Elsevier

Public Health

Volume 143, February 2017, Pages 60-70
Public Health

Review Paper
The health impact of the 2014–15 Ebola outbreak

https://doi.org/10.1016/j.puhe.2016.10.020Get rights and content

Highlights

  • The consequences of the Ebola outbreak were more severe than the outbreak itself.

  • Health system impacts included health worker deaths, resource diversion and hospital closures.

  • There was a breakdown of trust in health systems and reduced access to healthcare.

  • There were dramatic reductions in healthcare utilization especially among women and children.

  • There were major socio-economic consequences affecting key social determinants of health.

Abstract

Objectives

The 2014–15 outbreak in West Africa was the largest and deadliest Ebola outbreak recorded; however, there remains uncertainty over its wider health consequences. Our objective was to provide a comprehensive overview of the impact of the Ebola outbreak on population health in the three most affected countries: Sierra Leone, Liberia and Guinea.

Study design

Narrative review.

Methods

A narrative overview of the peer-reviewed and grey literature related to the impact and consequences of the Ebola outbreak was conducted, synthesizing the findings of literature retrieved from a structured search of biomedical databases, the Web and references of reviewed articles.

Results

The impact of the Ebola outbreak was profound and multifaceted. The health system was severely compromised due to overwhelming demand, healthcare workers deaths, resource diversion and closure of health facilities. Fear of Ebola and healthcare workers led to a breakdown in trust in health systems. Access to healthcare was compromised. Substantial reductions in healthcare utilization were reported including over 80% reductions in maternal delivery care in Ebola-affected areas, 40% national reductions in malaria admissions among children <5 years and substantial reductions in vaccination coverage. Socio-economic impacts included reduced community cohesion, education loss, reduced child protection, widespread job losses and food insecurity. Increased morbidity and mortality and reduced expected life expectancy were reported.

Conclusions

This review highlights the scope and scale of the consequences of the Ebola outbreak on population health. Sustained commitment of the international community is required to support health system re-building and to urgently address unmet population health needs.

Introduction

The Ebola virus causes an acute, severe, often fatal illness. The 2014–2015 outbreak in West Africa was the most extensive and deadliest Ebola outbreak recorded.

The outbreak began in rural Guinea in December 2013 and spread to neighbouring countries and urban centres becoming widespread and intense in Sierra Leone, Guinea and Liberia. These three countries had been recovering from years of civil conflicts and political instability. Their populations already experienced high rates of poverty, malnutrition and endemic disease and low life expectancy.1, 2, 3 Major cholera epidemics in the preceding years in the region provide a stark indication of the parlous state of public health.4, 5 Health systems in the three countries were chronically under-funded, under-resourced, over-burdened and ill prepared for an Ebola outbreak.6, 7

In August 2014 as the outbreak accelerated with uninterrupted transmission occurring in capital cities, the national governments of Guinea, Sierra Leone and Liberia responded by each declaring a state of emergency.8, 9 They imposed strict measures designed to control the spread of the disease including: mandatory hospitalization of suspected Ebola cases; quarantine of Ebola-affected households and communities; closure of schools and markets and banning of public gatherings; banning of traditional burial practices and enforcement of ‘safe and hygienic burial’ or cremation; and internal travel restrictions and border closures.8, 9, 10

Incidence surged in all three countries between August and December 2014 (the peak of the outbreak) and decreased over time due to protective behaviour changes at population level and internationally supported control efforts.11, 12 The outbreak was declared over in January 2016, although sporadic cases have arisen since.13

Over 28,000 people were infected by Ebola and over 11,000 died.11 The population health impact however was not confined to morbidity and mortality directly caused by Ebola virus disease (EVD). The consequences of the outbreak and the outbreak response were far reaching and severe.

We are not aware of a review in the scientific press to date which has provided a broad overview of the overall health impact of the Ebola outbreak including its impact on health systems and the socio-economic consequences. Here, we review the available literature aiming to provide a comprehensive picture of the full impact of the Ebola outbreak on population health.

Section snippets

Methods

A narrative overview of the peer-reviewed and grey literature related to the impact and consequences of the Ebola outbreak was conducted, synthesizing the findings of literature retrieved from a structured search of biomedical databases, the Web and references of reviewed articles. A search of the English language literature was performed in April 2016 to supplement existing data sources reporting incidence and mortality associated with the Ebola outbreak in Sierra Leone, Guinea and Liberia. A

Findings

The impact of the Ebola outbreak and the outbreak response was profound and multifaceted and included: direct morbidity and mortality caused by EVD; impact on the health system; a complex social impact including a breakdown in trust between populations and the health system; reduced access to healthcare; a dramatic reduction in health system utilization; increased unmet population health needs; and worsening social and economic circumstances for health (Fig. 2).

Limitations

This review is bound by the limitations of the available evidence. Weaknesses in health information systems contributed to the delay in detection of the outbreak and therefore its extent. After the outbreak, the longstanding limitations in the quantity and quality of routine health data hamper efforts to identify and understand its direct and wider health consequences. Relatively few studies were conducted during the outbreak and in the short time (in research terms) since it was declared over.

Ethical approval

Not required. This was a review of published material already in the public domain and did not involve analyses of primary or identifiable data.

Funding

None received.

