{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T09:29:04Z","timestamp":1780824544541,"version":"3.54.1"},"update-to":[{"DOI":"10.12688\/f1000research.18563.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T00:00:00Z","timestamp":1574121600000}}],"reference-count":13,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T00:00:00Z","timestamp":1574121600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"\n Background:<\/ns4:bold>\n Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality in the world. During infectious disease outbreaks, such as the Ebola virus disease outbreak in West Africa from 2014-2015, the health system is often strained, and diagnosis, management and care of NCDs may be compromised. This study assessed numbers and distribution of NCDs in all health facilities in the Western-Area District, Sierra Leone, in the post-Ebola period (June\u2013December 2015) comparing findings with the pre-Ebola (June\u2013December 2013) and Ebola outbreak (June\u2013December 2014) periods.\n <\/ns4:p>\n \n Methods:<\/ns4:bold>\n This was a cross-sectional study using secondary data from routine records of aggregate monthly NCD reports. Data were analysed using Open EPI and comparisons were made between the post-Ebola and pre-Ebola\/Ebola periods using the chi-square test.\n <\/ns4:p>\n \n Results:<\/ns4:bold>\n There were 10,011 people reported with NCDs during the three six-month periods, with 6194 (62%) presenting at peripheral health units (PHU). Reported NCDs decreased during Ebola and increased post-Ebola, but did not recover to pre-Ebola levels. Hypertension cases remained fairly constant throughout being mainly managed at PHU. Numbers with diabetes mellitus generally stayed the same except for a significant post-Ebola increase in tertiary hospitals. Small numbers were reported with mental health disorders across all facilities in all time periods.\n <\/ns4:p>\n \n Conclusion:<\/ns4:bold>\n NCD reporting is recovering in the immediate post-Ebola period. Decentralization of NCD care is welcome and is an effective strategy for management as evidenced by hypertension. To be successful, this must be supported by strengthening other elements of the health system such as training of health workers, robust information and referral systems and reliable medicine supply chains.\n <\/ns4:p>","DOI":"10.12688\/f1000research.18563.2","type":"journal-article","created":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T07:40:05Z","timestamp":1574149205000},"page":"795","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Non-communicable diseases in the Western Area District, Sierra Leone, following the Ebola outbreak"],"prefix":"10.12688","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0171-4297","authenticated-orcid":false,"given":"Ibrahim Baimba","family":"Koroma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dena","family":"Javadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4913-6270","authenticated-orcid":false,"given":"Katrina","family":"Hann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6113-9741","authenticated-orcid":false,"given":"Anthony D","family":"Harries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Smart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Samba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2019,11,19]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"1072-1088","DOI":"10.1016\/S0140-6736(18)31992-5","article-title":"NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4.","volume":"392","year":"2018","journal-title":"Lancet."},{"key":"ref-2","article-title":"Transforming our world: the 2030 agenda for sustainable development.","year":"2015"},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"245-252","DOI":"10.1016\/S0140-6736(18)31258-3","article-title":"Time to deliver: report of the WHO Independent High-Level Commission on NCDs.","volume":"392","author":"S Nishtar","year":"2018","journal-title":"Lancet."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"1902-1909","DOI":"10.1016\/S0140-6736(15)60644-4","article-title":"A retrospective and prospective analysis of the west African Ebola virus disease epidemic: robust national health systems at the foundation and an empowered WHO at the apex.","volume":"385","author":"L Gostin","year":"2015","journal-title":"Lancet."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"S1-S2","DOI":"10.5588\/pha.17.0029","article-title":"What was the effect of the West African Ebola outbreak on health programme performance, and did programmes recover?","volume":"7","author":"T Decroo","year":"2017","journal-title":"Public Health Action."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"S16-S21","DOI":"10.5588\/pha.16.0086","article-title":"Non-communicable diseases in the Western Area District, Sierra Leone, before and during the Ebola outbreak.","volume":"7","author":"T Samba","year":"2017","journal-title":"Public Heath Action."