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Setting: All community health workers (CHWs) in rural Kenema District, Sierra Leone. Objective: CHW programmes provide basic health services to fill gaps in human health resources. We compared trends in the reporting and management of childhood malaria, diarrhoea and pneumonia by CHWs before, during and after the Ebola outbreak (2014-2016). Design: Retrospective cross-sectional study using programme data. Results: CHW reporting increased from 59% pre-outbreak to 95% during the outbreak (P < 0.001), and was sustained at 98% post-outbreak. CHWs stopped using rapid diagnostic tests for malaria mid-outbreak, and their use had not resumed post-outbreak. The average monthly number of presumptive treatments for malaria increased from 2931 pre-outbreak to 5013 during and 5331 post-outbreak (P < 0.001). The average number of monthly treatments for diarrhoea and pneumonia decreased from respectively 1063 and 511 pre-outbreak to 547 and 352 during the outbreak (P = 0.01 and P = 0.04). Post-outbreak pneumonia treatments increased (mean 1126 compared to pre-outbreak, P = 0.003), and treatments for diarrhoea returned to pre-outbreak levels (P = 0.2). Conclusion: The CHW programme demonstrated vulnerability, but also resilience, during and in the early period after the Ebola outbreak. Investment in CHWs is required to strengthen the health care system, as they can cover pre-existing gaps in facility-based health care and those created by outbreaks.

A district hospital in conflict-torn Somalia.To report on in-patient paediatric morbidity, case fatality and exit outcomes as indicators of quality of care.Cross-sectional study.Of 6211 children, lower respiratory tract infections (48%) and severe acute malnutrition (16%) were the leading reasons for admission. The highest case-fatality rate was for meningitis (20%). Adverse outcomes occurred in 378 (6%) children, including 205 (3.3%) deaths; 173 (2.8%) absconded.Hospital exit outcomes are good even in conflict-torn Somalia, and should boost efforts to ensure that such populations are not left out in the quest to achieve universal health coverage.Un hôpital de district dans la Somalie en conflit.Rapport sur la morbidité, la létalité et les résultats à la sortie de l’hôpital comme indicateurs de la qualité des soins chez des patients admis en pédiatrie.Etude transversale.Chez 6211 enfants, les infections du tractus respiratoire inférieur (48%) et une malnutrition aiguë grave (16%) ont été les causes principales d’admission. Le taux de létalité le plus élevé survient dans les cas de méningite (20%). Des effets indésirables sont survenus chez 378 enfants (6%), notamment 205 décès (3,3%) et 173 évasions (2,8%).Les résultats à la sortie de l’hôpital sont bons même dans une Somalie en conflit, ce qui devrait stimuler les efforts pour garantir que de telles populations ne soient pas abandonnées dans la recherche d’une couverture universelle de la santé.Un hospital distrital en Somalia, un país fracturado por el conflicto armado.Comunicar los datos sobre la morbilidad y la letalidad de los niños hospitalizados y el desenlace de alta hospitalaria como indicadores de la calidad de la atención de salud.Fue este un estudio transversal.Las principales causas de hospitalización de los 6211 niños fueron la infección de las vías respiratorias inferiores (48%) y la desnutrición grave aguda (16%). El índice más alto de letalidad fue por meningitis (20%). Ocurrieron desenlaces desfavorables en 378 casos (6%), de los cuales 205 muertes (3,3%) y 173 altas voluntarias (2,8%).Los desenlaces de la hospitalización de los niños en Somalia son buenos, pese a las divisiones que causa el conflicto armado, lo cual debe estimular las iniciativas encaminadas a evitar que estas poblaciones queden aisladas de la búsqueda de una cobertura universal de salud.