Review PaperThe health impact of the 2014–15 Ebola outbreak
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.
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