Table 1 Description of the studies
References | Title | Study design | Methods | Objectives | Study setting, study population status and status of conflict | Target population | MNCH service domain | Conclusions | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Setting where the study was conducted | Type of conflict | Year of conflict ¶ | Duration from conflict to study of pandemic/ epidemic of interest (years)¶ | Study population status | Type of pandemic or epidemic | ||||||||
Altare et al. [43] | COVID-19 epidemiology and changes in health service utilization in Uganda’s refugee settlements during the first year of the pandemic | Secondary data analysis | Descriptive statistics, testing rates, incidence rates of COVID-19 cases, adjusted odds ratios for selected outcomes and applied interrupted time series analysis | To analyze the epidemiology of COVID-19 cases in Uganda’s refugee settlement, and evaluation of how health service utilization changed during the first year of the pandemic | Settlements in West Nile, South and Center regions of Uganda | Displaced population from multiple countries affected by conflicts: South Sudan, DR Congo, Somalia, Burundi, Rwanda | Conflict in multiple countries resulted in displacement | Not determined as study population is displaced | Refugees | COVID-19 | Children | Postnatal care (PNC) | Routine and preventative health services appear to have been little affected by the COVID-19 pandemic, while immediate reductions were reported mostly for infectious disease consultations. The situation may have been very different in the second and third years of the pandemic, with more contagious variants |
Barua et al. [47] | Community-based referral transportation system for accessing emergency obstetric services in the Rohingya refugee camp during the COVID-19 pandemic in Bangladesh: facilitators and barriers through beneficiaries’ and providers’ lens using a mixed-method design | Mixed methods | Survey among 100 women, the qualitative in-depth interviews with mothers and key informant interviews with providers | To present a community-based referral transportation system and explore its facilitators and barriers to improve the utilization of emergency obstetric services during the pandemic | Cox’s Bazar, Bangladesh | Persecution in Myanmar | 2017 | 3 | Refugees | COVID-19 | Mothers | Intrapartum care (IPC) | Alliances and connections help reaching out to women who need emergency transport services and ensure access to the facility when needed |
Rodo et al. [42] | A mixed methods study to assess the impact of COVID-19 on maternal, newborn, child health and nutrition in fragile and conflict-affected settings | Mixed methods | Key informant interviews | To investigate the collateral impacts of COVID-19 on funding, services and MNCHN outcomes in fragile and conflict affected setting (FCAs), as well as adaptations used in the field to continue activities | Afghanistan, DRC, Iraq, Somalia, Cameroon, South Sudan, Syria, Yemen, and Bangladesh | Fragile and conflict affected states, population in Conflict, and fragile settings. We only take findings which are collected from countries which are affected by conflict or hosting refugees because of conflict | Conflict in multiple countries resulted in displacement | Not determined | Refugees and internally displaced people (IDPs), Population affected by long civil war | COVID-19 | Mothers and children | General MNCH, IPC, Antenatal care (ANC), Family planning (FP), PNC | Humanitarian actors have made several adaptations to continue providing MNCHN services during the pandemic; these strategies have often been implemented unevenly within and across settings, and not been evaluated |
Njoh et al. [70] | Impact of periodic intensification of routine immunization within an armed conflict setting and COVID-19 outbreak in Cameroon in 2020 | Cross-sectional | Survey | To assess the impact of periodic intensification of routine immunization (PIRI) on vaccination coverage and disease surveillance in the region | Southwest Region (SW) of Cameroon | Anglophone Crisis | 2017 | 2 | Population living in conflict or IDPs | COVID- 1 | Children | PNC | PIRI improved the performance of routine vaccination coverage and disease surveillance of vendor drug programs (VPDs) in the SW of Cameroon in the context of insecurity and COVID-19. PIRI also helped to rapidly stimulate the uptake of newly introduced vaccines like the ones covering measles and rubella (MR-2) and human papilloma virus (HPV) |
