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Ebola Virus Disease Surveillance in Two High-Transmission Districts of Sierra Leone During the 2013–2015 Outbreak: Surveillance Methods, Implications for Maternal and Child Health, and Recommendations

  • Allison M. ConnollyEmail author
  • Alyssa J. Young
Chapter
Part of the Global Maternal and Child Health book series (GMCH)

Abstract

Effective surveillance for Ebola virus disease (EVD) was critical to control the 2013–2015 epidemic in West Africa. At the community level, this work was done by surveillance officers, who were responsible for conducting investigations to identify and refer suspected cases for testing and isolation. Surveillance was also conducted in health care facilities to identify potential cases of EVD and prevent spread of the disease within the facility.

Surveillance for EVD infection in pregnant, postpartum, and breastfeeding mothers and their children presented more challenges than in the general population. This was especially due to the nonspecific nature of the symptoms used to identify suspected cases of EVD, which overlapped with pregnancy, labor, and its complications, and diseases common in West Africa, notably, malaria. These challenges meant that conducting EVD surveillance itself had ramifications on maternal child health. These impacts were magnified by the breakdown in primary health care and restrictions on movement, which increased the number of ill persons detected through the surveillance system. At the same time, some people took measures to avoid the surveillance system by not reporting or seeking care for their sicknesses due to fear of referral to Ebola health care facilities.

Surveillance officers, mothers, and their families faced difficult choices, particularly regarding the separation of a mother from her baby when the mother met the criteria for suspected EVD and was referred for isolation and laboratory testing. If the baby was not also a suspected EVD case, the risk of nosocomial infection in Ebola holding facilities had to be weighed against the lack of infant formula in communities, making the decision on how to care for the baby difficult. Breakdowns in surveillance in communities and in health care facilities, along with lack of food and health services for those in quarantine, negatively impacted the health of mothers, their children, and the overall population. Additonally, it adversely affected outbreak control and the community’s trust and engagement on which it depended. Surveillance officers had to skillfully navigate these complex and dynamic circumstances in order to be effective.

Keywords

Ebola virus disease EVD surveillance Case investigation Epidemiology Pregnancy Quarantine Postpartum women Infection prevention and control Malaria Primary health care Children Hospital surveillance Prenatal care Ebola transmission Ebola hotline Nosocomial infection Maternal and child health Infant Ebola epidemic Community-based surveillance Outreak response 

Notes

Dedication and Acknowledgments

This chapter is dedicated with respect and gratitude to the surveillance officers of Sierra Leone, who worked under arduous conditions on the front lines of this prolonged outbreak. For review of this draft, the authors would like to acknowledge Sorie Ibrahim Beareh Kamara, Salieu Jalloh (Bombali District), and Alhaji D. Kamara (Port Loko District), who worked as MOHS surveillance officers during the outbreak. The authors also acknowledge Indu B. Ahluwalia, MPH, PhD, of the U.S. Centers for Disease Control and Prevention, who collaborated with MOHS and WHO colleagues to conduct the cluster investigation described in this chapter.