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"2254-2266","DOI":"10.1016\/S0140-6736(10)60550-8","article-title":"Diabetes in sub-Saharan Africa.","volume":"375","author":"J Mbanya","year":"2010","journal-title":"Lancet."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"e000471","DOI":"10.1136\/bmjgh-2017-000471","article-title":"Impact of Ebola experiences and risk perceptions on mental health in Sierra Leone, July 2015.","volume":"3","author":"M Jalloh","year":"2018","journal-title":"BMJ Glob Health."},{"key":"ref-9","article-title":"WHO proMIND: Profiles on Mental Health in Development Sierra Leone","author":"W Alemu","year":"2012"},{"key":"ref-10","doi-asserted-by":"publisher","first-page":"1-3","DOI":"10.1192\/bji.2019.17","article-title":"Mental health in Sierra Leone.","author":"D Harris","year":"2019","journal-title":"BJPsych International."},{"key":"ref-11","article-title":"National Health Sector Strategic Plan 2017-2021.","year":"2017"},{"key":"ref-12","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1186\/s12875-017-0613-5","article-title":"A systematic review of primary care models for non-communicable disease interventions in Sub-Saharan Africa.","volume":"18","author":"J Kane","year":"2017","journal-title":"BMC Fam Pract."},{"key":"ref-13","article-title":"Kamara_IbrahimK_SORTIT2_NCD_data.","author":"K Hann","year":"2019"}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/8-795\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/8-795\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/8-795\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T07:40:07Z","timestamp":1574149207000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/8-795\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,19]]},"references-count":13,"URL":"https:\/\/doi.org\/10.12688\/f1000research.18563.2","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.23285.r56767","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,19]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/8-795\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.20320.r49596, Jeffery Edwards, Department of Global Health, School of Public Health, University of Washington, WA, USA, 19 Jul 2019, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/8-795\/v1#referee-response-49596","order":0,"name":"referee-response-49596","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Katrina Hann<\/b>; \nPosted: 26 Oct 2019<\/i>; Zena NyakoojoSenior Managing EditorF1000 Research Ltd.Middlesex House34-42 Cleveland StreetLondon W1T 4LBUK  Dear Zena Nyakoojo, \nRE: Non-communicable diseases in the Western Area District, Sierra Leone, following the Ebola outbreak  [version 1; peer review: 2 approved]<\/u>We have carefully read through the peer review and have revised our manuscript accordingly. We see the manuscript as improved as a result of this peer review process, and thank you for your support in taking the process to this stage.Please find for your consideration the following: A point-by-point response to the comments and suggestions of the reviewers A new revised version of the manuscript, in tracked changes A new, revised version of the manuscript, no tracked changes.  We hope that these modifications meet with your favourable review. Please do not hesitate to request any further changes. Kind regards, Ibrahim Baimba KoromaDirectorate of Policy, Planning and Information (DPPI)Ministry of Health and Sanitation (MoHS)FreetownSierra Leone  \nAuthor Response to Reviewer Report for Version 1 from Jeffery Edwards 19 Jul 2019 <\/b> Thank you for your thoughtful review of the manuscript and your insightful suggestions. We have responded as below. \n1. Reviewer comment:<\/b>\nI appreciate the opportunity to review this well written and timely manuscript submitted by Koroma et al. It is certainly telling of the impact of the Ebola outbreak and the effects on the health system within Sierra Leone. Although it only uses aggregate data, the analysis is straight forward and highlights the struggles of providing\/reporting on healthcare within a developing country. <\/b>\nI believe this manuscript is very much worth of indexing and will add significantly to the growing knowledge base surrounding healthcare system management in developing countries. <\/b>\nResponse:<\/b>Thank you very much. \n2. Reviewer comment:<\/b>\nI would suggest one minor correction and an area which could be further discussed, where there is a gap in services being at least reported, if not provided. First, the last sentence in the 3rd paragraph is incomplete and needs to be corrected.