Effects of the West African Ebola virus disease on health-care utilization

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Utilization of maternal and child health services (especially vaccination) decreased during the Ebola outbreak, along with the uptake of HIV/AIDS and malaria services, general hospital admissions and major surgeries. The impact of Ebola includes indirect health service effects particularly in maternal, child and reproductive health.

In HIV/AIDS services, patient visits to facilities for HIV care reduced, transmission prevention of mother-to-child HIV in Sierra Leone decreased, treatment of new HIV patients reduced, and anti-retroviral drug prescriptions were less frequently renewed. Admission and treatment for malaria decreased in adults and children. Large reductions in hospital admission and major surgeries were reported, including a reduction of the volume of operative surgery in Sierra Leone by the end of 2014 to 3% of the volume of 2013, and 25% of the surgeons at one facility died of Ebola. Some general hospitals were converted into Ebola treatment centres.

The focus of this review is the West African 2013-16 Ebola outbreak, which was larger than any before (over 30000 cases and 10000 deaths). It intended to assess how indirect effects may occur, for instance modelling that every month of disruption to vaccination services in East Africa would result in around 20000 more unvaccinated children. The maternal case fatality rate in Sierra Leone and stillbirths increased and modelling also suggested that deaths from Ebola of healthcare workers would have a long-term effect on maternal mortality rates. It included 22 studies. 

Estimates from varied studies show that both morbidity and mortality have increased, and effects may be long-lasting, especially in terms of maternal death and HIV/AIDs treatment. The deaths of health care professionals in countries already having low numbers of health care workers could lead to higher mortality, with one estimate suggesting that 25000 additional deaths per year in Africa.

Further research is needed, as many of the research articles used in this review were rapidly initiated and opportunistic, making their conclusions less secure.

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