Hirani et al. [44] | Impact of COVID-19 on women who are refugees and mothering: a critical ethnographic study | Qualitative | Critical ethnographic study. Field observations, review of media reports, and in-depth, semi-structured interviews with study participants | To explore the impact of COVID-19 on women who are refugees and mothering young children aged 2 and under in Saskatchewan, Canada, as well as to explore major barriers (sociocultural, environmental, and economic) and determinants causing stress and adding to the vulnerability of women during the COVID-9 pandemic | Saskatchewan community, Canada | Displaced population from multiple countries affected by conflicts: Middle East and Africa | Conflict in multiple countries resulted in displacement | Not determined | Refugees | COVID-19 | Mothers and Children | ANC, IPC, PNC | Refugee women with young children are at risk of experiencing reduced physical, mental, and emotional well-being. During COVID-19, women who are refugees and mothering are at high risk of experiencing add on stressors due to limited social support, difficulty accessing health care, and other COVID-19-related restrictions put in place in their social environment. Fear of getting sick, limited socialization, lack of social support, economic difficulties, limited follow-up community-based care, inability to access health-care settings, and restrictions on their ability to stay with their sick hospitalized child due to COVID-19 restrictions caused negative effects on mothering refugees' mental health |
Barua et al. [55] | Implementation of a community-based referral project to improve access to emergency obstetric and newborn care in Rohingya population during COVID-19 pandemic in Bangladesh | Mixed methods | Secondary data of routine utilization of the 12 referral hubs through key informant interviews and a community survey conducted with 100 pregnant women | To describe the implementation process of the Referral Hub (RH) and present clients’ utilization and perception of the service | Refugee camps Bangladesh | Persecution in Myanmar | 2017 | 5 | Refugees | COVID-19 | Mothers | ANC | The RH is a timely innovation to increase access to emergency obstetric care in the Rohingya population even during the COVID-19 pandemic. Moreover, it is a boon to the Rohingya community that otherwise lacks proper and easy access to transport facilities, especially during an emergency. The success is evident from the increasing utilization and recommendations from clients |
Stirling et al [45] | “COVID affected us all:” the birth and postnatal health experiences of resettled Syrian refugee women during COVID-19 in Canada | Qualitative | Individual, semi-structured interviews | To understand the experiences of resettled Syrian refugee women accessing PNC and social support | Nova Scotia, Canada | Syrian war | 2011 | 8 | Refugees | COVID-19 | Mothers and Children | IPC, PNC, FP | Equity-oriented approach must be taken to reduce reproductive health disparities for resettled refugee women |
Lusambili et al. [52] | “We have a lot of home deliveries” A qualitative study on the impact of COVID-19 on access to and utilization of reproductive, maternal, newborn and child health care among refugee women in urban Eastleigh, Kenya | Qualitative | In-depth interviews | To improve understanding of the impact of COVID-19 on women refugees' access to and utilization of antenatal care, delivery and PNC in Eastleigh, Kenya in order to identify existing gaps and inform potential interventions that could improve uptake of services during the COVID-19 pandemic | Eastleigh, Kenya | Displaced population from multiple countries affected by conflicts: Somalia, Ethiopia, Tanzania, Uganda, Eritrea, and South Sudan. Most of the refugees are of Somali | Conflict in multiple countries resulted in displacement | Not determined | Refugees | COVID-19 | Mothers and Children | ANC, IPC, PNC | Findings identify gaps in existing national policies and call for urgent consideration for refugee women who have no access to facility-based skilled care during a pandemic. Findings show that refugees delayed uptake of RMNCH care, and facilities reported low attendance. This was often a result of refugees’ fear of contracting COVID-19 together with poverty, which meant that they could not afford masks or the cost of private maternity services |
Altare et al. [46] | COVID-19 epidemiology and changes in health service utilization in Azraq and Zaatari refugee camps in Jordan: A retrospective cohort study | Observational | Secondary data analysis | To describe the epidemiology of COVID-19 in Azraq and Zaatari refugee camps in Jordan and evaluate changes in routine health services during the COVID-19 pandemic | Azraq and Zaatari refugee camps, Jordan | Syrian war | 2011 | 9 | Refugees | COVID-19 | Mothers and Children | ANC, FP, PNC | The pandemic has both exacerbated existing inequalities and demonstrated that until all populations are included in national response plans, the world remains vulnerable to the current and the next pandemic |
Hossain et al. [66] | Exploring healthcare-seeking behavior of most vulnerable groups amid the COVID-19 pandemic in the humanitarian context in Cox’s Bazar, Bangladesh: Findings from an exploratory qualitative study | Mixed-method research | In-depth interviews | To understand the factors influencing healthcare-seeking behavior of the most vulnerable groups during COVID-19 pandemic | Ukhiya sub-district of Cox’s Bazar, Bangladesh | Persecution in Myanmar | 2017 | 3 | Refugees | COVID-19 | Pregnant and lactating women as well as other population | ANC and IPC | The healthcare-seeking behavior of MVGs amid the COVID-19 pandemic in the context of Rohingya and the host communities of Cox’s Bazar was influenced by several factors ranging from socioeconomic, demographic, individual, health belief-related, and institutional factors. However, these factors are not linear rather they are intertwined, and their intersectionality represents diverse nuances of the lived realities of these most vulnerable groups during the COVID-19 pandemic |
