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Desborough J, Dykgraaf SH, Phillips C, Wright M, Maddox R, Davis S, Kidd M. Lessons for the global primary care response to COVID-19: a rapid review of evidence from past epidemics. Fam Pract 2021; 38:811-825. [PMID: 33586769 PMCID: PMC7928916 DOI: 10.1093/fampra/cmaa142] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND COVID-19 is the fifth and most significant infectious disease epidemic this century. Primary health care providers, which include those working in primary care and public health roles, have critical responsibilities in the management of health emergencies. OBJECTIVE To synthesize accounts of primary care lessons learnt from past epidemics and their relevance to COVID-19. METHODS We conducted a review of lessons learnt from previous infectious disease epidemics for primary care, and their relevance to COVID-19. We searched PubMed/MEDLINE, PROQUEST and Google Scholar, hand-searched reference lists of included studies, and included research identified through professional contacts. RESULTS Of 173 publications identified, 31 publications describing experiences of four epidemics in 11 countries were included. Synthesis of findings identified six key lessons: (i) improve collaboration, communication and integration between public health and primary care; (ii) strengthen the primary health care system; (iii) provide consistent, coordinated and reliable information emanating from a trusted source; (iv) define the role of primary care during pandemics; (v) protect the primary care workforce and the community and (vi) evaluate the effectiveness of interventions. CONCLUSIONS Evidence highlights distinct challenges to integrating and supporting primary care in response to infectious disease epidemics that have persisted over time, emerging again during COVID-19. These insights provide an opportunity for strengthening, and improved preparedness, that cannot be ignored in a world where the frequency, virility and global reach of infectious disease outbreaks are increasing. It is not too soon to plan for the next pandemic, which may already be on the horizon.
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Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Sally Hall Dykgraaf
- Australian National University Rural Clinical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christine Phillips
- Australian National University Medical School, College of Health and Medicine Australian National University, Canberra, Australia
| | - Michael Wright
- Centre for Health Economics Research and Evaluation (CHERE), University Technology Sydney, Sydney, Australia
| | - Raglan Maddox
- COVID-19 Primary Care Response Group, Australian Department of Health, Canberra, Australia
- National Centre for Epidemiology and Public Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Stephanie Davis
- COVID-19 Primary Care Response Group, Australian Department of Health, Canberra, Australia
- National Centre for Epidemiology and Public Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Michael Kidd
- Australian Government Department of Health, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- World Health Organization Collaborating Centre on Family Medicine and Primary Care, Geneva, Switzerland
- Murdoch Children’s Research Institute, The Royal Children’s Hospital, Melbourne, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
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2
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Bozman CM, Fallah M, Sneller MC, Freeman C, Fakoli LS, Shobayo BI, Dighero-Kemp B, Reilly CS, Kuhn JH, Bolay F, Higgs E, Hensley LE. Increased Likelihood of Detecting Ebola Virus RNA in Semen by Using Sample Pelleting. Emerg Infect Dis 2021; 27:1239-1241. [PMID: 33755000 PMCID: PMC8007310 DOI: 10.3201/eid2704.204175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Ebola virus RNA can reside for months or years in semen of survivors of Ebola virus disease and is probably associated with increased risk for cryptic sexual transmission of the virus. A modified protocol resulted in increased detection of Ebola virus RNA in semen and improved disease surveillance.
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3
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Datta B, Jaiswal A, Goyal P, Prakash A, Tripathy JP, Trehan N. The untimely demise of the TB Free block model in the wake of coronavirus disease 2019 in India. Trans R Soc Trop Med Hyg 2020; 114:789-791. [PMID: 32797204 PMCID: PMC7454845 DOI: 10.1093/trstmh/traa067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/09/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bornali Datta
- Department of Respiratory Medicine, Medanta the Medicity, Gurgaon, Haryana, India
| | - Anand Jaiswal
- Department of Respiratory Medicine, Medanta the Medicity, Gurgaon, Haryana, India
| | - Pinky Goyal
- Department of Respiratory Medicine, Medanta the Medicity, Gurgaon, Haryana, India
| | - Ashish Prakash
- Department of Respiratory Medicine, Medanta the Medicity, Gurgaon, Haryana, India
| | - Jaya Prasad Tripathy
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
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4
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Frimpong S, Paintsil E. A Case for Girl-child Education to Prevent and Curb the Impact of Emerging Infectious Diseases Epidemics. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2020; 93:579-585. [PMID: 33005122 PMCID: PMC7513442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Not only do epidemics such as HIV/AIDS, Ebola Virus Disease (EVD), and the current Coronavirus Disease (COVID-19) cause the loss of millions of lives, but they also cost the global economy billions of dollars. Consequently, there is an urgent need to formulate interventions that will help control their spread and impact when they emerge. The education of young girls and women is one such historical approach. They are usually the vulnerable targets of disease outbreaks - they are most likely to be vehicles for the spread of epidemics due to their assigned traditional roles in resource-limited countries. Based on our work and the work of others on educational interventions, we propose six critical components of a cost-effective and sustainable response to promote girl-child education in resource-limited settings.
