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Das U, Fielding D. Higher local Ebola incidence causes lower child vaccination rates. Sci Rep 2024; 14:1382. [PMID: 38228678 PMCID: PMC10791637 DOI: 10.1038/s41598-024-51633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/08/2024] [Indexed: 01/18/2024] Open
Abstract
Ebola is a highly infectious and often fatal zoonotic disease endemic to West and Central Africa. Local outbreaks of the disease are common, but the largest recorded Ebola epidemic originated in Guinea in December 2013, spreading to Liberia, and Sierra Leone in the following year and lasting until April 2016. The epidemic presented a serious challenge to local healthcare systems and foreign aid agencies: it degraded services, caused the loss of healthcare professionals, disrupted the economy, and reduced trust in modern healthcare. This study aims to estimate the extent to which variation in one long-term measure of the quality of local healthcare (the child vaccination rate) is a consequence of local variation in the intensity of the epidemic. Applying a "difference-in-differences" model to household survey data from before and after the epidemic, we show that in 2018-2019, overall rates of vaccination for BCG, DPT, measles, and polio are lower in Guinean and Sierra Leonean districts that had a relatively high incidence of Ebola; statistical analysis indicates that this is a causal effect. The effects of the epidemic on access to healthcare have been local effects, at least in part.
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Affiliation(s)
- Upasak Das
- Global Development Institute, University of Manchester, Manchester, M13 9PL, UK
| | - David Fielding
- Global Development Institute, University of Manchester, Manchester, M13 9PL, UK.
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Ravi SJ, Potter CM, Paina L, Merritt MW. Post-epidemic health system recovery: A comparative case study analysis of routine immunization programs in the Republics of Haiti and Liberia. PLoS One 2023; 18:e0292793. [PMID: 37847680 PMCID: PMC10581452 DOI: 10.1371/journal.pone.0292793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 09/28/2023] [Indexed: 10/19/2023] Open
Abstract
Large-scale epidemics in resource-constrained settings disrupt delivery of core health services, such as routine immunization. Rebuilding and strengthening routine immunization programs following epidemics is an essential step toward improving vaccine equity and averting future outbreaks. We performed a comparative case study analysis of routine immunization program recovery in Liberia and Haiti following the 2014-16 West Africa Ebola epidemic and 2010s cholera epidemic, respectively. First, we triangulated data between the peer-reviewed and grey literature; in-depth key informant interviews with subject matter experts; and quantitative metrics of population health and health system functioning. We used these data to construct thick descriptive narratives for each case. Finally, we performed a cross-case comparison by applying a thematic matrix based on the Essential Public Health Services framework to each case narrative. In Liberia, post-Ebola routine immunization coverage surpassed pre-epidemic levels, a feat attributable to investments in surveillance, comprehensive risk communication, robust political support for and leadership around immunization, and strong public-sector recovery planning. Recovery efforts in Haiti were fragmented across a broad range of non-governmental agencies. Limitations in funding, workforce development, and community engagement further impeded vaccine uptake. Consequently, Haiti reported significant disparities in subnational immunization coverage following the epidemic. This study suggests that embedding in-country expertise within outbreak response structures, respecting governmental autonomy, aligning post-epidemic recovery plans and policies, and integrating outbreak response assets into robust systems of primary care contribute to higher, more equitable levels of routine immunization coverage in resource-constrained settings recovering from epidemics.
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Affiliation(s)
- Sanjana J. Ravi
- The Johns Hopkins Center for Health Security, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Christina M. Potter
- The Johns Hopkins Center for Health Security, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ligia Paina
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Maria W. Merritt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, United States of America
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Cooper S, Bicaba F, Tiendrebeogo CO, Bila A, Bicaba A, Druetz T. Vaccination coverage in rural Burkina Faso under the effects of COVID-19: evidence from a panel study in eight districts. BMC Health Serv Res 2023; 23:1016. [PMID: 37735414 PMCID: PMC10512531 DOI: 10.1186/s12913-023-10029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Improving infant immunization completion and promoting equitable vaccination coverage are crucial to reducing global under-5 childhood mortality. Although there have been hypotheses that the impact of the COVID-19 pandemic would decrease the delivery of health services and immunization campaigns in low- and middle-income countries, the available evidence is still inconclusive. We conducted a study in rural Burkina Faso to assess changes in vaccination coverage during the pandemic. A secondary objective was to examine long-term trends in vaccination coverage throughout 2010-2021. METHODS Using a quasi-experimental approach, we conducted three rounds of surveys (2019, 2020, 2021) in rural Burkina Faso that we pooled with two previous rounds of demographic and household surveys (2010, 2015) to assess trends in vaccination coverage. The study population comprised infants aged 0-13 months from a sample of 325 households randomly selected in eight districts (n = 736). We assessed vaccination coverage by directly observing the infants' vaccination booklet. Effects of the pandemic on infant vaccination completion were analyzed using multi-level logistic regression models with random intercepts at the household and district levels. RESULTS A total of 736 child-year observations were included in the analysis. The proportion of children with age-appropriate complete vaccination was 69.76% in 2010, 55.38% in 2015, 50.47% in 2019-2020, and 64.75% in 2021. Analyses assessing changes in age-appropriate full-vaccination coverage before and during the pandemic show a significant increase (OR: 1.8, 95% CI: 1.14-2.85). Our models also confirmed the presence of heterogeneity in full vaccination between health administrative districts. The pandemic could have increased inequities in infant vaccination completion between these districts. The analyses suggest no disruption in age-appropriate full vaccination due to COVID-19. Our findings from our sensitivity analyses to examine trends since 2010 did not show any steady trends. CONCLUSION Our findings in Burkina Faso do not support the predicted detrimental effects of COVID-19 on the immunization schedule for infants in low- and middle-income countries. Analyses comparing 2019 and 2021 show an improvement in age-appropriate full vaccination. Regardless of achieving and sustaining vaccination coverage levels in Burkina Faso, this should remain a priority for health systems and political agendas.
