Effect of Ebola virus disease on maternal and child health services in Guinea: a retrospective observational cohort study
Effect of Ebola virus disease on maternal and child health services in Guinea: a retrospective observational cohort study
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DOI：
10.1016/s2214-109x(17)30078-5
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发表时间：
2017-04-01
影响因子：
34.3
通讯作者：
De Brouwere, Vincent
中科院分区：
文献类型：
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作者：
Delamou, Alexandre;El Ayadi, Alison M.;De Brouwere, Vincent
2014年西非埃博拉病毒病疫情对受影响国家的卫生系统构成了重大威胁。我们试图量化埃博拉病毒病对孕产妇和儿童的健康服务在高度受影响的森林地区的guinea.Methods的后果，我们做了一个回顾性的，观察性队列研究的妇女和儿童参加公共卫生设施的产前保健，机构交付，并在六个七个卫生区在森林地区（贝拉，Guckdou，Kissidougou，洛拉，Macenta，和N 'Zerekore）的免疫接种服务。我们检查了8项妇幼卫生服务指标的月度服务使用数据：产前护理（>= 1次产前护理访视和>= 3次产前护理访视），机构分娩，以及接受五种婴儿疫苗：脊髓灰质炎、五价疫苗（白喉、破伤风、百日咳、乙型肝炎B病毒和流感嗜血杆菌B型）、黄热病、麻疹和结核病。我们使用中断时间序列模型来估计三个时间段内每个指标的趋势：埃博拉病毒病流行前（2013年1月至2014年2月），流行期间（2014年3月至2015年2月）和流行后（2015年3月至2016年2月）。我们使用分段普通最小二乘（OLS）回归，使用NeweyWest标准误差来适应序列自相关，并调整出生季节性对我们结果的任何潜在影响。从每月平均增加61名（95% CI 38-84）住院分娩到119名（95% CI 79-158）至少接受三次产前保健检查的妇女不等。在流行病期间，这些增长趋势发生了逆转：住院分娩减少（-240，95%CI-293至-187），实现至少一次产前保健的妇女较少（-418，95%CI-535至-300）或每月至少三次产前检查（-363，95%CI-485至-242）（所有患者p< 0.0001）。与疫情期间的负趋势相比，疫情后时期的趋势变化显示，（95% CI 51-294; p= 0.0074）至少接受过一次产前检查，257例（95%CI 117-398; p= 0.0010）至少接受过三次产前护理就诊，另有149人（95%CI 91-206; p< 0.0001）在医院分娩。然而，尽管这些指标的数字在流行病后时期有所增加，但所有指标的趋势都停滞不前。同样，在流行病爆发前，儿童疫苗接种完成率呈上升趋势，但随后大多数疫苗类型的接种率立即和呈趋势大幅下降。在疫情爆发前，完成每种疫苗接种的12个月以下儿童人数从结核病的5752人（95%CI 2821-8682）到黄热病的8043人（95%CI 7621-8464）不等。疫情爆发后，除黄热病疫苗接种率略有下降外，所有疫苗接种率都立即大幅下降。脊髓灰质炎和结核病的降幅最大，分别减少了-3594（95% CI -4811至-2377; p< 0.0001）和-3048（95% CI -5879至-216; p= 0.0362）次疫苗接种。与埃博拉病毒病爆发前的趋势相比，除小儿麻痹症外，所有疫苗都出现了显著下降，每月接种疫苗的儿童人数呈下降趋势，在爆发期间，BCG的-313（95%CI-683至-155; p= 0.0034）低于五价疫苗的-313（95%CI-446至-179; p< 0.0001）。在埃博拉病毒病爆发后，脊髓灰质炎、麻疹、黄热病的疫苗接种率持续下降，而结核病和五联疫苗的接种率与零相比没有明显变化。解读2014年埃博拉病毒病爆发期间，大部分妇幼健康指标都大幅下降。尽管在疫情爆发后，这一负面趋势有所减少，但基本妇幼保健服务的使用情况尚未恢复到疫情爆发前的水平，也没有全部恢复到不采取有针对性的干预措施就能恢复的程度。
Background The 2014 west African epidemic of Ebola virus disease posed a major threat to the health systems of the countries affected. We sought to quantify the consequences of Ebola virus disease on maternal and child health services in the highly-affected Forest region of Guinea.Methods We did a retrospective, observational cohort study of women and children attending public health facilities for antenatal care, institutional delivery, and immunisation services in six of seven health districts in the Forest region (Beyla, Guckdou, Kissidougou, Lola, Macenta, and N'Zerekore). We examined monthly service use data for eight maternal and child health services indicators: antenatal care (>= 1 antenatal care visit and >= 3 antenatal care visits), institutional delivery, and receipt of five infant vaccines: polio, pentavalent (diphtheria, tetanus, pertussis, hepatitis B virus, and Haemophilus influenzae type b), yellow fever, measles, and tuberculosis. We used interrupted time series models to estimate trends in each indicator across three time periods: pre-Ebola virus disease epidemic (January, 2013, to