The Impact of the West Africa Ebola Outbreak on Obstetric Health Care in Sierra Leone

BackgroundAs Sierra Leone celebrates the end of the Ebola Virus Disease (EVD) outbreak, we can begin to fully grasp its impact on already weak health systems. The EVD outbreak in West Africa forced many hospitals to close down or reduce their activity, either to prevent nosocomial transmission or because of staff shortages. The aim of this study is to assess the potential impact of EVD on nationwide access to obstetric care in Sierra Leone.Methods and FindingsCommunity health officers collected weekly data between January 2014—May 2015 on in-hospital deliveries and caesarean sections (C-sections) from all open facilities (public, private for-profit and private non-profit sectors) offering emergency obstetrics in Sierra Leone. This was compared to official data of EVD cases per district. Logistic and Poisson regression analyses were used to compute risk and rate estimates. Nationwide, the number of in-hospital deliveries and C-sections decreased by over 20% during the EVD outbreak. The decline occurred early on in the EVD outbreak and was mainly attributable to the closing of private not-for-profit hospitals rather than government facilities. Due to difficulties in collecting data in the midst of an epidemic, limitations of this study include some missing data points.ConclusionsBoth the number of in-hospital deliveries and C-sections substantially declined shortly after the onset of the EVD outbreak. Since access to emergency obstetric care, like C-sections, is associated with decreased maternal mortality, many women are likely to have died due to the reduced access to appropriate care during childbirth. Future research on indirect health effects of health system breakdown should ideally be nationwide and continue also into the recovery phase. It is also important to understand the mechanisms behind the deterioration so that important health services can be reestablished.

研究背景：在塞拉利昂庆祝埃博拉病毒病（Ebola Virus Disease, EVD）疫情结束之际，我们得以全面审视其对本已脆弱的卫生系统造成的冲击。西非地区的埃博拉疫情致使众多医院关停或缩减运营规模——此举既是为了防范院内传播，也是由于医护人员短缺。本研究旨在评估埃博拉疫情对塞拉利昂全国范围内产科医疗服务可及性的潜在影响。
研究方法与结果：2014年1月至2015年5月期间，社区卫生人员从塞拉利昂所有提供急诊产科服务的运营医疗机构（涵盖公立、营利性私立及非营利性私立机构）收集院内分娩与剖宫产（caesarean sections, C-sections）的周度数据。将上述数据与各辖区官方公布的埃博拉病例数据进行比对。研究采用逻辑回归与泊松回归分析方法计算风险与发生率估算值。疫情期间，全国范围内的院内分娩与剖宫产总量下降逾20%。该降幅在埃博拉疫情初期即已显现，且主要源于非营利性私立医院的关停，而非公立医疗机构。由于疫情期间数据收集存在难度，本研究存在部分数据缺失的局限性。
研究结论：埃博拉疫情暴发后不久，院内分娩与剖宫产的数量均出现显著下降。由于剖宫产等急诊产科服务的可及性与孕产妇死亡率降低密切相关，因此疫情期间分娩期间适宜医疗服务可及性下降，可能导致大量孕产妇死亡。未来针对卫生系统崩溃所引发的间接健康影响的研究，理想情况下应覆盖全国范围，并延续至疫情恢复阶段。此外，阐明医疗服务恶化背后的机制，对于重建关键卫生服务至关重要。