'Women and babies are dying but not of Ebola'

the effect of the Ebola virus epidemic on the availability, uptake and outcomes of maternal and newborn health services in Sierra Leone.

Susan Jones, Somasundari Gopalakrishnan, Charles A. Ameh, Sarah White, Nynke van den Broek

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND:
We sought to determine the impact of the Ebola virus epidemic on the availability, uptake and outcome of routine maternity services in Sierra Leone.

METHODS:
The number of antenatal and postnatal visits, institutional births, availability of emergency obstetric care (EmOC), maternal deaths and stillbirths were assessed by month, by districts and by level of healthcare for 10 months during, and 12 months prior to, the Ebola virus disease (EVD) epidemic. All healthcare facilities designated to provide comprehensive (n=13) or basic (n=67) EmOC across the 13 districts of Sierra Leone were included.

RESULTS:
Preservice students were not deployed during the EVD epidemic. The number of healthcare providers in facilities remained constant (incidence rate ratio (IRR) 1.03, 95% CI 1.00 to 1.07). Availability of antibiotics, oxytocics, anticonvulsants, manual removal of placenta, removal of retained products of conception, blood transfusion and caesarean section were not affected by the EVD epidemic. Across Sierra Leone, following the onset of the EVD epidemic, there was a 18% decrease in the number of women attending for antenatal (IRR 0.82, 95% CI 0.79 to 0.84); 22% decrease in postnatal attendance (IRR 0.78, 95% CI 0.75 to 0.80) visits and 11% decrease in the number of women attending for birth at a healthcare facility (IRR 0.89, 95% CI 0.87 to 0.91). There was a corresponding 34% increase in the facility maternal mortality ratio (IRR 1.34, 95% CI 1.07 to 1.69) and 24% increase in the stillbirth rate (IRR 1.24, 95% CI 1.14 to 1.35).

CONCLUSIONS:
During the EVD epidemic, fewer pregnant women accessed healthcare. For those who did, an increase in maternal mortality and stillbirth was observed. In the post-Ebola phase, 'readiness' (or not) of the global partners for large-scale epidemics has been the focus of debate. The level of functioning of the health system with regard to ability to continue to provide high-quality effective routine care needs more attention.
Original languageEnglish
Article numbere000065
Number of pages11
JournalBMJ Global Health
Volume1
Issue number3
DOIs
Publication statusPublished - 7 Oct 2016
Externally publishedYes

Fingerprint

Maternal Health Services
Sierra Leone
Ebolavirus
Ebola Hemorrhagic Fever
Stillbirth
Incidence
Delivery of Health Care
Maternal Mortality
Emergency Medical Services
Obstetrics
Retained Placenta
Oxytocics
Parturition
Maternal Death
Infant Health
Cesarean Section
Blood Transfusion
Health Personnel
Anticonvulsants
Health Status

Cite this

@article{f77fa8b203c941f28262d18f21f5fd44,
title = "'Women and babies are dying but not of Ebola': the effect of the Ebola virus epidemic on the availability, uptake and outcomes of maternal and newborn health services in Sierra Leone.",
abstract = "BACKGROUND:We sought to determine the impact of the Ebola virus epidemic on the availability, uptake and outcome of routine maternity services in Sierra Leone.METHODS:The number of antenatal and postnatal visits, institutional births, availability of emergency obstetric care (EmOC), maternal deaths and stillbirths were assessed by month, by districts and by level of healthcare for 10 months during, and 12 months prior to, the Ebola virus disease (EVD) epidemic. All healthcare facilities designated to provide comprehensive (n=13) or basic (n=67) EmOC across the 13 districts of Sierra Leone were included.RESULTS:Preservice students were not deployed during the EVD epidemic. The number of healthcare providers in facilities remained constant (incidence rate ratio (IRR) 1.03, 95{\%} CI 1.00 to 1.07). Availability of antibiotics, oxytocics, anticonvulsants, manual removal of placenta, removal of retained products of conception, blood transfusion and caesarean section were not affected by the EVD epidemic. Across Sierra Leone, following the onset of the EVD epidemic, there was a 18{\%} decrease in the number of women attending for antenatal (IRR 0.82, 95{\%} CI 0.79 to 0.84); 22{\%} decrease in postnatal attendance (IRR 0.78, 95{\%} CI 0.75 to 0.80) visits and 11{\%} decrease in the number of women attending for birth at a healthcare facility (IRR 0.89, 95{\%} CI 0.87 to 0.91). There was a corresponding 34{\%} increase in the facility maternal mortality ratio (IRR 1.34, 95{\%} CI 1.07 to 1.69) and 24{\%} increase in the stillbirth rate (IRR 1.24, 95{\%} CI 1.14 to 1.35).CONCLUSIONS:During the EVD epidemic, fewer pregnant women accessed healthcare. For those who did, an increase in maternal mortality and stillbirth was observed. In the post-Ebola phase, 'readiness' (or not) of the global partners for large-scale epidemics has been the focus of debate. The level of functioning of the health system with regard to ability to continue to provide high-quality effective routine care needs more attention.",
keywords = "Ebola virus, maternity care",
author = "Susan Jones and Somasundari Gopalakrishnan and Ameh, {Charles A.} and Sarah White and {van den Broek}, Nynke",
year = "2016",
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'Women and babies are dying but not of Ebola' : the effect of the Ebola virus epidemic on the availability, uptake and outcomes of maternal and newborn health services in Sierra Leone. / Jones, Susan; Gopalakrishnan, Somasundari; Ameh, Charles A.; White, Sarah; van den Broek, Nynke.