<\/b>\nResponse:<\/b>Thank you for this direction. We have amended the sentence based on this feedback. \n3. Reviewer comment:<\/b>\nSecondly, it is extremely interesting the lack of reporting of mental health visits - across all three levels of care. Additionally, I am curious, as with other African countries, do mental health visits include epilepsy as well? If so, this is an interesting perspective that should be mentioned. <\/b>\nResponse:<\/b>In Sierra Leone, epilepsy is considered as a neurological condition, but it is documented using a separate data capture form and reported into a different programme. Therefore, our study does not capture epilepsy results, and thus, we are limited in our ability to make conclusions on epilepsy specifically.We have made a clarification on this point in the description of the NCD reporting form in the methods section. \n4. Reviewer comment:<\/b>\nThe authors mention that "the small number of individuals reported with MHD is of concern...especially... post Ebola..." I think this could be another key finding, especially if it includes those with epilepsy. The prevalence of MHD and epilepsy in developing countries is unknown and regardless of the Ebola outbreak, the tremendous gap in reporting found in this study suggests that they are under-recognized and under-treated. The authors might want to point this out and provide some recommendations for Sierra Leone and other countries with similar contexts.<\/b>\nResponse:<\/b>Thank you for this insight. We have added an additional point on underreporting and the treatment gap in the discussion.","URL":"https:\/\/f1000research.com\/articles\/8-795\/v2#referee-comment-4993","order":1,"name":"referee-comment-4993","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.20320.r49599, Priyakanta Nayak, Field Epidemiology Training Program (FETP), Centers for Disease Control and Prevention, Dhaka, Bangladesh, 22 Jul 2019, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/8-795\/v1#referee-response-49599","order":2,"name":"referee-response-49599","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Katrina Hann<\/b>; \nPosted: 26 Oct 2019<\/i>; Zena Nyakoojo Senior Managing Editor F1000 Research Ltd. Middlesex House 34-42 Cleveland Street London W1T 4LB UK     Dear Zena Nyakoojo,   \nRE: Non-communicable diseases in the Western Area District, Sierra Leone, following the Ebola outbreak  [version 1; peer review: 2 approved]<\/u> We have carefully read through the peer review and have revised our manuscript accordingly. We see the manuscript as improved as a result of this peer review process, and thank you for your support in taking the process to this stage. Please find for your consideration the following: A point-by-point response to the comments and suggestions of the reviewers A new revised version of the manuscript, in tracked changes A new, revised version of the manuscript, no tracked changes.   We hope that these modifications meet with your favourable review. Please do not hesitate to request any further changes.   Kind regards,   Ibrahim Baimba Koroma Directorate of Policy, Planning and Information (DPPI) Ministry of Health and Sanitation (MoHS) Freetown Sierra Leone   \nPoint-by-point response to the reviewer suggestions<\/b> \nAuthor Response to Reviewer Report for Version 1 from Priyankanta Nayak 22 Jul 2019<\/b>   Thank you for your thoughtful review of the manuscript and your suggestions. We have responded as below. \n1. Reviewer comment:<\/b>\nThis is a good study, a kind of situational analysis of NCD in Sierra Leone during Ebola episodes. The methodology is good and the investigator has done a good job in evaluating the NCD reports across the PHUs.<\/b> \nResponse:<\/b> Thank you very much.   2. \nReviewer comment:<\/b>\nThe only concerned thing here is the conclusion. This is very generalized and did not necessarily explain about the artifacts. Its obvious that it would be increased awareness and increased surveillance\/screening activities as a result of the endemic but the same can not be generalized to the overall scenario. I recommend more clarity in the conclusion.<\/b> \nResponse:<\/b> Thank you for this thoughtful reflection. The conclusion only gave a snap shot of the latest developments of NCD reporting during the post-Ebola period and suggested strategies for the health sector to strengthen NCD reporting.","URL":"https:\/\/f1000research.com\/articles\/8-795\/v2#referee-comment-4994","order":3,"name":"referee-comment-4994","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The programme was funded by the Special Programme for Research and Training in Tropical Diseases hosted at the World Health Organization (TDR). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution IGO Licence.Data associated with the article are available under the terms of the Creative Commons Zero \"No rights reserved\" data waiver (CC0 1.0 Public domain dedication).","order":0,"name":"copyright-info","label":"Copyright"}]}}