General Settings
Sierra Leone has an estimated population of 7 million, of whom approximately 70% live below the poverty line[11]. The country’s indices for maternal and infant mortality are among the worst globally, ranking respectively fifth and eleventh. This is partly due to the period of civil conflict (1991–2002) that devastated the country and its health system. Even before the Ebola outbreak, there were only two doctors and 17 nurses per 100000 population, most of whom were situated in urban areas[11]. The health infrastructure is tiered into tertiary hospitals, district hospitals, and peripheral health units (PHUs) designed to deliver primary health care. The PHUs include community health centres (CHCs), community health posts (CHPs) and maternal and child health posts (MCHPs)[12].
The study was conducted in the Western Area urban and rural districts in the Western region and Kenema district in the Eastern region of Sierra Leone. The Western Area is the wealthiest region in Sierra Leone, having the largest economy, financial and cultural centre, as well as the seat of the country's national government. It is divided into two districts: Western Area Rural and Western Area Urban. Kenema district is the district headquarter of the Eastern Province of Sierra Leone. These two regions were regarded as epicentres, with up to 4000 cases of Ebola reported [2].
Study design, population, sampling, and data collection
This was a cross-sectional study among EVD child-adolescent survivors and their close contacts, between January and April 2017. EVD child survivors aged 5-17years were enrolled in this study. We excluded those less than five years and those who could not properly respond to some of the questions. EVD child survivors were identified based on a list obtained from a registry of Ebola survivors from the Ministry of Social Welfare, Gender and Children’s Affairs (MSWGCA) and Sierra Leone Association of Ebola Survivors. Potential controls were child contacts of EVD child-adolescent survivors from the same household who were not infected with Ebola. They were within the same age group as EVD child survivors. These controls provided a healthy cohort with similar genetic, socioeconomic, and environmental characteristics to the EVD child survivor cohort. A maximum of two household contact was chosen for every child EVD survivor.
Data variables and source
Trained personnel were used to collect information from survivors, contacts or parents/guardians of survivors and controls using a pre-designed questionnaire. The questionnaire was designed based on the available literature regarding post-Ebola sequelae among adult Ebola survivors[3, 13-15]. Data was collected through interviewer administered format and interviews were conducted in Creole (widely spoken language in Sierra Leone).at participants’ place of residence. The following information were collected; age, sex (male vs female), weight, geographical location (Western Area Urban, Western Area Rural and Kenema, social status (orphan vs non-orphan), education level (no formal education, primary and secondary), how many times they were hospitalised during and after the Ebola outbreak, history of any disease before EVD. We also collected data on post-Ebola symptoms of EVD based on the available literature [3, 4, 14-16].
Statistical analysis
Data from filled questionnaires were coded and analysed using Statistical Package for Social Sciences (SPSS) for Windows, Version 23 (Chicago Inc.). Categorical and continuous variables were represented in frequency, percentages, mean, and standard deviation, respectively. Bivariate analysis using Chi-square or Fisher exact tests were used to establish an association between survivors and controls. A backward stepwise multivariate regression analysis was used to determine the odds of presenting with a particular post-Ebola symptom between child survivors and their contacts. Age, sex, gender, weight, education level, geographical location, and social status (orphan vs non-orphan) were considered potential cofounders and controlled when conducting the regression analysis.
Ethical approval
Permission to conduct this study was obtained from the Sierra Leone Scientific and Ethics Review Committee, Ministry of Health and Sanitation, Freetown. Verbal and written informed parental/guardian consent were obtained for all participants using the WHO Research Ethics Committee (WHO ERC) template for research involving children.