The health impact of the 2014-15 Ebola outbreak.
OBJECTIVE
The 2014-15 outbreak in West Africa was the largest and deadliest Ebola outbreak recorded; however, there remains uncertainty over its wider health consequences. Our objective was to provide a comprehensive overview of the impact of the Ebola outbreak on population health in the three most affected countries: Sierra Leone, Liberia and Guinea.


METHODS
Narrative review.


METHODS
A narrative overview of the peer-reviewed and grey literature related to the impact and consequences of the Ebola outbreak was conducted, synthesizing the findings of literature retrieved from a structured search of biomedical databases, the Web and references of reviewed articles.


RESULTS
The impact of the Ebola outbreak was profound and multifaceted. The health system was severely compromised due to overwhelming demand, healthcare workers deaths, resource diversion and closure of health facilities. Fear of Ebola and healthcare workers led to a breakdown in trust in health systems. Access to healthcare was compromised. Substantial reductions in healthcare utilization were reported including over 80% reductions in maternal delivery care in Ebola-affected areas, 40% national reductions in malaria admissions among children <5 years and substantial reductions in vaccination coverage. Socio-economic impacts included reduced community cohesion, education loss, reduced child protection, widespread job losses and food insecurity. Increased morbidity and mortality and reduced expected life expectancy were reported.


CONCLUSIONS
This review highlights the scope and scale of the consequences of the Ebola outbreak on population health. Sustained commitment of the international community is required to support health system re-building and to urgently address unmet population health needs.
Field Epidemiology Training Programme, Public Health England, Blenheim House, Duncombe Street, Leeds, LS1 4PL, UK; Health Education Yorkshire and the Humber, Willow Terrace Road, University of Leeds, Leeds, LS2 9JT, UK. Electronic address: drjameselston@gmail.com.
J W T
JW
Elston
Health Education Yorkshire and the Humber, Willow Terrace Road, University of Leeds, Leeds, LS2 9JT, UK.
C
C
Cartwright
European Programme for Intervention Epidemiology Training (EPIET), Instituto de Salud Carlos III, Madrid, 28029, Spain.
P
P
Ndumbi
Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, BD9 6RJ, UK.
J
J
Wright
D000354:Africa, Western / Q000453:epidemiology; D001294:Attitude to Health; D003695:Delivery of Health Care / Q000458:organization & administration; D004196:Disease Outbreaks; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology*; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011634:Public Health; D064890:Social Determinants of Health; D012959:Socioeconomic Factors; D035502:Trust
Consequences; Ebola; Impact; Population health