Table 1 Evidence summary of a systematic review of the effect of the Ebola outbreak on maternal health services [16,17,18, 35, 39, 47,48,49,50,51,52,53]

Brolin et al. 2016 [35]

Sierra Leone

Cross-sectional study

From January 2014 to May 2015

To assess the potential impact of EVD on nationwide access to obstetric care

1. Pre-Ebola virus disease (EVD) outbreak hospital childbirth was 394, and hospital childbirth decreased by 312 (− 21%) during the outbreak

2. During EVD slow down hospital childbirth decreased by 283 (− 28%)

3. Pre-EVD caesarean section birth was 112, and caesarean section birth decreased by 89(− 20%) during peak the outbreak

4. During EVD slowdown caesarean section birth decreased by 89(-20%)

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Camara et al. 2017 [47]

Guinea

Ecological study

Pre-Ebola (1 March 2013 to 28 February 2014), during Ebola (1 March 2014 to 28 February 2015) and post-Ebola (1 March to 31 July 2016)

To compare trends in family planning, antenatal care, and institutional deliveries over the period before, during and after the outbreak

1. Pre-EVD average monthly ANC1 contact was 2053, and during EVD ANC1 contact declined by 59% (842) and similar trends ANC3 contact and above as ANC1 contact

2. During post-Ebola average monthly ANC1 contact increased by 1260 and recovered by 63% (recovery gap was 37%, p < 0.001 before Ebola)

3. Pre EVD average monthly institutional childbirth was 1223, during EVD institutional childbirth decreased by 62% (464) in October 2014 (during the peak EVD outbreak period)

4. During post-EVD average monthly institutional childbirth was 792 (recovery gap was 33%, p < 0.001)

5. Caesarean section significantly decreased during the peak of the EVD outbreak

6. A fully recovery was observed in post EVD caesarean section childbirth monthly mean caesarean section was (37, SD = 8) compared to the pre-Ebola level (38, SD = 7, p = 0.692)

7. Maternal deaths were low and remained similar across the three periods (0.1–0.2%, p > 0.05). Adverse new-born outcomes (deaths and stillbirths) were also low across the periods (range 1.1–1.7%) but were higher in the post-Ebola period compared to the pre-Ebola period (p < 0.01)

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Caulker et al. [52]

2017

Sierra Leone

Cross-sectional study

From 2013 to 2015

To compare maternal health service utilization trends before, during, and after the Ebola outbreak (2014–2016)

1. Pre-EVD outbreak monthly ANC1 contact was (N = 1350 ± 109), and ANC1 contact did not significantly decrease during EVD (N = 1329 ± 159, p = 0.7), and ANC1 contact did not increase during post EVD (N = 1388 ± 127, p = 0.9)

2. Pre-EVD outbreak monthly ANC4 contact was (N = 1172 ± 52), and ANC4 significantly decreased during EVD outbreak (N = 1115 ± 76, p = 0.05), and ANC4 significantly increased during post EVD (N = 1131 ± 46, p = 0.05)

3. Pre-EVD outbreak monthly institutional childbirth was (N = 1109 ± 65), and institutional childbirth did not significantly decrease during EVD outbreak (N = 1090 ± 56, p = 0.5), and institutional childbirth did not significantly increase during post-EVD (N = 1127 ± 72, p = 0.2)

4. Pre-EVD outbreak monthly maternal postnatal care was (n = 1110 ± 51), and maternal postnatal care did not significantly decrease during EVD outbreak (N = 1105 ± 61, p = 0.8) and maternal postnatal care did not significantly increase post-EVD (n = 1165 ± 87, p = 0.09)

5. Pre-EVD outbreak monthly neonatal postnatal care was (N = 1028 ± 41), and neonatal postnatal care did not significantly decrease during EVD outbreak (N = 1050 ± 67, p = 0.4) and neonatal postnatal care did not significantly increase post-EVD (N = 1085 ± 114, p = 0.3)

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Delamou et al. 2017 [16]

