EVD outbreak: impact on the treatment of malnutrition?
Case studies from Freetown-Western Area and Moyamba Districts
The provisions of basic health services in Sierra Leone have been severely challenged since the EVD outbreak started in May 2014. The preparedness of the health staff and health facilities to respond to the outbreak was limited and contributed to the disruption of provision of essential health services. This has led to the reduced uptake of health services and more likely the detriment of the health status of the population, particularly women and children under 5.
The disruption was mainly as a consequence of the heath staff and communities fear of contracting the virus while in the health facilities due to infected EVD patients or health staff. Indeed, in some cases, the EVD presents as malaria and diarrhoea leading to a poor understanding and diagnosis by health staff in identifying and managing, probable and definite cases. Misdiagnosis of EVD for common illnesses has resulted in the closure of several health facilities interrupting the service delivery and contributing to the growing mistrust among staff and communities that have resulted in lower attendance rates.
Since the beginning of the epidemic Action contre la Faim (ACF) has been monitoring the admissions of children under 5 years with severe acute malnutrition (SAM) in the Districts of Freetown-Western Area and Moyamba. ACF supports 14 Peripheral Health Units (PHUs) and 2 In-patient Facilities (IPF) in Western Area, and 40 PHUs and 1 IPF in Moyamba.
The period July-September 2014 has shown the highest decline in the admissions in PHUs and IPFs in FreetownWestern Area. Indeed, compare to the July’s admissions, in September the facilities have observed a 66% (PHUs) and 90% (IPFs) decline. In the same period, in Moyamba, the level of admissions declined by 25% in the PHUs and by 100% in the IPF. It is relevant however to note that in Moyamba, contrary to Freetown-Western Area, the number of admissions drastically decreased by 45% immediately after the first EVD confirmed case was identified in the district (July). It is also worth noting that in the same district another drastic decreased was registered in November, when the district has experienced another peak in the number of EVD confirmed cases.
In both districts, in the period October-December 2014 the number of admissions increased at PHU level almost realigning with the data of the same period in 2013. This trend could be explained by the implementation of the “infection, prevention and control” (IPC) measures training in all PHUs in Western Area and Moyamba districts that aimed at reducing the risk of infection of the staff and beneficiaries by providing training on precise safety protocols, protective gears and consumable to medical staff. In addition, social mobilization and health promotion activities might have also contributed to the increase in the number of admissions.
Although the data is not representative of the situation in the whole Western Area and Moyamba districts, it provides an illustration of the impact of the Ebola outbreak on the access to severe acute malnutrition treatment.