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

Research output: Contribution to journalArticle

Abstract

Objectives To assess the trends concerning utilisation ofmaternal and child health (MCH) services before, duringand after the Ebola outbreak, quantifying the contributionof a reorganised referral system (RS).Design A prospective observational study of MCHservices.Setting Pujehun district in Sierra Leone, 77 communityhealth facilities and 1 hospital from 2012 to 2017.Main outcome measures MCH utililization was evaluatedby assessing: (1) institutional deliveries, Cesareansections,paediatric and maternity admissions and deaths,and major direct obstetric complications (MDOCs), athospital level; (2) antenatal care (ANC) 1 and 4, institutionaldelivery and family planning, at community level.Contribution of a strengthened RS was also measured.Results At hospital level, there is a significant differencebetween trends Ebola versus pre-Ebola for maternaladmissions (7, 95% CI 4 to 11, p<0.001), MDOCs (4, 95% CI1 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 fromEbola to post-Ebola for maternal admissions (−7, 95% CI −10to −4, p<0.001), MDOCs (−4, 95% CI −7 to −1, p=0.009) andinstitutional deliveries (−3, 95% CI −5 to −1, p=0.001). Thedifferences between trends pre-Ebola versus post-Ebola areonly significant for paediatric admissions (3, 95% CI 0 to 5,p=0.035). At community level, the difference between trendsEbola versus pre-Ebola and Ebola versus post-Ebola are notsignificant for any indicators. The differences between trendspre-Ebola versus post-Ebola show a negative difference forinstitutional deliveries (−7, 95% CI −10 to −4, p<0.001), ANC1 (−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 withother districts in Sierra Leone and a strengthened RSenabled health facilities in Pujehun to maintain serviceprovision and uptake during and after the Ebola epidemic.
LanguageEnglish
Article numbere029093
Number of pages9
JournalBMJ Open
Volume9
Issue number9
DOIs
Publication statusPublished - 4 Sep 2019

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Sierra Leone
Reproductive Health Services
Obstetrics
Observational Studies
Disease Outbreaks
Prenatal Care
Family Planning Services
Prospective Studies
Referral and Consultation
Child Health Services
Pediatrics
Health Facilities
Mothers
Outcome Assessment (Health Care)
Health
cyclo(Arg-Pro)

Cite this

Quaglio, Gianluca ; Tognon, Francesca ; Finos, Livio ; Borne, David ; Sesay, Santigie ; Kebbie, Atiba ; Di Gennaro, Francesco ; Camara, Bienvenu ; Marotta, Claudia ; Pisani, Vincenzo ; Bangura, Zainab ; Pizzol, Damiano ; Saracino, Annalisa ; Mazzucco, Walter ; Jones, Susan ; Putoto, Giovanni. / Impact of Ebola outbreak on reproductive health services in a rural district of Sierra Leone : a prospective observational study. In: BMJ Open. 2019 ; Vol. 9, No. 9.
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abstract = "Objectives To assess the trends concerning utilisation ofmaternal and child health (MCH) services before, duringand after the Ebola outbreak, quantifying the contributionof a reorganised referral system (RS).Design A prospective observational study of MCHservices.Setting Pujehun district in Sierra Leone, 77 communityhealth facilities and 1 hospital from 2012 to 2017.Main outcome measures MCH utililization was evaluatedby assessing: (1) institutional deliveries, Cesareansections,paediatric and maternity admissions and deaths,and major direct obstetric complications (MDOCs), athospital level; (2) antenatal care (ANC) 1 and 4, institutionaldelivery and family planning, at community level.Contribution of a strengthened RS was also measured.Results At hospital level, there is a significant differencebetween trends Ebola versus pre-Ebola for maternaladmissions (7, 95{\%} CI 4 to 11, p<0.001), MDOCs (4, 95{\%} CI1 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 fromEbola to post-Ebola for maternal admissions (−7, 95{\%} CI −10to −4, p<0.001), MDOCs (−4, 95{\%} CI −7 to −1, p=0.009) andinstitutional deliveries (−3, 95{\%} CI −5 to −1, p=0.001). Thedifferences between trends pre-Ebola versus post-Ebola areonly significant for paediatric admissions (3, 95{\%} CI 0 to 5,p=0.035). At community level, the difference between trendsEbola versus pre-Ebola and Ebola versus post-Ebola are notsignificant for any indicators. The differences between trendspre-Ebola versus post-Ebola show a negative difference forinstitutional deliveries (−7, 95{\%} CI −10 to −4, p<0.001), ANC1 (−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 withother districts in Sierra Leone and a strengthened RSenabled health facilities in Pujehun to maintain serviceprovision and uptake during and after the Ebola epidemic.",
keywords = "Ebola, Sierra Leone, Reproductive Health",
author = "Gianluca Quaglio and Francesca Tognon and Livio Finos and David Borne and Santigie Sesay and Atiba Kebbie and {Di Gennaro}, Francesco and Bienvenu Camara and Claudia Marotta and Vincenzo Pisani and Zainab Bangura and Damiano Pizzol and Annalisa Saracino and Walter Mazzucco and Susan Jones and Giovanni Putoto",
year = "2019",
month = "9",
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doi = "10.1136/bmjopen-2019-029093",
language = "English",
volume = "9",
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issn = "2044-6055",
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Quaglio, G, Tognon, F, Finos, L, Borne, D, Sesay, S, Kebbie, A, Di Gennaro, F, Camara, B, Marotta, C, Pisani, V, Bangura, Z, Pizzol, D, Saracino, A, Mazzucco, W, Jones, S & Putoto, G 2019, 'Impact of Ebola outbreak on reproductive health services in a rural district of Sierra Leone: a prospective observational study', BMJ Open, vol. 9, no. 9, e029093. https://doi.org/10.1136/bmjopen-2019-029093