Guinea

Retrospective cohort study

Pre-Ebola virus disease epidemic (January 2013 to February 2014), during the epidemic (March 2014 to February 2015) and post epidemic (March 2015, to February 2016)

To examine monthly service use data for eight maternal and child health service indicators

1. Pre-EVD ANC1 contact significantly increased by 9568 (9568, 95% CI 8941 to 10 195, p < 0.0001), and ANC3 and above contact significantly increased 7555 (7555, 95% CI 7098 to 8012, p < 0.0001)

2. Pre-EVD ANC1 contact increased per month by 109 (109, 95% CI 54 to 164, p < 0.0005), and ANC3 and above contact increased per month by 119 (95% CI 79 to 158, p < 0.0001)

3.During EVD ANC1 contact average monthly decreased by 923 (− 923, 95% CI − 1882 to 36, p = 0.0585), and ANC3 contact decreased per month by 624 (− 624, 95% CI − 1568 to 320, p = 0.1834)

4. Trends changed during versus pre-EVD ANC1 contact significantly decreased by 418 (− 418, 95% CI − 535 to − 300, p < 0.0001), and ANC3 contact and above contacts significantly decreased by 363 (− 363, 95% CI − 485 to − 242, p < 0.0001)

5. Pre-EVD institutional childbirth significantly increased by 3602 (3602, 95% CI 3345 to 3859, p < 0.0001)

6. Pre-EVD institutional childbirth increased per month by 61 (61, 95% CI 38 to 84, p =  < 0.0001)

7. During EVD institutional childbirth decreased per month by 72 (72, 95% CI − 333 to 476, p = 0.7163)

8. During EVD institutional childbirth significantly decreased by 240 (− 240, 95% CI − 293 to − 187, p < 0·0001)

9. Post-EVD average monthly ANC1 attendance increased by 1712 (1712, 95% CI357 to 3066, p = 0·0157), and ANC3 contacts and above increased per month by 103 (103, 95% CI − 1385 to 1590, p = 0·8871)

10. Post-EVD institutional childbirth increased per month by 982 (982, 95% CI 362 to 1602, p = 0·0034)

11. Overall trend of post EVD ANC1 contact significantly declined by 136 (− 136, 95% CI − 231 to − 40, p = 0·0075), and ANC3 contact and above did not significantly decline by 13 (13, 95% CI − 109 to 134, p = 0.8286)

12.Overall trend of institutional childbirth did not significantly decline by 30 (− 30, 95% CI − 80, to 20, p = 0·2294)

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Jones et al

2016 [17]

Sierra Leone

Cross-sectional study

April 2013–January 2015

To determine the impact of the Ebola virus epidemic on routine maternity services

1. ANC1 and above contact significantly decreased by 18% (IRR = 0.82, 95% CI 0.79 to 0.84, p < 0.001) during the EVD outbreak

2. Institutional childbirths significantly decreased by 11% (IRR = 0.89, 95% CI 0.87 to 0.91, p < 0.001) during EVD outbreak

3. Postnatal care significantly decreased 22% (IRR = 0.78, 95% CI 0.75 to 0.80; p < 0.001) during the EVD outbreak

4. Maternal mortality ratio at the health facilities significantly increased by 34% (IRR = 1.34, 95% CI 1.07 to 1.69, p = 0.01) during the EVD outbreak, and stillbirth rate significantly increased by 24% (IRR = 1.24, 95% CI 1.14 to 1.35, p < 0.001) during the EVD outbreak

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Leno et al. 2018 [48]

Guinea

Cross-sectional study

From January 1, 2013, to December 31, 2014

To compare PMTCT indicators before Ebola (2013) and during Ebola (2014)

1. Pre-EVD the mean ANC1 and above contact was (1617 ± 53) in 2013 versus during EVD 1065 ± 29 in 2014, p = 0.0004 EVD affected areas. ANC contact declined by 41%

