Counting indirect crisis-related deaths in the context of a low-resilience health system: the case of maternal and neonatal health during the Ebola epidemic in Sierra Leone
Counting indirect crisis-related deaths in the context of a low-resilience health system: the case of maternal and neonatal health during the Ebola epidemic in Sierra Leone
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DOI：
10.1093/heapol/czx108
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发表时间：
2017-11-01
影响因子：
3.2
通讯作者：
Nam, Sara
中科院分区：
文献类型：
--
作者：
Sochas, Laura;Channon, Andrew Amos;Nam, Sara
虽然2013年至2016年西非埃博拉疫情期间与埃博拉直接相关的死亡人数已被量化，但由于常规卫生服务利用率下降而导致的间接死亡人数仍然未知。这类信息是卫生系统复原力的关键组成部分，对于为“危机应对活动”和“核心职能”充分分配资源至关重要。评估间接死亡也可能有助于卫生系统复原力的概念在政治上胜过针对特定疾病的传统监测方法。本研究通过使用中断时间序列回归分析卫生管理信息系统（HMIS）数据，量化了埃博拉疫情期间塞拉利昂基本生殖、孕产妇和新生儿卫生服务利用率下降的程度，从而回应了这些迫切需要。然后，我们使用挽救生命的工具，就产妇和新生儿死亡以及死胎而言，对这种利用率下降的含义进行了建模。我们发现，由于埃博拉疫情，产前保健覆盖率下降幅度最大，与最保守的反事实情景相比，人口覆盖率估计下降了22个百分点（p.p.）。计划生育、设施接生和产后护理服务的使用率也有所下降，但下降幅度较小（分别为- 6%、- 8%和- 13%）。在最保守的情况下，利用挽救生命的保健服务的减少意味着2014- 2015年孕产妇、新生儿和死胎死亡人数增加3600人。换句话说，我们估计，在缺乏恢复力的卫生系统背景下，危机对死亡率的间接影响可能与危机本身对死亡率的直接影响一样重要。
Although the number of direct Ebola-related deaths from the 2013 to 2016 West African Ebola outbreak has been quantified, the number of indirect deaths, resulting from decreased utilization of routine health services, remains unknown. Such information is a key ingredient of health system resilience, essential for adequate allocation of resources to both 'crisis response activities' and 'core functions'. Taking stock of indirect deaths may also help the concept of health system resilience achieve political traction over the traditional approach of disease-specific surveillance. This study responds to these imperatives by quantifying the extent of the drop in utilization of essential reproductive, maternal and neonatal health services in Sierra Leone during the Ebola outbreak by using interrupted time-series regression to analyse Health Management Information System (HMIS) data. Using the Lives Saved Tool, we then model the implication of this decrease in utilization in terms of excess maternal and neonatal deaths, as well as stillbirths. We find that antenatal care coverage suffered from the largest decrease in coverage as a result of the Ebola epidemic, with an estimated 22 percentage point (p.p.) decrease in population coverage compared with the most conservative counterfactual scenario. Use of family planning, facility delivery and post-natal care services also decreased but to a lesser extent (-6, -8 and -13 p.p. respectively). This decrease in utilization of life-saving health services translates to 3600 additional maternal, neonatal and stillbirth deaths in the year 2014-15 under the most conservative scenario. In other words, we estimate that the indirect mortality effects of a crisis in the context of a health system lacking resilience may be as important as the direct mortality effects of the crisis itself.