Determinants of patient survival during the 2014 Ebola Virus Disease outbreak in Bong County, Liberia

Weppelmann, Thomas A., Donewell, Bangure, Haque, Ubydul, Hu, Wenbiao, Magalhaes, Ricardo J. Soares, Lubogo, Mutaawe, Godbless, Lucas, Shabani, Sasita, Maeda, Justin, Temba, Herilinda, Malibiche, Theophil C., Berhanu, Naod, Zhang, Wenyi and Bawo, Luke (2016) Determinants of patient survival during the 2014 Ebola Virus Disease outbreak in Bong County, Liberia. Global Health Research and Policy, 1 5. doi:10.1186/s41256-016-0005-8


Author Weppelmann, Thomas A.
Donewell, Bangure
Haque, Ubydul
Hu, Wenbiao
Magalhaes, Ricardo J. Soares
Lubogo, Mutaawe
Godbless, Lucas
Shabani, Sasita
Maeda, Justin
Temba, Herilinda
Malibiche, Theophil C.
Berhanu, Naod
Zhang, Wenyi
Bawo, Luke
Title Determinants of patient survival during the 2014 Ebola Virus Disease outbreak in Bong County, Liberia
Journal name Global Health Research and Policy
ISSN 2397-0642
Publication date 2016-06-23
Sub-type Article (original research)
DOI 10.1186/s41256-016-0005-8
Open Access Status DOI
Volume 1
Start page 5
Total pages 10
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Abstract The unprecedented size of the 2014 Ebola Virus Disease (EVD) outbreak in West Africa has allowed for a more extensive characterization of the clinical presentation and management of this disease. In this study, we report the trends in morbidity, mortality, and determinants of patient survival as EVD spread into Bong County, Liberia.

An analysis of suspected, probable, or confirmed cases of EVD (n = 607) reported to the Liberian Ministry of Health and Social Welfare (MOHSW) between March 23rd and December 31st 2014 was conducted. The likelihood of infection given exposure factors was determined using logistic regression in individuals with a definitive diagnosis by RT-PCR (n = 321). The risk of short-term mortality (30 days) given demographic factors, clinical symptoms, and highest level of treatment received was assessed with Cox regression and survival analyses (n = 391).

The overall mortality rate was 53.5 % (95 % CI: 49 %, 58 %) and decreased as access to medical treatment increased. Those who reported contact with another EVD case were more likely to be infected (OR: 5.7), as were those who attended a funeral (OR: 3.9). Mortality increased with age (P < 0.001) and was higher in males compared to females (P =0.006). Fever (HR: 6.63), vomiting (HR: 1.93), diarrhea (HR: 1.99), and unexplained bleeding (HR: 2.17) were associated with increased mortality. After adjusting for age, hospitalized patients had a 74 % reduction in the risk of short term mortality (P < 0.001 AHR: 0.26; 95 % CI AHR: 0.18, 0.37), compared to those not given medical intervention.

Even treatment with only basic supportive care such as intravenous rehydration therapy was able to significantly improve patient survival in suspected, probable, or confirmed EVD cases.
Formatted abstract
Background
The unprecedented size of the 2014 Ebola Virus Disease (EVD) outbreak in West Africa has allowed for a more extensive characterization of the clinical presentation and management of this disease. In this study, we report the trends in morbidity, mortality, and determinants of patient survival as EVD spread into Bong County, Liberia.

Methods
An analysis of suspected, probable, or confirmed cases of EVD (n = 607) reported to the Liberian Ministry of Health and Social Welfare (MOHSW) between March 23rd and December 31st 2014 was conducted. The likelihood of infection given exposure factors was determined using logistic regression in individuals with a definitive diagnosis by RT-PCR (n = 321). The risk of short-term mortality (30 days) given demographic factors, clinical symptoms, and highest level of treatment received was assessed with Cox regression and survival analyses (n = 391).

Results
The overall mortality rate was 53.5 % (95 % CI: 49 %, 58 %) and decreased as access to medical treatment increased. Those who reported contact with another EVD case were more likely to be infected (OR: 5.7), as were those who attended a funeral (OR: 3.9). Mortality increased with age (P < 0.001) and was higher in males compared to females (P =0.006). Fever (HR: 6.63), vomiting (HR: 1.93), diarrhea (HR: 1.99), and unexplained bleeding (HR: 2.17) were associated with increased mortality. After adjusting for age, hospitalized patients had a 74 % reduction in the risk of short term mortality (P < 0.001 AHR: 0.26; 95 % CI AHR: 0.18, 0.37), compared to those not given medical intervention.

Conclusion
Even treatment with only basic supportive care such as intravenous rehydration therapy was able to significantly improve patient survival in suspected, probable, or confirmed EVD cases.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Veterinary Science Publications
Child Health Research Centre Publications
 
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Created: Mon, 29 Aug 2016, 22:59:01 EST by Dr Ricardo J. Soares Magalhães on behalf of School of Veterinary Science