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Affiliation(s)
- Sarah Cooper
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique, Montreal, QC, Canada
| | - Frank Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
- Sciences de la Vie et de la Santé, University Aix-Marseille, Marseille, France
| | - Cheick Oumar Tiendrebeogo
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique, Montreal, QC, Canada
| | - Alice Bila
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Thomas Druetz
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
- Centre de recherche en santé publique, Montreal, QC, Canada.
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
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Ghaznavi C, Eguchi A, Suu Lwin K, Yoneoka D, Tanoue Y, Kumar Rauniyar S, Horiuchi S, Hashizume M, Nomura S. Estimating global changes in routine childhood vaccination coverage during the COVID-19 pandemic, 2020-2021. Vaccine 2023:S0264-410X(23)00583-2. [PMID: 37246068 DOI: 10.1016/j.vaccine.2023.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/13/2023] [Accepted: 05/13/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has disrupted the distribution of routine immunizations globally. Multi-country studies assessing a wide spectrum of vaccines and their coverage rates are needed to determine global performance in achieving vaccination goals. METHODS Global vaccine coverage data for 16 antigens were obtained from WHO/UNICEF Estimates of National Immunization Coverage. Tobit regression was performed for all country-antigen pairs for which data were continuously available between 2015-2020 or 2015-2021 to predict vaccine coverage in 2020/2021. Vaccines for which multi-dose data were available were assessed to determine whether vaccine coverage for subsequent doses were lower than that of first doses. RESULTS Vaccine coverage was significantly lower-than-predicted for 13/16 antigens in 2020 and all assessed antigens in 2021. Lower-than-predicted vaccine coverage was typically observed in South America, Africa, Eastern Europe, and Southeast Asia. There was a statistically significant coverage drop for subsequent doses of the diphtheria-tetanus-pertussis, pneumococcus, and rotavirus vaccines compared to first doses in 2020 and 2021. CONCLUSION The COVID-19 pandemic exerted larger disruptions to routine vaccination services in 2021 than in 2020. Global efforts will be needed to recoup vaccine coverage losses sustained during the pandemic and broaden vaccine access in areas where coverage was previously inadequate.
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Affiliation(s)
- Cyrus Ghaznavi
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Medical Education Program, Washington University School of Medicine in St Louis, Saint Louis, USA.
