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PLoS One. 2017 May 1;12(5):e0176692. doi: 10.1371/journal.pone.0176692. eCollection 2017.

Ebola management centre proximity associated with reduced delays of healthcare of Ebola Virus Disease (EVD) patients, Tonkolili, Sierra Leone, 2014-15.

Author information

1
European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
2
Institut de Veille Sanitaire, Saint-Maurice, France.
3
Médecins Sans Frontières, Magburaka, Sierra Leone.
4
Manson Unit, Médecins Sans Frontières, London, United Kingdom.
5
State Office for Health and Social Affairs, Berlin, Germany.
6
Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany.
7
District Health Management Team, Ministry of Health and Sanitation, Magburaka, Sierra Leone.
8
Operational Centre Amsterdam, Médecins Sans Frontières, Amsterdam, The Netherlands.
9
National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canbera, Australia.

Abstract

Between August-December 2014, Ebola Virus Disease (EVD) patients from Tonkolili District were referred for care to two Médecins Sans Frontières (MSF) Ebola Management Centres (EMCs) outside the district (distant EMCs). In December 2014, MSF opened an EMC in Tonkolili District (district EMC). We examined the effect of opening a district-based EMC on time to admission and number of suspect cases dead on arrival (DOA), and identified factors associated with fatality in EVD patients, residents in Tonkolili District. Residents of Tonkolili district who presented between 12 September 2014 and 23 February 2015 to the district EMC and the two distant EMCs were identified from EMC line-lists. EVD cases were confirmed by a positive Ebola PCR test. We calculated time to admission since the onset of symptoms, case-fatality and adjusted Risk Ratios (aRR) using Binomial regression. Of 249 confirmed Ebola cases, 206 (83%) were admitted to the distant EMCs and 43 (17%) to the district EMC. Of them 110 (45%) have died. Confirmed cases dead on arrival (n = 10) were observed only in the distant EMCs. The median time from symptom onset to admission was 6 days (IQR 4,8) in distant EMCs and 3 days (IQR 2,7) in the district EMC (p<0.001). Cases were 2.0 (95%CI 1.4-2.9) times more likely to have delayed admission (>3 days after symptom onset) in the distant compared with the district EMC, but were less likely (aRR = 0.8; 95%CI 0.6-1.0) to have a high viral load (cycle threshold ≤22). A fatal outcome was associated with a high viral load (aRR 2.6; 95%CI 1.8-3.6) and vomiting at first presentation (aRR 1.4; 95%CI 1.0-2.0). The opening of a district EMC was associated with earlier admission of cases to appropriate care facilities, an essential component of reducing EVD transmission. High viral load and vomiting at admission predicted fatality. Healthcare providers should consider the location of EMCs to ensure equitable access during Ebola outbreaks.

PMID:
28459838
PMCID:
PMC5411047
DOI:
10.1371/journal.pone.0176692
[Indexed for MEDLINE]
Free PMC Article

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