Disruptions in livelihoods, healthcare access and health outcomes in west africa during emerging infectious disease outbreaks

Background: Outbreaks of infectious diseases like Ebola virus disease, Lassa fever, and COVID-19 have severely strained infrastructural systems and social services across West Africa. We investigated the disruptions caused by emerging outbreaks on access to healthcare, health outcomes, and livelihoods in West Africa. Method: A mixed-methods approach was utilized, conducting extensive studies in Nigeria, Sierra Leone, Guinea, and Liberia through structured questionnaires, in-depth interviews with key informants, and focus group discussions. Using a device-to-cloud system guided by GIS for randomized sampling across the four nations, this technique allowed us to comprehensively analyze implications across imposed lifestyle changes on health and wellbeing due to disrupted healthcare. Results: Our findings indicate drastic shifts in food consumption patterns and healthcare access. In Guinea, self-reported Once Daily meals astonishingly surged from 148 to 775 individuals (p<0.001), with analogous substantial increases observed in Liberia and Sierra Leone. Nigeria exhibited a varied response, with notable rises both in Once Daily and Twice Daily meal frequencies (p<0.001), reflecting broad dietary adaptations out of necessity. Additionally, there was a significant decrease in consumption of traditional protein sources like bushmeat, beef, and mutton, mainly because of disrupted supply chains and heightened concerns over food insecurity. Conversely, fish consumption slightly fell possibly due to its perceived safety or accessibility amidst the outbreak. Healthcare services faced severe disruptions, particularly acute in Sierra Leone and Liberia compared to Guinea and Nigeria. The interruption of services drastically impacted everything from immunization rates to mental health, with a rise in reported anxiety and depression alongside public dissatisfaction towards the healthcare disruptions. Conclusion: This study demonstrates the dramatic effects of infectious disease outbreaks on health access and diets in West Africa. The research calls for integrating health initiatives with social protection to strengthen the resilience of societies to meet all types of health challenges. It is imperative districts establish robust health systems and social security mechanisms to counter future public health crises. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Funding for this study was provided by the International Development Research Centre(IDRC) under the Collaborative One Health Research Initiative on Epidemics (COHRIE). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Sierra Leone Ethics and Scientific Review Committee reviewed and approved the study protocol. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors