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. 2018 Sep 21;5(10):ofy239.
doi: 10.1093/ofid/ofy239. eCollection 2018 Oct.

Care of Ebola Survivors and Factors Associated With Clinical Sequelae-Monrovia, Liberia

A de St Maurice  1   2 , E Ervin  1 , R Orone  3 , M Choi  1 , E K Dokubo  4 , P E Rollin  1 , S T Nichol  1 , D Williams  4 , J Brown  3 , R Sacra  3 , J Fankhauser  3 , B Knust  1
Affiliations

Care of Ebola Survivors and Factors Associated With Clinical Sequelae-Monrovia, Liberia

A de St Maurice et al. Open Forum Infect Dis. .

Abstract

Background: The Eternal Love Winning Africa (ELWA) Clinic was the first clinic to provide free, comprehensive care to Ebola virus disease (EVD) survivors in Liberia. The objectives of this analysis were to describe the demographics and symptoms of EVD survivors at ELWA from January 2015 through March 2017 and to identify risk factors for development of sequelae.

Methods: Patients' demographic and clinical information was collected by chart review in June 2016 and March 2017. Associations with clinical sequelae were analyzed using the chi-square test, t test, and multivariate logistic regression.

Results: From January 2015 to March 2017, 329 EVD survivors were evaluated at ELWA. Most survivors experienced myalgia/arthralgia (73%; n = 239) and headache (53%; n = 173). The length of time from Ebola Treatment Unit (ETU) discharge to first clinic visit ranged from 0 to 30 months. Many visits (30%) occurred 24 or more months after ETU discharge. The proportion of visits for headache, weight loss, joint pain, visual problems, insomnia, fatigue, memory loss, decreased libido, depression, and uveitis decreased over time. More men than women had visits for depression; however, these differences were not significant. Symptom prevalence differed in adults and children; significantly more adults experienced myalgia/arthralgia (77% vs 44%), visual problems (41% vs 12%), post-EVD-related musculoskeletal pain (42% vs 15%), and insomnia (17% vs 2%).

Conclusions: EVD survivors frequented ELWA for EVD-related symptoms many months after ETU discharge, indicating a long-term need for care. Reported symptoms changed over time, which may reflect eventual resolution of some sequelae.

Keywords: ELWA hospital; Ebola; Liberia; Monrovia; survivors.

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Figures

Figure 1.
Figure 1.
Comparison of number of confirmed Ebola virus disease (EVD) cases in Liberia and survivor clinic visits—January 2014 to March 2017. The monthly number of EVD cases in Liberia is compared with the number of EVD survivors seen at the Eternal Love Winning Africa (ELWA) Clinic per month. Bars represent the number of ELWA clinic visits per month, whereas the lines represent the number of EVD cases in Liberia (using World Health Organization data).
Figure 2.
Figure 2.
Total number of survivor clinic visits by months since Ebola Treatment Unit (ETU) discharge. The bars represent the number of patient visits occurring in the months elapsed from patient’s recorded ETU discharge date. The totals include multiple visits by some patients over time. Abbreviation: ELWA, Eternal Love Winning Africa Clinic.
Figure 3.
Figure 3.
Changes in the prevalence of symptoms per clinic visit since Ebola Treatment Unit (ETU) discharge. Only those that had a significant change in incidence over time are shown in these figures (P < .05). Data for those that were nonsignificant are in Supplementary Table 1. A, Proportion of visits for headache, weight loss, joint pain, visual problem, insomnia, and fatigue during each 6-month period from ETU discharge date. B, Proportion of visits for poor memory, post–Ebola virus disease musculoskeletal syndrome (post-EVD MSK syndrome), hearing loss, decreased libido, depression, and uveitis during each 6-month time period. C, Proportion of visits for weakness, malaria, urinary tract infection (UTI), respiratory tract infection (RTI), and hypertension during each 6-month period.
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