In: BMJ Global Health, Vol. 1, No. 3, e000065, 07.10.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 'Women and babies are dying but not of Ebola'

T2 - the effect of the Ebola virus epidemic on the availability, uptake and outcomes of maternal and newborn health services in Sierra Leone.

AU - Jones, Susan

AU - Gopalakrishnan, Somasundari

AU - Ameh, Charles A.

AU - White, Sarah

AU - van den Broek, Nynke

PY - 2016/10/7

Y1 - 2016/10/7

N2 - BACKGROUND:We sought to determine the impact of the Ebola virus epidemic on the availability, uptake and outcome of routine maternity services in Sierra Leone.METHODS:The number of antenatal and postnatal visits, institutional births, availability of emergency obstetric care (EmOC), maternal deaths and stillbirths were assessed by month, by districts and by level of healthcare for 10 months during, and 12 months prior to, the Ebola virus disease (EVD) epidemic. All healthcare facilities designated to provide comprehensive (n=13) or basic (n=67) EmOC across the 13 districts of Sierra Leone were included.RESULTS:Preservice students were not deployed during the EVD epidemic. The number of healthcare providers in facilities remained constant (incidence rate ratio (IRR) 1.03, 95% CI 1.00 to 1.07). Availability of antibiotics, oxytocics, anticonvulsants, manual removal of placenta, removal of retained products of conception, blood transfusion and caesarean section were not affected by the EVD epidemic. Across Sierra Leone, following the onset of the EVD epidemic, there was a 18% decrease in the number of women attending for antenatal (IRR 0.82, 95% CI 0.79 to 0.84); 22% decrease in postnatal attendance (IRR 0.78, 95% CI 0.75 to 0.80) visits and 11% decrease in the number of women attending for birth at a healthcare facility (IRR 0.89, 95% CI 0.87 to 0.91). There was a corresponding 34% increase in the facility maternal mortality ratio (IRR 1.34, 95% CI 1.07 to 1.69) and 24% increase in the stillbirth rate (IRR 1.24, 95% CI 1.14 to 1.35).CONCLUSIONS:During the EVD epidemic, fewer pregnant women accessed healthcare. For those who did, an increase in maternal mortality and stillbirth was observed. In the post-Ebola phase, 'readiness' (or not) of the global partners for large-scale epidemics has been the focus of debate. The level of functioning of the health system with regard to ability to continue to provide high-quality effective routine care needs more attention.

AB - BACKGROUND:We sought to determine the impact of the Ebola virus epidemic on the availability, uptake and outcome of routine maternity services in Sierra Leone.METHODS:The number of antenatal and postnatal visits, institutional births, availability of emergency obstetric care (EmOC), maternal deaths and stillbirths were assessed by month, by districts and by level of healthcare for 10 months during, and 12 months prior to, the Ebola virus disease (EVD) epidemic. All healthcare facilities designated to provide comprehensive (n=13) or basic (n=67) EmOC across the 13 districts of Sierra Leone were included.RESULTS:Preservice students were not deployed during the EVD epidemic. The number of healthcare providers in facilities remained constant (incidence rate ratio (IRR) 1.03, 95% CI 1.00 to 1.07). Availability of antibiotics, oxytocics, anticonvulsants, manual removal of placenta, removal of retained products of conception, blood transfusion and caesarean section were not affected by the EVD epidemic. Across Sierra Leone, following the onset of the EVD epidemic, there was a 18% decrease in the number of women attending for antenatal (IRR 0.82, 95% CI 0.79 to 0.84); 22% decrease in postnatal attendance (IRR 0.78, 95% CI 0.75 to 0.80) visits and 11% decrease in the number of women attending for birth at a healthcare facility (IRR 0.89, 95% CI 0.87 to 0.91). There was a corresponding 34% increase in the facility maternal mortality ratio (IRR 1.34, 95% CI 1.07 to 1.69) and 24% increase in the stillbirth rate (IRR 1.24, 95% CI 1.14 to 1.35).CONCLUSIONS:During the EVD epidemic, fewer pregnant women accessed healthcare. For those who did, an increase in maternal mortality and stillbirth was observed. In the post-Ebola phase, 'readiness' (or not) of the global partners for large-scale epidemics has been the focus of debate. The level of functioning of the health system with regard to ability to continue to provide high-quality effective routine care needs more attention.

KW - Ebola virus

KW - maternity care

UR - http://gh.bmj.com/

U2 - 10.1136/bmjgh-2016-000065

DO - 10.1136/bmjgh-2016-000065

M3 - Article

VL - 1

JO - BMJ Global Health

JF - BMJ Global Health

SN - 2059-7908

IS - 3

M1 - e000065

ER -