The Impact of the West Africa Ebola Outbreak on Obstetric Health Care in Sierra Leone
Open accessAbstract
BACKGROUND: As Sierra Leone celebrates the end of the Ebola Virus Disease (EVD) outbreak, we can begin to fully grasp its impact on already weak health systems. The EVD outbreak in West Africa forced many hospitals to close down or reduce their activity, either to prevent nosocomial transmission or because of staff shortages. The aim of this study is to assess the potential impact of EVD on nationwide access to obstetric care in Sierra Leone. METHODS AND FINDINGS: Community health officers collected weekly data between January 2014-May 2015 on in-hospital deliveries and caesarean sections (C-sections) from all open facilities (public, private for-profit and private non-profit sectors) offering emergency obstetrics in Sierra Leone. This was compared to official data of EVD cases per district. Logistic and Poisson regression analyses were used to compute risk and rate estimates. Nationwide, the number of in-hospital deliveries and C-sections decreased by over 20% during the EVD outbreak. The decline occurred early on in the EVD outbreak and was mainly attributable to the closing of private not-for-profit hospitals rather than government facilities. Due to difficulties in collecting data in the midst of an epidemic, limitations of this study include some missing data points. CONCLUSIONS: Both the number of in-hospital deliveries and C-sections substantially declined shortly after the onset of the EVD outbreak. Since access to emergency obstetric care, like C-sections, is associated with decreased maternal mortality, many women are likely to have died due to the reduced access to appropriate care during childbirth. Future research on indirect health effects of health system breakdown should ideally be nationwide and continue also into the recovery phase. It is also important to understand the mechanisms behind the deterioration so that important health services can be reestablished.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The Ebola outbreak severely disrupted the healthcare system's operation and economic activities due to government-enforced measures such as lockdown or stay-at-home orders.
“Studies reported that this outbreak severely disrupted healthcare system’s operation and economic activities due to government-enforced measures such as lockdown or stay-at-home orders [33–35].”
From Financial barriers to healthcare access among reproductive-age women in Sierra Leone: evidence from demographic health surveys of 2008, 2013, and 2019 (2026) · cites this paper as [35]
The Abstract (Methods and Findings) reports that in-hospital deliveries and C-sections in Sierra Leone fell by over 20% during the Ebola outbreak, supporting disruption to healthcare. The Introduction attributes facility closures or reduced activity to infection fears and patients being turned away or transferred. The copy does not establish disruption to economic activity or attribute the healthcare disruption to government-enforced lockdowns or stay-at-home orders. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe unchanged proportion of reproductive-age women facing financial barriers to healthcare access in 2013 and 2019 may be linked to recurrent outbreaks in Sierra Leone over the past decade, particularly the Ebola outbreak.
“A plausible reason for the unchanged proportion of reproductive-age women who faced financial barriers to access healthcare in 2013 and 2019 may be linked to the recurrent outbreaks in Sierra Leone over the past decade.”
From Financial barriers to healthcare access among reproductive-age women in Sierra Leone: evidence from demographic health surveys of 2008, 2013, and 2019 (2026) · cites this paper as [35]
The Conclusions report that the 2014 Ebola outbreak halted improvements in access to obstetric care and reduced in-hospital deliveries and C-sections. The paper does not examine financial barriers, compare their prevalence in 2013 and 2019, or assess recurrent outbreaks as an explanation for an unchanged proportion. (LLM, conf=0.84)
Experimental — accuracy not yet measuredRestrictions during the Ebola outbreak limited women's income-generating activities, thereby exacerbating their financial barriers to access healthcare.
“These restriction limited women’s income-generating activities, thereby exacerbating their financial barriers to access healthcare [35].”