Galle et al. [49] | Utilization of services along the continuum of maternal healthcare during the COVID-19 pandemic in Lubumbashi, DRC: findings from a cross-sectional household survey of women | Cross-sectional | Survey | The continuum of maternal care along antenatal (ANC), intrapartum and postnatal care (PNC) is fundamental for protecting women’s and newborns’ health. The COVID-19 pandemic interrupted the provision and use of these essential services globally. This study examines maternal healthcare utilisation along the continuum during the COVID-19 pandemic in the Democratic Republic of the Congo (DRC) | Lubumbashi, DRC, | Armed conflict | 2020 and later | 1 | Population living in conflict or IDPs | COVID-19 | Pregnant women | ANC, intrapartum, and PNC | During the COVID-19 pandemic, maternal healthcare seeking behaviors were shaped by vaccine hesitancy and care unaffordability in Lubumbashi. Addressing the high cost of maternal healthcare and vaccine hesitancy appear essential to improve access to maternal healthcare |
Nomhwange et al. [48] | Measles outbreak response immunization during the COVID-19 pandemic: lessons from Borno State, Nigeria | Retrospective | review assessment of the WHO framework, epidemiological reports and vaccination response data | documents the implementation of an outbreak response immunization (ORI) during the COVID-19 pandemic and the implementation of global guidelines for mass vaccination | Borno state across six local government areas (LGAs) | Armed conflict | 2019 | 2 | Population living in conflict or IDPs | COVID-19 | Children | Vaccination | the WHO decision-making framework for implementing mass vaccinations in the context of the COVID-19 Pandemic was utilized for the outbreak response immunization in Borno State, Nigeria with 181,634 children aged 9 Months-9 years vaccinated with the measles vaccine. The use of the WHO decision-making framework to assess risk benefits of initiating mass vaccination campaigns remains a very important practical tool. These types of responses in Nigeria and other low- and middle-income countries (LMICs), with hitherto suboptimal immunization coverage and weak health systems and other settings, affected by humanitarian emergencies is essential in the achievement of the regional measle's elimination targets |
Gizelis et al. [50] | Maternal Health Care in the Time of Ebola: A Mixed-Method Exploration of the Impact of the Epidemic on Delivery Services in Monrovia | Mixed methods | Multinomial logit model with in-depth semi-structured interviews | data on the utilization of maternal health care services from two representative surveys | Liberian DHS and urban Monrovia | Civil war | Ended in 2003 | 12 | Population affected by long civil war | Ebola | Women | MNCH and Delivery services | Our findings indicate that resources to shore up healthcare institutions should be directed toward interventions that support private facilities and health personnel working privately in communities during times of crisis so that these facilities are safe alternatives for women during crisis |
Elston et al. [51] | Maternal health after Ebola: unmet needs and barriers to healthcare in rural Sierra Leone | Mixed methods | Household survey targeting women who had given birth since onset of the Ebola outbreak; structured interviews at rural sites investigating maternal deaths and reporting; and in-depth interviews (IDIs) targeting mothers, community leaders and health workers | described health outcomes and health-seeking behavior amongst pregnant women to inform health policy | urban and rural areas of Tonkolili District of Seirra Leone | Civil war | Ended in 2002 | 12 | Population affected by long civil war | Ebola | Postpartum mothers, community leaders and health workers | health-seeking behaviors, barriers to healthcare, and childbirth outcomes | Pregnant women faced important barriers to care, particularly in rural areas, leading to high preventable mortality and morbidity. Women wanted to access healthcare, but services available were often costly, unreachable and poor quality. We recommend urgent interventions, including health promotion, free healthcare access and strengthening rural services to address barriers to maternal healthcare |
Delamou et al. [58] | Maternal and Child Health Services in the Context of the Ebola Virus Disease: Health Care Workers' Knowledge, Attitudes and Practices in Rural Guinea | Cross-sectional | standardized self-administered questionnaire | to document maternal and child health care workers' knowledge, attitudes and practices on service delivery before, during and after the 2014 EVD outbreak | ten health districts in rural Guinea | Armed conflict | Ended in 2001 | 14 | Population affected by long civil war | Ebola | maternal and child health care workers | MNCH service delivery | Infection prevention and control measures established during the EVD outbreak have substantially improved self-reported provider practices for maternal and child health services in rural Guinea. However, more efforts are needed to maintain and sustain the gain achieved |
