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Maternal health services were disrupted during the Ebola epidemic in rural Liberia

August 02, 2016

Facility-based deliveries were reduced by approximately 8% during the Ebola epidemic in rural Liberia, according to a study by John Kraemer from the Georgetown University, Washington, DC, USA, and colleagues, published in PLOS Medicine.

The researchers conducted a survey to develop a representative sample of births in Rivercess County, Liberia, a part of the country with relatively limited Ebola transmission. Controlling for potential confounders, the researchers compared the odds of facility-based delivery among 686 births in the period before the Ebola epidemic with 212 births during the epidemic. They observed that the odds of facility-based delivery were 41% 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. Because health facilities never closed in Rivercess County, this estimate may under-approximate the effect seen in the most heavily affected areas.

The authors say: "Though health systems were most drastically affected in locations where Ebola transmission directly affected healthcare workers and facilities, our results suggest that significant collateral health effects also occurred in relatively lightly affected regions"
Research Article


Direct Relief and UBS Optimus Foundation provided programmatic evaluation funds to Last Mile Health for the survey on which this analysis was conducted (no grant identification numbers). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. MJS receives research support from the National Institutes of Health (K23 MH099916).

Competing Interests:

The authors declare that no competing interests exist.


Ly J, Sathananthan V, Griffiths T, Kanjee Z, Kenny A, Gordon N, et al. (2016) Facility-Based Delivery during the Ebola Virus Disease Epidemic in Rural Liberia: Analysis from a Cross-Sectional, Population-Based Household Survey. PLoS Med 13(8): e1002096. doi:10.1371/journal.pmed.1002096

Author Affiliations:

Medical Team, Last Mile Health, Zwedru, Liberia
Monitoring and Evaluation Team, Last Mile Health, Zwedru, Liberia
Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
Cambridge Health Alliance, Cambridge, Massachusetts, United States of America
Harvard Medical School, Boston, Massachusetts, United States of America
Implementation Team, Last Mile Health, Cestos City, Liberia
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
Rivercess County Health Team, Liberian Ministry of Health and Social Welfare, Cestos City, Liberia
Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
Department of Health Systems Administration, Georgetown University, Washington, DC, United States of America
African Studies Program, Georgetown University, Washington, DC, United States of America



John D. Kraemer
Assistant Professor
Department of Health Systems Administration
Georgetown University
3700 Reservoir Road NW
231 St Mary's Hall
Washington, DC 20057


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