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Observational Study
. 2019 Sep 4;9(9):e029093.
doi: 10.1136/bmjopen-2019-029093.

Impact of Ebola outbreak on reproductive health services in a rural district of Sierra Leone: a prospective observational study

Gianluca Quaglio  1   2   3 , Francesca Tognon  4 , Livio Finos  5 , David Bome  6 , Santigie Sesay  6 , Atiba Kebbie  7 , Francesco Di Gennaro  8 , Bienvenu Salim Camara  9 , Claudia Marotta  10 , Vincenzo Pisani  7 , Zainab Bangura  7 , Damiano Pizzol  3 , Annalisa Saracino  8 , Walter Mazzucco  10 , Susan Jones  11 , Giovanni Putoto  3
Affiliations
Observational Study

Impact of Ebola outbreak on reproductive health services in a rural district of Sierra Leone: a prospective observational study

Gianluca Quaglio et al. BMJ Open. .

Abstract

Objectives: To assess the trends concerning utilisation of maternal and child health (MCH) services before, during and after the Ebola outbreak, quantifying the contribution of a reorganised referral system (RS).

Design: A prospective observational study of MCH services.

Setting: Pujehun district in Sierra Leone, 77 community health facilities and 1 hospital from 2012 to 2017.

Main outcome measures: MCH utililization was evaluated by assessing: (1) institutional deliveries, Cesarean-sections, paediatric and maternity admissions and deaths, and major direct obstetric complications (MDOCs), at hospital level; (2) antenatal care (ANC) 1 and 4, institutional delivery and family planning, at community level. Contribution of a strengthened RS was also measured.

Results: At hospital level, there is a significant difference between trends Ebola versus pre-Ebola for maternal admissions (7, 95% CI 4 to 11, p<0.001), MDOCs (4, 95% CI 1 to 7, p=0.006) and institutional deliveries (4, 95% CI 2 to 6, p=0.001). There is also a negative trend in the transition from Ebola to post-Ebola for maternal admissions (-7, 95% CI -10 to -4, p<0.001), MDOCs (-4, 95% CI -7 to -1, p=0.009) and institutional deliveries (-3, 95% CI -5 to -1, p=0.001). The differences between trends pre-Ebola versus post-Ebola are only significant for paediatric admissions (3, 95% CI 0 to 5, p=0.035). At community level, the difference between trends Ebola versus pre-Ebola and Ebola versus post-Ebola are not significant for any indicators. The differences between trends pre-Ebola versus post-Ebola show a negative difference for institutional deliveries (-7, 95% CI -10 to -4, p<0.001), ANC 1 (-6, 95% CI -10 to -3, p<0.001), ANC 4 (-8, 95% CI -11 to -5, p<0.001) and family planning (-85, 95% CI -119 to -51, p<0.001).

Conclusions: A stronger health system compared with other districts in Sierra Leone and a strengthened RS enabled health facilities in Pujehun to maintain service provision and uptake during and after the Ebola epidemic.

Keywords: community gynaecology; paediatrics; public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study area, the Pujehun district in Sierra Leone.
Figure 2
Figure 2
Maternal and paediatric admissions at hospital level.
Figure 3
Figure 3
C-sections, deliveries, MDOCs, paediatric and maternal deaths at hospital level. MDOCs, major direct obstetric complications.
Figure 4
Figure 4
ANC 1, ANC 4, deliveries and family planning at community level. ANC, antenatal care.
See this image and copyright information in PMC

References

    1. World Health Organization. Ebola response roadmap. Situation reports. 2018. http://www.who.int/csr/disease/ebola/situation-reports/archive/en/ (Accessed Mar 2019).
    1. Jones S, Ameh C. Exploring the impact of the Ebola outbreak on routine maternal health services in Sierra Leone. 2015. https://www.vsointernational.org/sites/vso_international/files/vso_sierr... (Accessed March 2019).
    1. Streifel C. How did Ebola impact maternal and child health in Liberia and Sierra Leone? A report of the CSIS Global Health Policy Center: CSIS, 2015.
    1. Brolin Ribacke KJ, Saulnier DD, Eriksson A, et al. . Effects of the West Africa Ebola virus disease on health-care utilization - a systematic review. Front Public Health 2016;4:222 10.3389/fpubh.2016.00222 - DOI - PMC - PubMed
    1. Government of Sierra Leone. Ebola virus disease situation report: Ministry of Health and Sanitation, 2015.

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