References

  1. Alpren, C., Jalloh, M., Kaiser, R., Diop, M., Kargbo, S., Castle, E., et al. (2017). The 117 call alert system in Sierra Leone: From rapid Ebola notification to routine death reporting. BMJ Global Health, 2, e000392. Retrieved May 1, 2018, from http://gh.bmj.com/content/2/3/e000392.CrossRefGoogle Scholar
  2. Bower, H., Johnson, S., Bangura, M., Kamara, A., Kamara, O., Mansaray, S., et al. (2016). Effects of mother’s illness and breastfeeding on risk of Ebola virus disease in a cohort of very young children. PLOS Neglected Tropical Diseases, 10(4), e0004622. Retrieved May 1, 2018, from http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004622.CrossRefGoogle Scholar
  3. Brolin Ribacke, K., Saulnier, D., Eriksson, A., & von Schreeb, J. (2016). Effects of the West Africa Ebola virus disease on health-care utilization – A systematic review. Frontiers in Public Health, 4, 222. https://doi.org/10.3389/fpubh.2016.00222.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Check Hayden, E. (2015). Maternal health: Ebola’s lasting legacy. Nature, 519, 24–26. https://doi.org/10.1038/519024a. Retrieved April 30, 2018, from http://www.nature.com/news/maternal-health-ebola-s-lasting-legacy-1.17036.CrossRefGoogle Scholar
  5. Connolly, A., Young, A., Mancuso, B., Hartley, M., Hoar, A., Kaur, G., et al. (2016). Surveillance strategies during low Ebola transmission in a district in Sierra Leone. Online Journal of Public Health Informatics, 8(1), e56. https://doi.org/10.5210/ojphi.v8i1.6470.CrossRefGoogle Scholar
  6. Deaver, J., & Cohen, W. (2015). Ebola virus screening during pregnancy in West Africa: Unintended consequences. Journal of Perinatal Medicine, 43(6), 649–651. https://doi.org/10.1515/jpm-2015-0118.CrossRefGoogle Scholar
  7. Dunn, A., Walker, T., Redd, J., Sugerman, D., McFadden, J., Singh, T., et al. (2016). Nosocomial transmission of Ebola virus disease on pediatric and maternity wards: Bombali and Tonkolili, Sierra Leone, 2014. American Journal of Infection Control, 44(3), 269–272. https://doi.org/10.1016/j.ajic.2015.09.016.CrossRefGoogle Scholar
  8. Elston, J., Moosa, A., Moses, F., Walker, G., Dotta, N., Waldman, R., et al. (2015). Impact of the Ebola outbreak on health systems and population health in Sierra Leone. Journal of Public Health, 38(4), 673–678. https://doi.org/10.1093/pubmed/fdv158. Retrieved April 30, 2018, from https://academic.oup.com/jpubhealth/article/38/4/673/2966926.
  9. Gomes, M., de la Fuente-Núñez, V., Saxena, A., & Kuesel, A. (2017). Protected to death: Systematic exclusion of pregnant women from Ebola virus disease trials. Reproductive Health, 14(S3), 47–55. https://doi.org/10.1186/s12978-017-0430-2. Retrieved April 30, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5751665/.
  10. Government of Sierra Leone. (2014). Sierra Leone emergency management program standard operating procedure for management of quarantine, Freetown, Sierra Leone, October 2014.Google Scholar
  11. Government of Sierra Leone. (2015). Sierra Leone emergency management program standard operating procedures for the safe provision of hospital services during a haemorrhagic fever outbreak, with a focus on Ebola, Freetown, Sierra Leone, February 2015.Google Scholar
  12. Kilmarx, P., Clarke, K., Dietz, P., Hamel, M. J., Husain, F., McFadden, J. D., et al. (2014). Ebola virus disease in health care workers-Sierra Leone, 2014. MMWR Morbidity and Mortality Weekly Report, 63(49), 1168–1171. Retrieved April 25, 2018, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6349a6.htm.PubMedPubMedCentralGoogle Scholar
  13. Maxmen, A. (2015). In Sierra Leone, quarantines without food threaten Ebola Response. Aljazeera America. Retrieved April 30, 2018, from http://america.aljazeera.com/articles/2015/2/19/in-sierra-leone-quarantined-ebola-survivors.html.
  14. Ministry of Local Government and Rural Development [Sierra Leone], National Council of Paramount Chiefs. (2014). Byelaws on the prevention of Ebola and other diseases. Retrieved September 25, 2018 from https://www.humanitarianresponse.info/files/documents/files/by-laws.pdf
  15. Schwartz, D. A. (2013). Challenges in improvement of perinatal health in developing nations: Role of perinatal pathology. Archives of Pathology & Laboratory Medicine, 137(6), 742–746. Retrieved May 1, 2018, from http://www.archivesofpathology.org/doi/full/10.5858/arpa.2012-0089-ED.CrossRefGoogle Scholar
  16. Sierra Leone Ministry of Local Government and Rural Development, & National Council of Paramount Chiefs. (2014). Byelaws on the prevention of Ebola of Ebola and other diseases.Google Scholar
  17. Statistics Sierra Leone, Ministry of Health and Sanitation, & ICF International. (2014). Sierra Leone demographic and health survey 2013. Retrieved April 26, 2018, from https://dhsprogram.com/pubs/pdf/fr297/fr297.pdf.
  18. Tran, A., Hoar, A., Young, A., Connolly, A., Hartley, M., Boland, S., et al. (2016). Strengthening community surveillance of Ebola virus disease in Sierra Leone. Online Journal of Public Health Informatics, 8(1), e164. https://doi.org/10.5210/ojphi.v8i1.6583.CrossRefGoogle Scholar
  19. Uneke, C. J. (2007). Impact of placental Plasmodium falciparum malaria on pregnancy and perinatal outcome in Sub-Saharan Africa. Yale Journal of Biology and Medicine, 80(2), 39–50. Retrieved May 1, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2140183/.PubMedGoogle Scholar
  20. Wahome, W. (2014). Quarantines in Sierra Leone: Putting people first in the Ebola crisis. Oxfam. Retrieved February 17, 2018, from https://oxfamilibrary.openrepository.com/oxfam/handle/10546/336992.
  21. Walker, P., White, M., Griffin, J., Reynolds, A., Ferguson, N., & Ghani, A. (2015). Malaria morbidity and mortality in Ebola-affected countries caused by decreased health-care capacity, and the potential effect of mitigation strategies: A modelling analysis. The Lancet Infectious Diseases, 15(7), 825–832. https://doi.org/10.1016/s1473-3099(15)70124-6. Retrieved May 2, 2018, from https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)70124-6/fulltext.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Westcott, L. (2014). Thousands break Sierra Leone Ebola quarantine for food. Newsweek. Retrieved May 2, 2018, from http://www.newsweek.com/thousands-break-sierra-leone-ebola-quarantine-food-282471.
  23. World Health Organization. (2014). Case definition recommendations for Ebola or Marburg virus diseases. Retrieved February 10, 2018, from http://www.who.int/csr/resources/publications/ebola/case-definition/en//.
  24. World Health Organization. (2016). Ebola situation report - 20 January 2016. Retrieved April 26, 2018, from http://apps.who.int/ebola/current-situation/ebola-situation-report-20-january-2016.
  25. Yang, W., Zhang, W., Kargbo, D., Yang, R., Chen, Y., Chen, Z., et al. (2015). Transmission network of the 2014–2015 Ebola epidemic in Sierra Leone. Journal of the Royal Society Interface, 12(112), 20150536. https://doi.org/10.1098/rsif.2015.0536. Retrieved May 1, 2018, from http://rsif.royalsocietypublishing.org/content/12/112/20150536.CrossRefPubMedCentralGoogle Scholar
  26. Young, A., Connolly, A., Hoar, A., Mancuso, B., Esplana, J. M., Kaur, G., et al. (2016). Use of peripheral health units in low-transmission Ebola virus disease surveillance. Online Journal of Public Health Informatics, 8(1), e177. https://doi.org/10.5210/ojphi.v8i1.6596. Retrieved May 2, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854600/.CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Palladium (Data, Informatics and Analytical Solutions)Washington, DCUSA
  2. 2.Clinton Health Access Initiative (Malaria Analytics and Surveillance)BostonUSA

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