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331451
Impact of the Ebola Viral Disease Epidemic on Reproductive and Maternal and Child Health Services in Sierra Leone


Tuesday, November 3, 2015

Sharice Preston, MS, CHES, Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL
Laura Miller, MPH, International Rescue Committee - Sierra Leone, Freetown, Sierra Leone
Consuelo Beck-Sague, MD, FAAP, Dept. of Health Promotion and Disease Prevention, Florida International University Robert Stempel College of Public Health and Social Work, Miami, FL
Tamba Sam, International Rescue Committee Sierra Leone, International Rescue Committee, Freetown, Sierra Leone
Mohamed Vandi, Dr. Med., Kenema District Office, Kenema, Sierra Leone
Andrew Dean, MD, MPH, Dept. of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
Darren Hertz, MEd, International Rescue Committee, Freetown, Sierra Leone
Yolanda Barberá-Lainez, MSc, Health Unit, International Rescue Committee, New York, NY
     
Background: Sierra Leone has reported the highest number of cases among countries in the 2014 Ebola viral disease epidemic, the largest Ebola epidemic ever documented. Sierra Leonean healthcare providers have been disproportionately impacted and access and utilization of healthcare services may have decreased due to the epidemic.

Methods: We conducted an analysis to assess the impact of the epidemic on reproductive and maternal and child health services in Kenema, the second Sierra Leone district to report Ebola cases. We compared numbers of patients who used key reproductive, maternal and child health services during the six-month pre-epidemic period (January-June, 2014) to numbers of patients during the maximum Ebola reporting period (July-September, 2014) and to numbers of patients in the months when Ebola reporting began declining (October-December, 2014).   

Results:Decreased utilization occurred during months of maximum Ebola reporting (July-September) from pre-epidemic levels in numbers of women who: received contraceptive pills (-20.6%), injections (-30.2%) and implants (-47.3%); attended one and four or more antenatal visits (-14.8%, -21.9%, respectively) and postnatal (-16.6%) visits; had antenatal HIV screening (-25.3%), institutional vaginal (-14.5%) or cesarean (-81.0%) deliveries; and attended community (-33.5%) and school-based (-72.4%) reproductive health information sessions (all p<.01). But in subsequent months, when Ebola reporting declined, numbers of patients utilizing these services rose by 3.2% to 290.0% from nadirs remaining from 9.5% to over 95% below pre-epidemic levels.    

Conclusions: The Ebola viral disease epidemic is impacting services essential to reducing maternal and child mortality. These data suggest resiliency and potential for post-epidemic recovery in most services.

Learning Areas:

Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Epidemiology
Provision of health care to the public

Learning Objectives:
Describe the impact of the Sierra Leonean Ebola viral disease (EVD) epidemic on reproductive and maternal and child health services in Kenema, Sierra Leone. Compare the impact of the EVD epidemic by type of service, particularly in-hospital vaginal and cesarean deliveries versus community-based services Assess the recovery in the months after the epidemic peak, to identify the most impacted, least resilient services

Keyword(s): Maternal and Child Health, Women's Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a doctoral student (PhD) in the Dept. of Health Promotion and Disease Prevention of the Stempel College of Public Health and Social Work, Florida International University. My MS is in biology. I have collaborated in Global Public Health projects, conducting data analyses in studies of depression in patients with HIV infection using combined antiretroviral therapy (cART) and disclosure of their status to perinatally HIV-infected youth in Haiti and the Dominican Republic.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4143.0: Global Health Students Panel II