High Sierra Leonean maternal and newborn death rates attributed to women’s fears of contracting Ebola while giving birth at health centres

VSOOct 6 2015

Despite adequate numbers of maternal health workers showing up to work, new research published on October 6^th reveals it was the patients who stayed away at their own peril for fear of catching the disease. The study, commissioned by leading international development charity, VSO and conducted by the Centre for Maternal and Newborn Health at Liverpool School of Tropical Medicine, has shown the devastating impact of Ebola on Sierra Leone’s pregnant women and newborn children.

The research – in partnership with WaterAid and the Ministry of Health and Sanitation in Sierra Leone – was carried out from February to July 2015. Data was collected from 81 interviewees and 76 health care facilities across the country which provide emergency obstetric and newborn care.

Key findings from the report during the epidemic:

• 18% decrease in women accessing antenatal care.
• 22% decrease in women accessing postnatal care.
• 11% decrease in deliveries at health care centres.
• 30% increase in maternal deaths.
• 24% increase in newborn deaths.
• 7 out of 9 critical areas of maternity care were still provided.

An anonymous mother from Tonkolili District, explains why she avoided the health care centre:

When I was in labour I was afraid to come to the hospital.  I have to deliver at home.”

An anonymous State Community Health Nurse expresses her frustration when her help was rejected:

“We need more sensitization because some people are very stubborn. The message needs to be repeated because some people still use traditional practice. When someone is sick, they take them to the herbalist instead of the hospital, so the disease continued to spread.”

Another anonymous State Community Health Nurse says:

They prefer it when you meet them outside of the clinic. When you ask them why they don’t go to the clinic for antenatal care or immunisation, they will tell you that they are afraid to go because, at that time, Ebola was at its peak in this community. The community were afraid to come to the clinic.”

Peter Nderitu, Sierra Leone Country Director for VSO, says:

“Before the Ebola epidemic, we had been working with Sierra Leone’s Ministry of Health for 6 years to reduce maternal and new-born mortality and we had made good progress. Despite the impact of this devastating outbreak, we will continue to build on the work we have already done.  This research shows that Sierra Leone’s health care system was still able to provide basic patient care throughout the Ebola crisis, but the real challenge was lack of public confidence in the safety of those services during that difficult time. Rebuilding public trust in health services is critical to improving maternal and newborn health. VSO will continue to work with the Government by helping to implement their recently launched ‘National Ebola Recovery and Resilience plan’.”

Dr Charles Ameh from Liverpool School of Tropical Medicine’s Centre for Maternal and Newborn Health (CMNH) says:

“The CMNH has been working with the Government of Sierra Leone since 2009, helping to reduce maternal and newborn mortality by training local health care workers in emergency obstetric care. This study raises serious concerns about mothers not accessing services. Unchecked complications in pregnancy consequently put their lives - and the lives of their babies - in danger. The inevitable increase in the number of maternal and newborn deaths is a tragedy for their families and for the whole country. We will continue to work with the Government and health care workers to overcome some of the post Ebola challenges faced by Sierra Leone.”

Key recommendations from the report:

• Implementation of nationwide, long term health education programmes to inform the public about vital antenatal and post-natal care visits and assisted childbirth.

• Ebola public awareness campaigns to be continued for the foreseeable future to avoid any re-emergence in ‘clear’ districts.

• Take measures to increase public confidence, e.g., improving the capacity of health care facilities and better provision of safe, quality services.

• Total eradication of the disease still remaining in other districts.

• In the event of any future outbreaks, take measures to ensure that public confidence in services will not be derailed.

The report has highlighted some gaps which VSO will help to address as follows:

• Deploy skilled medical volunteers to provide on-the-job training and mentoring to local health workers which will improve maternal health outcomes.

• Establish a postgraduate medical training programme and Regional Training Institutions in Sierra Leone for community health workers.

• Strengthen referral systems, provide health technology advice and set-up standard operating procedures for Basic and Comprehensive Obstetric Care Centres.

• Support on Ebola public awareness campaigns.

The report will be launched at the Sierra Light Hotel in Freetown, Sierra Leone at 8.30am on Tuesday 6^th October. Key speeches will be made by VSO representatives and volunteers, Sierra Leone’s Ministry of Health. Liverpool School of Tropical Medicine, the UK’s Dept for International Development (DFID) and the World Health Organisation. It will be attended by a range of policymakers, NGOs and academics.