{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T09:30:08Z","timestamp":1780824608053,"version":"3.54.1"},"reference-count":12,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,10,5]]},"abstract":"<jats:p>Little is known about the residual effects of the west African Ebola virus disease (Ebola) epidemic on non-Ebola mortality and health-seeking behavior in Sierra Leone. We conducted a retrospective household survey to estimate mortality and describe health-seeking behavior in Western Area, Sierra Leone, between May 25, 2014, and February 16, 2015. We used two-stage cluster sampling, selected 30 geographical sectors with probability proportional to population size, and sampled 30 households per sector. Survey teams conducted face-to-face interviews and collected information on mortality and health-seeking behavior. We calculated all-cause and Ebola-specific mortality rates and compared health-seeking behavior before and during the Ebola epidemic using \u03c7<jats:sup>2<\/jats:sup> and Fisher's exact tests. Ninety-six deaths, 39 due to Ebola, were reported in 898 households. All-cause and Ebola-specific mortality rates were 0.52 (95% confidence interval [CI] = 0.29\u20130.76) and 0.19 (95% CI = 0.01\u20130.38) per 10,000 inhabitants per day, respectively. Of those households that reported a sick family member during the month before the survey, 86% (73\/85) sought care at a health facility before the epidemic, compared with 58% (50\/86) in February 2015 (<jats:italic>P<\/jats:italic> = 0.013). Reported self-medication increased from 4% (3\/85) before the epidemic to 23% (20\/86) during the epidemic (<jats:italic>P<\/jats:italic> = 0.013). Underutilization of health services and increased self-medication did not show a demonstrable effect on non-Ebola-related mortality. Nevertheless, the residual effects of outbreaks need to be taken into account for the future. Recovery efforts should focus on rebuilding both the formalized health system and the population's trust in it.<\/jats:p>","DOI":"10.4269\/ajtmh.16-0295","type":"journal-article","created":{"date-parts":[[2016,7,26]],"date-time":"2016-07-26T02:48:37Z","timestamp":1469501317000},"page":"897-901","source":"Crossref","is-referenced-by-count":20,"title":["Changes in Health-Seeking Behavior Did Not Result in Increased All-Cause Mortality During the Ebola Outbreak in Western Area, Sierra Leone"],"prefix":"10.4269","volume":"95","author":[{"given":"Sabine","family":"Vygen","sequence":"first","affiliation":[{"name":"1French Institute of Public Health Surveillance, Alerts and Regions Coordination Department, Regional office in Aquitaine, Bordeaux, France."},{"name":"2European Program for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden."},{"name":"3Robert Koch-Institut, Berlin, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Tiffany","sequence":"additional","affiliation":[{"name":"4Epicentre, Geneva, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Rull","sequence":"additional","affiliation":[{"name":"5M\u00e9decins Sans Fronti\u00e8res, Geneva, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Ventura","sequence":"additional","affiliation":[{"name":"5M\u00e9decins Sans Fronti\u00e8res, Geneva, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Wolz","sequence":"additional","affiliation":[{"name":"5M\u00e9decins Sans Fronti\u00e8res, Geneva, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amara","family":"Jambai","sequence":"additional","affiliation":[{"name":"6Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaudia","family":"Porten","sequence":"additional","affiliation":[{"name":"7Epicentre, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"Origins of the 2014 Ebola Epidemic","author":"World Health Organization (WHO)","year":"2015"},{"key":"ref2","series-title":"Ebola Situation Report: 20 January 2016","author":"World Health Organization (WHO)","year":"2016"},{"key":"ref3","series-title":"Ebola in Sierra Leone: A Slow Start to an Outbreak That Eventually Outpaced All Others","author":"World Health Organization (WHO)","year":"2015"},{"key":"ref4","series-title":"Health Worker Ebola Infections in Guinea, Liberia and Sierra Leone. A Preliminary Report","author":"World Health Organization (WHO)","year":"2015"},{"key":"ref5","series-title":"PLoS Curr","article-title":"Ebola and indirect effects on health service function in Sierra Leone","volume":"6","author":"Bolkan","year":"2014"},{"key":"ref6","series-title":"Lancet Infect Dis","first-page":"1017","article-title":"Effect of the Ebola-virus-disease epidemic on malaria case management in Guinea, 2014: a cross-sectional survey of health facilities","volume":"15","author":"Plucinski","year":"2015"},{"key":"ref7","series-title":"Ebola Outbreak in West Africa: Impact on Health Service Utilization in Sierra Leone. March 25, 2015","author":"The Assessment Capacities Project (ACAPS)","year":"2015"},{"key":"ref8","series-title":"JAMA","first-page":"3296","article-title":"Prevention of excess mortality in refugee and displaced populations in developing countries","volume":"263","author":"Toole","year":"1990"},{"key":"ref9","series-title":"Sierra Leone Demographic and Health Survey 2013","author":"Statistics Sierra Leone (SSL) and ICF International","year":"2014"},{"key":"ref10","series-title":"Soc Sci Med","first-page":"1986","article-title":"Are urban children really healthier? Evidence from 47 developing countries","volume":"65","author":"Van de Poel","year":"2007"},{"key":"ref11","series-title":"Travel Med Infect Dis","first-page":"131","article-title":"Gastro enteritis in a military population deployed in west Africa in the UK Ebola response; was the observed lower disease burden due to handwashing?","volume":"14","author":"Tuck","year":"2016"},{"key":"ref12","series-title":"Sierra Leone: WHO Statistical Profile","author":"World Health Organization (WHO)","year":"2015"}],"container-title":["The American Society of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/95\/4\/article-p897.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/95\/4\/article-p897.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/95\/4\/article-p897.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T21:55:00Z","timestamp":1723067700000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/95\/4\/article-p897.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10,5]]},"references-count":12,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.16-0295","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,10,5]]}}}