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 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
Volume9
Issue number9
DOIs
Publication statusPublished - 4 Sep 2019

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

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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title = "Impact of Ebola outbreak on reproductive health services in a rural district of Sierra Leone: a prospective observational study",
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 = "Ebola, Sierra Leone, Reproductive Health, paediatrics, community gynaecology, public 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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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 - a prospective observational study

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 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.

AB - 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.

KW - Ebola

KW - Sierra Leone

KW - Reproductive Health

KW - paediatrics

KW - community gynaecology

KW - public health

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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

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ER -