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. 2020 Aug 18;14(8):e0008624.
doi: 10.1371/journal.pntd.0008624. eCollection 2020 Aug.

National reporting of deaths after enhanced Ebola surveillance in Sierra Leone

Mohamed F Jalloh  1   2 , Reinhard Kaiser  1 , Mariam Diop  3 , Amara Jambai  4 , John T Redd  1 , Rebecca E Bunnell  1 , Evelyn Castle  3 , Charles Alpren  1 , Sara Hersey  1 , Anna Mia Ekström  2   5 , Helena Nordenstedt  2
Affiliations

National reporting of deaths after enhanced Ebola surveillance in Sierra Leone

Mohamed F Jalloh et al. PLoS Negl Trop Dis. .

Abstract

Background: Sierra Leone experienced the largest documented epidemic of Ebola Virus Disease in 2014-2015. The government implemented a national tollfree telephone line (1-1-7) for public reporting of illness and deaths to improve the detection of Ebola cases. Reporting of deaths declined substantially after the epidemic ended. To inform routine mortality surveillance, we aimed to describe the trends in deaths reported to the 1-1-7 system and to quantify people's motivations to continue reporting deaths after the epidemic.

Methods: First, we described the monthly trends in the number of deaths reported to the 1-1-7 system between September 2014 and September 2019. Second, we conducted a telephone survey in April 2017 with a national sample of individuals who reported a death to the 1-1-7 system between December 2016 and April 2017. We described the reported deaths and used ordered logistic regression modeling to examine the potential drivers of reporting motivations.

Findings: Analysis of the number of deaths reported to the 1-1-7 system showed that 12% of the expected deaths were captured in 2017 compared to approximately 34% in 2016 and over 100% in 2015. We interviewed 1,291 death reporters in the survey. Family members reported 56% of the deaths. Nearly every respondent (94%) expressed that they wanted the 1-1-7 system to continue. The most common motivation to report was to obey the government's mandate (82%). Respondents felt more motivated to report if the decedent exhibited Ebola-like symptoms (adjusted odds ratio 2.3; 95% confidence interval 1.8-2.9).

Conclusions: Motivation to report deaths that resembled Ebola in the post-outbreak setting may have been influenced by knowledge and experiences from the prolonged epidemic. Transitioning the system to a routine mortality surveillance tool may require a robust social mobilization component to match the high reporting levels during the epidemic, which exceeded more than 100% of expected deaths in 2015.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Distribution of the monthly unadjusted aggregated number of deaths reported to the 1-1-7 system, Sierra Leone, 2014–2019.
Fig 2
Fig 2. Percent distribution of preferences expressed by respondents for the continuation of the 1-1-7 system, Sierra Leone, 2017.
Total of 1174 respondents with complete data.
Fig 3
Fig 3. Percent distribution of motivations expressed by respondents for reporting deaths to the 1-1-7 system, Sierra Leone, 2017.
Total of 1291 respondents with complete data.
See this image and copyright information in PMC

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