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

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 exam...

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Bibliographic Details
Published in:PloS one 2017-05, Vol.12 (5), p.e0176692-e0176692
Main Authors: Theocharopoulos, Georgios, Danis, Kostas, Greig, Jane, Hoffmann, Alexandra, De Valk, Henriette, Jimissa, Augustine, Tejan, Sumaila, Sankoh, Mohammed, Kleijer, Karline, Turner, Will, Achar, Jay, Duncombe, Jennifer, Lokuge, Kamalini, Gayton, Ivan, Broeder, Rob, Kremer, Ronald, Caleo, Grazia
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Biology and Life Sciences
Care and treatment
Child
Child, Preschool
Diarrhea
Disease control
Disease Outbreaks
Disease transmission
Ebola hemorrhagic fever
Ebola virus
Ebolavirus
Engineering and Technology
Ethics
Female
Food
Forecasts and trends
Health care access
Health care delivery
Health care services accessibility
Health facilities
Health risks
Health Services Accessibility
Hemorrhage
Hemorrhagic fever
Hemorrhagic Fever, Ebola - mortality
Hemorrhagic Fever, Ebola - physiopathology
Hemorrhagic Fever, Ebola - therapy
Humans
Isolation units
Laboratories
Location
Male
Medicine and Health Sciences
Middle Aged
Monoclonal antibodies
Mortality
Outbreaks
Patient Admission
Patients
People and places
Polymerase chain reaction
Protein-tyrosine kinase
Proximity
Public health
Regression Analysis
Relief Work
Research and Analysis Methods
Retrospective Studies
Reverse transcription
Risk
Risk factors
Saliva
Sanitation
Sierra Leone - epidemiology
Time-to-Treatment - statistics & numerical data
Travel
Viral Load
Viremia
Vomiting - physiopathology
Vomiting - therapy
Young Adult
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Summary: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 (p3 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.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0176692