August 15, 2016
2 min read

Ebola outbreak drives Liberian women from facility-based deliveries

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Fear of hospital infection during and after the Ebola virus outbreak led to a 30% decline in facility-based deliveries within one rural Liberian county, according to a recently published household survey.

Further, reports of greater Ebola burden and health facility shutdowns outside of the county suggest that this estimate may be low compared with other areas affected by the epidemic, John D. Kraemer, JD, MPH, assistant professor of health systems administration at Georgetown University School of Nursing and Health Studies, and colleagues wrote.

“The stigma associated with Ebola interfered with people seeking health care services, [as did] the perception that people can contract Ebola if they go to health facilities,” Kraemer said in a press release. “It appears these perceptions are a major factor in the decrease of the number of people utilizing health facilities.”

Kraemer and colleagues conducted a two-stage, cluster-sample household survey between March and April 2015. They spoke with women aged 18 to 49 living in Liberia’s Rivercess County — which saw 34 confirmed or suspected Ebola cases — to determine whether respondents delivered during the epidemic or in the 4 years prior, if they delivered in a health care facility or another setting, and if they believed health care facilities to be a source of Ebola transmission. The researchers analyzed the survey responses to identify any trends in facility-based delivery rates, and conducted sensitivity analyses to assess for robustness.

There were 898 births during the study period among the 1,298 eligible women who provided a complete birth history. Of these, 686 occurred prior to the Ebola outbreak and 212 occurred during. The median age of participating women was 29 years; 86.3% reported less than secondary education. Respondents reporting births during the Ebola outbreak reported lower median wealth index scores, but increased primary school attendance.

After adjustment for household wealth and maternal education, the rate of facility-based deliveries declined from 70.4% to 62.9% (AOR = 0.7; 95% CI, 0.5-0.98). Fifty-six percent of women believed health facilities to be a source of Ebola transmission. After similar adjustment, these respondents were 41% less likely (95% CI, 0.36-0.97) to have a facility-based delivery during the epidemic, while those who were not concerned with hospital transmission were 10% less likely (95% CI, 0.59-1.37). These associations were generally similar in the sensitivity analysis.

If these estimates were extrapolated to the rest of Liberia, the researchers wrote that approximately 5,900 deliveries occurred outside of health facilities from June 2014 to May 2015. However, this estimate may be low, as other areas within the country were hit harder by the outbreak.

“Prior to the Ebola epidemic, Liberia made big gains in the rate of babies being delivered at health facilities, which translates into healthier moms and babies,” Kraemer said in the release. “Maternal health, like almost all other health services in Liberia, was badly damaged by the epidemic. It is critical that we stay focused on rebuilding Liberia’s health care system, which will require long-term investment.” – by Dave Muoio

Disclosure: The researchers report no relevant financial disclosures.