Impact of the 2018-2020 Democratic Republic of Congo Ebola epidemic on health system utilization and health outcomes

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Abstract Background.In the 2018-2020 Ebola epidemic in eastern Democratic Republic of Congo, 3,481 people were infected, resulting in 2,299 deaths. We assessed the impact on health system utilization and health outcomes. Methods.From January to March 2020, a retrospective cross-sectional survey was administered to 3,631 households in Ebola-affected and non-affected health zones in North Kivu province. We tested for associations between residence in an Ebola zone and outcomes using linear models. Administrative data from health facilities in Ebola zones was also used to test for statistically significant changes in operative volume and disease rates before and during the epidemic. Findings. Operative volume before the epidemic was statistically indistinguishable from during the epidemic, but households in Ebola zones were 16 percentage points more likely to report going to the hospital more often than normal because of free access (p<0.01). Households in Ebola zones reported fewer measles vaccinations and less willingness to vaccinate children compared to non-Ebola zones; however, the administrative data showed no change in vaccination before and during Ebola in Ebola zones. Households in Ebola zones reported fewer cases of childhood measles and diarrhea compared to non-Ebola zones, although the administrative data showed no change in either, comparing before-Ebola to during-Ebola in Ebola zones. Conclusion. The Ebola epidemic does not appear to have had large effects on health system utilization or health outcomes (other than Ebola virus disease). This suggests that the Congolese and international response were successful in maintaining health system capacity during the epidemic.

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