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 Bome; Santigie Sesay; Atiba Kebbie; Francesco Di Gennaro; Bienvenu Salim Camara; Claudia Marotta; Vincenzo Pisani; Zainab Bangura; Damiano Pizzol; Annalisa Saracino; Walter Mazzucco; Susan Jones; Giovanni Putoto

doi:10.1136/bmjopen-2019-029093

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

BMJ Open. 2019 Sep 4;9(9):e029093. doi: 10.1136/bmjopen-2019-029093.

Authors

Gianluca Quaglio^{1

2

3}, Francesca Tognon⁴, Livio Finos⁵, David Bome⁶, Santigie Sesay⁶, Atiba Kebbie⁷, Francesco Di Gennaro⁸, Bienvenu Salim Camara⁹, Claudia Marotta¹⁰, Vincenzo Pisani⁷, Zainab Bangura⁷, Damiano Pizzol³, Annalisa Saracino⁸, Walter Mazzucco¹⁰, Susan Jones¹¹, Giovanni Putoto³

Affiliations

¹ European Parliamentary Research Services (EPRS), European Parliament, Brussels, Belgium.
² Department of International Health/CAPHRI, University of Maastricht, Maastricht, The Netherlands.
³ Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy.
⁴ Department for Woman and Child Health, University of Padua, Padua, Italy.
⁵ Department of Developmental Psychology and Socialisation, University of Padua, Padua, Italy.
⁶ Ministry of Health and Sanitation, Freetown, Sierra Leone.
⁷ Department for Woman and Child Health, Pujehun Hospital, Pujehun, Sierra Leone.
⁸ Department of Infectious Diseases, University of Bari, Bari, Italy.
⁹ National Centre for Training and Research in Rural Health of Maferinyah, Forécariah, Guinea.
¹⁰ Department of Science for Health Promotion and Mother to Child Care, University of Palermo, Palermo, Italy.
¹¹ Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, London, UK.

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: community gynaecology; paediatrics; public health.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Child, Preschool
Disease Outbreaks*
Female
Hemorrhagic Fever, Ebola / epidemiology*
Humans
Infant
Infant, Newborn
Male
Maternal-Child Health Services*
Prospective Studies
Rural Population
Sierra Leone / epidemiology