Elston et al. [56] | Impact of the Ebola outbreak on health systems and population health in Sierra Leone | Mixed methods | interviews, focus groups, and interrogation and analysis of data from health facilities, district health records and burial teams | identify and quantify the impact of the Ebola outbreak on population health and health systems | Two districts of Sierra Leone | Civil war | Ended in 2002 | 12 | Population affected by long civil war | Ebola | key local stakeholders, Ebola response team members; civil and traditional authority figures, HCWs, community workers, social mobilizers, patients, and NGO members | General MNCH service utilization | The findings indicate a public health emergency as a legacy of the Ebola outbreak. Sustained commitment of the international community is required to support health system re-building |
Kotiso et al. [65] | Impact of the COVID-19 pandemic on the utilization of health services at public hospitals in Yemen: a retrospective comparative study | Retrospective | routinely hospital services data and medical records by using the DHIS2 system and by phone | Delivery of health services is investigated both before and during the outbreak of the COVID-19 pandemic at public hospitals in Yemen to assess the impact of COVID-19 on the utilization of health services | 127 hospitals in Yemen | War in Yemen | 2014 | 5 | Population living in conflict or IDPs | COVID-19 | General hospitals, maternal and children’s hospitals, psychiatric hospitals and district hospitals | continuity of MNCH services delivery | The impact of COVID-19 on continuity of health services delivery in Yemen has been distinct and profound, where the study revealed that the number of the consultations, surgeries and number of vaccinated children have been declined during the COVID-19 pandemic, likely due to the partially lockdown measures taken and fear of being infected. However, the deliveries and C-section services remained nearly in the same level and did not affect by the COVID-19 pandemic |
Hategeka et al. [67] | Impact of the COVID-19 pandemic and response on the utilization of health services in public facilities during the first wave in Kinshasa, the Democratic Republic of the Congo | Observational | Monthly time series data from the DRC Health Management Information System (January 2018 to December 2020) and interrupted time series with mixed effects segmented Poisson regression models | Evaluated the impact of the pandemic on the use of essential health services (outpatient visits, maternal health, vaccinations, visits for common infectious diseases and non-communicable diseases) during the first wave of the pandemic in Kinshasa | Gombe commune of Kinshasa, city in Africa | Armed conflict | 2020 and later | 1 | Population living in conflict or IDPs | COVID-19 | health facilities (i.e., health centers and hospitals) | Health service use (outpatient visits, maternal health, vaccinations, visits for common infectious diseases and non-communicable diseases) | The COVID-19 pandemic resulted in important reductions in health service utilization in Kinshasa, particularly Gombe. Lifting of lockdown led to a rebound in the level of health service use but it remained lower than prepandemic levels |
Quaglio et al. [61] | Impact of Ebola outbreak on reproductive health services in a rural district of Sierra Leone: a prospective observational study | Prospective Observational | MCH services uptake using routinely collected health services data | To assess the trends concerning utilization of maternal and child health (MCH) services before, during and after the Ebola outbreak, quantifying the contribution of a reorganized referral system (RS) | Pujehun district in Sierra Leone, 77 community health facilities and 1 hospital from 2012 to 2017 | Civil war | Ended in 2002 | 12 | Population affected by long civil war | Ebola | 77 community health facilities and 1 hospital | Utilization of maternal and child health (MCH) services, institutional deliveries, Cesarean-sections, pediatric and maternity admissions and deaths, and major direct obstetric complications (MDOCs), at hospital level; (2) antenatal care (ANC) 1 and 4, institutional delivery and family planning, at community level | A stronger health system compared with other districts in Sierra Leone and a strengthened RS enabled health facilities in Pujehun to maintain service provision and uptake during and after the Ebola epidemic |
McKay et al. [69] | Family Planning in the Sierra Leone Ebola Outbreak: Women's Proximal and Distal Reasoning | Qualitative | In-depth interviews | to explore women's perspectives on delaying pregnancy during the Ebola outbreak using family planning methods | Kambia District of West Africa | Civil war | Ended in 2002 | 12 | Population affected by long civil war | Ebola | Women who were either family planning users or nonusers | FP use during outbreak | Using the lens of family planning to consider how women choose to access health care in an outbreak gives us a unique perspective into how all health care interactions are impacted by a generalized outbreak of Ebola, and how outbreak responses struggle to ensure such services remain a priority |