Competing interests

None declared.

References (92)

  • BBC

    Ebola outbreak: Guinea declares emergency

    (2014)
  • M. Mark

    State of emergency declared in Liberia and Sierra Leone after Ebola outbreak

    (2014)
  • Plan International

    Ebola: beyond the health emergency

    (2015)
  • World Health Organization

    Ebola data and statistics

    (2016)
  • Centers for Disease Control and Prevention

    Ebola outbreak in West Africa

    (2014)
    (2016)
  • World Health Organization

    Latest Ebola outbreak over in Liberia; West Africa is at zero, but new flare-ups are likely to occur

    (2016)
  • L.A. McNamara et al.

    Ebola surveillance—Guinea, Liberia, and Sierra Leone

    MMWR Suppl

    (2016)
  • A. Tiffany et al.

    Ebola virus disease complications as experienced by survivors in Sierra Leone

    Clin Infect Dis Off Publ Infect Dis Soc Am

    (2016)
  • J.T. Scott et al.

    Post-Ebola syndrome, Sierra Leone

    Emerg Infect Dis

    (2016)
  • Diseases NIoAaI

    Ebola survivor study yields insights on complications of disease

    (2016)
  • S. Yadav et al.

    The current mental health status of Ebola survivors in Western Africa

    J Clin Diagn Res

    (2015)
  • T. Van Bortel et al.

    Psychosocial effects of an Ebola outbreak at individual, community and international levels

    Bull World Health Organ

    (2016)
  • A. Mohammed et al.

    An evaluation of psychological distress and social support of survivors and contacts of Ebola virus disease infection and their relatives in Lagos, Nigeria: a cross sectional study–2014

    BMC Public Health

    (2015)
  • MEASURE Evaluation

    Une évaluation rapide des effets de la flambée d'Ebola sur la prestation et utilisation des services de santé génésique, maternelle, néonatale, et infantile en Guinée

    (2015)
  • World Health Organization

    Health worker Ebola infections in Guinea, Liberia and Sierra Leone

    (2015)
  • A.S. Fauci

    Ebola—underscoring the global disparities in health care resources

    N Engl J Med

    (2014)
  • P.H. Kilmarx et al.

    Ebola virus disease in health care workers–Sierra Leone

    MMWR Morb Mortal Wkly Rep

    (2014)
  • M. Grinnell et al.

    Ebola virus disease in health care workers–Guinea

    MMWR Morb Mortal Wkly Rep

    (2014)
  • World Health Organization

    Ebola situation report - 30th September 2015

    (2015)
  • I. Bundu et al.

    Surgery in the time of Ebola: how events impacted on a single surgical institution in Sierra Leone

    J R Army Med Corps

    (2016)
  • D.K. Evans et al.

    The next wave of deaths from Ebola? The impact of health care worker mortality

    (2015)
  • World Health Organization

    Density of doctors, nurses and midwives in the 49 priority countries

    (2010)
  • World Bank Group

    Physicians (per 1,000 people)

    (2016)
  • World Bank Group

    Nurses and midwives (per 1,000 people)

    (2016)
  • Confédérations suisse

    Note Guinée/Sierra Leone/Libéria Epidémie d'Ebola

    (2015)
  • United Nations Development Group - Western and Central Africa

    Socio-economic impact of Ebola virus disease in West Africa countries - a call for national and regional containment, recovery and prevention

    (2015)
  • UNMEER

    UN Mission for Ebola Emergency Response (UNMEER) External Situation Report - 18th February 2015

    (2015)
  • J.D. Forrester et al.

    Cluster of Ebola cases among Liberian and U.S. health care workers in an Ebola treatment unit and adjacent hospital – Liberia

    MMWR Morb Mortal Wkly Rep

    (2014)
  • The Washington Post

    Terrifying new normal? An Ebola outbreak that never really goes away

    (2014)
  • Medicins Sans Frontieres

    Sierra Leone: MSF suspends emergency pediatric and maternal services in Gondama

    (2014)
  • Republic of Liberia Ministry of Health and Social Welfare

    Quarterly report of the health sector pool fund

    (July 1, 2014)
  • Doctors of the World

    Beyond Ebola: rebuilding health services in Moyamba, Sierra Leone

    (2015)
  • J.W. Elston et al.

    Impact of the Ebola outbreak on health systems and population health in Sierra Leone

    J Public Health (Oxford, England)

    (2015)
  • Ministry of Health and Sanitation [Sierra Leone] and UN Children's Fund

    Sierra Leone Health Facility Survey - assessing the impact of the EVD outbreak on health systems in Sierra Leone

    (2014)
  • Ministry of Health and Sanitation [Sierra Leone] and UN Children's Fund

    Sierra Leone health facility assessment 2015

    (2015)
  • VSO

    Exploring the impact of the Ebola outbreak on routine maternal health services in Sierra Leone

    (2015)
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      Furthermore, many health facilities were closed, which reduced access to healthcare. For instance, Elston et al. [27] reported 80% reductions in maternal delivery, 40% national reductions in malaria admissions among children <5 years and significant reductions in vaccination coverage. Generally, there was a 60% mortality rate of those infected with Ebola [1] and an estimated 10,600 deaths due to a reduction in healthcare services because of the outbreak.

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