| | - Akifumi Eguchi
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Kaung Suu Lwin
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Yoneoka
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Tokyo Foundation for Policy Research, Tokyo, Japan; Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuta Tanoue
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Institute for Business and Finance, Waseda University, Tokyo, Japan
| | - Santosh Kumar Rauniyar
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sayaka Horiuchi
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuhei Nomura
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Tokyo Foundation for Policy Research, Tokyo, Japan
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Wisniewski J, Worges M, Lusamba-Dikassa PS. Impact of a free care policy on routine health service volumes during a protracted Ebola virus disease outbreak in the Democratic Republic of Congo. Soc Sci Med 2023; 322:115815. [PMID: 36889222 DOI: 10.1016/j.socscimed.2023.115815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 02/02/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND In response to the DRC's 10th Ebola Virus Disease (EVD) outbreak, the government subsidized routine health services in select health zones with the goal of maintaining routine service volumes. We assess the impact of the initial and revised Free Care Policies (FCP) on total clinic visits, uncomplicated malaria, simple pneumonia, fourth antenatal care clinic visits, and measles vaccinations, testing the hypothesis that routine services would not significantly decrease during the FCP. METHODS AND FINDINGS We used data from the DRC's national health information system spanning January 2017 to November 2020. Intervention facilities were those that were initially and secondarily enrolled in the FCP, which occurred in August 2018 and November 2018, respectively. Comparison facilities were limited to the North Kivu Province and were from health zones that recorded at least one case of Ebola. A controlled interrupted time series analysis was conducted. The FCP appeared to have a positive effect in increasing overall clinic attendance rates, uncomplicated malaria case rates, and simple pneumonia case rates in those health zones where the policy was enacted relative to comparison sites. The longer-term effects of the FCP were mostly non-significant or, if significant, relatively modest in nature. Rates for measles vaccinations and fourth ANC clinic visits appeared to be unaffected or minimally affected, respectively, by the implementation of the FCP and relative to comparison sites. We did not observe the decrease in measles vaccinations that has been observed elsewhere. The study is limited in that we were unable to account for health facility bypassing and service volumes at private health facilities. CONCLUSIONS Our findings provide evidence that FCPs can be used to maintain routine service provision during outbreaks. Additionally, the study design demonstrates that routinely reported health information from the DRC are sensitive enough to detect changes in health policy.
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Affiliation(s)
- Janna Wisniewski
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St. Suite 2200, New Orleans, Louisiana, USA.
| | - Matt Worges
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St. Suite 2200, New Orleans, Louisiana, USA.
| | - Paul-Samson Lusamba-Dikassa
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St. Suite 2200, New Orleans, Louisiana, USA; University of Kinshasa School of Public Health, Faculty of Medicine, Kinshasa, Congo.
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Lunghi I, Babington-Ashaye A, Vassalli JD, Heller Y, Michaud PA, Wernli D, Heller O, Flahault A, Dagron S. The impact of the Ebola epidemics on children's rights: a scoping review. Glob Health Action 2022; 15:2061240. [PMID: 35506948 PMCID: PMC9090402 DOI: 10.1080/16549716.2022.2061240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The Ebola virus is known as one of the deadliest pathogens to infect humans. Children represent a minority of Ebola Virus Disease cases globally. Yet, the different Ebola outbreaks in Africa had a wide impact on children's lives and children' rights. OBJECTIVE Review the published literature to date on Children's rights during Ebola outbreaks. Outcomes shall contribute to get a better understanding of the main limitations or violations of children's rights, identify potential gaps in the literature and support the promotion and protection of children's rights for current and future health crisis. METHODS A scoping review from PubMed, Medline, Cochrane Library and Web of Science was performed using PRISMA-ScR guidelines. Articles, reports and editorial, published on Ebola Outbreaks between 1976 and 2020 were retrieved. The UNCRC clusters of rights and treaty specific guidelines were used as a framework. Documents were found through a targeted search of websites from international or regional organisations involved in Ebola crises and children's protection. RESULTS 48 articles and reports were reviewed. Few documents focused solely on children's rights. Several articles covered the topic of children and Ebola outbreaks. Most of the data are linked to basic health, education, discrimination of orphans and survivors. 31% of the reviewed articles underline the violence against the children (rape, abuse, Female genital mutilations), while 21% focus on the right to education. 23% cover the topic of orphans. Impact on mental health and SRH were amongst the other covered topics. CONCLUSION A lack of data on children's rights and their violations during epidemics is observed. Regional and international collaboration is needed to document the situation of children in health emergencies. Health measures and strategies based on children's opinions and raising awareness of their crucial role in society is key. Child-centred guidelines should be developed based on these elements.
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Affiliation(s)
- Irene Lunghi
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Awa Babington-Ashaye
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Dominique Vassalli
- International Institute for the rights of the child (Institut International des Droits de l’Enfant, IDE), Sion, Switzerland
| | - Yvon Heller
- International Institute for the rights of the child (Institut International des Droits de l’Enfant, IDE), Sion, Switzerland
| | | | - Didier Wernli
- Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Olivia Heller
- Department of Primary Care, Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Antoine Flahault
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphanie Dagron
- Faculties of Law and Medicine, Global Studies Institute, University of Geneva, Geneva, Switzerland,CONTACT Stéphanie Dagron University of Geneva Global Studies Institute Sciences II- 30, Quai Ernest-Ansermet Case Postale CH-1211 Genève 4, Geneva, Switzerland
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Child mortality after the Ebola virus disease outbreak across Guinea, Liberia, and Sierra Leone. Int J Infect Dis 2022; 122:944-952. [PMID: 35781098 DOI: 10.1016/j.ijid.2022.06.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/30/2022] [Accepted: 06/27/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The Ebola virus disease outbreak in 2014-2016 had a substantial impact on population health in Guinea, Liberia, and Sierra Leone. This study aimed to assess whether the impact continued after the outbreak ended in regards to child mortality. METHODS Cross-sectional logistic regressions were run using data from the Demographic and Health Surveys in the three countries. RESULTS The average child mortality rate was significantly lower for children born after the outbreak ended than those born before. However, the association of the child mortality rate with an increase in the number of cases per 100,000 was significantly stronger for children born after the outbreak ended. Also, the change in the utilization of maternal health services after the outbreak varied across health services. CONCLUSIONS Restoring disrupted child health services to pre-Ebola levels may be more difficult in areas that suffered a higher number of cases. The recovery of maternal health services after the outbreak might be affected by factors such as the resilience of health systems at the subnational level. This study suggests that strengthening health system is crucial to fully recover from the Ebola outbreak and to cope with future epidemics.
