Effect of the 2014/2015 Ebola outbreak on reproductive health services in a rural district of Guinea: an ecological study.
The 2014/2015 Ebola outbreak was the most sustained in history. In Guinea, we compared trends in family planning, antenatal care, and institutional deliveries over the period before, during and after the outbreak.



We carried out an ecological study involving all the health facilities during pre-Ebola (1 March 2013 to 28 February 2014), intra-Ebola (1 March 2014 to 28 February 2015) and post-Ebola (1 March to 31 July 2016) periods in Macenta district.



Utilization of family planning declined from a monthly average of 531 visits during the pre-Ebola period to 242 visits in the peak month of the Ebola outbreak (51% decline) but recovered in the post-Ebola period. From a monthly average of 2053 visits pre-Ebola, antenatal care visits declined by 41% during Ebola and then recovered to only 63% of the pre-Ebola level (recovery gap of 37%, p<0.001). From a monthly average of 1223 deliveries pre-Ebola, institutional deliveries also declined during Ebola and then recovered to only 66% of the pre-Ebola level (p<0.001).



All services assessed were affected by Ebola. Family planning recovered post-Ebola; however, shortfalls were observed in recovery of antenatal care and institutional deliveries. We call for stronger political will, international support and generous funding to change the current state of affairs.
Department of Public Health, Gamal University of Conakry, Conakry, Guinea.
Bienvenu S
BS
Camara
Department of Public Health, Gamal University of Conakry, Conakry, Guinea.|Woman and Child Health Research Centre, Institute of Tropical Medicine, Antwerp, Belgium.
Alexandre
A
Delamou
University of Gondar, Gondar, Ethiopia.
Ermias
E
Diro
Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forecariah, Guinea.
Abdoul H
AH
Béavogui
Bixby Center for Global Reproductive Health, University of California, San Francisco, USA.
Alison M
AM
El Ayadi
Department of Public Health, Gamal University of Conakry, Conakry, Guinea.
Sidikiba
S
Sidibé
Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forecariah, Guinea.
Fassou M
FM
Grovogui
International Union Against Tuberculosis and Lung Disease, Paris, France.
Kudakwashe C
KC
Takarinda
Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forecariah, Guinea.
Patrice
P
Bouedouno
Department of Public Health, Gamal University of Conakry, Conakry, Guinea.
Sah D
SD
Sandouno
Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
Junko
J
Okumura
Department of Public Health, Gamal University of Conakry, Conakry, Guinea.
Mamadou D
MD
Baldé
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
Johan
J
Van Griensven
Médecins Sans Frontières, Brussels Operational Centre (LuxOR), Luxembourg city, Luxembourg.
Rony
R
Zachariah
D000293:Adolescent; D000328:Adult; D016550:Birthing Centers; D003696:Delivery Rooms; D003695:Delivery of Health Care; D036861:Delivery, Obstetric; D004196:Disease Outbreaks; D005193:Family Planning Services; D005260:Female; D016701:Guinea / Q000453:epidemiology; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011295:Prenatal Care; D034121:Reproductive Health Services; D012189:Retrospective Studies; D012424:Rural Population; D055815:Young Adult
Ebola; Guinea; Health service utilization; Health systems; Operational research; Sustainable Development Goals