The Impact of the West Africa Ebola Outbreak on Obstetric Health Care in Sierra Leone
The Impact of the West Africa Ebola Outbreak on Obstetric Health Care in Sierra Leone
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DOI：
10.1371/journal.pone.0150080
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发表时间：
2016-02-24
期刊：
影响因子：
3.7
通讯作者：
Ekstrom, AnnaMia
中科院分区：
文献类型：
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作者：
Ribacke, Kim J. Brolin;van Duinen, Alex J.;Ekstrom, AnnaMia
在塞拉利昂庆祝埃博拉病毒病（EVD）疫情结束之际，我们可以开始充分了解它对本已薄弱的卫生系统的影响。西非的EVD疫情迫使许多医院关闭或减少活动，以防止医院内传播或因为工作人员短缺。本研究的目的是评估EVD对全国范围内获得产科护理在Sierra Leone.Methods and FindingsCommunity卫生官员收集每周数据2014年1月至2015年5月期间在医院分娩和剖腹产（剖腹产）从所有开放式设施（公共，私人营利性和私人非营利部门）提供紧急产科在塞拉利昂。这与每个地区EVD病例的官方数据进行了比较。Logistic和Poisson回归分析用于计算风险和比率估计。在全国范围内，在EVD爆发期间，住院分娩和剖腹产的数量下降了20%以上。这一下降发生在EVD爆发的早期，主要是由于关闭了私人非营利医院而不是政府设施。由于在收集数据中的流行病，本研究的局限性，包括一些缺失的datapoints.ConclusionsBoth在医院分娩和剖腹产的数量大幅下降后不久，EVD爆发。由于获得紧急产科护理，如剖腹产，与孕产妇死亡率下降有关，许多妇女可能因分娩时获得适当护理的机会减少而死亡。未来关于卫生系统崩溃对健康的间接影响的研究最好是在全国范围内进行，并继续进行到恢复阶段。同样重要的是要了解恶化背后的机制，以便能够重建重要的保健服务。
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 inhospital 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 inhospital 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.