Abstract
The 2013–2015 West African Ebola epidemic had a profound impact on the region’s fragile healthcare systems, leading to devastating outcomes for pregnant women. While the direct impact of Ebola virus disease on pregnant women is often clinically described, the second story of women without Ebola—and the worsening of their health outcomes, including increased maternal mortality—receives scant attention. Safe pregnancy and childbirth require access to functional health systems, making pregnant women among the most vulnerable in low-resource settings where health systems are weak. Prior to the Ebola epidemic, Liberia, Sierra Leone, and Guinea had some of the weakest health systems in the world, demonstrated by limited access to Emergency Obstetric Care (EmOC) services and high maternal mortality rates. In this context, with limited staff, stuff, space, and systems that comprise a functional health system, Ebola spread rapidly across the region—causing further devastation to essential functions and limiting essential services for pregnant women. In the context of the Ebola epidemic, outcomes for pregnant women without Ebola worsened, including less access to antenatal care, increased stigma, decreased facility-based deliveries, and decreased access to surgical delivery—leading to an increase in maternal mortality. We describe the efforts of Partners In Health, a nongovernmental organization, to strengthen health services delivery across the pillars of staff, stuff, space, and systems and to improve health outcomes for pregnant women during and following the epidemic.
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References
Barden-O’Fallon, J., Barry, M. A., Brodish, P., & Hazerjian, J. (2015). Rapid assessment of Ebola-related implications for reproductive, maternal, newborn and child health service delivery and utilization in Guinea. PLoS Currents, 4, 7. Retrieved December 22, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4542265/.
Connolly, A., Bayor, F. A., Edgerley, S., Sessay, T., & Jamieson, D. J. (2017). An Ebola virus cluster linked to a hospital maternity ward in Bombali District, Sierra Leone: Implications for mother, infants and the community. Presented at the annual meeting of the American Anthropological Society, Washington, DC.
Connolly, A.M., & Young, A.J. (2019). Ebola virus disease surveillance in two high-transmission districts of Sierra Leone during the 2013–2015 outbreak: Surveillance methods, implications for maternal and child health, and recommendations. In: D.A. Schwartz, J.N. Anoko, & S.A. Abramowitz (Eds.), Pregnant in the time of Ebola: Women and their children in the 2013-2015 West African epidemic. New York: Springer. ISBN 978-3-319-97636-5.
Crompton, J., Kingham, T. P., Kamara, T. B., Brennan, M. F., & Kushner, A. L. (2010). Comparison of surgical care deficiencies between US civil war hospitals and present-day hospitals in Sierra Leone. World Journal of Surgery, 34(8), 1743–1747.
Davtyan, M., Brown, B., & Folayon, M. O. (2014). Addressing Ebola-related stigma: Lessons from HIV/AIDS. Global Health Action, 7. https://doi.org/10.3402/gha.v7.26058. Retrieved December 20, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225220/.
Deaver, J. E., & Cohen, W. R. (2015). Ebola virus screening during pregnancy in West Africa: Unintended consequences. Journal of Perinatal Medicine, 43(6), 649–655.
Delamou, A., Hammonds, R. M., Caluwaerts, S., Utz, B., & Delveaux, T. (2014). Ebola in Africa: Beyond epidemics, reproductive health in crisis. Lancet, 384(9960), 2105. Retrieved December 20, 2017, from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62364-3/fulltext.
Dunn, A. C., Walker, T. A., Redd, J., Sugerman, D., McFadden, J., Singh, T., et al. (2016). Nosocomial transmission of Ebola virus disease on pediatric and maternity wards: Bombali and Tonkolili, Sierra Leone, 2014. American Journal of Infection Control, 44(3), 269–272.
Dynes, M. M., Miller, L., Sam, T., Vandi, M. A., Tomcyzk, B., & Centers for Disease Control and Prevention (CDC). (2015). Perceptions of the risk for Ebola and health facility use among health workers and pregnant and lactating women—Kenema District, Sierra Leone, September 2014. MMWR. Morbidity and Mortality Weekly Report, 63(51), 1226–1227. Retrieved December 22, 2017, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6351a3.htm.
