RESUMEN
Between March 2014 and July 2015 at least 10,500 Ebola cases including more than 4,800 deaths occurred in Liberia, the majority in Monrovia. However, official numbers may have underestimated the size of the outbreak. Closure of health facilities and mistrust in existing structures may have additionally impacted on all-cause morbidity and mortality. To quantify mortality and morbidity and describe health-seeking behaviour in Monrovia, Médecins sans Frontières (MSF) conducted a mobile phone survey from December 2014 to March 2015. We drew a random sample of households in Monrovia and conducted structured mobile phone interviews, covering morbidity, mortality and health-seeking behaviour from 14 May 2014 until the day of the survey. We defined an Ebola-related death as any death meeting the Liberian Ebola case definition. We calculated all-cause and Ebola-specific mortality rates. The sample consisted of 6,813 household members in 905 households. We estimated a crude mortality rate (CMR) of 0.33/10,000 persons/day (95%CI:0.25-0.43) and an Ebola-specific mortality rate of 0.06/10,000 persons/day (95%-CI:0.03-0.11). During the recall period, 17 Ebola cases were reported including those who died. In the 30 days prior to the survey 277 household members were reported sick; malaria accounted for 54% (150/277). Of the sick household members, 43% (122/276) did not visit any health care facility. The mobile phone-based survey was found to be a feasible and acceptable alternative method when data collection in the community is impossible. CMR was estimated well below the emergency threshold of 1/10,000 persons/day. Non-Ebola-related mortality in Monrovia was not higher than previous national estimates of mortality for Liberia. However, excess mortality directly resulting from Ebola did occur in the population. Importantly, the small proportion of sick household members presenting to official health facilities when sick might pose a challenge for future outbreak detection and mitigation. Substantial reported health-seeking behaviour outside of health facilities may also suggest the need for adapted health messaging and improved access to health care.
Asunto(s)
Teléfono Celular/estadística & datos numéricos , Fiebre Hemorrágica Ebola/mortalidad , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Epidemias , Composición Familiar , Femenino , Humanos , Liberia/epidemiología , Malaria/epidemiología , Masculino , Morbilidad , Encuestas y CuestionariosRESUMEN
BACKGROUND: The EVAPIL scale is a self-questionnaire aimed to assess tolerability of oral contraceptives (OC). METHODS: For initial development: a list of questions addressing the more frequent or more unpleasant minor side effects of OC was developed by a group of gynecologists and submitted to several sets of OC users. A final version with 14 questions was issued with scoring rules. For validation, the EVAPIL scale was submitted to 3502 women who were OC users for at least 6 months to evaluate internal consistency and factorial structure. Test-retest reproducibility was studied 30 days apart in 53 other OC users. RESULTS: Internal consistency was good (Cronbach's alpha .71) without redundant questions. Principal components analysis with Varimax rotation was used to summarise information given by the 14 questions in a smaller number of multivariate dimensions. Dimension 1 explained 22% of the total variance, strongly correlated with all symptoms except oily skin, acne and cycle control. Dimension 2 accounted for 10% of the total variance and was correlated with oily skin and acne. Dimensions 3 and 4 were better correlated with cycle control. Reproducibility was excellent (intraclass correlation 0.88). The EVAPIL scale was found easy to use and took no more than 5 min to complete. CONCLUSION: The EVAPIL scale demonstrated interesting psychometric properties to evaluate the tolerability of OCs in OC users. Further research is needed to address sensitivity to change and usefulness in new OC users.