Caring for children with Ebola in the Democratic Republic of the Congo

Country: Democratic Republic of the Congo Source: World Health Organization **Bunia, Democratic Republic of the Congo—**In just three months, the Ebola outbreak in the Democratic Republic of the Congo grew to become the country’s largest on record. While adults account for most cases, children under five years have the highest cases fatality ratio of over 60% compared with around 40% among adults. They also account for most of the deaths outside Ebola treatment centres—be it at home or in health centres where they are not identified as Ebola patients. “The fatality rate in children under five years with the Bundibudgyo virus continues to be higher than in older children and adults. This is consistent with previous Ebola outbreaks, where evidence demonstrates that under-fives have a higher risk of mortality than other age groups, ” says Dr Daniel Youkee, Ebola case management team lead with World Health Organization (WHO). “Young children have a lower physiological reserve and not fully developed immune systems. They require constant attention and special care. They need specific expertise, equipment and medications which are sometimes not readily available. Standardized supply kits need to incorporate paediatric sized equipment and medication with paediatric dosage and presentation. Staff need to be trained on paediatric guidelines including response to hypoglycaemia and ionic shock in children, ” he explains. WHO’s clinical guidelines recommend close monitoring of blood glucose, careful management of fluids and electrolytes, treatment of shock and suspected bacterial infections, and ongoing clinical assessment throughout recovery. WHO and partners are working closely with the national authorities and clinicians to reinforce quality and specificity of care and other critical aspects such as laboratory services, medical supplies and emergency coordination to help ensure children and adults receive timely, quality treatment and care. Due to their physical vulnerability, the condition of a paediatric Ebola patient can deteriorate very rapidly, says Dr Chaka Keita, a paediatrician with ALIMA, an NGO working along other partners in the ongoing Ebola outbreak response, and which runs five treatment centres across Ituri Province. He notes that emotional stress of isolation and treatment also takes a harder toll on children and needs to be considered by healthcare workers. “Isolation is a major factor contributing to emotional stress, agitation and irritability, ” says Keita. “Care must therefore be comprehensive and holistic: beyond medical treatment, it requires a constant presence, emotional support, small, frequent meals throughout the day, and the essential presence of a caregiver with the child throughout their treatment and recovery journey. Response partners are setting up measures to involve people who have recovered from Ebola for the care of others. The survivors’ acquired immunity makes it easier for them to work in high-risk zone. Additionally, Ebola treatment centres are always established to ensure robust safety of all patients and health personnel. “Wherever possible, the utmost should be done to keep children with their caregivers, ” says Youkee. “Treatment centre designs have been adapted so that staff can have more interaction with children without having to wear PPE, and also to enable family visits. ” Children are also eligible to participate in the ongoing clinical trial for a treatment for the Bundibudgyo virus, with the consent of their parents, offering additional chances of survival. While agencies involved in the response continue their efforts to improve outcomes for children, efforts are also underway to overcome challenges including shortages of medical equipment designed for children, and a greater need for nursing staff to monitor young children more closely, as well as ensuring that routine care for children such as vaccination programmes can continue throughout the outbreak. Media contacts HARRINGTON Grainne Isobel Communications consultant Email: harringtong@who. int Eugene Kabambi Communications Officer WHO DRC Tel: +243 81 715 1697 Office: +47 241 39 027 Email: kabambie@who. int

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