foregoing, we hypothesize that the economic dislocation caused by the coronavirus will disproportionately affect the health of the poor.

METHODS

Using the fifth wave of the National Income Dynamics Study (NIDS) dataset conducted in 2017 and the first wave of the NIDS-Coronavirus Rapid Mobile Survey (NIDS-CRAM) dataset conducted in May/June 2020, this paper estimated income-related health inequalities in South Africa before and during the COVID-19 pandemic. Health was a dichotomized self-assessed health measure, with fair and poor health categorized as "poor" health, while excellent, very good and good health were categorized as "better" health. Household per capita income was used as the ranking variable. Concentration curves and indices were used to depict the income-related health inequalities. Furthermore, we decomposed the COVID-19 era income-related health inequality in order to ascertain the significant predictors of such inequality.

RESULTS

The results indicate that poor health was pro-poor in the pre-COVID-19 and COVID-19 periods, with the latter six times the value of the former. Being African (relative to white), per capita household income and household experience of hunger significantly predicted income-related health inequalities in the COVID-19 era (contributing 130%, 46% and 9% respectively to the inequalities), while being in paid employment had a nontrivial but statistically insignificant contribution (13%) to health inequality.

CONCLUSIONS

Given the significance and magnitude of race, hunger, income and employment in determining socioeconomic inequalities in poor health, addressing racial disparities and hunger, income inequality and unemployment will likely mitigate income-related health inequalities in South Africa during the COVID-19 pandemic.

Self-Reporting and Photothermally Enhanced Rapid Bacterial Killing on a Laser-Induced Graphene Mask

Wearing face masks has been widely recommended to contain respiratory virus diseases, yet the improper use of masks poses a threat of jeopardizing the protection effect. We here identified the bacteria viability on common face masks and found that the majority of bacteria (90%) remain alive after 8 h. Using laser-induced graphene (LIG), the inhibition rate improves to ∼81%. Combined with the photothermal effect, 99.998% bacterial killing efficiency could be attained within 10 min. For aerosolized bacteria, LIG also showed superior antibacterial capacity. The LIG can be converted from a diversity of carbon precursors including biomaterials, which eases the supply stress and environmental pressure amid an outbreak. In addition, self-reporting of mask conditions is feasible using the moisture-induced electricity from gradient graphene. Our results improve the safe use of masks and benefit the environment.

The impact of the COVID-19 pandemic on firms: a survey in Guangdong Province, China

Background

The COVID-19 pandemic has affected all sectors of the world economy and society. To understand the impact of the pandemic on firms in China and suggest public policies to deal with the negative effects, we investigated firms in Guangdong Province.

Methods

The survey sample included 524 firms in 15 cities in Guangdong Province. We chose these firms from the list published by the government, considering the industrial characteristics of Guangdong province and firm size. The questionnaire was developed based on previous studies carried out by UNDP. It comprised four categories with a total of 17 questions. The executives of firms were contacted by telephone or WeChat, and were invited to answer self-administered questionnaires through an online survey platform. The data was analyzed by SPSS.

Results

The following key findings were revealed through the survey: (1) 48.7% of firms maintained stability, and 35.1% experienced a halt in operation or faced closure; (2) Nearly 70-90% already exploit online commerce or are willing to do so, and also remote office work, and digital operations. (3) 46% believe that they will certainly incur losses for 2020, and 83.5% expect the city's GDP to decrease.

Conclusions

Firms in Guangdong Province have faced great challenges in the epidemic. Their production and operation activities have been limited, and they are facing significant risks. It is necessary to implement policies that would profoundly lower production costs for firms, help them survive this difficult period, and gradually return to normal business.

The monetary value of human lives lost through Ebola virus disease in the Democratic Republic of Congo in 2019

BACKGROUND

Between 8 May 2018 and 27 May 2019, cumulatively there were 1286 deaths from Ebola Virus Disease (EVD) in the Democratic Republic of Congo (DRC). The objective of this study was to estimate the monetary value of human lives lost through EVD in DRC.

METHODS

Human capital approach was applied to monetarily value years of life lost due to premature deaths from EVD. The future losses were discounted to their present values at 3% discount rate. The model was reanalysed using 5 and 10% discount rates. The analysis was done alternately using the average life expectancies for DRC, the world, and the Japanese females to assess the effect on the monetary value of years of life lost (MVYLL).

RESULTS

The 1286 deaths resulted in a total MVYLL of Int$17,761,539 assuming 3% discount rate and DRC life expectancy of 60.5 years. The average monetary value per EVD death was of Int$13,801. About 44.7 and 48.6% of the total MVYLL was borne by children aged below 9 years and adults aged between 15 years and 59 years, respectively. Re-estimation of the algorithm with average life expectancies of the world (both sexes) and Japanese females, holding discount rate constant at 3%, increased the MVYLL by Int$ 3,667,085 (20.6%) and Int$ 7,508,498 (42.3%), respectively. The application of discount rates of 5 and 10%, holding life expectancy constant at 60.5 years, reduced the MVYLL by Int$ 4,252,785 (- 23.9%) and Int$ 9,658,195 (- 54.4%) respectively.

CONCLUSION

The EVD outbreak in DRC led to a considerable MVYLL. There is an urgent need for DRC government and development partners to disburse adequate resources to strengthen the national health system and other systems that address social determinants of health to end recurrence of EVD outbreaks.