February, 2014), during-epidemic (March, 2014, to February, 2015) and postepidemic (March, 2015, to Feb, 2016). We used segmented ordinary least-squares (OLS) regression using NeweyWest standard errors to accommodate for serial autocorrelation, and adjusted for any potential effect of birth seasonality on our outcomes.Findings In the months before the Ebola virus disease outbreak, all three maternal indicators showed a significantly positive change in trend, ranging from a monthly average increase of 61 (95% CI 38-84) institutional deliveries to 119 (95% CI 79-158) women achieving at least three antenatal care visits. These increasing trends were reversed during the epidemic: fewer institutional deliveries occurred (-240, 95% CI -293 to -187), and fewer women achieved at least one antenatal care visit (-418, 95% CI -535 to -300) or at least three antenatal care visits (-363, 95% CI -485 to -242) per month (p< 0.0001 for all). Compared with the negative trend during the outbreak, the change in trend during the post-outbreak period showed that 173 more women per month (95% CI 51-294; p= 0.0074) had at least one antenatal care visit, 257 more (95% CI 117-398; p= 0.0010) had at least three antenatal care visits and 149 more (95% CI 91-206; p< 0.0001) had institutional deliveries. However, although the numbers for these indicators increased in the post-epidemic period, the trends for all stagnated. Similarly, the increasing trend in child vaccination completion during the pre-epidemic period was followed by significant immediate and trend reductions across most vaccine types. Before the outbreak, the number of children younger than 12 months who had completed each vaccination ranged from 5752 (95% CI 2821-8682) for tuberculosis to 8043 (95% CI 7621-8464) for yellow fever. Immediately after the outbreak, significant reductions occurred in the level of all vaccinations except for yellow fever for which the reduction was marginal. The greatest reductions were noted for polio and tuberculosis at -3594 (95% CI -4811 to -2377; p< 0.0001) and -3048 (95% CI -5879 to -216; p= 0.0362) fewer vaccines administered, respectively. Compared with pre-Ebola virus disease outbreak trends, significant decreases occurred for all vaccines except polio, with the trend of monthly decreases in the number of children vaccinated ranging from -419 (95% CI -683 to -155; p= 0.0034) fewer for BCG to -313 (95% CI-446 to -179; p< 0.0001) fewer for pentavalent during the outbreak. In the post-Ebola virus disease outbreak period, vaccination coverage for polio, measles, and yellow fever continued to decrease, whereas the trend in coverage for tuberculosis and pentavalent did not significantly differ from zero.Interpretation Most maternal and child health indicators significantly declined during the Ebola virus disease outbreak in 2014. Despite a reduction in this negative trend in the post-outbreak period, the use of essential maternal and child health services have not recovered to their pre-outbreak levels, nor are they all on a course that suggests that they will recover without targeted interventions.