TY - JOUR
T1 - Utilization of non-Ebola health care services during Ebola outbreaks
T2 - A systematic review and meta-analysis
AU - Wilhelm, Jess Alan
AU - Helleringer, Stéphane
N1 - Funding Information:
We would like to thank the two reviewers, Nikita Viswasam and Joanna Lai, for their assistance, and Claire Twose for her help with the literature search strategy. Guy Harling provided two articles that had not been identified through our literature search. Caitlin Kennedy provided input on the design of the study. We would like to acknowledge researchers and study teams that generated the data on which the articles included in this review are based. In particular, the data collectors who visited health facilities at great personal risk should be commended for their courage and dedication. This project was funded through a Programme Cooperation Agreement between the West and Central African Regional Office (WCARO) of UNICEF (Dakar, Senegal) and Johns Hopkins University (Baltimore, USA) The funder had no role in study design or in the decision to publish results.
Publisher Copyright:
© 2019 The Author(s) JoGH.
PY - 2019
Y1 - 2019
N2 - 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.
AB - 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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U2 - 10.7189/jogh.09.010406
DO - 10.7189/jogh.09.010406
M3 - Article
C2 - 30701070
AN - SCOPUS:85060959509
SN - 2047-2978
VL - 9
JO - Journal of global health
JF - Journal of global health
IS - 1
M1 - 010406
ER -