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Chepkurui V, Amponsah-Dacosta E, Haddison EC, Kagina BM. Characterization of National Immunization Programs in the Context of Public Health Emergencies: A Case Study of 13 Countries in the WHO Africa Region. Front Public Health 2021; 9:736532. [PMID: 34650952 PMCID: PMC8505981 DOI: 10.3389/fpubh.2021.736532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
Multiple public health emergencies (PHEs) experienced annually in the World Health Organisation (WHO) Africa region affect the provision of health services, including immunization. However, there is limited information on the performance of national immunization programs (NIPs) in WHO Africa countries that experience PHEs. This study assessed PHEs (armed conflicts, disasters, and disease outbreaks) and the performance of NIPs using global and regional immunization targets outlined for the Decade of Vaccines. Thirteen beneficiary countries of PHE mitigation funds from the African Public Health Emergency Fund were used as case studies. Data on PHEs and immunization indicators between 2010 and 2019 in selected countries were extracted from different PHE databases and the WHO/UNICEF immunization database, respectively. The data were stratified by country and summarized using descriptive statistics. Mann-Whitney U test was done to determine the association between the frequency of PHEs and the performance of NIPs. There were 175 disease outbreaks, 288 armed conflicts, and 318 disasters in the examined countries between 2010 and 2019. The Democratic Republic of Congo had the highest total PHE count (n = 208), while Liberia had the lowest (n = 20). Only three of the 13 countries had a median coverage value for the third dose of the combined Diphtheria, Tetanus, and Pertussis vaccine (DTP3) that had attained the target for ≥90% immunization coverage. Higher counts of armed conflict and total PHEs were associated with not meeting immunization targets for national DTP3 coverage of ≥90% and Maternal and Neonatal Tetanus elimination, p < 0.01. It was clear that in the WHO Africa region, PHEs are prevalent, irrespective of a country’s level of immunization maturity, and have the potential to derail the progress of NIPs in the absence of effective interventions. As we transition toward the Immunization Agenda 2030, we recommend that the WHO Africa region prioritizes interventions to mitigate the impacts of PHEs on NIPs.
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Affiliation(s)
- Viola Chepkurui
- Faculty of Health Science, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Edina Amponsah-Dacosta
- Faculty of Health Science, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Benjamin Mugo Kagina
- Faculty of Health Science, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Gray KL, Walker NF, Martineau F, Bhadelia N, Harmon-Gray WM, Skrip LA, DeMarco J, Konwloh P, Dunbar N. Interruption of tuberculosis detection and care during the Ebola virus disease epidemic (2014-2015) in Liberia: time-series analyses for 2013-2017. Int J Infect Dis 2021; 112:13-20. [PMID: 34433096 DOI: 10.1016/j.ijid.2021.08.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Interrupted time-series analyses, using 5 years of routinely collected health information system data, were conducted to estimate the magnitude of impact of the 2014-2015 Ebola virus disease (EVD) epidemic and determine trends in tuberculosis (TB) care services in Liberia. METHODS A segmented linear regression model was used to generate estimates and predictions for trends for three TB service indicators before, during, and after EVD, from January 2013 to December 2017. RESULTS It was found that the number of presumptive TB cases declined significantly at the start of the EVD outbreak, with an estimated loss of 3222 cases (95% confidence interval (CI) -5691 to -752; P = 0.014). There was also an estimated loss of 709 cases per quarter post-EVD (95% CI -1346 to -71; P = 0.032). However, over the post-EVD period, quarterly increases were observed in the proportion of smear-positive to presumptive cases (1.45%, 95% CI 0.38% to 2.5%; P = 0.011) and the proportion of treatment success to TB cases evaluated (3.3%, 95% CI 0.82% to 5.79%; P = 0.013). CONCLUSIONS These findings suggest that the EVD outbreak (2014-2015) negatively affected TB care services. Rigorous quantitative analyses can be used to assess the magnitude of interruption and advocate for preparedness in settings with limited healthcare capacity.
