National reporting of deaths after enhanced Ebola surveillance in Sierra Leone

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 substantiall...

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Bibliographic Details
Published in:PLoS neglected tropical diseases 2020-08, Vol.14 (8), p.e0008624-e0008624
Main Authors: Jalloh, Mohamed F, Kaiser, Reinhard, Diop, Mariam, Jambai, Amara, Redd, John T, Bunnell, Rebecca E, Castle, Evelyn, Alpren, Charles, Hersey, Sara, Ekstrom, Anna Mia, Nordenstedt, Helena
Format: Article
Language:English
Subjects:
Bias
Biology and Life Sciences
Call centers
Confidence intervals
Data collection
Disease control
Disease prevention
Disease reporting
Ebola hemorrhagic fever
Ebola virus
Ebolavirus
Epidemics
Fatalities
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Global health
Health surveillance
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
Hälsovetenskap
Infektionsmedicin
Klinisk medicin
Medicin och hälsovetenskap
Medicine and Health Sciences
Mortality
Motivation
Patient outcomes
People and places
Polls & surveys
Public health
Questionnaires
Regression analysis
Reporting
Response rates
Sanitation
Sierra Leone
Signs and symptoms
Social Sciences
Statistical analysis
Supervision
Surveillance
Surveying
Surveys
Symptoms
Telephone services
Trends
Tropical diseases
Viral diseases
Viruses
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Summary: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.
ISSN:1935-2735
1935-2727
1935-2735
DOI:10.1371/journal.pntd.0008624