Functional and Psychosocial Impact of Eye Disease in Pediatric Ebola Survivors, Sierra Leone

Abstract

Purpose : To determine the ophthalmic complications in pediatric Ebola virus disease (EVD) survivors and EVD close-contacts, and the impact on quality of life and mental health within Sierra Leone.

Methods : Cross-sectional study. Pediatric EVD survivors and first-degree close contact controls were identified through the Sierra Leone Association of Ebola Survivors and Ministry of Health. EVD survivor status was confirmed by Ebola serum IgG testing. Patients enrolled in this study underwent a medical questionnaire and, ocular examination, and Quality of Life was evaluated with the Pediatric Quality of Life Inventory Version 4.0 (PedsQL). PedsQL assessed holistic quality of life over 4 domains. 1) Physical Functioning 2) Emotional Functioning 3) Social Functioning 4) School function.

Results : A total of 86 Ebola affected pediatric patients were examined which included twenty-three EVD survivors and 63 close contacts. Of EVD survivors, 39.1% were female and mean age was 11.5 years. Among close contacts, 46% were female and mean age was 9.5 years. Higher prevalence of uveitis was observed in the EVD survivor (13.0%) cohort compared to close contacts (1.7%) (p=0.032). Overall, 56.5% and 42.9% of EVD survivor eyes and close contact eyes presented with an ocular diagnosis that impaired vision, there was no statistically significant difference. The PedsQL total score showed low overall quality life in both patient populations (60.6 vs 67.0, p=0.250). The emotional functioning domain parent report was significantly lower among parents of EVD survivors compared to close contacts (57.4 vs 70.0, p=0.035). The main driver was a greater number of parents of EVD survivors affirming the question: “I feel Sad or Blue” (48.21 vs 65.71, p=0.035)

Conclusions : We observed a high burden of ocular and psychosocial sequelae in pediatric Ebola survivors in Sierra Leone. While uveitis was observed with a higher prevalence in this cohort of pediatric EVD survivors, non-uveitis eye disease also led to substantial visual acuity impairment in both groups. Psychosocial health burden was also observed within this pediatric population, irrespective of EVD infection. Future studies that examine the relationship between eye health and mental health in pediatric EVD survivors could better define these important relationships, particularly given the current pandemic.

This is a 2021 ARVO Annual Meeting abstract.