Elston, J. W., Cartwright, C., Ndumbi, P., & Wright, J. (2017). The health impact of the 2014-15 Ebola outbreak. Public Health, 143, 60–70.
Evans, D. K., Goldstein, M., & Popova, A. (2015). Health-care worker mortality and the legacy of the Ebola epidemic. The Lancet Global Health, 3(8), e439–e440.
Garde, D. L., Hall, A. M. R., Marsh, R. H., Barron, K. P., Dierberg, K. P., & Koroma, A. P. (2016). Implementation of the first dedicated Ebola screening and isolation for maternity patients in Sierra Leone. Annals of Global Health, 82(3), 418. Retrieved December 19, 2017, from http://www.annalsofglobalhealth.org/article/S2214-9996(16)30191-6/fulltext#sec3.
Garrett, L. (2015). Ebola’s lessons: How the W.H.O. mishandled the crisis. Foreign Affairs. Retrieved December 22, 2017, from https://www.foreignaffairs.com/articles/west-africa/2015-08-18/ebolas-lessons.
Hogan, C. (2014). Ebola striking women more frequently than men. Washington Post. Retrieved November 17, 2017, from https://www.washingtonpost.com/national/health-science/2014/08/14/3e08d0c8-2312-11e4-8593-da634b334390_story.html?utm_term=.660dc6b7fb83.
Iyengar, P., Kerber, K., Howe, C. J., & Dahn, B. (2015). Services for mothers and newborns during the Ebola outbreak in Liberia: The need for improvement in emergencies. PLoS Currents, 16, 7. Retrieved December 22, 2017, from http://currents.plos.org/outbreaks/article/services-for-mothers-and-newborns-during-the-ebola-outbreak-in-liberia-the-need-for-improvement-in-emergencies/.
Jones, S. A., Gopalakrishnan, S., Ameh, C. A., White, S., & van den Broek, N. R. (2016). ‘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. BMJ Global Health, 1(3), e000065. Retrieved December 20, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5321347/.
Kilmarx, P. H., Clarke, K. R., Dietz, P. M., Hamel, M. J., Husain, F., & McFadden, J. D. (2014). Ebola virus disease in healthcare workers—Sierra Leone, 2014. MMWR. Morbidity and Mortality Weekly Report, 63(49), 1168–1171. Retrieved December 19, 2017, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6349a6.htm.
Liberia Institute of Statistics and Geo-Information Services (LISGIS), Ministry of Health and Social Welfare [Liberia], National AIDS Control Program [Liberia], & ICF International. (2014). Liberia demographic and health survey 2013. Monrovia: Liberia Institute of Statistics and Geo-Information Services (LISGIS) and ICF International.
Lori, J. R., Rominski, S. D., Perosky, J. E., Munro, M. L., Williams, G., Bell, S. A., et al. (2015). A case series study on the effect of Ebola on facility-based deliveries in rural Liberia. BMC Pregnancy and Childbirth, 15, 254. Retrieved December 20, 2017, from https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0694-x.
Luginaah, I. N., Kangmennaang, J., Fallah, M., Dahn, B., Kateh, F., & Nyenswah, T. (2016). Timing and utilization of antenatal care services in Liberia: Understanding the pre-Ebola epidemic context. Social Science and Medicine, 160, 75–86.
Ly, J., Sathananthan, V., Griffiths, T., Kanjee, Z., Kenny, A., Gordon, N., et al. (2016). Facility-based delivery during the Ebola virus disease epidemic in rural Liberia: Analysis from a cross-sectional, population-based household survey. PLoS Medicine, 13(8), e1002096. Retrieved December 22, 2017, from http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002096.
Marsh, R. (2015). Partners In Health. Personal communication.
Médecins Sans Frontières. (2017). Ebola. Retrieved December 22, 2017, from http://www.doctorswithoutborders.org/our-work/medical-issues/ebola.
Menendez, C., Lucas, A., Munguambe, K., & Langer, A. (2015). Ebola crisis: The unequal impact on women and children’s health. Lancet Global Health, 3(3), e130. Retrieved December 19, 2017, from http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)70009-4/fulltext.
