Preserving Maternal and Child Health Care in Sierra Leone During the Time of Ebola: The Experiences of Doctors with Africa
Sierra Leone is one of the poorest countries in the world. The Ebola virus disease outbreak further affected the already impaired health system, especially health care services to women and children. This chapter assesses the extent to which maternal and child hospital services were maintained during the Ebola epidemic in the Pujehun district in Sierra Leone. Measures to control the Ebola epidemic were based upon prevention of infection, case management, and surveillance. These included organizing a rapid response to Ebola cases; isolation and clinical management of persons suspected of being infected; safe burials; triage, contact tracing, and quarantine; training and provision of personnel protective gear to health care workers; infection prevention and control; human resources management; and community sensitization. The numbers of admissions in the Pediatric Ward of the Pujehun Hospital in 2014 showed a significant decrease after the beginning of June—this was when the first Ebola case was reported in Sierra Leone. This reduction of pediatric admissions also occurred in the period from July to December, declining from 424 in 2013 to 312 in 2014. There were 716 admissions to the Maternity Ward in 2014 (781 in 2013, p 0.07) with no statistical differences. The total number of deliveries occurring in the Pujehun Hospital was 460 in 2014 (453 in 2013, p 0.41), with a reduction between June–August 2014, before resuming a positive trend. Factors such as competent local leadership, continuity of care, staff protection, human resources management, and community involvement, all combined to help contain the local spread of the Ebola epidemic while keeping the overall functioning of the hospital mother and child health care services functioning.
KeywordsObstetrics Pediatrics Hospital Maternity ward Sierra Leone Pujehun Hospital Pediatric ward Pujehun District Doctors with Africa Nongovernmental organization Ebola outbreak Maternal health
We are deeply grateful to all of the staff of Pujehun district hospital and PHUs, District Health Management, and the personnel of Doctors with Africa CUAMM who worked in Pujehun during the epidemic. Special thanks also to Dr. Agostine Kabano, Dr. Elamin Hayfa, and Dr. Yaron Wolman of UNICEF Sierra Leone for their continuous support and technical advice. We are in debt to Marco Ajelli, Stefano Merler, and Stefano Parlamento of the Fondazione Bruno Kessler for their accurate epidemiological investigation. Finally, we are extremely grateful to Sophie Mathewson for her comments and suggestions in the revision of the manuscript.
- Ajelli, M., Parlamento, S., Bome, D., Kebbi, A., Atzori, A., Frasson, C., et al. (2015). The 2014 Ebola virus disease outbreak in Pujehun, Sierra Leone: Epidemiology and impact of interventions. BMC Medicine, 13, 281. Retrieved December 23, 2017, from https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0524-z.CrossRefGoogle Scholar
- Black, B. O., Caluwaerts, S., & Achar, J. (2015). Ebola viral disease and pregnancy. Obstetric Medicine, 8(3), 108–113. Retrieved December 21, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582839/.CrossRefGoogle Scholar
- Bolkan, H. A., Bash-Taqi, D. A., Samai, M., Gerdin, M., & von Schreeb, J. (2014). Ebola and indirect effects on health service function in Sierra Leone. PLoS Currents Outbreaks, 6. https://doi.org/10.1371/currents.outbreaks.0307d588df619f9c9447f8ead5b72b2d.
- Delamou, A., Hammonds, R. M., Caluwaerts, S., Utz, B., & Delvaux, T. (2014). Ebola in Africa: Beyond epidemics, reproductive health in crisis. Lancet, 384(9960), 2105. Retrieved December 27, 2017, from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62364-3/fulltext.CrossRefGoogle Scholar
- Doctors with Africa CUAMM. (2016). Doctors with Africa CUAMM Annual Report 2015. Retrieved January 8, 2018, from http://www.mediciconlafrica.org/en/wpcontent/uploads/sites/2/2016/10/cuamm_ANNUALreport2015_INGLESE_ok_INTERObassaDISTILLATO.pdf.
- Hayden, E. C. (2015). Maternal health: Ebola’s lasting legacy. Nature, 519(7541), 24–26. Retrieved January 7, 2018, from http://www.nature.com/news/maternal-health-ebola-s-lasting-legacy-1.17036.CrossRefGoogle Scholar
- Médecins Sans Frontières. (2014). MSF suspends emergency pediatric and maternal services in Gondama. Retrieved December 19, 2017, from http://www.doctorswithoutborders.org/article/sierra-leone-msf-suspends-emergencypediatric-and-maternal-services-gondama.
- Sierra Leone Ministry of Health and Sanitation. National Ebola Response Centre (NERC). (2016). Ebola virus disease—situation report. Ministry of Health and Sanitation of the Republic of Sierra Leone. 10 January 2015.Google Scholar
- Statistics Sierra Leone. (2014). Sierra Leone Demographic and Health Survey 2013. Retrieved January 7, 2018, from https://dhsprogram.com/pubs/pdf/FR297/FR297.pdf.
- The Guardian. (2015). Sierra Leone declares first Ebola-free district. Retrieved January 3, 2018, from http://www.theguardian.com/world/2015/jan/10/sierra-leone-first-ebola-free-district-who.
- The World Bank. (2017). Maternal mortality ratio. Retrieved January 3, 2018, from http://data.worldbank.org/indicator/SH.STA.MMRT.
- UNICEF. (2015a). Levels & trends in child mortality. Report 2015. Retrieved January 5, 2018, from http://www.childmortality.org/files_v21/download/IGME%20report%202015%20child%20mortality%20final.pdf.
- UNICEF. (2015b). Annual report. Retrieved January 2, 2018, from https://www.unicef.org/publications/files/UNICEF_Annual_Report_2015_En.pdf.
- World Health Organization. (2015). Ebola response roadmap—situation report, March 2015. Retrieved March 1, 2017, from http://www.who.int/csr/disease/ebola/situation-reports/en/.
- World Health Organization. (2016). Summary report of Ebola cases/deaths in Pujehun district 2014. Geneva: World Health Organization.Google Scholar
- World Health Organization. (2017). Density of physicians. Retrieved March 1, 2017, from http://www.who.int/gho/health_workforce/physicians_density/en/.