From Financial barriers to healthcare access among reproductive-age women in Sierra Leone: evidence from demographic health surveys of 2008, 2013, and 2019 (2026) · cites this paper as [35]
The Discussion reports reduced access to obstetric care during the Ebola outbreak and attributes much of the decline to hospital closures. Our copy does not address whether restrictions limited women’s income-generating activities or increased financial barriers to care (searched: income, financial barriers, restrictions, and quarantine). (LLM, conf=0.72)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 14 · Cited by 100
Research works printed but not linked: 13
- [2]Bolkan HA, Von Schreeb J, Samai MM, Bash-Taqi DA, Kamara TB, Salvesen O, et al Met and unmet needs for surgery in Sierra Leone: A comprehensive, retrospective, countrywide survey from all health care facilities performing operations in 2012. Surgery. 2015 6; 157(6): 992– 1001. 10.1016/j.surg.2014.12.028 25934081 · DOI
- [3]Hayden EC. Ebola threatens a way of life. Nature. 2014; 516(7531): 295– 6. 10.1038/516295a 25519108 · DOI
- [5]Donnelly J. How did Sierra Leone provide free health care? Lancet. 2011; 377(9775): 1393– 6. 21520507
- [6]Dorwie FM, Pacquiao DF. Practices of traditional birth attendants in Sierra Leone and perceptions by mothers and health professionals familiar with their care. Journal of transcultural nursing: official journal of the Transcultural Nursing Society / Transcultural Nursing Society. 2014 1; 25(1): 33– 41. 24084702
- [7]Kingham TP, Kamara TB, Cherian MN, Gosselin RA, Simkins M, Meissner C, et al Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care. Archives of surgery. 2009 2; 144(2): 122– 7; discussion 8. 10.1001/archsurg.2008.540 19221322 · DOI
- [10]World Health Organization Human Reproduction Programme A. WHO Statement on caesarean section rates. Reproductive health matters. 2015; 23(45): 149– 50. 10.1016/j.rhm.2015.07.007 26278843 · DOI
- [11]Ye J, Zhang J, Mikolajczyk R, Torloni MR, Gulmezoglu AM, Betran AP. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data. BJOG: an international journal of obstetrics and gynaecology. 2015 8 24. PMC5014131 26331389
- [12]Bolkan HA, Bash-Taqi DA, Samai M, Gerdin M, von Schreeb J. Ebola and indirect effects on health service function in sierra leone. PLoS currents. 2014; 6. PMC4318968 25685617
- [14]Hayden EC. Maternal health: Ebola's lasting legacy. Nature. 2015; 519(7541): 24– 6 10.1038/519024a 25739614 · DOI
- [15]Barden-O'Fallon J, Barry MA, Brodish P, Hazerjian J. Rapid Assessment of Ebola-Related Implications for Reproductive, Maternal, Newborn and Child Health Service Delivery and Utilization in Guinea. PLoS currents. 2015; 7 PMC4542265 26331094
- [16]Iyengar P, Kerber K, Howe CJ, Dahn B. Services for mothers and newborns during the ebola outbreak in liberia: the need for improvement in emergencies. PLoS currents. 2015; 7. PMC4404271 25932347
- [17]Lori JR, Rominski SD, Perosky JE, Munro ML, Williams G, Bell SA, et al A case series study on the effect of Ebola on facility-based deliveries in rural Liberia. BMC pregnancy and childbirth. 2015; 15: 254 10.1186/s12884-015-0694-x 26459295 PMC4603295 · DOI
- [20]Dumont A, de Bernis L, Bouvier-Colle MH, Breart G, MOMA study group. Caesarean section rate for maternal indication in sub-Saharan Africa: a systematic review. Lancet. 2001 10 20; 358(9290): 1328– 33. 11684214
- Authors
- Brolin Ribacke, K. J., van Duinen, A. J., Nordenstedt, H., Höijer, J., Molnes, R., Froseth, T. W., Koroma, A., Darj, E., Bolkan, H. A., & Ekström, A.
- Affiliations
- Karolinska Institutet (SE)
- Norwegian University of Science and Technology (NO)
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2016-02-24
- Volume
- 11
- Issue
- 2
- Pages
- e0150080
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4766087
- OpenAlex
- W2286345832
- Cited by
- 100
- References
- 14
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 8 · 2023: 5 · 2022: 13 · 2021: 19 · 2020: 13 · 2019: 11 · 2018: 8 · 2017: 9 · 2016: 5
- FWCI
- 12.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Funders
- Norges Teknisk-Naturvitenskapelige Universitet
- Socialstyrelsen
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Health Professions › General Health Professions › Health and Conflict Studies
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Outbreaks Research
- Keywords
- Ebola outbreak, obstetric care, emergency obstetric care, cesarean section, access to maternal health services, health system collapse, nosocomial transmission, Sierra Leone, maternal mortality
- MeSH terms
- Adult, Delivery of Health Care, Disease Outbreaks, Female, Humans, Obstetrics, Sierra Leone, Hemorrhagic Fever, Ebola, Delivery, Obstetric
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