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Affiliation(s)
| | | | | | | | | | | | - Jean DeMarco
- University of North Carolina, Chapel Hill, North Carolina, USA
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Shapira G, Ahmed T, Drouard SHP, Amor Fernandez P, Kandpal E, Nzelu C, Wesseh CS, Mohamud NA, Smart F, Mwansambo C, Baye ML, Diabate M, Yuma S, Ogunlayi M, Rusatira RJDD, Hashemi T, Vergeer P, Friedman J. Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-Saharan African countries. Health Policy Plan 2021; 36:1140-1151. [PMID: 34146394 PMCID: PMC8344431 DOI: 10.1093/heapol/czab064] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/01/2021] [Accepted: 05/27/2021] [Indexed: 12/31/2022] Open
Abstract
The coronavirus-19 pandemic and its secondary effects threaten the continuity of essential health services delivery, which may lead to worsened population health and a protracted public health crisis. We quantify such disruptions, focusing on maternal and child health, in eight sub-Saharan countries. Service volumes are extracted from administrative systems for 63 954 facilities in eight countries: Cameroon, Democratic Republic of Congo, Liberia, Malawi, Mali, Nigeria, Sierra Leone and Somalia. Using an interrupted time series design and an ordinary least squares regression model with facility-level fixed effects, we analyze data from January 2018 to February 2020 to predict what service utilization levels would have been in March-July 2020 in the absence of the pandemic, accounting for both secular trends and seasonality. Estimates of disruption are derived by comparing the predicted and observed service utilization levels during the pandemic period. All countries experienced service disruptions for at least 1 month, but the magnitude and duration of the disruptions vary. Outpatient consultations and child vaccinations were the most commonly affected services and fell by the largest margins. We estimate a cumulative shortfall of 5 149 491 outpatient consultations and 328 961 third-dose pentavalent vaccinations during the 5 months in these eight countries. Decreases in maternal health service utilization are less generalized, although significant declines in institutional deliveries, antenatal care and postnatal care were detected in some countries. There is a need to better understand the factors determining the magnitude and duration of such disruptions in order to design interventions that would respond to the shortfall in care. Service delivery modifications need to be both highly contextualized and integrated as a core component of future epidemic response and planning.
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Affiliation(s)
- Gil Shapira
- Development Research Group, The World Bank, 1818 H St NW, Washington, DC 20433, USA
| | - Tashrik Ahmed
- Development Research Group, The World Bank, 1818 H St NW, Washington, DC 20433, USA
| | | | - Pablo Amor Fernandez
- Development Research Group, The World Bank, 1818 H St NW, Washington, DC 20433, USA
| | - Eeshani Kandpal
- Development Research Group, The World Bank, 1818 H St NW, Washington, DC 20433, USA
| | - Charles Nzelu
- Nigeria Federal Ministry of Health, Federal Secretariat Complex, Phase III, Shehu Shagari Way, Central Business District, Abuja, Nigeria
| | | | - Nur Ali Mohamud
- Somalia Ministry of Health, Corso Somalia, Mogadishu, Somalia
| | - Francis Smart
- Sierra Leone Ministry of Health and Sanitation, Wilkinson Road, Freetown, Sierra Leone
| | | | - Martina L Baye
- Cameroun Ministére de la Sante Publiqué, Ave Marchand, Yaoundé, Cameroon
| | - Mamatou Diabate
- Ministère de la Santé et de l’Hygiène Publique du Mali, Cité Administrative Bamako, Bamako BP 232, Mali
| | - Sylvain Yuma
- Republique Democratique du Congo Ministére de la Sante, Boulevard du 30 juin #4310, Commune de la Gombe B.P. 3088 Kinshasa/Gombe, République Démocratique du Congo
| | - Munirat Ogunlayi
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H ST NW, Washington, DC, 204333, USA
| | - Rwema Jean De Dieu Rusatira
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H ST NW, Washington, DC, 204333, USA
| | - Tawab Hashemi
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H ST NW, Washington, DC, 204333, USA
| | - Petra Vergeer
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H ST NW, Washington, DC, 204333, USA
| | - Jed Friedman
- Development Research Group, The World Bank, 1818 H St NW, Washington, DC 20433, USA
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Inzaule SC, Ondoa P, Loembe MM, Tebeje YK, Ouma AEO, Nkengasong JN. COVID-19 and indirect health implications in Africa: Impact, mitigation measures, and lessons learned for improved disease control. PLoS Med 2021; 18:e1003666. [PMID: 34161318 PMCID: PMC8266084 DOI: 10.1371/journal.pmed.1003666] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
Seth Inzaule and co-authors discuss implications of the COVID-19 pandemic for health in African countries.
