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Setting: All 100 health facilities providing maternal services in Moyamba, Sierra Leone, a rural district that experienced a smaller Ebola outbreak than other areas. Objective: To compare trends in antenatal care (the first and fourth visit [ANC1 and ANC4]), delivery, and postnatal care (PNC1) service utilisation before, during and after the Ebola outbreak (2014-2016). Design: Cross-sectional study using secondary programme data. Results: A total of 211 Ebola cases occurred in Moyamba District. The mean number of monthly ANC visits remained stable over time, except for the subset of care provided via outreach visits where, compared with before the outbreak ( n = 390), ANC1 visits declined during ( n = 331, P = 0.002) and after the outbreak ( n = 342, P = 0.03). Most (&gt;97%) deliveries occurred in health facilities, assisted by maternal and child health aides (&gt;80%). During the outbreak, the mean number of community-based deliveries per month declined from 31 to 21 ( P = 0.03), and the mean number of deliveries performed by midwives increased from 49 to 78 ( P &lt; 0.001) compared with before the outbreak. Before, during and after Ebola, there was no significant change in the mean number of live births (respectively n = 1134, n = 1110, n = 1162), maternal PNC1 (respectively n = 1110, n = 1105, n = 1165) or neonatal PNC1 (respectively n = 1028, n = 1050, n = 1085). Conclusion: In a rural district less affected by Ebola transmission than other areas, utilisation of maternal primary care remained robust, despite the outbreak.

Life goes on: the resilience of maternal primary care during the Ebola outbreak in rural Sierra Leone