Research Article: Reporting quality of the 2014 Ebola outbreak in Africa: A systematic analysis

Date Published: June 25, 2019

Publisher: Public Library of Science

Author(s): Nina Huynh, Andrea Baumann, Mark Loeb, John Schieffelin.


The objective of this study was to conduct a systematic analysis of the reporting quality of the Ebola Virus Disease (EVD) outbreak in West Africa from 2014–2018 using the Modified STROBE statement. We included studies on the 2014 EVD outbreak alone, limited to those on human patients in Africa. We searched the following databases (MEDLINE, EMBASE, and Web of Science) for outbreak reports published between 2014–2018. We assessed factors potentially associated with the quality of reporting. A total of 69 of 131 (53%) articles within the full-text review fulfilled our eligibility criteria and underwent the Modified STROBE assessment for analyzing the quality of reporting. The Modified STROBE scores of the included studies ranged from 11–26 points and the mean was found to be 19.54 out of 30 with a standard deviation (SD) of ± 4.30. The top three reported Modified STROBE components were descriptive characteristics of study participants, scientific background and evidence rational, and clinical significance of observations. More than 75% of the studies met a majority of the criteria in the Modified STROBE assessment tool. Information that was commonly missing included addressing potential source of bias, sensitivity analysis, further results/analysis such as risk estimates and odds ratios, presence of a flowchart, and addressing missing data. In multivariable analysis, peer-reviewed publication was the only predictor that remained significantly associated with a higher Modified STROBE score. In conclusion, the large range of Modified STROBE scores observed indicates variability in the quality of outbreak reports for EVD. The review identified strong reporting in some areas, whereas other areas are in need of improvement, in particular providing an important description of the outbreak setting and identifying any external elements (potential biases and confounding factors) that could hinder the credibility of the findings.

Partial Text

Since 1976, Ebola Virus Disease (EVD) has persisted as a rare and deadly illness that has caused socioeconomic disruptions worldwide due to a fatality rate ranging from 25% to 90% in previous outbreaks[1]. Notably, the 2014–2015 epidemic in Africa severely impacted Guinea, Sierra Leone and Liberia and was 11 times larger than all of the past outbreaks combined [2]. Numerous studies have demonstrated that many affected countries were ill-equipped to handle the magnitude of the 2014 epidemic because they lacked the clinical capacity and resources; inadequate funds were invested into the public health system; and surveillance systems were poorly governed[3–5].

The main finding from this study was that of the 69 articles assessed, the reports on average met only a modest number of criteria (66%) within the Modified STROBE assessment tool. The total Modified score out of 30 points ranged from 11 to 26. We also found in the multivariable analysis that peer-reviewed articles were associated with a significantly higher Modified STROBE score in comparison to epidemiological reports. To assist in the interpretation of this analysis, it is fundamental to note that we analyzed the completeness of reporting through the total Modified STROBE score and not methodological quality. Hence, items were recorded based on sufficient information to conduct appraisal.