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Affiliation(s)
- Seth C. Inzaule
- Africa Centres for Disease Control and Prevention, African Union Headquarters, Addis Ababa, Ethiopia
| | - Pascale Ondoa
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | | | - Yenew Kebede Tebeje
- Africa Centres for Disease Control and Prevention, African Union Headquarters, Addis Ababa, Ethiopia
| | - Ahmed E Ogwell Ouma
- Africa Centres for Disease Control and Prevention, African Union Headquarters, Addis Ababa, Ethiopia
| | - John N. Nkengasong
- Africa Centres for Disease Control and Prevention, African Union Headquarters, Addis Ababa, Ethiopia
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12
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Piché-Renaud PP, Ji C, Farrar DS, Friedman JN, Science M, Kitai I, Burey S, Feldman M, Morris SK. Impact of the COVID-19 pandemic on the provision of routine childhood immunizations in Ontario, Canada. Vaccine 2021; 39:4373-4382. [PMID: 34108076 DOI: 10.1016/j.vaccine.2021.05.094] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The COVID-19 pandemic has a worldwide impact on all health services, including childhood immunizations. In Canada, there is limited data to quantify and characterize this issue. METHODS We conducted a descriptive, cross-sectional study by distributing online surveys to physicians across Ontario. The survey included three sections: provider characteristics, impact of COVID-19 on professional practice, and impact of COVID-19 on routine childhood immunization services. Multivariable logistic regression identified factors associated with modification of immunization services. RESULTS A total of 475 respondents answered the survey from May 27th to July 3rd 2020, including 189 family physicians and 286 pediatricians. The median proportion of in-person visits reported by physicians before the pandemic was 99% and dropped to 18% during the first wave of the pandemic in Ontario. In total, 175 (44.6%) of the 392 respondents who usually provide vaccination to children acknowledged a negative impact caused by the pandemic on their immunization services, ranging from temporary closure of their practice (n = 18; 4.6%) to postponement of vaccines in certain age groups (n = 103; 26.3%). Pediatricians were more likely to experience a negative impact on their immunization services compared to family physicians (adjusted odds ratio [aOR] = 2.64, 95% CI: 1.48-4.68), as well as early career physicians compared to their more senior colleagues (aOR = 2.69, 95% CI: 1.30-5.56), whereas physicians from suburban settings were less impacted than physicians from urban settings (aOR = 0.62, 95% CI: 0.39-0.99). Some of the proposed solutions to decreased immunization services included assistance in accessing personal protective equipment, dedicated centers or practices for vaccination, universal centralized electronic immunization records and education campaigns for parents. CONCLUSIONS COVID-19 has caused substantial modifications to pediatric immunization services across Ontario. Strategies to mitigate barriers to immunizations during the pandemic need to be implemented in order to avoid immunity gaps that could lead to an eventual increase in vaccine preventable diseases.
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Affiliation(s)
| | - Catherine Ji
- Toronto Western Family Health Team, University Health Network, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Canada
| | - Daniel S Farrar
- Centre for Global Child Health, The Hospital for Sick Children, Canada
| | - Jeremy N Friedman
- Division of Pediatric Medicine, The Hospital for Sick Children, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Canada
| | - Michelle Science
- Division of Infectious Diseases, The Hospital for Sick Children, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Canada
| | - Ian Kitai
- Division of Infectious Diseases, The Hospital for Sick Children, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Canada
| | - Sharon Burey
- Pediatricians Alliance of Ontario, Canada; Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Mark Feldman
- Division of Pediatric Medicine, The Hospital for Sick Children, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, The Hospital for Sick Children, Canada; Centre for Global Child Health, The Hospital for Sick Children, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Canada; Division of Clinical Public Health and Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, Canada.
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13
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Yun HE, Ryu BY, Choe YJ. Impact of social distancing on incidence of vaccine-preventable diseases, South Korea. J Med Virol 2020; 93:1814-1816. [PMID: 33079384 DOI: 10.1002/jmv.26614] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/29/2020] [Accepted: 10/16/2020] [Indexed: 11/06/2022]
Abstract
While vaccination remains the cornerstone of controlling vaccine-preventive diseases (VPD), little is known about the effect of social distancing on incidence of VPDs. We investigated the impact of social distancing practiced during the coronavirus disease 2019 (COVID-19) pandemic on the incidence of selected VPDs in South Korea. National surveillance data on monthly incidence of hepatitis A, hepatitis B, varicella, mumps, invasive pneumococcal disease (IPD), and pertussis were retrieved and compared the VPD incidences in 2020 to the average of the last 4 years (2015-2019) of the corresponding months. In 2020, there were 44% decline for mumps, 44% decline for varicella, 28% decline for pertussis, 22% decline for IPD, 14% decline in incidence of hepatitis A, and no change for hepatitis B incidences, compared to baseline years (2015-2019). The largest decline of total VPDs was in April (65%) and in May (67%), during the intensified social distancing measures. In the setting of sustained vaccination coverage, social distancing may provide additional public health benefit in controlling the VPDs.
