Volume 95, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Little is known about the residual effects of the west African Ebola virus disease (Ebola) epidemic on non-Ebola mortality and health-seeking behavior in Sierra Leone. We conducted a retrospective household survey to estimate mortality and describe health-seeking behavior in Western Area, Sierra Leone, between May 25, 2014, and February 16, 2015. We used two-stage cluster sampling, selected 30 geographical sectors with probability proportional to population size, and sampled 30 households per sector. Survey teams conducted face-to-face interviews and collected information on mortality and health-seeking behavior. We calculated all-cause and Ebola-specific mortality rates and compared health-seeking behavior before and during the Ebola epidemic using χ and Fisher's exact tests. Ninety-six deaths, 39 due to Ebola, were reported in 898 households. All-cause and Ebola-specific mortality rates were 0.52 (95% confidence interval [CI] = 0.29–0.76) and 0.19 (95% CI = 0.01–0.38) per 10,000 inhabitants per day, respectively. Of those households that reported a sick family member during the month before the survey, 86% (73/85) sought care at a health facility before the epidemic, compared with 58% (50/86) in February 2015 ( = 0.013). Reported self-medication increased from 4% (3/85) before the epidemic to 23% (20/86) during the epidemic ( = 0.013). Underutilization of health services and increased self-medication did not show a demonstrable effect on non-Ebola-related mortality. Nevertheless, the residual effects of outbreaks need to be taken into account for the future. Recovery efforts should focus on rebuilding both the formalized health system and the population's trust in it.


Article metrics loading...

Loading full text...

Full text loading...



  1. World Health Organization (WHO), 2015. Origins of the 2014 Ebola Epidemic. Available at: http://who.int/csr/disease/ebola/one-year-report/virus-origin/en/. Accessed June 26, 2015.
  2. World Health Organization (WHO), 2016. Ebola Situation Report: 20 January 2016. Available at: http://apps.who.int/ebola/sites/default/files/atoms/files/who_ebola_situation_report_20-01-2016_1.pdf?ua=1&ua=1. Accessed July 8, 2016.
  3. World Health Organization (WHO), 2015. Ebola in Sierra Leone: A Slow Start to an Outbreak That Eventually Outpaced All Others. Available at: http://who.int/csr/disease/ebola/one-year-report/sierra-leone/en/. Accessed June 26, 2015.
  4. World Health Organization (WHO), 2015. Health Worker Ebola Infections in Guinea, Liberia and Sierra Leone. A Preliminary Report. Available at: http://www.who.int/csr/resources/publications/ebola/health-worker-infections/en/. Accessed July 28, 2015.
  5. Bolkan HA, Bash-Taqi DA, Samai M, Gerdin M, von Schreeb J, , 2014 Ebola and indirect effects on health service function in Sierra Leone. PLoS Curr 6.
  6. Plucinski MM, Guilavogui T, Sidikiba S, Diakité N, Diakité S, Dioubaté M, Bah I, Hennessee I, Butts JK, Halsey ES, McElroy PD, Kachur SP, Aboulhab J, James R, Keita M, , 2015. Effect of the Ebola-virus-disease epidemic on malaria case management in Guinea, 2014: a cross-sectional survey of health facilities. Lancet Infect Dis 15: 10171023.[Crossref]
  7. The Assessment Capacities Project (ACAPS), 2015. Ebola Outbreak in West Africa: Impact on Health Service Utilization in Sierra Leone. March 25, 2015. Available at: http://www.acaps.org/themes/ebola. Accessed May 24, 2016.
  8. Toole MJ, Waldman RJ, , 1990. Prevention of excess mortality in refugee and displaced populations in developing countries. JAMA 263: 32963302.[Crossref]
  9. Statistics Sierra Leone (SSL) and ICF International, 2014. Sierra Leone Demographic and Health Survey 2013. Freetown, Sierra Leone and Rockville, MD: SSL and ICF International. Available at: http://dhsprogram.com/pubs/pdf/FR297/FR297.pdf. Accessed May 24, 2016.
  10. Van de Poel E, O'Donnell O, Van Doorslaer E, , 2007. Are urban children really healthier? Evidence from 47 developing countries. Soc Sci Med 65: 19862003.[Crossref]
  11. Tuck JJH, Williams JR, Doyle AL, , 2016. Gastro enteritis in a military population deployed in west Africa in the UK Ebola response; was the observed lower disease burden due to handwashing? Travel Med Infect Dis 14: 131136.[Crossref]
  12. World Health Organization (WHO), 2015. Sierra Leone: WHO Statistical Profile. Available at: http://www.who.int/gho/countries/sle.pdf?ua=1. Accessed May 20, 2016.

Data & Media loading...

  • Received : 15 Apr 2016
  • Accepted : 13 Jun 2016

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error