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Changes in Health-Seeking Behavior Did Not Result in Increased All-Cause Mortality During the Ebola Outbreak in Western Area, Sierra Leone

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  • 1 French Institute of Public Health Surveillance, Alerts and Regions Coordination Department, Regional office in Aquitaine, Bordeaux, France.
  • | 2 European Program for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
  • | 3 Robert Koch-Institut, Berlin, Germany.
  • | 4 Epicentre, Geneva, Switzerland.
  • | 5 Médecins Sans Frontières, Geneva, Switzerland.
  • | 6 Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone.
  • | 7 Epicentre, Paris, France.

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 χ2 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 (P = 0.013). Reported self-medication increased from 4% (3/85) before the epidemic to 23% (20/86) during the epidemic (P = 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.

Author Notes

* Address correspondence to Amanda Tiffany, Epicentre, 78 Rue de Lausanne, Geneva 1202, Switzerland. E-mail: amanda.tiffany@geneva.msf.org† These authors contributed equally to this work.

Financial support: Epicentre received funding from Médecins Sans Frontières to carry out this work.

Authors' addresses: Sabine Vygen, Robert Koch-Institut, Berlin, Germany, E-mail: vygen-bonnets@rki.de. Amanda Tiffany, Epicentre, Geneva, Switzerland, E-mail: amanda.tiffany@geneva.msf.org. Monica Rull, Alexandre Ventura, and Anja Wolz, Médecins Sans Frontières, Geneva, Switzerland, E-mails: monica.rull@geneva.msf.org, alexandre.ventura@geneva.msf.org, and anjawolz@gmail.com. Amara Jambai, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone, E-mail: amarajambai@yahoo.com. Klaudia Porten, Epicentre, Paris, France, E-mail: klaudia.porten@epicentre.paris.org.

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