O’Hare, B. (2015). Weak health systems and Ebola. The Lancet Global Health, 3(2), e71–e72. Retrieved December 20, 2017, from http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70369-9/fulltext.
Partners In Health. (2016a). Ebola. Retrieved January, 2017, from http://www.pih.org/blog/partners-in-health-ebola-response.
Partners In Health. (2016b). An X-ray machine that inspires devotion. Retrieved November 17, 2017, from http://www.pih.org/blog/x-rays-help-inspire.
Partners In Health. (2017a). Three boys, three joys: Triplets born in Liberia. Retrieved November 17, 2017, from http://www.pih.org/blog/triplets-born-at-j.j.-dossen-hospital-in-liberia.
Partners In Health. (2017b). Pleebo. Retrieved November 17, 2017, from http://www.pih.org/pages/pleebo.
Partners In Health. (2017c). Liberia. Retrieved November 17, 2017, from http://www.pih.org/country/liberia.
Partners In Health. (2017d). Blindness. Retrieved November 17, 2017, from http://www.pih.org/blog/blindness-uveitis-partners-in-health-sierra-leone-eye-care.
Pieterse, P., & Lodge, T. (2015). When free healthcare is not free. Corruption and mistrust in Sierra Leone’s primary healthcare system immediately prior to the Ebola outbreak. International Health, 7(6), 400–404.
Raykar, N. P., Kralievits, K. E., Greenberg, S. L., Gillies, R. D., Roy, N., & Meara, J. G. (2015). The blood drought in context. Lancet Global Health, 3(Suppl 2), S4–S5. Retrieved December 22, 2017, from http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70351-1/abstract.
Ribacke, K. J. B., van Duinen, A. J., Nordenstedt, H., Höijer, J., Molnes, R., Froseth, T. W., et al. (2016). The impact of the West Africa Ebola outbreak on obstetric healthcare in Sierra Leone. PLoS One, 211(2), e0150080. Retrieved December 22, 2017, from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0150080.
Sack, K., Fink, S., Belluck, P., & Nossiter, A. (2014). How Ebola roared back. New York Times. Retrieved November 17, 2017, from www.nytimes.com/2014/12/30/health/how-ebola-roared-back.
Save the Children. (2015). A wake-up call: Lessons from Ebola for the world’s health systems. Retrieved November 17, 2017, from https://www.savethechildren.net/sites/default/files/libraries/WAKE%20UP%20CALL%20REPORT%20PDF.pdf.
Sharkey, A., Yansaneh, A., Bangura, P. S., Kabano, A., Brady, E., Yumkella, F., et al. (2016). Maternal and newborn care practices in Sierra Leone: A mixed methods study of four underserved districts. Health Policy and Planning, 32(2), 151–162.
Sheku, M. (2018). Koidu Government Hospital. Personal communication.
Strong, A., & Schwartz, D. A. (2016). Sociocultural aspects of risk to pregnant women during the 2013-2015 multinational Ebola virus outbreak in West Africa. Health Care for Women International, 37(8), 922–942. https://doi.org/10.1080/07399332.2016.1167896.
Strong, A., & Schwartz, D. A. (2019). Effects of the West African Ebola epidemic on health care of pregnant women—Stigmatization with and without infection. In D. A. Schwartz, J. N. Anoko, & S. Abramowitz (Eds.), Pregnant in the time of Ebola: Women and their children in the 2013-2015 West African Ebola epidemic. New York: Springer. ISBN 978-3-319-97636-5.
Tavernise, S. (2016). Maternal mortality rate in U.S. rises, defying global trend, study finds. The New York Times. Retrieved November 17, 2017, from https://www.nytimes.com/2016/09/22/health/maternal-mortality.html.
Treacy, L., & Sagbakken, M. (2015). Exploration of perceptions and decision-making processes related to childbirth in rural Sierra Leone. BMC Pregnancy and Childbirth, 15, 87. Retrieved December 21, 2017, from https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0500-9.
