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. 2018 Nov 9;18(1):846.
doi: 10.1186/s12913-018-3666-9.

Admissions and surgery as indicators of hospital functions in Sierra Leone during the west-African Ebola outbreak

Håkon A Bolkan  1   2   3 , Alex van Duinen  4   5   6 , Mohammed Samai  7   8 , Donald Alpha Bash-Taqi  7   8 , Ibrahim Gassama  7 , Bart Waalewijn  6 , Arne Wibe  4   5 , Johan von Schreeb  9
Affiliations

Admissions and surgery as indicators of hospital functions in Sierra Leone during the west-African Ebola outbreak

Håkon A Bolkan et al. BMC Health Serv Res. .

Abstract

Background: In an attempt to assess the effects of the Ebola viral disease (EVD) on hospital functions in Sierra Leone, the aim of this study was to evaluate changes in provisions of surgery and non-Ebola admissions during the first year of the EVD outbreak.

Methods: All hospitals in Sierra Leone known to perform inpatient surgery were assessed for non-Ebola admissions, volume of surgery, caesarean deliveries and inguinal hernia repairs between January 2014 and May 2015, which was a total of 72 weeks. Accumulated weekly data were gathered from readily available hospital records at bi-weekly visits during the peak of the outbreak from September 2014 to May 2015. The Mann-Whitney U test was used to compare weekly median admissions during the first year of the EVD outbreak, with the 20 weeks before the outbreak, and weekly median volume of surgeries performed during the first year of the EVD outbreak with identical weeks of 2012. The manuscript is prepared according to the STROBE checklist for cross-sectional studies.

Results: Of the 42 hospitals identified, 40 had available data for 94% (2719/2880) of the weeks. There was a 51% decrease in weekly median non-Ebola admissions and 41% fewer weekly median surgeries performed compared with the 20 weeks before the outbreak (admission) and 2012 (volume of surgery). Governmental hospitals experienced a smaller reduction in non-Ebola admissions (45% versus 60%) and surgeries (31% versus 53%) compared to private non-profit hospitals. Governmental hospitals realized an increased volume of cesarean deliveries by 45% during the EVD outbreak, thereby absorbing the 43% reduction observed in the private non-profit hospitals.

Conclusions: Both non-Ebola admissions and surgeries were severely reduced during the EVD outbreak. In addition to responding to the EVD outbreak, governmental hospitals were able to maintain certain core health systems functions. Volume of surgery is a promising indicator of hospital functions that should be further explored.

Keywords: Ebola viral disease; Hospital functioning; Inpatient admissions; Sierra Leone; Surgery.

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Conflict of interest statement

Ethics approval and consent to participate

This study did not require an ethics approval from the local ethics committee, which has been confirmed by Office of the Sierra Leone Ethics and Scientific Review Committee.

Consent for publication

All authors have consented for publication.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Weekly admission and surgery before and during the EVD outbreak Legend: The grey bars depict weekly confirmed new Ebola cases until May 17, 2015, which was 52 weeks after the onset of the epidemic in Sierra Leone (All panels). Weekly admissions by hospital owner between January 2014 to week 20 of 2015 (Panel a). Weekly surgical procedures performed between January 2014 and week 20 of 2015 compared to similar facilities and weeks in 2012 (Panel b). Weekly number of surgical procedures by hospital owner in 2014 and the first 20 weeks of 2015 (Panel c)
Fig. 2
Fig. 2
Proportion of inguinal hernia repairs and caesarean deliveries out of all surgeries performed. Legend: Grey bars are weekly confirmed new Ebola cases until May 17, 2015, 52 weeks after the onset of the epidemic in Sierra Leone (Both panels). Proportion of hernia repairs out of all surgeries performed for governmental and private non-profit hospitals before and during the EVD outbreak (Panel a). Proportion of caesarean deliveries out of all surgeries performed for governmental and private non-profit hospitals before and during the EVD outbreak (Panel b)
See this image and copyright information in PMC

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