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Affiliation(s)
- Shadrack Frimpong
- Department of Epidemiology of Microbial Diseases, Yale
School of Public Health, New Haven, CT,Department of Pediatrics, Yale School of Medicine, New
Haven, CT,To whom all correspondence should be addressed:
Shadrack Frimpong, MS, MPH, Department of Pediatrics, 464 Congress St, New
Haven, CT, 06520; Tel: +13474093278;
; ORCID iD: https://orcid.org/0000-0003-0304-6189
| | - Elijah Paintsil
- Department of Epidemiology of Microbial Diseases, Yale
School of Public Health, New Haven, CT,Department of Pediatrics, Yale School of Medicine, New
Haven, CT
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5
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Oyeniran OI, Chia T. Fighting the Coronavirus disease (Covid-19) pandemic: Employing lessons from the Ebola virus disease response. ACTA ACUST UNITED AC 2020; 15:100558. [PMID: 32837995 PMCID: PMC7332950 DOI: 10.1016/j.jemep.2020.100558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 11/20/2022]
Abstract
Coronavirus disease (COVID-19) is caused by a beta-coronavirus (SARS-CoV-2) that affects the lower respiratory tract and appears as pneumonia in humans. COVID-19 became apparent in December 2019 in Wuhan City of China, and has propagated profusely globally. Despite stringent global quarantine and containment drives, the incidence of COVID-19 keeps soaring high. Measures to minimize human-to-human transmission have been implemented to control the pandemic. However, special efforts to reduce transmission via efficient public health communications and dissemination of risks should be applied in susceptible populations including children, health care providers, and the elderly. In response to this global pandemic, this article summarizes proven strategies that could be employed to combat the COVID-19 disease outbreak, taking a cue from lessons learned from the Ebola virus disease response.
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Affiliation(s)
- O I Oyeniran
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Nile University of Nigeria, Abuja, Nigeria
| | - T Chia
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, Nile University of Nigeria, Abuja, Nigeria
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6
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Gil Cuesta J, Whitehouse K, Kaba S, Nanan-N'Zeth K, Haba B, Bachy C, Panunzi I, Venables E. 'When you welcome well, you vaccinate well': a qualitative study on improving vaccination coverage in urban settings in Conakry, Republic of Guinea. Int Health 2020; 13:586-593. [PMID: 31927565 PMCID: PMC8643481 DOI: 10.1093/inthealth/ihz097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/27/2019] [Accepted: 09/19/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Recurrent measles outbreaks followed by mass vaccination campaigns (MVCs) occur in urban settings in sub-Saharan countries. An understanding of the reasons for this is needed to improve future vaccination strategies. The 2017 measles outbreak in Guinea provided an opportunity to qualitatively explore suboptimal vaccination coverage within an MVC among participants through their perceptions, experiences and challenges. METHODS We conducted focus group discussions with caregivers (n=68) and key informant interviews (n=13) with health professionals and religious and community leaders in Conakry. Data were audio-recorded, transcribed verbatim from Susu and French, coded and thematically analysed. RESULTS Vaccinations were widely regarded positively and their preventive benefits noted. Vaccine side effects and the subsequent cost of treatment were commonly reported concerns, with further knowledge requested. Community health workers (CHWs) play a pivotal role in MVCs. Caregivers suggested recruiting CHWs from local neighbourhoods and improving their attitude, knowledge and skills to provide information about vaccinations. Lack of trust in vaccines, CHWs and the healthcare system, particularly after the 2014-2016 Ebola epidemic, were also reported. CONCLUSIONS Improving caregivers' knowledge of vaccines, potential side effects and their management are essential to increase MVC coverage in urban settings. Strengthening CHWs' capacities and appropriate recruitment are key to improving trust through a community involvement approach.
