Effects of the 2014 Ebola outbreak on antenatal care and delivery outcomes in Liberia: a nationwide analysis

Shannon, Fulton; Horace-Kwemi, E.; Najjemba, Robinah; Owiti, Philip; Edwards, Jeffrey K.; Shringarpure, Kalpita; Bhat, Prashant; Kateh, Francis

doi:10.5588/pha.16.0099

Cited by 36 publications

(49 citation statements)

References 13 publications

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“…These findings suggest the need for the development of best practices, coordinated responses, and larger global investments in public-sector health system strengthening efforts when responding to future global public health emergencies [ 34 ]. The emerging evidence from Sierra Leone [ 2 , 16 , 17 , 22 ], Guinea [ 3 , 4 , 11 , 15 ], and Liberia ([ 6 – 10 ] and our study) suggests that, in terms of morbidity and mortality, the collateral effects from the EVD outbreak on public-sector primary healthcare delivery will greatly exceed the direct effects from EVD infection. Analyses using population-based surveys in Liberia suggest that distrust of the government and the health system was the primary source of reduced health service demand during the EVD outbreak, rather than supply-side factors [ 29 ].…”

Section: Discussionmentioning

confidence: 73%

“…Analyses using routine health information system (RHIS) data originating from Guinea and Sierra Leone have recently chronicled the effect of the EVD epidemic on the delivery of public-sector care for maternal, child, and reproductive health services, showing dramatic decreases during the Ebola outbreak (on the order of 50% declines) and sustained low levels not suggesting recovery [ 3 – 5 ]. Previous descriptive studies using RHIS data from Liberia have shown decreases in maternal and child health (MCH) indicators [ 6 , 7 ], malaria treatment [ 8 ], HIV testing [ 9 ], and tuberculosis diagnoses [ 10 ] during the EVD outbreak. Others have estimated that EVD-related disruptions in treating malaria alone will contribute to significantly more excess deaths than direct EVD-related mortality [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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The 2014–2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010–2016

et al. 2018

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BackgroundThe aim of this study is to estimate the immediate and lasting effects of the 2014–2015 Ebola virus disease (EVD) outbreak on public-sector primary healthcare delivery in Liberia using 7 years of comprehensive routine health information system data.Methods and findingsWe analyzed 10 key primary healthcare indicators before, during, and after the EVD outbreak using 31,836 facility-month service outputs from 1 January 2010 to 31 December 2016 across a census of 379 public-sector health facilities in Liberia (excluding Montserrado County). All indicators had statistically significant decreases during the first 4 months of the EVD outbreak, with all indicators having their lowest raw mean outputs in August 2014. Decreases in outputs comparing the end of the initial EVD period (September 2014) to May 2014 (pre-EVD) ranged in magnitude from a 67.3% decrease in measles vaccinations (95% CI: −77.9%, −56.8%, p < 0.001) and a 61.4% decrease in artemisinin-based combination therapy (ACT) treatments for malaria (95% CI: −69.0%, −53.8%, p < 0.001) to a 35.2% decrease in first antenatal care (ANC) visits (95% CI: −45.8%, −24.7%, p < 0.001) and a 38.5% decrease in medroxyprogesterone acetate doses (95% CI: −47.6%, −29.5%, p < 0.001). Following the nadir of system outputs in August 2014, all indicators showed statistically significant increases from October 2014 to December 2014. All indicators had significant positive trends during the post-EVD period, with every system output exceeding pre-Ebola forecasted trends for 3 consecutive months by November 2016. Health system outputs lost during and after the EVD outbreak were large and sustained for most indicators. Prior to exceeding pre-EVD forecasted trends for 3 months, we estimate statistically significant cumulative losses of −776,110 clinic visits (95% CI: −1,480,896, −101,357, p = 0.030); −24,449 bacille Calmette–Guérin vaccinations (95% CI: −45,947, −2,020, p = 0.032); −9,129 measles vaccinations (95% CI: −12,312, −5,659, p < 0.001); −17,191 postnatal care (PNC) visits within 6 weeks of birth (95% CI: −28,344, −5,775, p = 0.002); and −101,857 ACT malaria treatments (95% CI: −205,839, −2,139, p = 0.044) due to the EVD outbreak. Other outputs showed statistically significant cumulative losses only through December 2014, including losses of −12,941 first pentavalent vaccinations (95% CI: −20,309, −5,527, p = 0.002); −5,122 institutional births (95% CI: −8,767, −1,234, p = 0.003); and −45,024 acute respiratory infections treated (95% CI: −66,185, −24,019, p < 0.001). Compared to pre-EVD forecasted trends, medroxyprogesterone acetate doses and first ANC visits did not show statistically significant net losses. ACT treatment for malaria was the only indicator with an estimated net increase in system outputs through December 2016, showing an excess of +78,583 outputs (95% CI: −309,417, +450,661, p = 0.634) compared to pre-EVD forecasted trends, although this increase was not statistically significant. However, comparing December 2013 to December 2017, ACT malaria cases h...

