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Meta-Analysis
. 2019 Jun;9(1):010406.
doi: 10.7189/jogh.09.010406.

Utilization of non-Ebola health care services during Ebola outbreaks: a systematic review and meta-analysis

Jess Alan Wilhelm  1 , Stéphane Helleringer  2
Affiliations
Meta-Analysis

Utilization of non-Ebola health care services during Ebola outbreaks: a systematic review and meta-analysis

Jess Alan Wilhelm et al. J Glob Health. 2019 Jun.

Abstract

Background: Beyond their direct effects on mortality, outbreaks of Ebola Virus Disease (EVD) might disrupt the provision of health care services in affected countries, possibly resulting in an increase in the number of deaths from non-EVD causes. We conducted a systematic review and meta-analysis of studies documenting the impact of EVD outbreaks on health care utilization.

Methods: We searched PubMed, Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Global Health, Pascal and grey literature to identify observational studies that compared indicators of health care utilization before and during the outbreak. We identified 14 752 unique citations, 22 of which met inclusion criteria. All were related to the 2013-2016 West African EVD outbreak. From the 22 studies, we extracted 235 estimates of the relative change in health care utilization during the EVD outbreak. We used multivariate regression to estimate the average effect of the outbreak on health care utilization, and to assess heterogeneity across study characteristics.

Findings: On average, health care utilization declined by 18.0% during the outbreak (95% Confidence Interval: -26.5%, -9.5%). The observed declines in health care utilization were largest in settings affected by higher levels of EVD incidence (>2.5 cases per 100 000 per week) whereas utilization did not change in settings with EVD incidence less than 0.5 cases per 100 000 per week. Declines in utilization were greater for inpatient care and for deliveries than for outpatient care. They were also larger in studies based on small samples of health facilities, suggestive of publication bias. However, several studies based on larger samples of facilities also observed declines in health care utilization.

Conclusions: During the West African EVD outbreak, the utilization of health services declined significantly. During outbreaks of EVD, attention needs to be paid to the disruption of the health services, which can have large indirect health impacts.

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Conflict of interest statement

Competing interests: The authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author), and declare no conflict of interest.

Figures

Figure 1
Figure 1
Literature review flowchart.
Figure 2
Figure 2
Change in utilization by study and Ebola incidence.
Figure 3
Figure 3
Distribution of study reference and Ebola exposure periods (2011-2015).
See this image and copyright information in PMC

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