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RESEARCH PRODUCT
Impact of Ebola outbreak on reproductive health services in a rural district of Sierra Leone: a prospective observational study
Gianluca QuaglioGianluca QuaglioDavid BomeLivio FinosClaudia MarottaFrancesco Di GennaroAnnalisa SaracinoFrancesca TognonGiovanni PutotoSusan JonesDamiano PizzolBienvenu Salim CamaraAtiba KebbieWalter MazzuccoSantigie SesayVincenzo PisaniZainab Bangurasubject
AdultMaleRural Populationmedicine.medical_specialtypaediatricAdolescentMaternal-Child Health Servicesviruses030231 tropical medicineSettore MED/42 - Igiene Generale E ApplicataSierra leoneDisease OutbreaksSierra LeonepaediatricsLESSONS03 medical and health sciences0302 clinical medicineEPIDEMICMedicineHumansEMERGENCY OBSTETRIC CARE030212 general & internal medicineProspective Studies15061703Reproductive healthbusiness.industryPublic healthHealth PolicyResearchMORTALITYpublic healthInfant NewbornOutbreakvirus diseasesInfantRural districtcommunity gynaecology; paediatrics; public healthGeneral MedicineHemorrhagic Fever EbolaFamily planningChild PreschoolCommunity healthObservational studyFemalecommunity gynaecologybusinessDemographyVIRUS DISEASEdescription
ObjectivesTo 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).DesignA prospective observational study of MCH services.SettingPujehun district in Sierra Leone, 77 community health facilities and 1 hospital from 2012 to 2017.Main outcome measuresMCH 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.ResultsAt 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).ConclusionsA 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.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2019-09-01 |