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Open Access Ebola, fragile health systems and tuberculosis care: a call for pre-emptive action and operational research

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The Ebola outbreak that started in late 2013 is by far the largest and most sustained in history. It occurred in a part of the world where pre-existing health systems were already fragile, and these deteriorated further during the epidemic due to a large number of health worker deaths; temporary or permanent closure of health facilities; non-payment of health workers; intrinsic fear of contracting or being stigmatised by Ebola among the population, which negatively influenced health-seeking behaviour; enforced quarantine of Ebola-affected communities, restricting the access of vulnerable individuals to health facilities; and late response by the international community. There are also reports of drug and consumable stockouts due to deficiencies in the procurement and supply chain as a result of overriding Ebola-related priorities. Providing tuberculosis (TB) care and achieving favourable treatment outcomes require a fully functioning health system, accurate patient tracking and high patient adherence to treatment. Furthermore, as Ebola is easily transmitted through body fluids, the use of needles—essential for TB diagnosis and treatment—needs to be avoided during an outbreak. We highlight ways in which a sustained Ebola outbreak could jeopardise TB activities and suggest pre-emptive preventive measures while awaiting operational research evidence.
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Keywords: Ebola outbreak; HIV testing; TB treatment; needles; operational research

Document Type: Research Article

Affiliations: 1: Operational Research Unit, Brussels Operational Centre, Médecins Sans Frontières (MSF), Luxembourg 2: Damien Foundation, Conakry, Guinea 3: MSF, Bo Town, Sierra Leone 4: Akilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia 5: Department of Pulmonary Diseases, Radboudumc Nijmegen/Universitair Centrum voor Chronische Ziekten Dekkerswald, Nijmegen University, Nijmegen, The Netherlands 6: International Union Against Tuberculosis and Lung Disease, Paris, France; London School of Hygiene & Tropical Medicine, London, UK

Publication date: November 1, 2015

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

    Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian. These are available on the Union website.

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