2. Pre-EVD the mean ANC1 and above contact was (1817 ± 331) in 2013 versus during EVD (1689 ± 280 in 2014, p = 0.5696) in EVD unaffected areas. ANC1 and above contact declined by 7% (1689 ± 280 in 2014, p = 0.5696) EVD unaffected areas

3. The proportion of HIV+ pregnant women who gave birth at home increased significantly during the EVD (7% in 2013 versus 18% in 2014) EVD affected areas, p < 0.0001

4. Pregnant women tested for HIV significantly decreased (1460 ± 266) in 2013 versus during EVD (717 ± 140 in 2014, p = 0.000) EVD affected areas. Pregnant women tested for HIV did not significantly decrease (1622 ± 247) in 2013 versus during EVD (1379 ± 212, p = 0.1556) in 2014 EVD unaffected areas

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Lori et al. 2015 [39]

Liberia

Case series study

January 1–October 30, 2014

To determine women’s maternal health service uptake between January 2012 and October 2014

1. Pre-EVD, average monthly institutional births were 400–500

2. In this study EVD cases increased while the institutional childbirths dramatically decreased by 113 in August 2014

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Ly et al. 2016 [18]

Liberia

Cross-sectional study

The pre-EVD period (March 24, 2011–June 14, 2014) and EVD period (June 15, 2014–April 13, 2015)

To estimate the impact of the Ebola outbreak on facility-based birth

1. Pre-EVD outbreak, 686 child births were reported and 212 during the outbreak

2. During EVD outbreak institutional childbirths significantly declined by 30% (AOR = 0.70, 95% CI 0.50–0.98, p = 0.037)

Women’s belief that health facilities are or maybe a source of Ebola transmission (AOR = 0.59, 95% CI 0.36 to0.97, p = 0.038)

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Quaglio et al. [53]

2019

Sierra Leone

Prospective observational study

From 2012 to 2018

To determine the trends concerning the utilization of maternal and child health (MCH) services before, during

and after the Ebola outbreak

1. Pre-Ebola monthly average ANC1 contact increased by 7 (7, 95% CI 4 to 10, p < 0.001), and ANC4 contact increased by 6 (6, 95% CI 4 to 8, p < 0.001) at community level

2. Pre-Ebola monthly average institutional childbirth increased by 8 (8, 95% CI 6 to 10, p < 0.001) at community level

3. The trends pre-EVD versus during EVD significantly changed ANC1 contact by 74 (74, 95% CI 3 to 145, p = 0.042) and ANC 4 contact by 80 (80, 95% CI 21 to 139, p = 0.008) at community level

4. The trends pre-EVD versus during EVD significantly changed institutional childbirths by 148 (148, 95% CI 99 to 196, p < 0.001) at community level

5. The trends pre-EVD versus post EVD significantly decreased ANC 1 contact by 6 (− 6, 95% CI − 10 to − 3, p < 0.001), ANC 4 by 8 (− 8, 95% CI − 11 to − 5, p < 0.001) at community level

6. The trends pre-EVD versus post EVD institutional childbirth significantly decreased (− 7, 95% CI − 10 to − 4, p < 0.001) at community level

7. Pre-EVD institutional childbirth significantly increased by 11 (11, 95% CI 2 to 21, p = 0.02) at hospital level

8. The trends pre-EVD versus during EVD major obstetric complications significantly changed by 4 (4, 95% CI 1 to 7, p = 0.006) at hospital level

9. The trends pre-EVD versus during EVD institutional childbirth significantly changed by 4 (4, 95% CI 2 to 6, p = 0.001) at hospital level

10. The trends pre-EVD versus during EVD in the reduction of maternal deaths by 1 (− 1,95% CI − 2 to 0, p = 0.042) at hospital level

11. The trends pre-EVD versus post EVD major obstetric complications significantly decreased by 4 (− 4, 95% CI − 7 to − 1, p = 0.009) at hospital level

12.The trends pre-EVD versus post EVD institutional childbirth significantly decreased by 3 (− 3, 95% CI − 5 to − 1, p = 0.001) at hospital level

