Long term stress and impairment in children and youth after an acute infectious disease outbreak: A longitudinal study of the social, familial and individual effects of Ebola viral disease (EVD)

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Project Abstract. The unprecedented 2013-2016 Ebola virus disease (EVD) epidemic resulted in more infections and deaths than all prior outbreaks in the 40-year history of this virus combined. Among the more than 28,000 people infected with EVD approximately 21% were children under the age of 16, and more than 16,000 children lost one or both parents during the outbreak. Prior research on chronic infectious diseases such as HIV has demonstrated lasting health, social and psychosocial outcomes. Yet, little is known about the long-term complications of EVD, or more generally, mental health and psychosocial complications related to acute infectious disease outbreaks. Our goals are to understand the physical and ecological effects on physical health, cognitive and emotional development; and to inform development of interventions that will help EVD-affected individuals achieve their full potential for healthy and productive lives. This study is guided by three Specific Aims: AIM 1: Identify ecological factors influencing processes of risk and resilience among EVD-infected, affected and unaffected children. Children and youth, aged 7-17 years, will be studied from an established cohort of EVD-infected (n=350), EVD–affected (n=350), and control (n=350) children in Sierra Leone. We will evaluate two areas: (a) Family and community acceptance, and the experience of disease stigma for those infected or affected by EVD; and (b) Psychosocial adjustment of children and caregivers by examining mental health and adaptive attitudes and behaviors. AIM 2: Identify differences in the physical health and functioning of EVD-infected, affected and unaffected children over time. We will utilize validated developmental assessment tools to identify differences among infected, affected, and control children in markers of long-term stress: (a) cognitive health and development; (b) physical health; and (c) stress presentation including collection of biomarker samples. AIM 3: Strengthen the capacity of key organizations to conduct ongoing research on vulnerable children and families' psychosocial well-being and physical health. We will partner with Sustaining Health Systems and Kenema Government Hospital to strengthen their capacities in two areas: (a) Identifying clinically significant symptomatology and creating appropriate referral pathways to services; and (b) Improving diagnostic and analytic capacity through training in research methodologies, and introduction of critically needed diagnostic equipment and training in its use.