title: Ebola and indirect effects on health service function in sierra leone.
abstract: BACKGROUND
  The indirect effects of the Ebola epidemic on health service function may be significant but is not known. The aim of this study was to quantify to what extent admission rates and surgery has changed at health facilities providing such care in Sierra Leone during the time of the Ebola epidemic.
  
  
  METHODS
  Weekly data on facility inpatient admissions and surgery from admission and surgical theatre register books were retrospectively retrieved during September and October. 21 Community Health Officers enrolled in a surgical task-shifting program personally visited the facilities. The study period was January 6 (week 2) to October 12, (week 41) 2014.
  
  
  RESULTS
  Data was retrieved from 40 out of 55 facilities. A total of 62,257 admissions and 12,124 major surgeries were registered for the study period. Total admissions in the week of the first Ebola case were 2,006, median 40 (IQR 20-76) compared to 883, median 12 (IQR 4-30) on the last week of the study. This equals a 70% drop in median number of admissions (p=0.005) between May and October. Total number of major surgeries fell from 342, median 6 (IQR 2-14) to 231, median 3 (IQR 0-6) in the same period, equal 50% reduction in median number of major surgeries (p=0.014).
  
  
  CONCLUSIONS
  Inpatient health services have been severely affected by the Ebola outbreak. The dramatic documented decline in facility inpatient admissions and major surgery is likely to be an underestimation. Reestablishing such care is urgent and must be a priority.
authors: Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; CapaCare, Trondheim, Norway.
authors: Håkon Angell
authors: HA
authors: Bolkan
authors: Ministry of Health and Sanitation, Freetown, Sierra Leone.
authors: Donald Alpha
authors: DA
authors: Bash-Taqi
authors: College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
authors: Mohammed
authors: M
authors: Samai
authors: Department of Public Health Sciences, Health system and policy, Karolinska Institute, Stockholm, Sweden.
authors: Martin
authors: M
authors: Gerdin
authors: Department of Public Health Sciences, Health system and policy, Karolinska Institute, Stockholm, Sweden.
authors: Johan
authors: J
authors: von Schreeb
keywords: Epidemiology; Surveillance; ebola