U.S. Centers for Disease Control and Prevention. (2016). CDC’s ongoing work to contain Ebola in West Africa. Retrieved November 17, 2017, from https://www.cdc.gov/vhf/ebola/pdf/cdcs-ongoing-work.pdf.
United Nations. (2016). Global Ebola Response. UN Mission for Ebola Emergency Response (UNMEER). Retrieved November 17, 2017, from http://ebolaresponse.un.org/un-mission-ebola-emergency-response-unmeer.
United Nations Development Programme (UNDP). (2017). About Sierra Leone. Retrieved December 22, 2017, from http://www.sl.undp.org/content/sierraleone/en/home/countryinfo.html.
United Nations Population Fund (UNFPA). (2014). Setting standards for emergency obstetric and newborn care. Retrieved November 17, 2017, from http://www.unfpa.org/resources/setting-standards-emergency-obstetric-and-newborn-care.
VSO. (2015). Exploring the impact of the Ebola outbreak on routine maternal health services in Sierra Leone. Retrieved December 22, 2017, from https://www.vsointernational.org/news/press-releases/higher-maternal-and-newborn-death-rates-sierra-leone-due-ebola-fears.
Walker, P. G., White, M. T., Griffin, J. T., Reynolds, A., Ferguson, N. M., & Ghani, A. C. (2015). Malaria morbidity and mortality in Ebola-affected countries caused by decreased health-care capacity, and the potential effect of mitigation strategies: A modelling analysis. Lancet Infectious Diseases, 15(7), 825–832. Retrieved December 22, 2017, from http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)70124-6/abstract.
WHO Ebola Response Team. (2015). West African Ebola epidemic after one year—Slowing but not yet under control. New England Journal of Medicine, 372, 584–587. Retrieved December 22, 2017, from http://www.nejm.org/doi/full/10.1056/NEJMc1414992#t=article.
World Health Organization. (2014). Statement on the 1st meeting of the IHR Emergency Committee on the 2014 Ebola outbreak in West Africa. Retrieved November 17, 2017, from http://www.who.int/mediacentre/news/statements/2014/ebola-20140808/en/.
World Health Organization. (2015a). Ebola situation report—30th September 2015. Retrieved November 17, 2017, from http://apps.who.int/ebola/current-situation/ebola-situation-report-30-september-2015.
World Health Organization. (2015b). Factors that contributed to undetected spread of the Ebola virus and impeded rapid containment. Retrieved November 17, 2017, from http://www.who.int/csr/disease/ebola/one-year-report/factors/en/.
World Health Organization. (2016a). Latest Ebola outbreak over in Liberia; West Africa is at zero, but new flare-ups are likely to occur. Retrieved November 17, 2017, from http://www.who.int/mediacentre/news/releases/2016/ebola-zero-liberia/en/.
World Health Organization. (2016b). Ebola virus disease. Fact sheet. Retrieved November 17, 2017, from http://www.who.int/mediacentre/factsheets/fs103/en/.
World Health Organization. (2016c). Ebola data and statistics: Situation summary by sex and age group, 11 May 2016. Retrieved November 17, 2017, from http://apps.who.int/gho/data/view.ebola-sitrep.ebola-summary-latest-age-sex.
World Health Organization. (2016d). Global Health Observatory data repository. Retrieved November 17, 2017, from http://apps.who.int/gho/data/.
World Health Organization. (2017a). WHO Statement on Caesarean Section Rates. Retrieved on 17 November 2017, http://apps.who.int/iris/bitstream/10665/161442/1/WHO_RHR_15.02_eng.pdf.
World Health Organization. (2017b). Ebola virus disease brings opportunities for improved blood systems in West Africa. Retrieved November 17, 2017, from http://www.who.int/medicines/ebola-treatment/ebola_improved_bs_wa/en/.
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Marsh, R.H. et al. (2019). The Challenges of Pregnancy and Childbirth Among Women Who Were Not Infected with Ebola Virus During the 2013–2015 West African Epidemic. In: Schwartz, D., Anoko, J., Abramowitz, S. (eds) Pregnant in the Time of Ebola. Global Maternal and Child Health. Springer, Cham. https://doi.org/10.1007/978-3-319-97637-2_3
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