title: Ebola, fragile health systems and tuberculosis care: a call for pre-emptive action and operational research.
abstract: The Ebola outbreak that started in late 2013 is by far the largest and most sustained in history. It occurred in a part of the world where pre-existing health systems were already fragile, and these deteriorated further during the epidemic due to a large number of health worker deaths; temporary or permanent closure of health facilities; non-payment of health workers; intrinsic fear of contracting or being stigmatised by Ebola among the population, which negatively influenced health-seeking behaviour; enforced quarantine of Ebola-affected communities, restricting the access of vulnerable individuals to health facilities; and late response by the international community. There are also reports of drug and consumable stockouts due to deficiencies in the procurement and supply chain as a result of overriding Ebola-related priorities. Providing tuberculosis (TB) care and achieving favourable treatment outcomes require a fully functioning health system, accurate patient tracking and high patient adherence to treatment. Furthermore, as Ebola is easily transmitted through body fluids, the use of needles-essential for TB diagnosis and treatment-needs to be avoided during an outbreak. We highlight ways in which a sustained Ebola outbreak could jeopardise TB activities and suggest pre-emptive preventive measures while awaiting operational research evidence.
authors.affiliation: Operational Research Unit, Brussels Operational Centre, Médecins Sans Frontières (MSF), Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
authors.affiliation: Damien Foundation, Conakry, Guinea.
authors.forename: N
authors.initials: N
authors.lastname: Ortuno
authors.affiliation: MSF, Bo Town, Sierra Leone.
authors.forename: V
authors.initials: V
authors.lastname: Hermans
authors.affiliation: Akilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: W
authors.initials: W
authors.lastname: Desalegn
authors.affiliation: Operational Research Unit, Brussels Operational Centre, Médecins Sans Frontières (MSF), Luxembourg.
authors.forename: S
authors.initials: S
authors.lastname: Rust
authors.affiliation: Operational Research Unit, Brussels Operational Centre, Médecins Sans Frontières (MSF), Luxembourg.
authors.forename: A J
authors.initials: AJ
authors.lastname: Reid
authors.affiliation: Department of Pulmonary Diseases, Radboudumc Nijmegen/Universitair Centrum voor Chronische Ziekten Dekkerswald, Nijmegen University, Nijmegen, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Boeree
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
mesh_terms: D004196:Disease Outbreaks; D006282:Health Personnel / Q000191:economics / Q000523:psychology*; D006297:Health Services Accessibility; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology*; D006801:Humans; D009874:Operations Research; D057545:Social Stigma; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control