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 (97%) deliveries occurred in health facilities,
assisted by maternal and child health aides (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  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.