The researchers composed a cluster-sample survey that included questions regarding the birth history of women in Rivercess County, Liberia, as well as the location for all of their deliveries. Prior to the Ebola epidemic, maternal health had become a national priority in Liberia with FBD rates having increased from 38% to 56% between 2007 and 2013, according to the study
, which was published in PLOS Medicine. However, researchers noticed a 30% reduction in facility-based delivery in the current survey, with only 212 births reported during the epidemic compared to the 686 births reported prior to the epidemic. Unlike most areas, the healthcare facilities remained open in the district that they surveyed, which means that their results might actually underestimate the impact of the epidemic on FDBs in other highly impacted areas where the facilities had closed, said Kraemer.
Commenting on Liberian women's fear of transmission, Kraemer noted, “We…know that the stigma associated with Ebola interfered with people seeking healthcare services in addition to the perception that people can contract Ebola if they go to health facilities. It appears these perceptions are a major factor in the decrease of the number of people utilizing health facilities.”
“The drop appears to be correlated with fear, Kraemer says. The odds of facility-based delivery were 41 percent lower among women who reported a belief that Ebola was or may be transmitted in health facilities, but not significantly lower among women who reported believing that Ebola was not transmitted in health facilities.”
The results of the survey suggest that the West African Ebola epidemic caused collateral harm to healthcare services. Through understanding how the epidemic affected people and how it still influences their perception of health facilities, researchers stress the need for long-term health system reconstruction.
According to the study authors, “These are the first population-based survey data to show collateral disruptions to facility-based delivery caused by the West African EVD epidemic, and they reinforce the need to consider the full spectrum of implications caused by public health emergencies.”
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