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

*Corresponding author for this work

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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

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 number029093
Number of pages9
JournalBMJ Open
Issue number9
Publication statusPublished - Sep 2019


  • paediatrics
  • public health
  • community gynaecology

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