Jones et al. [63] | 'Even when you are afraid, you stay': Provision of maternity care during the Ebola virus epidemic: A qualitative study | A hermeneutic phenomenological approach | Face to face interviews | To explore nurse-midwives understanding of their role in and ability to continue to provide routine and emergency maternity services during the time of the Ebola virus disease epidemic in Sierra Leone | 14 districts of Sierra Leone | Civil war | Ended in 2002 | 12 | Population affected by long civil war | Ebola | Nurses, midwives, medical staff and managers providing maternal and newborn care during the Ebola epidemic in facilities designated to provide basic or emergency obstetric care | Overall MNCH | Nurse-midwives faced increased risks of catching Ebola compared to other health workers but continued to provide essential maternity care |
Siekmans et al. [53] | Community-based health care is an essential component of a resilient health system: evidence from Ebola outbreak in Liberia | Mixed methods | collect data from CHWs (structured survey, n = 60; focus group discussions, n = 16), government health facility workers and project staff. Monthly data on child diarrhea and pneumonia treatment were gathered from CHW case registers and local health facility records | to examine the value of a community-based health system in ensuring continued treatment of child illnesses during the outbreak and the role that CHWs had in Ebola prevention activities | Bomi County, Montserrado County, Gbarpolu County | Civil war | Ended in 2003 | 12 | Population affected by long civil war | Ebola | CHWs, government health facility workers and project staff | community-based treatment of child diarrhea and pneumonia | Investments in community-based health service delivery contributed to continued access to lifesaving treatment for child pneumonia and diarrhea during the Ebola outbreak, making communities more resilient when facility-based health services were impacted by the crisis. To maximize the effectiveness of these interventions during a crisis, proactive training of CHWs in infection prevention and “no touch” iCCM guidelines, strengthening drug supply chain management and finding alternative ways to provide supportive supervision when movements are restricted are recommended |
Jones et al. [60] | ‘Women and babies are dying but not of Ebola’: The effect of the Ebola virus epidemic on the availability, uptake and outcomes of maternal and newborn health services in Sierra Leone | Mixed methods | The number of antenatal and postnatal visits, institutional births, availability of emergency obstetric care (EmOC), maternal deaths and stillbirths were assessed by month, by districts and by level of healthcare for 10 months during, and12 months prior to, the Ebola virus disease (EVD)epidemic | to determine the impact of the Ebola virus epidemic on the availability, uptake and outcome of routine maternity services in SierraLeone | All healthcare facilities designated to provide comprehensive (n = 13) or basic (n = 67) EmOC across the 13 districts of Sierra Leone were included | Civil war | Ended in 2002 | 12 | Population affected by long civil war | Ebola | Healthcare facilities designated to provide comprehensive (n = 13) or basic (n = 67) EmOC | Number of antenatal and postnatal visits, institutional births, availability of emergency obstetric care (EmOC), maternal deaths and stillbirths | During the EVD epidemic, fewer pregnant women accessed healthcare. For those who did, an increase in maternal mortality and stillbirth was observed. In the post-Ebola phase, ‘readiness’ (or not) of the global partners for large-scale epidemics has been the focus of debate. The level of functioning of the health system with regard to ability to continue to provide high-quality effective routine care needs more attention |
Evens et al. [57] | "Africans, we know how to adapt indeed": Adaptations to family planning and reproductive health services in humanitarian settings in Nigeria during the COVID-19 pandemic | Mixed methods | quantitative analysis of data from routine programmatic activities, qualitative data from in-depth interviews (IDIs) with project staff and process documentation of programmatic activities and modifications | 1) identify modifications in FP/RH services due to COVID-19, 2) understand staff perception of their utility and impact, and 3) gauge trends in key FP/RH in-service delivery indicators to assess changes prior to and after the March 2020 lockdown | Borno State and Cross River State, in Nigeria | Armed conflict | 2019 | 2 | Population living in conflict or IDPs | COVID-19 | data from routine programmatic activities, project staff and process documentation of programmatic activities and modifications | Family Planning/Reproductive Health (FP/RH) services | Lessons learned included the need to better sensitize and educate communities, maintain FP commodities and increase support provided to health workers. Deliberate adaptations in IHANN II and UNHCR-SS-HNIR projects turned challenges to opportunities, ensuring continuity of services to the most vulnerable populations |
