More than 100,000 malaria cases went untreated when Liberia's health care system buckled under the 2014-2015 Ebola outbreak, according to a new study.
The research, published in the journal PLOS Medicine, shows how the toll of the Ebola outbreak goes beyond the 11,000 killed in West Africa by the virus itself. Basic health care took a major hit as well.
Ebola kills about half of the people it infects. It causes flu-like symptoms, followed by vomiting and diarrhea, and can lead to internal and external hemorrhaging. The disease spreads through contact with an infected person's bodily fluids.
The countries of West Africa were ill-equipped to deal with the 2014-15 outbreak. Many clinics lacked the most basic tools for dealing with the disease, including latex gloves and face masks.
“Rightfully so, people were afraid to go to the clinic because they might get Ebola when they’re at the clinic,” said study lead author Brad Wagenaar at the University of Washington.
Wagenaar and colleagues found that by four months into the epidemic, clinics were delivering one-third to two-thirds fewer basic services, which he described as a “huge, dramatic decrease.”
'Huge, dramatic decrease'
The researchers studied monthly data on health visits from 379 clinics outside the capital, Monrovia, from 2010 through 2016.
They found measles vaccinations dropped by 67 percent. Anti-malarial treatment fell by 61 percent. Thirty-five percent fewer pregnant women came in for their first pre-natal visits.
It took more than a year-and-a-half for all services to return to pre-outbreak levels.
In that time, more than three-quarters of a million clinic visits were lost, the researchers estimate, based on extrapolations from pre-outbreak trends.
That includes more than 5,000 births at health care facilities, in a country with one of the world's highest rates of maternal death, along with a loss of 100, 000 malaria treatments. These figures, Wagenaar adds, suggest a loss of other services that may have a long-term impact, such as distributing bed nets and spraying houses with insecticides.
“Some of these other things didn’t happen during the Ebola outbreak because the health system and other partners were busy with other issues,” he said. “And now, the cases have been increasing.”
Malaria cases were 50 percent higher in December of 2017 than they were before the Ebola epidemic.
Wagenaar says the research highlights how more attention must be devoted to maintaining basic services during a health emergency. The data his group analyzed could be used in other outbreaks to prioritize services that have been overlooked.
Funding for public health systems
And after the emergency, funding should focus on strengthening public health systems.
“We know that this epidemic happened in Liberia due to multiple factors, but one being the public sector ministry of health system has been underfunded,” he said, adding that remains the case.
Donors earmarked funds for strengthening the health system, he said. But, “that money never really materialized,” he added.