Operational research: did health systems in Sierra Leone recover after the 2014-15 Ebola outbreak?

Capacity building in operational research on obstetric fistula: Experience in the Democratic Republic of Congo, 2017-2021

OBJECTIVE

To implement a Flexible Operational Research Training (FORT) course within the Fistula Care Plus Project, Democratic Republic of Congo, from 2017 to 2021.

METHODS

A descriptive study using design and implementation (process and outcome) data. Two to four members of medical teams from three supported sites were selected for the training based on their research interests and level of involvement in the program.

RESULTS

Two courses (13-14 months each) involving nine facilitators and 17 participants overall were conducted between 2017 and 2021. Most participants in both courses were medical doctors (67% and 71%, respectively) from the supported hospitals (83% and 77%, respectively). About half were women. In addition to classic face-to-face didactic modules, the courses integrated online platforms to cope with the changing contexts (Ebola virus and COVID-19). Most participants reported having gained new skills in developing research protocols, collecting, managing, and analyzing data, and developing research manuscripts. The two courses resulted in six scientific manuscripts and three presentations at international conferences. Participants subsequently published five papers from their research after the first course. The total direct costs for both courses were representing a cost of $3669 per participant trained.

CONCLUSION

The FORT model proved feasible, efficient, and successful. However, scaling up will require more adaptation efforts from programs and participating sites.

Indirect Effects of Ebola Virus Disease Epidemics on Health Systems in the Democratic Republic of the Congo, Guinea, Sierra Leone and Liberia: A Scoping Review Supplemented with Expert Interviews

Ebola Virus Disease (EVD) epidemics have been extensively documented and have received large scientific and public attention since 1976. Until July 2022, 16 countries worldwide had reported at least one case of EVD, resulting in 43 epidemics. Most of the epidemics occurred in the Democratic Republic of Congo (DRC) but the largest epidemic occurred from 2014-2016 in Guinea, Sierra Leone and Liberia in West Africa. The indirect effects of EVD epidemics on these countries' health systems, i.e., the consequences beyond infected patients and deaths immediately related to EVD, can be significant. The objective of this review was to map and measure the indirect effects of the EVD epidemics on the health systems of DRC, Guinea, Sierra Leone and Liberia and, from thereon, draw lessons for strengthening their resilience vis-à-vis future EVD outbreaks and other similar health emergencies. A scoping review of published articles from the PubMed database and gray literature was conducted. It was supplemented by interviews with experts. Eighty-six articles were included in this review. The results were structured based on WHO's six building blocks of a health system. During the EVD outbreaks, several healthcare services and activities were disrupted. A significant decline in indicators of curative care utilization, immunization levels and disease control activities was noticeable. Shortages of health personnel, poor health data management, insufficient funding and shortages of essential drugs characterized the epidemics that occurred in the above-mentioned countries. The public health authorities had virtually lost their leadership in the management of an EVD response. Governance was characterized by the development of a range of new initiatives to ensure adequate response. The results of this review highlight the need for countries to invest in and strengthen their health systems, through the continuous reinforcement of the building blocks, even if there is no imminent risk of an epidemic.

The impact of on IPC compliance during the Ebola virus outbreak in Mbandaka/Democratic Republic of the Congo: a before and after design

OBJECTIVES

To assess the impact of refresher training of healthcare workers (HCWs) in infection prevention and control (IPC), ensuring consistent adequate supplies and availability of IPC kits and carrying out weekly monitoring of IPC performance in healthcare facilities (HCFs) DESIGN: This was a before and after comparison study SETTINGS: This study was conducted from June to July 2018 during an Ebola virus disease (EVD) outbreak in Equateur Province in the Democratic Republic of the Congo (DRC).

PARTICIPANTS

48 HCFs INTERVENTIONS: HCWs capacity building in basic IPC, IPC kit donation and IPC mentoring.

PRIMARY OUTCOME MEASURES

IPC score RESULTS: 48 HCFs were evaluated and 878 HCWs were trained, of whom 437 were women and 441 were men. The mean IPC score at baseline was modestly higher in hospitals (8%) compared with medical centres (4%) and health centres (4%), respectively. The mean IPC score at follow-up significantly increased to 50% in hospitals, 39% in medical centres and 36% in health centres (p value<0.001). The aggregate mean IPC score at baseline for all HCFs, combined was 4.41% and at follow-up it was 39.51% with a mean difference of 35.08% (p-value<0.001).

CONCLUSIONS

Implementation of HCW capacity building in IPC, IPC kit donation to HCF and mentoring in IPC improved IPC compliance during the ninth EVD outbreak in the DRC.