Tesfai [64] | Human Rights Violations and Mistrust among Refugees in South Africa: Implications for Public Health during the COVID Pandemic | Qualitative | In-depth interviews | about refugees’ access to healthcare in South Africa during the COVID-19 pandemic and the consequences of inconsistent access and discrimination on their trust of public healthcare initiatives | South Africa | Armed conflict | Conflict in multiple countries resulted in displacement | Not determined as study population is displaced | Refugees | COVID-19 | 11 key stakeholders from the refugee community, 7 community leaders, and 4 NGO staff members who served refugee communities | refugees’ access to healthcare in South Africa during the COVID-19 pandemic and the consequences of inconsistent access and discrimination on their trust of public healthcare initiatives | The results suggest that refugees’ access to public healthcare services were perceived as exclusionary and discriminatory. Furthermore, the growing mistrust in institutions and authorities, particularly the healthcare system, and misperceptions of COVID-19 compromised refugees’ trust and adherence to public health initiatives. This ultimately exacerbates the vulnerability of the refugee community, as well as the wellbeing of the overall population |
Camara et al. [68] | Effect of the 2014/2015 Ebola outbreak on reproductive health services in a rural district of Guinea: an ecological study | Ecological study | routine service data | compared trends in family planning, antenatal care, and institutional deliveries over the period before, during and after the outbreak | Macenta district of Guinea | Armed conflict | 2001 | 14 | Population affected by long civil war | Ebola | all the health facilities data in Macenta district | trends in family planning, antenatal care, and institutional deliveries | 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 |
Shannon, II et al. [59] | Effects of the 2014 Ebola outbreak on antenatal care and delivery outcomes in Liberia: a nationwide analysis | Cross-sectional | Routinely reported program data | To determine access to antenatal care (ANC), deliveries and their outcomes before, during and after the 2014–2015 Ebola outbreak | All health facilities, public and private, in Liberia, West Africa | Civil war | Ended in 2003 | 12 | Population affected by long civil war | Ebola | Women seeking ANC at health facilities, all institutional and community deliveries and all newborns | antenatal care (ANC) and deliveries | The Liberian health system was considerably weakened during the Ebola outbreak and had difficulties providing basic maternal health services. In the light of the major reporting gaps during the Ebola period, and the reduced use of health facilities for maternal care, these findings highlight the need for measures to avoid such disruptions during future outbreaks |
Quaglio et al. [54] | Maintaining maternal and child health services during the Ebola outbreak: experience from Pujehun, Sierra Leone | Mixed methods | Hospital registers and contact tracing form data with healthcare workers and local population interviews, the transmission chain was reconstructed. Data on the utilization of maternal and neonatal health services were collected from the local district’s Health Management Information System | to provide information on understanding of how Ebola impacted maternal and child health services in Sierra Leone | Pujehun district, in Sierra Leone | Civil war | Ended in 2002 | 12 | Population affected by long civil war | Ebola | Hospital registers and contact tracing form data with healthcare workers and local population | Women seeking ANC at health facilities, all institutional and community deliveries and all newborns | The Ebola outbreak reduced the number of patients at hospital level in Pujehun district. However, the activities undertaken to manage Ebola reduced the spread of infection and the impact of the disease in mothers and children. A number of reasons which may explain these results are presented and discussed |
Caulker et al. [62] | Life goes on: the resilience of maternal primary care during the Ebola outbreak in rural Sierra Leone | Cross-sectional | secondary program data | To compare trends in antenatal care (the first and fourth visit [ANC1 and ANC4]), delivery, and postnatal care (PNC1) service utilization before, during and after the Ebola outbreak (2014–2016) | All 100 health facilities providing maternal services in Moyamba, Sierra Leone, a rural district that experienced a smaller Ebola outbreak than other areas | Civil war | Ended in 2002 | 12 | Population affected by long civil war | Ebola | 100 health facilities secondary program data | antenatal care (the first and fourth visit [ANC1 and ANC4]), delivery, and postnatal care (PNC1) service utilization | In a rural district less affected by Ebola transmission than other areas, utilization of maternal primary care remained robust, despite the outbreak |