Impact of Ebola outbreak on reproductive health services in a rural district of Sierra Leone : a prospective observational study. / Quaglio, Gianluca; Tognon, Francesca; Finos, Livio; Borne, David ; Sesay, Santigie; Kebbie, Atiba ; Di Gennaro, Francesco; Camara, Bienvenu; Marotta, Claudia; Pisani, Vincenzo; Bangura, Zainab; Pizzol, Damiano; Saracino, Annalisa; Mazzucco, Walter; Jones, Susan; Putoto, Giovanni.

In: BMJ Open, Vol. 9, No. 9, e029093, 04.09.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of Ebola outbreak on reproductive health services in a rural district of Sierra Leone

T2 - BMJ Open

AU - Quaglio, Gianluca

AU - Tognon, Francesca

AU - Finos, Livio

AU - Borne, David

AU - Sesay, Santigie

AU - Kebbie, Atiba

AU - Di Gennaro, Francesco

AU - Camara, Bienvenu

AU - Marotta, Claudia

AU - Pisani, Vincenzo

AU - Bangura, Zainab

AU - Pizzol, Damiano

AU - Saracino, Annalisa

AU - Mazzucco, Walter

AU - Jones, Susan

AU - Putoto, Giovanni

PY - 2019/9/4

Y1 - 2019/9/4

N2 - Objectives To assess the trends concerning utilisation ofmaternal and child health (MCH) services before, duringand after the Ebola outbreak, quantifying the contributionof a reorganised referral system (RS).Design A prospective observational study of MCHservices.Setting Pujehun district in Sierra Leone, 77 communityhealth facilities and 1 hospital from 2012 to 2017.Main outcome measures MCH utililization was evaluatedby assessing: (1) institutional deliveries, Cesareansections,paediatric and maternity admissions and deaths,and major direct obstetric complications (MDOCs), athospital level; (2) antenatal care (ANC) 1 and 4, institutionaldelivery and family planning, at community level.Contribution of a strengthened RS was also measured.Results At hospital level, there is a significant differencebetween trends Ebola versus pre-Ebola for maternaladmissions (7, 95% CI 4 to 11, p<0.001), MDOCs (4, 95% CI1 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 fromEbola to post-Ebola for maternal admissions (−7, 95% CI −10to −4, p<0.001), MDOCs (−4, 95% CI −7 to −1, p=0.009) andinstitutional deliveries (−3, 95% CI −5 to −1, p=0.001). Thedifferences between trends pre-Ebola versus post-Ebola areonly significant for paediatric admissions (3, 95% CI 0 to 5,p=0.035). At community level, the difference between trendsEbola versus pre-Ebola and Ebola versus post-Ebola are notsignificant for any indicators. The differences between trendspre-Ebola versus post-Ebola show a negative difference forinstitutional deliveries (−7, 95% CI −10 to −4, p<0.001), ANC1 (−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 withother districts in Sierra Leone and a strengthened RSenabled health facilities in Pujehun to maintain serviceprovision and uptake during and after the Ebola epidemic.

AB - Objectives To assess the trends concerning utilisation ofmaternal and child health (MCH) services before, duringand after the Ebola outbreak, quantifying the contributionof a reorganised referral system (RS).Design A prospective observational study of MCHservices.Setting Pujehun district in Sierra Leone, 77 communityhealth facilities and 1 hospital from 2012 to 2017.Main outcome measures MCH utililization was evaluatedby assessing: (1) institutional deliveries, Cesareansections,paediatric and maternity admissions and deaths,and major direct obstetric complications (MDOCs), athospital level; (2) antenatal care (ANC) 1 and 4, institutionaldelivery and family planning, at community level.Contribution of a strengthened RS was also measured.Results At hospital level, there is a significant differencebetween trends Ebola versus pre-Ebola for maternaladmissions (7, 95% CI 4 to 11, p<0.001), MDOCs (4, 95% CI1 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 fromEbola to post-Ebola for maternal admissions (−7, 95% CI −10to −4, p<0.001), MDOCs (−4, 95% CI −7 to −1, p=0.009) andinstitutional deliveries (−3, 95% CI −5 to −1, p=0.001). Thedifferences between trends pre-Ebola versus post-Ebola areonly significant for paediatric admissions (3, 95% CI 0 to 5,p=0.035). At community level, the difference between trendsEbola versus pre-Ebola and Ebola versus post-Ebola are notsignificant for any indicators. The differences between trendspre-Ebola versus post-Ebola show a negative difference forinstitutional deliveries (−7, 95% CI −10 to −4, p<0.001), ANC1 (−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 withother districts in Sierra Leone and a strengthened RSenabled health facilities in Pujehun to maintain serviceprovision and uptake during and after the Ebola epidemic.

KW - Ebola

KW - Sierra Leone

KW - Reproductive Health

U2 - 10.1136/bmjopen-2019-029093

DO - 10.1136/bmjopen-2019-029093

M3 - Article

VL - 9

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 9

M1 - e029093

ER -