Forty-two years of responding to Ebola virus outbreaks in Sub-Saharan Africa: a review
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Date
2020-01-27
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Global Health
Abstract
Introduction Ebola virus disease (EVD) is one of the
deadliest haemorrhagic fevers affecting humans and non-
human primates. Thirty-four outbreaks have been reported
in Africa since it was first recognised in 1976. This review
analysed 42 years of EVD outbreaks and identified various
challenges and opportunities for its control and prevention
in Sub-Saharan Africa.
Methods A literature search of relevant articles on EVD
was done in PubMed, Web of Science and Google Scholar
electronic databases. Articles published from 1976 to 2019
were reviewed to document reports of EVD outbreaks in
Sub-Saharan Africa. Data extraction focused on the year
of outbreak, geographical spread, virus strain involved,
number of cases and deaths, case fatality, and outbreak
management. Analyses of trends in case fatality were
performed by calculating ORs between times.
Results In the past four decades, a total of 34 EVD
outbreaks affecting 34 356 cases and causing 14 823
deaths were reported in 11 countries in Sub-Saharan
Africa. The overall case fatality rate (95% CI) was 66%
(62 to 71) and did not change substantially over time (OR
in 2019 vs 1976=1.6 (95% CI 1.5 to 1.8), p<0.001). The
results of this review indicate that challenges to control
EVD outbreaks are related to epidemiological, sociocultural
and health system factors.
Conclusions Sub-Saharan Africa continues to face
considerable challenges in EVD control, whereby there
are no significant changes in case fatality rates observed
during the past four decades. Socioeconomic and cultural
processes need to be critically considered to shape the
community behaviours that lead to exposure to EVD
outbreaks. Areas that need to be addressed to prevent
future EVD outbreaks include a broad-based, one-health
approach, effective communication, social mobilisation,
and strengthening of the health systems.
Description
Article
Keywords
Ebola virus disease (EVD), Deadliest haemorrhagic fevers, Ebola virus outbreaks, Sub-Saharan Africa