{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T06:52:52Z","timestamp":1789887172752,"version":"4.0.1"},"reference-count":17,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2016,8,19]]},"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>We sought to determine the impact of the Ebola virus epidemic on the availability, uptake and outcome of routine maternity services in Sierra Leone.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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\u2005months during, and 12\u2005months 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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, \u2018readiness\u2019 (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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2016-000065","type":"journal-article","created":{"date-parts":[[2016,10,7]],"date-time":"2016-10-07T23:19:23Z","timestamp":1475882363000},"page":"e000065","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":82,"title":["\u2018Women and babies are dying but not of Ebola\u2019: the effect of the Ebola virus epidemic on the availability, uptake and outcomes of maternal and newborn health services in Sierra Leone"],"prefix":"10.1136","volume":"1","author":[{"given":"Susan A","family":"Jones","sequence":"first","affiliation":[{"name":"Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7833-5367","authenticated-orcid":false,"given":"Somasundari","family":"Gopalakrishnan","sequence":"additional","affiliation":[{"name":"Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2341-7605","authenticated-orcid":false,"given":"Charles A","family":"Ameh","sequence":"additional","affiliation":[{"name":"Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"White","sequence":"additional","affiliation":[{"name":"Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8523-2684","authenticated-orcid":false,"given":"Nynke R","family":"van den Broek","sequence":"additional","affiliation":[{"name":"Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,10,7]]},"reference":[{"key":"2025072914035372000_1.3.e000065.1","unstructured":"Ministry of Health and Sanitation. Ebola Virus Disease Update. 2015. http:\/\/nerc.sl\/?q=ebola-big-idea-evd-updates"},{"key":"2025072914035372000_1.3.e000065.2","unstructured":"World Health Organization. Sierra Leone stops transmission of Ebola virus. Geneva: World Health Organization, 2015. http:\/\/www.who.int\/mediacentre\/news\/releases\/2015\/sierra-leone-stops-ebola\/en\/"},{"key":"2025072914035372000_1.3.e000065.3","unstructured":"WHO. Ebola Situation Report \u2013 16 March 2016. http:\/\/apps.who.int\/iris\/bitstream\/10665\/204629\/1\/ebolasitrep_16Mar2016_eng.pdf?ua=1&ua=1"},{"key":"2025072914035372000_1.3.e000065.4","unstructured":"WHO, UNFPA, UNICEF, AMDD. Monitoring emergency obstetric care: a handbook. Geneva: World Health Organization, 2009. http:\/\/www.who.int\/reproductivehealth\/publications\/monitoring\/9789241547734\/en\/"},{"key":"2025072914035372000_1.3.e000065.5","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1111\/1471-0528.13232","article-title":"Obstetrics in the time of Ebola: challenges and dilemmas in providing lifesaving care during a deadly epidemic","volume":"122","author":"Black","year":"2015","journal-title":"Br J Obstet Gynaecol"},{"key":"2025072914035372000_1.3.e000065.6","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1177\/1753495X15597354","article-title":"Ebola viral disease and pregnancy","volume":"8","author":"Black","year":"2014","journal-title":"Obstet Med"},{"key":"2025072914035372000_1.3.e000065.7","unstructured":"United Nations Population Fund. Ebola wiping out gains in safe motherhood. New York: UNFPA, 2014. http:\/\/esaro.unfpa.org\/news\/ebola-wiping-out-gains-safe-motherhood"},{"key":"2025072914035372000_1.3.e000065.8","unstructured":"World Health Organization. Sierra Leone WHO Statistical Profile. Geneva: World Health Organization, 2015. http:\/\/www.who.int\/gho\/countries\/sle.pdf?ua=1"},{"key":"2025072914035372000_1.3.e000065.9","unstructured":"World Health Organization. World Health Statistics 2014. Geneva: World Health Organization, 2014. http:\/\/apps.who.int\/iris\/bitstream\/10665\/112738\/1\/9789240692671_eng.pdf"},{"key":"2025072914035372000_1.3.e000065.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00946-0"},{"key":"2025072914035372000_1.3.e000065.11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0049938"},{"key":"2025072914035372000_1.3.e000065.12","unstructured":"Ministry of Health and Sanitation. Basic package of essential health services. Freetown, Sierra Leone, 2010."},{"key":"2025072914035372000_1.3.e000065.13","unstructured":"Reuters. Sierra Leone to reopen schools in March as Ebola infections slow; 21 Jan 2015. http:\/\/www.reuters.com\/article\/us-health-ebola-education-idUSKBN0KU2N120150121"},{"key":"2025072914035372000_1.3.e000065.14","first-page":"1226","article-title":"Perceptions of the risk of Ebola and Health use among health workers and pregnant and lactating women\u2014Kenema District, Sierra Leone, September 2014","volume":"63","author":"Dynes","year":"2015","journal-title":"Morb Mortal Wkly Rep"},{"key":"2025072914035372000_1.3.e000065.15","first-page":"7","article-title":"Rapid assessment of Ebola related implications for reproductive, maternal and newborn and child health service delivery and utilization in Guinea","volume":"4","author":"Bardon-O'Fallon","year":"2015","journal-title":"PLoS Curr"},{"key":"2025072914035372000_1.3.e000065.16","unstructured":"Ministry of Health and Sanitation. Guidelines and protocol for delivering maternal and newborn services at health facilities in the context of Ebola. Freetown, Sierra Leone, 2014."},{"key":"2025072914035372000_1.3.e000065.17","unstructured":"WHO. Managing emergency obstetric care: a handbook. Geneva: WHO, 2009."}],"container-title":["BMJ Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjgh-2016-000065","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T21:04:41Z","timestamp":1753823081000},"score":1,"resource":{"primary":{"URL":"https:\/\/gh.bmj.com\/lookup\/doi\/10.1136\/bmjgh-2016-000065"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10]]},"references-count":17,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2016,10,7]]},"published-print":{"date-parts":[[2016,10]]}},"alternative-id":["10.1136\/bmjgh-2016-000065"],"URL":"https:\/\/doi.org\/10.1136\/bmjgh-2016-000065","relation":{},"ISSN":["2059-7908"],"issn-type":[{"value":"2059-7908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,10]]}}}