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Open Access Did the Ebola outbreak disrupt immunisation services? A case study from Liberia

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Setting: All health facilities providing routine immunisation services in Liberia.

Objective: To compare the number of routine facility-based and outreach immunisations and measles cases before, during and after the Ebola outbreak.

Design: A descriptive cross-sectional study.

Results: Immunisation coverage for fully immunised children before the Ebola outbreak was 73%. Immunisation coverage for all antigens declined by half compared to baseline during the outbreak. These findings were similar in facility-based and outreach immunisations. During the outbreak, the proportion of fully immunised children dropped by respectively 58%, 33% and 39% in the most, moderately and least Ebola-affected counties. Immunisation rate of recovery in the post-Ebola period was respectively 82%, 21% and 9% in the most, moderately and least affected counties compared to the Ebola-outbreak period. Outreach immunisation recovered slowly compared to facility-based immunisation. The mean number of measles cases reported per month was 12 pre-Ebola, 16 Ebola and 60 post-Ebola.

Conclusion: This study provides insights into the possible impact of an Ebola outbreak on countrywide immunisation. The outbreak weakened a struggling national immunisation programme, and post-outbreak recovery took significant time, which likely contributed to the measles epidemic. Recommendations for the improvement of immunisation services that could limit further preventable epidemics in Liberia and similar contexts at risk for Ebola are provided.
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Keywords: Africa; SORT IT; measles; operational research; vaccination

Document Type: Research Article

Affiliations: 1: Ministry of Health, Republic of Liberia, Monrovia, Liberia 2: Makerere University College of Health Sciences, Kampala, Uganda 3: Médecins Sans Frontières, Brussels, Belgium, Johns Hopkins University, School of Public Health, Baltimore, Maryland, USA 4: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya, The International Union Against Tuberculosis and Lung Disease, Paris, France 5: The International Union Against Tuberculosis and Lung Disease, Paris, France, The Lighthouse Trust, Lilongwe, Malawi 6: Ministry of Health, Government of Karnataka, Bangalore, India

Publication date: June 21, 2017

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  • Public Health Action (PHA), The Union's quarterly open access on-line journal, provides a platform for its mission 'Health solutions for the poor'. PHA addresses the need for show-casing operational research that addresses issues in health systems and services. It publishes high-quality scientific research that provides new knowledge to improve access, equity, quality and efficiency of health systems and services.

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