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

Abstract

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.

Maternal caesarean section infection (MACSI) in Sierra Leone: a case–control study

“…Hence, these variables serve as proxies of discomfort experienced by such populations in Sierra Leone which has undergone a prolonged civil war (1991–2002) followed by Ebola virus disease outbreak (2014–2016). These events have profoundly affected the already fragile healthcare system, leading to significant worsening of maternal health indicators [16, 17].…”

An Observational Study of a National Referral System: An Analysis of 14,266 Referrals in Sierra Leone

“…Pujehun as a district has bene ted from a targeted health system intervention to improve access, through ambulance service provision and improved quality of care at the district hospital. 18 The Western Area high referral index is likely multifactorial; the presence of tertiary hospitals offering higher levels of care; higher density of skilled healthcare workers 19 ; less distance and more availability of transport to access care; and a different socio-economic makeup to the national average. 17 Notably, national referrals to tertiary hospitals in the Western Area were very low 71 (0•5%) and do not account for the higher referral index observed.…”

Malaria and COVID-19: Common and Different Findings

“…Especially in rural communities, which may have reduced attention, this will affect children with malaria, making an already vulnerable population even more vulnerable. In general, there could be a reduction in access to healthcare facilities due to the fear of contracting COVID-19 [ 40 ]. This could have a negative impact on pediatric care.…”

“…The Ebola lesson should be valued for the impact it had on malaria control measures, where a significant reduction in malaria diagnoses (but not deaths from malaria) was observed due to the perceived risk of Ebola contagion resulting in a lower number of people accessing healthcare centers [ 40 , 52 ]. In addition, during the Ebola outbreak, it was estimated that malaria cases in Guinea, Liberia, and Sierra Leone could increase to 1 million in 2014 following the disruption in the distribution of insecticide-treated bed nets (ITNs) [ 53 ].…”