Precarity, clinical labour and graduation from Ebola clinical research in West Africa

The provision of gifts and payments for healthy volunteer subjects remains an important topic in global health research ethics. This paper provides empirical insights into theoretical debates by documenting participants' perspectives on an Ebola vaccine trial in West Africa. This trial provided hundreds of Africans with regular payments, food packages and certificates for participation. The researchers conducting the trials considered these socioeconomic provisions to be gifts in accordance with contemporary ethical standards and principles. Trial participants viewed them differently, however, approaching trial participation as a means for training and employment in what was from their perspective a new job market: the post-Ebola expansion of research and health care systems. This paper analyses participation in contemporary research by viewing the context-specific histories of trial participants through the lens of prior interventions, specifically participatory reintegration programmes conducted in Anglophone West Africa to overcome civil war crises. In particular, we argue that participation in the Ebola vaccine trial was inadvertently shaped by the design and outcomes of past reintegration programmes. Our results highlight the need to investigate existing socioeconomic landscapes which surround and indeed permeate clinical research as a prerequisite for understanding the participatory motives of vulnerable participants in West Africa and elsewhere.

The impact of the Ebola virus disease (EVD) epidemic on agricultural production and livelihoods in Liberia

There is unequivocal evidence in the literature that epidemics adversely affect the livelihoods of individuals, households and communities. However, evidence in the literature is dominated by the socioeconomic impacts of HIV/AIDS and malaria, while evidence on the impact of the Ebola virus disease (EVD) on households' livelihoods remains fragmented and scant. Our study investigates the effect of the EVD epidemic on the livelihoods of Liberian households using the Sustainable Livelihood Framework (SLF). The study also explores the effect of the EVD epidemic on agricultural production and productive efficiency of farm households using Spatial Stochastic Frontier Analysis (SSFA). We collected data from 623 households across Liberia in 2015, using a systematic random sampling design. Our results indicated that the annual income of sample households from communities where EVD occurred did not differ from the annual income of households from communities where EVD did not occur. Nonetheless, the majority of sample households reported a decrease in their income, compared to their income in the year before the survey. This suggests that the impact of the EVD epidemic might not only have been limited to communities directly affected by the epidemic, but also it may have indirectly affected communities in areas where EVD was not reported. We also found that the community-level incidence of EVD negatively affected crop production of farm households, which may have exacerbated the problem of food insecurity throughout the country. Moreover, we found that the EVD epidemic weakened the society's trust in Liberian institutions. In a nutshell, our results highlight that epidemics, such as the recent EVD outbreak, may have long-lasting negative effects on the livelihoods of a society and their effect may extend beyond the communities directly affected by the epidemics. This means that the nation's recovery from the impact of the epidemic would be more challenging, and the social and economic impacts of the epidemic may extend well beyond the end of the health crisis.

Rebuilding transformation strategies in post-Ebola epidemics in Africa

Rebuilding transformation strategies in post-Ebola epidemics in West Africa requires long-term surveillance and strengthening health system preparedness to disease outbreak. This paper assesses reconstruction efforts from socio-cultural, economic and ecological transformation response approaches and strategies in improving sustainable survivors and affected communities livelihood and wellbeing. A comprehensive approach is required in the recovery and rebuilding processes. Investing in rebuilding transformation requires fostering evidence-based and effective engaging new investors partnership strengthening, financing community-based programmes ownership, novel socio-economic innovations strategies and tools against the evolving and future Ebola epidemics. Thus, there should be improved community partnership, health and economic rebuilding programmes to address mistrust and care underutilization, poverty and care access inequity at all levels. Implementing effective post-Ebola national 'One Health' approach coupled with climate change mitigation and adaptations strategies is urgent public health needs aiming at improving the quality healthcare access, delivery trust and uptake in anticipation of EVD immunization program, productivity and emerging economy.

Patterns of demand for non-Ebola health services during and after the Ebola outbreak: panel survey evidence from Monrovia, Liberia

Introduction

The recent Ebola virus disease (EVD) outbreak was unprecedented in magnitude, duration and geographic scope. Hitherto there have been no population-based estimates of its impact on non-EVD health outcomes and health-seeking behaviour.

Methods

We use data from a population-based panel survey conducted in the late-crisis period and two postcrisis periods to track trends in (1) the prevalence of adult and child illness, (2) subsequent usage of health services and (3) the determinants thereof.

Results

The prevalence of child and adult illness remained relatively steady across all periods. Usage of health services for children and adults increased by 77% and 104%, respectively, between the late-crisis period and the postcrisis periods. In the late-crisis period, (1) socioeconomic factors weakly predict usage, (2) distrust in government strongly predicts usage, (3) direct exposure to the EVD outbreak, as measured by witnessing dead bodies or knowing Ebola victims, negatively predicts trust and usage and (4) exposure to government-organised community outreach predicts higher trust and usage. These patterns do not obtain in the post-crisis period.

Interpretation

Supply-side and socioeconomic factors are insufficient to account for lower health-seeking behaviour during the crisis. Rather, it appears that distrust and negative EVD-related experiences reduced demand during the outbreak. The absence of these patterns outside the crisis period suggests that the rebound after the crisis reflects recovery of demand. Policymakers should anticipate the importance of demand-side factors, including fear and trust, on usage of health services during health crises.