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

Gianluca Quaglio, Francesca Tognon, Livio Finos, David Borne, Santigie Sesay, Atiba Kebbie, Francesco Di Gennaro, Bienvenu Camara, Claudia Marotta, Vincenzo Pisani, Zainab Bangura, Damiano Pizzol, Annalisa Saracino, Walter Mazzucco, Susan Jones, Giovanni Putoto

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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.

Original languageEnglish
Article numbere029093
Number of pages9
JournalBMJ Open
Issue number9
Publication statusPublished - 4 Sep 2019


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