13. The reduction of maternal deaths pre versus during EVD (-1, 95% CI -2 to 0, p = 0.042) at hospital level

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Shannon et al. 2017 [49]

Liberia

Cross-sectional study

Before (July–December 2013), during (July–December 2014) and after (July–December 2015) the EVD outbreak

To determine access to antenatal care (ANC), deliveries and their outcomes before, during and after the 2014–2015 Ebola outbreak

1. ANC1 declined by 14%, and ANC4 and above also declined by 9% in 2014 compared with 2013

2. During EVD, skilled birth attendance declined by 32%, unskilled birth attendance declined by 76%, and caesarean section declined by 60%

3. Pre-Ebola, there were 538 stillbirths from 48,864 total births

4. During Ebola, there were 328 stillbirths from 30,781 total births (RR = 0.61, 95% CI 0.53 to 0.70)

5. Post-Ebola 504 stillbirths from 48,260 total births (RR = 0.60, 95% CI 0.53 to 0.68)

6. Pre-Ebola, there were 276 neonatal deaths from 48,326 live births

7. During Ebola, there were 98 neonatal deaths from 30,453 live births (RR = 0.56, 95% CI 0.45 to 0.71)

8. Post-Ebola, there were 212 neonatal deaths from 47,765 live births (RR = 0.78, 95% CI 0.65 to 0.93)

9. Pre-Ebola, there were 155 maternal deaths from 48,864 live births

10. During Ebola, there were 73 maternal deaths from 30,781 live births (RR = 0.75, 95% CI 0.57 to 0.98)

11. Post-Ebola, there were 130 maternal deaths from 48,260 live births (RR = 0.85, 95% CI 0.67 to 1.07)

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Sochas et al.2017 [51]

Sierra Leone

Cross-sectional study

From 2012 to 2015

To quantify the extent of the drop in utilization of essential reproductive, maternal, and neonatal health services

1. Pre-Ebola ANC4 attendance was 74.2%, and during EVD ANC4 attendance decreased by 30.7%

2. During post-EVD ANC4 attendance decreased by 22.2%

3. Pre-Ebola institutional childbirth was 57.4% and during EVD declined by 13.0%

4. During post-EVD institutional childbirth decreased by 8.7%

5. Pre-Ebola PNC was 68.3%, and during EVD, it declined by 19.8%

6. Post-Ebola PNC decreased by 13%

7. Due to the decline of obstetric care, an additional 3593 maternal, neonatal and stillbirth deaths occurred in 2014–2015

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Wagenaar et al. 2018 [50]

Liberia

Cross-sectional study

from 1 January 2010 to 31 December 2016

To estimate the immediate and lasting effects of the 2014–2015 Ebola virus disease (EVD) outbreak on public-sector primary healthcare delivery

1.Pre-EVD ANC1 significantly decreased by 30.8% (-30.8,95% CI − 38.4% to − 23.3%, p < 0.001)

2. Early EVD ANC1 contact significantly decreased by 35.2% (− 35.2, 95% CI − 45.8% to − 24.7%, p < 0.001)

3. Post EVD ANC1 contact decreased by 12,426 (-12,426, 95% CI − 53,898 to + 29,546, = 0.558)

4. Pre-EVD institutional births significantly increased by 91.6% (+ 91.6%, 95% CI 95% CI + 61.4% to + 121.9%, p < 0.001)

5.During EVD Institutional births significantly decreased by 5122 (− 5122, 95% CI − 8767 to − 1234, p = 0.003)

6. Post EVD institutional childbirth decreased by 1639 (− 1639, 95% CI − 18,343 to + 16,229, p = .804)

7. Early EVD Postnatal care significantly lessened within 6 weeks of births by 17,191 (− 17,191, 95% CI − 28,344 to − 5,775, p = 0.002)

8. Post EVD PNC significantly declined by 15,144 (− 15,144, 95% CI − 29,453 to − 787, p = 0.040)

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