Last year’s Ebola crisis first broke in Guinea in February, 2014. The Ebola Virus Disease (EBV,前面描述）soon spread to 9 countries,claiming over 11,000 liveswith the majority occurring across three countries in West Africa- Sierra Leone, Liberia and Guinea. The devastating outbreak has indirectly impacted the affected regions in many ways, including increasing malaria transmission, cases and mortality.
What is more, this devastating outbreak has indirectly impacted the affected regions in many other ways. A year later the situation is under much better control, however transmission is still ongoing. In a recent blog, PhD student (LSHTM) Allie Robinsonrecounted her experiences在部署到塞拉利昂的诊断医生时。
So far this monthonly 5 new cases已报告- ou以来的最低数字tbreak started a year ago. This is essentially a result of stringent control programmes focusing on strengthening capacity building for contact tracing and case investigations.
Complications and knock-on effects
爆发的规模在很大程度上是由于当地卫生系统的完全分解。当然，这对困扰着这些地区的其他疾病产生了连锁反应。例如，由于出生期间，埃博拉病毒从患者传播到卫生保健工作者，许多产科病房被迫完全关闭。在世界上最高的产妇和新生儿死亡率之一的环境中，缺乏获得这种宝贵服务的机会是引起人们关注的严重原因。在诊断和治疗腹泻以及这些国家常见的呼吸道疾病方面，这是类似的情况。
除了卫生保健中心被员工失去到疟疾传播所造成的大量患者所淹没外，病例和死亡率还受到进一步的并发症的影响。当被视为“您去世的地方”时，发热的患者不愿参加卫生中心，阻止疟疾患者寻求治疗，并经常拜访传统的治疗师。即使他们确实参加了诊所，技术人员也很担心抽血以诊断疟疾。
Several violent riots and incidents of looting took place at health centres and hospitals across the 3 main countries, resulting in further disruption of the control programmes. Suspicion and anger arose when locals were lead to believe that medical staff were somehow responsible for bringing EVD to their villages, leading to对医务人员和车辆运送床网的攻击。Further suspicion arose around the usage of bednets when it was recommended that bednets belonging to EVD victims be buried with them.
谁对疟疾控制的反应
Recognising that Ebola response programmes could be enhanced by a reduction in febrile cases, the WHO publishedguidelines for temporary measures for malaria controlin Ebola affected countries. The guidelines focus on deploying non-frontline long-lasting ACTs through emergency mass drug administration campaigns, with the aim of 1. Reducing malaria morbidity and mortality, 2. Reducing non-EVD febrile cases and 3. Protecting frontline healthcare workers dealing with these diseases.
建模对疟疾发病率和死亡率的影响
Walker等人，2015年已经分析了此类运动的可能效果。它们对埃博拉影响国家医疗保健能力降低对疟疾发病率，死亡率的影响，，，，and analyse the potential effect of mitigation strategies advised by the WHO guidelines.
他们的模型乘以每个行政部门的年龄分层病例发病率和年龄分层的人口估计，以估计埃博拉疫情引起的额外疟疾病例的数量。他们的数据显示，总共有350万例未经治疗的疟疾病例，其中大多数通常会发生，但通常会接受治疗。其中只有一小部分是由于停止疟疾治疗而导致的传播增加。
他们发现，停止床网分布将对额外的疟疾病例的数量产生更深远的影响，如果分配在2015年的雨季之前未恢复，则会加剧这一病例，导致另外270万例病例。
为了估计这些价值如何转化为疟疾的死亡率，它们会考虑到每个行政单位中疟疾病例人口的年龄分布，以计算可归因于疟疾的死亡人数。他们估计在没有诊所和医院护理的情况下，有10,900个额外的疟疾可归因于死亡率，由于床网分布的破坏，又有3,900人死亡。如果医疗保健提供在疫情爆发之前恢复到水平的水平，他们仍然预测2015年疟疾死亡31,800人。
他们还显示了大众药物管理制度在2015年1月管理二氢蛋白素蛋白素的影响6个月，将导致最低的疟疾 - 可杀伤力死亡人数，而每年的不同时间与3个月的制度相比。这些数据假定卫生系统仍被中断，覆盖率为70％。
Overall, their models reveal the importance of getting health systems up and running as soon as possible, so that we can start tackling all of the diseases neglected during the outbreak. This effort will be absolutely necessary if we are to prevent the undoing of decades of disease control programmes and continue on our path toward elimination.
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