Setting: All health facility and community malnutrition
screening programmes in Tonkolili, a rural Ebola-affected
district in Sierra Leone.
Objectives: Before the Ebola disease outbreak, Sierra Leone
had set a goal to reduce the prevalence of severe
acute malnutrition (SAM) in children aged 5 years to
0.2%. We compared the number of children screened,
diagnosed and treated for malnutrition before, during
and after the outbreak (2013–2016).
Design: This was a retrospective cross-sectional study.
Results: Health facility screening declined from 16805
children per month pre-outbreak to 13510 during the
outbreak (P = 0.02), and returned to pre-outbreak levels
after the outbreak. Community-based screening remained
stable during the outbreak, and increased by
30% post-outbreak (P  0.001). The proportion diagnosed
with moderate acute malnutrition using mid-upper
arm circumference increased from respectively 3.6%
and 5.1% pre-outbreak in the community and health facilities
to 8.2% and 7.9% post-outbreak (P  0.001, P =
0.003). The proportion of children diagnosed with SAM
using a weight-for-age ratio at health facilities increased
from 1.5% pre-outbreak to 3.5% post-outbreak (P =
0.003). On average, for every four children diagnosed
with SAM per month, one child completed SAM
treatment.
Conclusion: After a decline in screening during the Ebola
outbreak, diagnoses of acute malnutrition increased
post-outbreak. Nutrition programmes need to be
strengthened to pre-empt such effects in the event of future
Ebola outbreaks.