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Affiliation(s)
- Hyo Eun Yun
- Department of Social and Preventive Medicine, Hallym University College of Medicine, Chuncheon-si, Gangwon-do, Korea
| | - Bo Young Ryu
- Division of Infectious Disease Response, Gyeongnam Regional Center for Disease Control and Prevention, Korea Disease Control and Prevention Agency, Busan, Korea
| | - Young June Choe
- Department of Social and Preventive Medicine, Hallym University College of Medicine, Chuncheon-si, Gangwon-do, Korea
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14
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Graham M, Suk JE, Takahashi S, Metcalf CJ, Jimenez AP, Prikazsky V, Ferrari MJ, Lessler J. Challenges and Opportunities in Disease Forecasting in Outbreak Settings: A Case Study of Measles in Lola Prefecture, Guinea. Am J Trop Med Hyg 2018. [PMID: 29532773 PMCID: PMC5953353 DOI: 10.4269/ajtmh.17-0218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report on and evaluate the process and findings of a real-time modeling exercise in response to an outbreak of measles in Lola prefecture, Guinea, in early 2015 in the wake of the Ebola crisis. Multiple statistical methods for the estimation of the size of the susceptible (i.e., unvaccinated) population were applied to weekly reported measles case data on seven subprefectures throughout Lola. Stochastic compartmental models were used to project future measles incidence in each subprefecture in both an initial and a follow-up iteration of forecasting. Measles susceptibility among 1- to 5-year-olds was estimated to be between 24% and 43% at the beginning of the outbreak. Based on this high baseline susceptibility, initial projections forecasted a large outbreak occurring over approximately 10 weeks and infecting 40 children per 1,000. Subsequent forecasts based on updated data mitigated this initial projection, but still predicted a significant outbreak. A catch-up vaccination campaign took place at the same time as this second forecast and measles cases quickly receded. Of note, case reports used to fit models changed significantly between forecast rounds. Model-based projections of both current population risk and future incidence can help in setting priorities and planning during an outbreak response. A swiftly changing situation on the ground, coupled with data uncertainties and the need to adjust standard analytical approaches to deal with sparse data, presents significant challenges. Appropriate presentation of results as planning scenarios, as well as presentations of uncertainty and two-way communication, is essential to the effective use of modeling studies in outbreak response.
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Affiliation(s)
- Matthew Graham
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jonathan E Suk
- World Health Organization, Geneva, Switzerland.,European Centre for Disease Prevention and Control, Solna, Sweden
| | - Saki Takahashi
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey
| | - C Jessica Metcalf
- Woodrow Wilson School, Princeton University, Princeton, New Jersey.,Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey
| | - A Paez Jimenez
- World Health Organization, Geneva, Switzerland.,European Centre for Disease Prevention and Control, Solna, Sweden
| | - Vladimir Prikazsky
- World Health Organization, Geneva, Switzerland.,European Centre for Disease Prevention and Control, Solna, Sweden
| | - Matthew J Ferrari
- Department of Statistics, Pennsylvania State University, University Park, Pennsylvania.,Department of Biology, Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, Pennsylvania
| | - Justin Lessler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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15
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Wagenaar BH, Augusto O, Beste J, Toomay SJ, Wickett E, Dunbar N, Bawo L, Wesseh CS. The 2014-2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010-2016. PLoS Med 2018; 15:e1002508. [PMID: 29462138 PMCID: PMC5819774 DOI: 10.1371/journal.pmed.1002508] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/16/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of this study is to estimate the immediate and lasting effects of the 2014-2015 Ebola virus disease (EVD) outbreak on public-sector primary healthcare delivery in Liberia using 7 years of comprehensive routine health information system data. METHODS AND FINDINGS We analyzed 10 key primary healthcare indicators before, during, and after the EVD outbreak using 31,836 facility-month service outputs from 1 January 2010 to 31 December 2016 across a census of 379 public-sector health facilities in Liberia (excluding Montserrado County). All indicators had statistically significant decreases during the first 4 months of the EVD outbreak, with all indicators having their lowest raw mean outputs in August 2014. Decreases in outputs comparing the end of the initial EVD period (September 2014) to May 2014 (pre-EVD) ranged in magnitude from a 67.3% decrease in measles vaccinations (95% CI: -77.9%, -56.8%, p < 0.001) and a 61.4% decrease in artemisinin-based combination therapy (ACT) treatments for malaria (95% CI: -69.0%, -53.8%, p < 0.001) to a 