'Women and babies are dying but not of Ebola': the effect of the Ebola virus epidemic on the availability, uptake and outcomes of maternal and newborn health services in Sierra Leone
'Women and babies are dying but not of Ebola': the effect of the Ebola virus epidemic on the availability, uptake and outcomes of maternal and newborn health services in Sierra Leone
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DOI：
10.1136/bmjgh-2016-000065
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发表时间：
2016-11-01
影响因子：
8.1
通讯作者：
van den Broek, Nynke R.
中科院分区：
文献类型：
--
作者：
Jones, Susan A.;Gopalakrishnan, Somasundari;van den Broek, Nynke R.
背景资料：我们试图确定埃博拉病毒流行对塞拉利昂常规产科服务的可用性、使用率和结果的影响。方法：对产前和产后就诊次数、住院分娩次数、产科急诊次数、孕产妇死亡和死产按月、按地区和按保健水平进行了评估，评估时间为10个月期间和12个月之前，埃博拉病毒病（EVD）。指定提供全面的（n=13）或基本的（n=67）EmOC在塞拉利昂的13个地区的所有医疗保健设施included.Results：未部署在EVD流行病的预备役学生。医疗机构的医疗保健提供者数量保持不变（发病率比（IRR）1.03，95% CI 1.00 - 1.07）。抗生素、催产素、抗惊厥药、人工移除胎盘、移除妊娠残留物、输血和剖腹产的可用性不受EVD流行的影响。在塞拉利昂各地，EVD疫情爆发后，接受产前检查的妇女人数减少了18%，（IRR 0.82，95% CI 0.79 - 0.84）;产后护理减少22%（IRR 0.78，95% CI 0.75 - 0.80）就诊，在医疗机构分娩的妇女人数减少11%（IRR 0.89，95% CI 0.87 - 0.91）。设施孕产妇死亡率相应增加34%（IRR 1.34，95%CI 1.07至1.69），死产率增加24%（IRR 1.24，95%CI 1.14至1.35）。结论：在EVD流行期间，孕妇获得医疗保健的人数减少。对于那些这样做的人，观察到孕产妇死亡率和死产率增加。在后埃博拉阶段，全球合作伙伴对大规模流行病的“准备”（或不准备）一直是辩论的焦点。卫生系统在继续提供高质量、有效的日常护理方面的运作水平需要更多的关注。
Background: We sought to determine the impact of the Ebola virus epidemic on the availability, uptake and outcome of routine maternity services in Sierra Leone.Methods: The number of antenatal and postnatal visits, institutional births, availability of emergency obstetric care (EmOC), maternal deaths and stillbirths were assessed by month, by districts and by level of healthcare for 10 months during, and 12 months prior to, the Ebola virus disease (EVD) epidemic. All healthcare facilities designated to provide comprehensive (n=13) or basic (n=67) EmOC across the 13 districts of Sierra Leone were included.Results: Preservice students were not deployed during the EVD epidemic. The number of healthcare providers in facilities remained constant (incidence rate ratio (IRR) 1.03, 95% CI 1.00 to 1.07). Availability of antibiotics, oxytocics, anticonvulsants, manual removal of placenta, removal of retained products of conception, blood transfusion and caesarean section were not affected by the EVD epidemic. Across Sierra Leone, following the onset of the EVD epidemic, there was a 18% decrease in the number of women attending for antenatal (IRR 0.82, 95% CI 0.79 to 0.84); 22% decrease in postnatal attendance (IRR 0.78, 95% CI 0.75 to 0.80) visits and 11% decrease in the number of women attending for birth at a healthcare facility (IRR 0.89, 95% CI 0.87 to 0.91). There was a corresponding 34% increase in the facility maternal mortality ratio (IRR 1.34, 95% CI 1.07 to 1.69) and 24% increase in the stillbirth rate (IRR 1.24, 95% CI 1.14 to 1.35).Conclusions: During the EVD epidemic, fewer pregnant women accessed healthcare. For those who did, an increase in maternal mortality and stillbirth was observed. In the post-Ebola phase, 'readiness' (or not) of the global partners for large-scale epidemics has been the focus of debate. The level of functioning of the health system with regard to ability to continue to provide high-quality effective routine care needs more attention.