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Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

The 2014–2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010–2016

et al. 2018

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“…Public health crises, such as the 2014 outbreak of Ebola virus disease (EVD) in West Africa, risk disrupting MHS and progress made in maternal health outcomes, particularly in regions with weak existing health infrastructure. 3 There is evidence from the 2014 outbreak of EVD in Guinea, Liberia and Sierra Leone that shows a deterioration in uptake and provision of MHS, [4][5][6][7][8][9][10] while just two studies, both conducted in Sierra Leone, reported insignificant changes in access to MHS. 11 12 When compared with preoutbreak metrics,…”

Section: Introductionmentioning

confidence: 99%

Barriers to maternal health services during the Ebola outbreak in three West African countries: a literature review

et al. 2020

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IntroductionThe Ebola virus disease (EVD) outbreak in West Africa, affecting Guinea, Liberia and Sierra Leone from 2014 to 2016, was a substantial public health crisis with health impacts extending past EVD itself. Access to maternal health services (MHS) was disrupted during the epidemic, with reductions in antenatal care, facility-based deliveries and postnatal care. We aimed to identify and describe barriers related to the uptake and provision of MHS during the 2014–2016 EVD outbreak in West Africa.MethodsIn June 2020, we conducted a scoping review of peer-reviewed publications and grey literature from relevant stakeholder organisations. Search terms were generated to identify literature that explained underlying access barriers to MHS. Published literature in scientific journals was first searched and extracted from PubMed and Web of Science databases for the period between 1 January 2014 and 27 June 2020. We hand-searched relevant stakeholder websites. A ‘snowball’ approach was used to identify relevant sources uncaptured in the systematic search. The identified literature was examined to synthesise themes using an existing framework.ResultsNineteen papers were included, with 26 barriers to MHS uptake and provision identified. Three themes emerged: (1) fear and mistrust, (2) health system and service constraints, and (3) poor communication. Our analysis of the literature indicates that fear, experienced by both service users and providers, was the most recurring barrier to MHS. Constrained health systems negatively impacted MHS on the supply side. Poor communication and inadequately coordinated training efforts disallowed competent provision of MHS.ConclusionsBarriers to accessing MHS during the EVD outbreak in West Africa were influenced by complex but inter-related factors at the individual, interpersonal, health system and international level. Future responses to EVD outbreaks need to address underlying reasons for fear and mistrust between patients and providers, and ensure MHS are adequately equipped both routinely and during crises.

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“…6 Sixteen studies were conducted, and are assembled here for this special issue. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Through the study of routine data the performance of a wide range of programmes was assessed before, during and after the outbreak. These studies present data from mother and child health care services, the human immunodeficiency virus (HIV), tuberculosis, vaccination, malaria, malnutrition and non-communicable diseases programmes.…”

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confidence: 99%

What was the effect of the West African Ebola outbreak on health programme performance, and did programmes recover?

Decroo

Fitzpatrick

Amone

2017

public health action

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The West African Ebola virus disease (EVD) outbreak was the largest in history. The vast majority of cases were reported in Guinea, Sierra Leone and Liberia. Altogether, 28 646 people were infected and 11 323 died. 1 One of the explanations for the extent of the outbreak was the lack of response of local health systems. These health systems were incapable of responding adequately to the outbreak due to a lack of human resources, information, research, supply of medical products, financing and governance. 2 The devastating effect of the Ebola outbreak stretched far beyond the number of Ebola cases, and resulted in the deterioration of the provision and utilisation of routine health care. On the one hand the EVD outbreak compromised the functioning of the health system, due to the deaths of many health care workers and the closure of health facilities, 3,4 while at the same time communities had little trust in the capacity of providers to secure safe health care. In Ebola-affected communities many individuals feared to seek care, even for curable conditions. 4,5 The manner in which the provision and utilisation of programmes were affected by the outbreak was difficult to monitor during the outbreak response, given the state of emergency. All the attention of national and international health care providers was focused on limiting further spread of EVD, and reducing mortality in infected patients. We therefore studied in retrospect the effect of the Ebola outbreak on health system performance. Two Structured Operational Research Training Initiative (SORT IT) courses were organised, one in Liberia and one in Sierra Leone. The participants, the first authors of the manuscripts included in this supplement, were involved in the local health programmes during the Ebola outbreak. Course participation was defined as successful if the participant submitted a scientific manuscript to a peer-reviewed journal by the end of the course. 6 Sixteen studies were conducted, and are assembled here for this special issue. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Through the study of routine data the performance of a wide range of programmes was assessed before, during and after the outbreak. These studies present data from mother and child health care services, the human immunodeficiency virus (HIV), tuberculosis, vaccination, malaria, malnutrition and non-communicable diseases programmes. In addition, infection prevention monitoring, community health worker programme and performance-based financing are included.The different studies illustrate how service delivery and utilisation of most programmes dropped significantly during the Ebola outbreak. The greater the area affected, the sharper the decline, and the longer it took for performance to recover to pre-Ebola levels. The level of programme performance pre-Ebola also affected recovery post-Ebola. For example, in Liberia the already struggling immunisation programme was further weakened during the outbreak and took significant time to recover post-Ebola. 19 Ne...

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Effects of the 2014 Ebola outbreak on antenatal care and delivery outcomes in Liberia: a nationwide analysis

Cited by 36 publications

References 13 publications

The 2014–2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010–2016

The 2014–2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010–2016

Barriers to maternal health services during the Ebola outbreak in three West African countries: a literature review

What was the effect of the West African Ebola outbreak on health programme performance, and did programmes recover?

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