35.2% decrease in first antenatal care (ANC) visits (95% CI: -45.8%, -24.7%, p < 0.001) and a 38.5% decrease in medroxyprogesterone acetate doses (95% CI: -47.6%, -29.5%, p < 0.001). Following the nadir of system outputs in August 2014, all indicators showed statistically significant increases from October 2014 to December 2014. All indicators had significant positive trends during the post-EVD period, with every system output exceeding pre-Ebola forecasted trends for 3 consecutive months by November 2016. Health system outputs lost during and after the EVD outbreak were large and sustained for most indicators. Prior to exceeding pre-EVD forecasted trends for 3 months, we estimate statistically significant cumulative losses of -776,110 clinic visits (95% CI: -1,480,896, -101,357, p = 0.030); -24,449 bacille Calmette-Guérin vaccinations (95% CI: -45,947, -2,020, p = 0.032); -9,129 measles vaccinations (95% CI: -12,312, -5,659, p < 0.001); -17,191 postnatal care (PNC) visits within 6 weeks of birth (95% CI: -28,344, -5,775, p = 0.002); and -101,857 ACT malaria treatments (95% CI: -205,839, -2,139, p = 0.044) due to the EVD outbreak. Other outputs showed statistically significant cumulative losses only through December 2014, including losses of -12,941 first pentavalent vaccinations (95% CI: -20,309, -5,527, p = 0.002); -5,122 institutional births (95% CI: -8,767, -1,234, p = 0.003); and -45,024 acute respiratory infections treated (95% CI: -66,185, -24,019, p < 0.001). Compared to pre-EVD forecasted trends, medroxyprogesterone acetate doses and first ANC visits did not show statistically significant net losses. ACT treatment for malaria was the only indicator with an estimated net increase in system outputs through December 2016, showing an excess of +78,583 outputs (95% CI: -309,417, +450,661, p = 0.634) compared to pre-EVD forecasted trends, although this increase was not statistically significant. However, comparing December 2013 to December 2017, ACT malaria cases have increased 49.2% (95% CI: 33.9%, 64.5%, p < 0.001). Compared to pre-EVD forecasted trends, there remains a statistically significant loss of -15,144 PNC visits within 6 weeks (95% CI: -29,453, -787, p = 0.040) through December 2016. CONCLUSIONS The Liberian public-sector primary healthcare system has made strides towards recovery from the 2014-2015 EVD outbreak. All primary healthcare indicators tracked have recovered to pre-EVD levels as of November 2016. Yet, for most indicators, it took more than 1 year to recover to pre-EVD levels. During this time, large losses of essential primary healthcare services occurred compared to what would have been expected had the EVD outbreak not occurred. The disruption of malaria case management during the EVD outbreak may have resulted in increased malaria cases. Large and sustained investments in public-sector primary care health system strengthening are urgently needed for EVD-affected countries.
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Affiliation(s)
- Bradley H. Wagenaar
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Partners in Health, Monrovia, Liberia
- Health Alliance International, Seattle, Washington, United States of America
- * E-mail:
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Health Alliance International, Seattle, Washington, United States of America
- Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Jason Beste
- Partners in Health, Monrovia, Liberia
- Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | | | - Luke Bawo
- Ministry of Health, Monrovia, Liberia
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16
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Abstract
The West African outbreak of 2013 to 2016 was the largest Ebola epidemic in history. With tens of thousands of patients treated during this outbreak, much was learned about how to optimize clinical care for children with Ebola. In anticipation of inevitable future outbreaks, a firsthand summary of the major aspects of pediatric Ebola case management in austere settings is presented. Emphasis is on early and aggressive critical care, including fluid resuscitation, electrolyte repletion, antimicrobial therapy, and nutritional supplementation.
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Affiliation(s)
- Indi Trehan
- Lao Friends Hospital for Children, Luang Prabang, Lao PDR; Department of Pediatrics, One Children's Place, Campus Box 8116, St Louis, MO 63110, USA; Maforki Ebola Holding and Treatment Centre, Port Loko, Sierra Leone.
| | - Stephanie C De Silva
- Department of Pediatrics, One Children's Place, Campus Box 8116, St Louis, MO 63110, USA
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17
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Decroo T, Fitzpatrick G, Amone J. What was the effect of the West African Ebola outbreak on health programme performance, and did programmes recover? Public Health Action 2017; 7:S1-S2. [PMID: 28744431 DOI: 10.5588/pha.17.0029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Tom Decroo
- Unit HIV & Infectious Diseases, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Jackson Amone
- Department of Clinical Services, Ministry of Health, Kampala, Uganda
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