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Affiliation(s)
- Julita Gil Cuesta
- Luxembourg Operational Research Unit, Médecins Sans Frontières, 68 Rue de Gasperich, L-1617, Luxembourg.,Medical Department, Médecins Sans Frontières,46 Arbre Benit, 1050, Brussels, Belgium
| | - Katherine Whitehouse
- Luxembourg Operational Research Unit, Médecins Sans Frontières, 68 Rue de Gasperich, L-1617, Luxembourg.,Medical Department, Médecins Sans Frontières,46 Arbre Benit, 1050, Brussels, Belgium
| | - Salimou Kaba
- Médecins Sans Frontières, Coléah Abattoir, Corniche Sud, Commune de Matam, BP3523, Conakry, Republic of Guinea
| | - Kassi Nanan-N'Zeth
- Médecins Sans Frontières, Coléah Abattoir, Corniche Sud, Commune de Matam, BP3523, Conakry, Republic of Guinea
| | - Benoit Haba
- Médecins Sans Frontières, Coléah Abattoir, Corniche Sud, Commune de Matam, BP3523, Conakry, Republic of Guinea
| | - Catherine Bachy
- Medical Department, Médecins Sans Frontières,46 Arbre Benit, 1050, Brussels, Belgium
| | - Isabella Panunzi
- Medical Department, Médecins Sans Frontières,46 Arbre Benit, 1050, Brussels, Belgium
| | - Emilie Venables
- Luxembourg Operational Research Unit, Médecins Sans Frontières, 68 Rue de Gasperich, L-1617, Luxembourg.,Medical Department, Médecins Sans Frontières,46 Arbre Benit, 1050, Brussels, Belgium.,Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, South Africa
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7
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Ousman K, Kabego L, Talisuna A, Diaz J, Mbuyi J, Houndjo B, Ngandu JP, Omba G, Aruna A, Mossoko M, Djingarey MH, Balde T, Abok P, Diallo B, Dovlo D, Yao M, Fortin A, Formenty P, Fall IS. The impact of Infection Prevention and control (IPC) bundle implementationon IPC compliance during the Ebola virus outbreak in Mbandaka/Democratic Republic of the Congo: a before and after design. BMJ Open 2019; 9:e029717. [PMID: 31492782 PMCID: PMC6731777 DOI: 10.1136/bmjopen-2019-029717] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To assess the impact of refresher training of healthcare workers (HCWs) in infection prevention and control (IPC), ensuring consistent adequate supplies and availability of IPC kits and carrying out weekly monitoring of IPC performance in healthcare facilities (HCFs) DESIGN: This was a before and after comparison study SETTINGS: This study was conducted from June to July 2018 during an Ebola virus disease (EVD) outbreak in Equateur Province in the Democratic Republic of the Congo (DRC). PARTICIPANTS 48 HCFs INTERVENTIONS: HCWs capacity building in basic IPC, IPC kit donation and IPC mentoring. PRIMARY OUTCOME MEASURES IPC score RESULTS: 48 HCFs were evaluated and 878 HCWs were trained, of whom 437 were women and 441 were men. The mean IPC score at baseline was modestly higher in hospitals (8%) compared with medical centres (4%) and health centres (4%), respectively. The mean IPC score at follow-up significantly increased to 50% in hospitals, 39% in medical centres and 36% in health centres (p value<0.001). The aggregate mean IPC score at baseline for all HCFs, combined was 4.41% and at follow-up it was 39.51% with a mean difference of 35.08% (p-value<0.001). CONCLUSIONS Implementation of HCW capacity building in IPC, IPC kit donation to HCF and mentoring in IPC improved IPC compliance during the ninth EVD outbreak in the DRC.
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Affiliation(s)
- Kevin Ousman
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Landry Kabego
- Infection Control Africa Network, Bukavu, Democratic Republic of the Congo
- Microbiology, Universite Catholique de Bukavu Faculte de Medecine, Bukavu, Democratic Republic of the Congo
| | - Ambrose Talisuna
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Janet Diaz
- World Health Organization, Geneva, Switzerland
| | - John Mbuyi
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Bienvenu Houndjo
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Gaston Omba
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Aaron Aruna
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Mathias Mossoko
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | | | - Thierno Balde
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Patrick Abok
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Boubacar Diallo
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Delanyo Dovlo
- International Health System Services Expert, Accra, Ghana
| | - Michel Yao
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Anne Fortin
- World Health Organization, Geneva, Switzerland
| | | | - Ibrahima Soce Fall
- World Health Organization Regional Office for Africa, Brazzaville, Congo
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8
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Koroma IB, Javadi D, Hann K, Harries AD, Smart F, Samba T. Non-communicable diseases in the Western Area District, Sierra Leone, following the Ebola outbreak. F1000Res 2019; 8:795. [PMID: 31354948 PMCID: PMC6652098 DOI: 10.12688/f1000research.18563.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/05/2023] Open
Abstract
Background: Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality in the world. During infectious disease outbreaks, such as the Ebola virus disease outbreak in West Africa from 2014-2015, the health system is often strained, and diagnosis, management and care of NCDs may be compromised. This study assessed numbers and distribution of NCDs in all health facilities in the Western-Area District, Sierra Leone, in the post-Ebola period (June-December 2015) comparing findings with the pre-Ebola (June-December 2013) and Ebola outbreak (June-December 2014) periods. Methods: This was a cross-sectional study using secondary data from routine records of aggregate monthly NCD reports. Data were analysed using Open EPI and comparisons were made between the post-Ebola and pre-Ebola/Ebola periods using the chi square test. Results: There were 10,011 people reported with NCDs during the three six-month periods, with 6194 (62%) presenting at peripheral health units (PHU). Reported NCDs decreased during Ebola and increased post-Ebola, but did not recover to pre-Ebola levels. Hypertension cases remained fairly constant throughout being mainly managed at PHU. Numbers with diabetes mellitus generally stayed the same except for a significant post-Ebola increase in tertiary hospitals. Small numbers were reported with mental health disorders across all facilities in all time periods. Conclusion: NCD reporting is recovering in the immediate post-Ebola period. Decentralization of NCD care is welcome and is an effective strategy for management as evidenced by hypertension. To be successful, this must be supported by strengthening other elements of the health system such as training of health workers, robust information and referral systems and reliable medicine supply chains.
