Achieving parenteral access for re-hydration: This Cochrane Review draws on evidence from 17 studies involving nearly 900 people to investigate different ways to give fluids to people in situations where it is impossible to maintain adequate hydration simply by giving fluids orally, as is the case for many patients with Ebola. Collectively, these alternatives are termed parenteral access. They include putting fluids into a vein (intravenously), bone marrow, fatty tissue under the skin or the abdominal space. Giving fluids intravenously is a commonly used method, but this can be particularly challenging in patients with Ebola. Getting access to a vein can be difficult in very dehydrated patients, and this is made even worse if the care-givers are obliged to wear protective suits, and where there is a risk of transmission of the virus. This review helps health workers caring for patients with Ebola to know the advantages and disadvantages of the other ways to give fluids, so they can decide which is the most suitable for their patients. It shows us that if intravenous access can be achieved easily, then this should be used as it allows the infusion of larger volumes of fluid. A video is also available for the review.
Effects of the West Africa Ebola Virus Disease on healthcare utilization: health systems must be supported in maintaining routine and preventative health service delivery before and during disasters, to achieve the best health outcomes and build a more resilient health system. The recent Ebola outbreak in West Africa greatly and directly impacted health and health systems, substantially affecting health service delivery in the short- and long-term in the affected countries. However, understanding how the recent Ebola outbreak in West Africa indirectly affected health may improve health in future disasters by guiding policy for strengthening health systems. This review synthesized the currently available literature in order to assess the magnitude of the indirect health effects of the West Africa Ebola outbreak. Clear reductions in health service utilization were seen in multiple services, especially reproductive, maternal and child health services, while the uptake of health service provision also decreased. The changes resulted in an increase in non-Ebola morbidity and mortality that may be greater than the direct effects of Ebola itself.
Disaster risk communication: a review of communication interventions relevant to disasters, including infection outbreaks. Interventions associated with increased knowledge of preventive measures include individual and group face-to-face information sessions, telephone calls, delivery of written information, mass media campaigns, mass SMS text messages and games for children. There was mixed evidence of change in planned risk behaviours relating to infection.
Handwashing and other hygiene measures: a Cochrane Review showing the benefits of various physical methods for reducing the spread of respiratory viruses, which may help to prevent the transmission of ebola.
Isotonic versus hypotonic solutions for maintenance intravenous fluid administration in children: a Cochrane Review comparing isotonic fluid (containing a sodium concentration similar to plasma) with hypotonic fluid (containing a sodium concentration less than plasma) for maintenance intravenous hydration in children. It found that isotonic fluid reduced the risk of hyponatraemia.
Needle injuries: a Cochrane Review of medical devices designed to reduce the risk of virus transmission through percutaneous exposure injuries caused by needles.
Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff: A Cochrane review concerning the effectiveness of glasses, masks and respirators, hoods, clothing and shoes or boots that aim to protect health care workers from viral or bacterial infections.
Suture needle injuries: a Cochrane Review showing that blunt suture needles halve the risk of a needle-stick injury, compared to sharp needles.
Surgical gloves: a Cochrane Review showing that the use of two pairs of ordinary surgical gloves more than halves the risk of needle stick or sharps injuries, compared to only one pair of gloves.
Reviews in progress
Behavioural and self-management prevention interventions for people at risk of contracting Ebola: This review will seek studies of behavioural (including education for behaviour change) or self-management interventions, to show which interventions prevent or have an impact on the survival rates or transmission rates of Ebola, with the aim of reducing incidence and prevalence of the disease in the most vulnerable communities. It will seek not only interventions that are effective but those which are culturally sensitive (i.e. that compliment traditional ways of living and not eradicate them) so as to enhance adoption and longevity of the intervention. The review will be published Open Access.
Structural adjustment and the impact on those people at risk of contracting Ebola: This review will seek studies of structural adjustments intended to reduce the incidence and prevalence of Ebola, and improve survival rates. Structural interventions are those relating to healthcare organisation, service delivery or both; and will include recently introduced health surveillance and monitoring systems. The review will also examine the impact of tax reform, and changes to domestic or environmental policy, which may be legislated by governmental or encouraged by non-governmental organisations. The review will be published Open Access.
Other ongoing reviews
PROSPERO is a prospective register of systematic reviews in health and social care, which can be searched freely on the internet for recently started systematic reviews relevant to Ebola.