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Nutritional Care for Patients with Ebola Virus Disease in Ebola Treatment Units: Past and Current Experiences

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The World Health Organization (WHO) declared the outbreak of Ebola Virus Disease (EVD) in West Africa from March 2014 until June 2016, affecting multiple countries, in particular, Guinea, Liberia and Sierra Leone [1]. The scale of the outbreak resulted in United Nations agencies issuing new or updated guidelines on care and treatment of EVD patients. In November 2014, the WHO, in collaboration with United Nations Children’s Fund (UNICEF), and the World Food Programme (WFP), produced interim guidelines (iGL) on providing nutritional support to patients in Ebola treatment units (ETUs) [2]. These guidelines aimed to address nutritional needs and optimal nutritional care in the current Ebola crisis, with a particular focus on the practical aspects of the care within ETUs for EVD patients.

Since the onset of the 2018-2019 EVD outbreaks in the Democratic Republic of the Congo (DRC), the 2014 iGL have been translated into French and issued by the Ministry of Health, UNICEF, and WHO in adapted versions. However, to date, there is limited literature available on the impact the WHO/UNICEF/WFP iGL have had on the nutritional support and care of EVD patients.

Kodish et al. reviewed the use of three interim guidelines co-issued by WHO in Guinea. The assessed guidelines included: Nutritional Care of Children and Adults with Ebola Virus Disease in Treatment Centers, Infant Feeding in the Context of Ebola, and Clinical Care for Survivors of Ebola Virus Disease [2-4]. Key informants from a broad group of stakeholders comprising primary care organizations involved in nutritional support, EVD survivors, family members of EVD patients, midwives, and frontline health workers were included in the review.

Key informants expressed mixed opinions toward the usefulness of the guidelines, including lack of awareness of their existence and not using them. Some key informants noted that while they were theoretically useful, some of the recommended practices were difficult to implement in practice [5].

A previous literature review found a limited number of publications on specific nutritional care in ETUs that often lacked detailed descriptions of the actual nutritional care provided (Ververs/Gabra unpublished). The review emphasized the importance of reporting on practitioners’ experience to revise existing guidelines for increased applicability and acceptability. This investigation is a follow on to the previous review with the objectives to a) identify experiences and lessons learned from practitioners on the operational aspects of nutritional care and support in EVD outbreaks and b) evaluate the utilization of the 2014 iGL in the West Africa and current DRC EVD outbreak and perception of practitioners.