Sesay Tom, Denisiuk Olga, Zachariah Rony
Child Health and Immunization Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone.
Alliance for Public Health, Kiev, Ukraine.
F1000Res. 2019 Jun 6;8:796. doi: 10.12688/f1000research.18552.2. eCollection 2019.
Sierra Leone was severely affected by the 2014/2015 Ebola outbreak which is likely to have had longer term repercussions on the health system including on paediatric morbidity and mortality. We thus assessed under-five morbidity and mortality for malaria, acute respiratory Infections (ARI)/pneumonia, watery diarrhoea and measles during the post-Ebola period in Sierra Leone and compared this with the pre- and intra-Ebola periods. This was a retrospective cross-sectional study using program data from the District Health Information system (DHIS2) and sourced from 14 districts in Sierra Leone. It included under-five children from 1,250 health facilities country-wide. Study periods included: before (June 1 , 2013-April 30 , 2014); during (June 1 , 2014-April 30 , 2015); and after Ebola (June 1 , 2016-April 30 , 2017). Malaria, ARI/pneumonia and diarrhoea consultations declined during Ebola but recovered to pre-Ebola levels in the post-Ebola period. During the post-Ebola period, there was a highly significant reduction in case-fatality for the first three morbidities compared to the pre-Ebola period ( <0.0001). Average number of measles cases increased from 48/month in the pre-Ebola period to 568/month (12-fold increase) post-Ebola. Although there was no difference in measles case-fatality between the pre- and post-Ebola periods, case-fatality post-Ebola was significantly lower than during Ebola (Relative Risk: 0.05, 95% confidence interval 0.02-0.15, <0.0001). Consultations for under-five children at health facilities in Sierra Leone recovered to pre-Ebola levels and case-fatality for common childhood illnesses declined significantly. This is a change for the better. However, the high level of reported measles cases in the post-Ebola period indicates gaps in immune status and needs focused attention.
塞拉利昂在2014/2015年埃博拉疫情中受到严重影响，这可能对卫生系统产生了长期影响，包括对儿童发病率和死亡率的影响。因此，我们评估了塞拉利昂埃博拉疫情后五岁以下儿童疟疾、急性呼吸道感染（ARI）/肺炎、水样腹泻和麻疹的发病率和死亡率，并将其与埃博拉疫情前和疫情期间进行了比较。这是一项回顾性横断面研究，使用了地区卫生信息系统（DHIS2）的项目数据，数据来源于塞拉利昂的14个地区。研究对象包括全国1250个卫生设施中的五岁以下儿童。研究时间段包括：疫情前（2013年6月1日至2014年4月30日）；疫情期间（2014年6月1日至2015年4月30日）；以及埃博拉疫情后（2016年6月1日至2017年4月30日）。疟疾、ARI/肺炎和腹泻的就诊人数在埃博拉疫情期间有所下降，但在疫情后恢复到了疫情前的水平。在疫情后阶段，与疫情前相比，前三种疾病的病死率显著降低（<0.0001）。麻疹病例的平均数量从疫情前的每月48例增加到疫情后的每月568例（增加了12倍）。虽然埃博拉疫情前后麻疹病死率没有差异，但疫情后的病死率显著低于疫情期间（相对风险：0.05，95%置信区间0.02 - 0.15，<0.0001）。塞拉利昂卫生设施中五岁以下儿童的就诊人数恢复到了疫情前的水平，常见儿童疾病的病死率显著下降。这是一个向好的变化。然而，疫情后报告的麻疹病例数量居高不下，表明免疫状况存在差距，需要重点关注。