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Affiliation(s)
- Ibrahim Baimba Koroma
- Directorate of Policy, Planning and Information (DPPI), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - Dena Javadi
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Katrina Hann
- Sustainable Health Systems, Freetown, Sierra Leone
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene and Tropical Medicine, London, UK
| | - Francis Smart
- Directorate of Policy, Planning and Information (DPPI), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - Thomas Samba
- National Public Health Agency (NPHA), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
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9
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Koroma IB, Javadi D, Hann K, Harries AD, Smart F, Samba T. Non-communicable diseases in the Western Area District, Sierra Leone, following the Ebola outbreak. F1000Res 2019; 8:795. [PMID: 31354948 PMCID: PMC6652098 DOI: 10.12688/f1000research.18563.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2019] [Indexed: 01/28/2023] Open
Abstract
Background: Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality in the world. During infectious disease outbreaks, such as the Ebola virus disease outbreak in West Africa from 2014-2015, the health system is often strained, and diagnosis, management and care of NCDs may be compromised. This study assessed numbers and distribution of NCDs in all health facilities in the Western-Area District, Sierra Leone, in the post-Ebola period (June-December 2015) comparing findings with the pre-Ebola (June-December 2013) and Ebola outbreak (June-December 2014) periods. Methods: This was a cross-sectional study using secondary data from routine records of aggregate monthly NCD reports. Data were analysed using Open EPI and comparisons were made between the post-Ebola and pre-Ebola/Ebola periods using the chi-square test. Results: There were 10,011 people reported with NCDs during the three six-month periods, with 6194 (62%) presenting at peripheral health units (PHU). Reported NCDs decreased during Ebola and increased post-Ebola, but did not recover to pre-Ebola levels. Hypertension cases remained fairly constant throughout being mainly managed at PHU. Numbers with diabetes mellitus generally stayed the same except for a significant post-Ebola increase in tertiary hospitals. Small numbers were reported with mental health disorders across all facilities in all time periods. Conclusion: NCD reporting is recovering in the immediate post-Ebola period. Decentralization of NCD care is welcome and is an effective strategy for management as evidenced by hypertension. To be successful, this must be supported by strengthening other elements of the health system such as training of health workers, robust information and referral systems and reliable medicine supply chains.
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Affiliation(s)
- Ibrahim Baimba Koroma
- Directorate of Policy, Planning and Information (DPPI), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - Dena Javadi
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Katrina Hann
- Sustainable Health Systems, Freetown, Sierra Leone
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene and Tropical Medicine, London, UK
| | - Francis Smart
- Directorate of Policy, Planning and Information (DPPI), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - Thomas Samba
- National Public Health Agency (NPHA), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
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10
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Decroo T, Delamou A, Reeder JC. Operational research: did health systems in Sierra Leone recover after the 2014-15 Ebola outbreak? F1000Res 2019; 8:792. [PMID: 31231516 PMCID: PMC6556999 DOI: 10.12688/f1000research.19077.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2019] [Indexed: 11/30/2022] Open
Abstract
Findings from participants who attended the second post-Ebola SORT-IT course are reported in five short papers on the "legacy of Ebola on health Systems in Sierra-Leone". After a decline of health service provision and utilisation during the Ebola outbreak, present findings show recovery over time in the post-Ebola period. However, important challenges remain, including an important health workforce gap.
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Affiliation(s)
- Tom Decroo
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Antwerp, 2000, Belgium
| | - Alexandre Delamou
- Department of Public Health, Gamal Abdel Nasser University, Conakry, Guinea
| | - John C. Reeder
- Special Programme for Research and Training in Tropical Diseases, UNICEF/UNDP/World Bank/WHO, Geneva, Switzerland
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