The 2014/2015 Ebola outbreak was the most sustained in history. In Guinea, we compared trends in family planning, antenatal care, and institutional deliveries over the period before, during and after the outbreak. We carried out an ecological study involving all the health facilities during pre-Ebola (1 March 2013 to 28 February 2014), intra-Ebola (1 March 2014 to 28 February 2015) and post-Ebola (1 March to 31 July 2016) periods in Macenta district. Utilization of family planning declined from a monthly average of 531 visits during the pre-Ebola period to 242 visits in the peak month of the Ebola outbreak (51% decline) but recovered in the post-Ebola period. From a monthly average of 2053 visits pre-Ebola, antenatal care visits declined by 41% during Ebola and then recovered to only 63% of the pre-Ebola level (recovery gap of 37%, p<0.001). From a monthly average of 1223 deliveries pre-Ebola, institutional deliveries also declined during Ebola and then recovered to only 66% of the pre-Ebola level (p<0.001). 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.

Background: Persistent inequalities in coverage of maternal health services in sub-Saharan Africa (SSA), a region home to two-thirds of global maternal deaths in 2017, poses a challenge for countries to achieve the Sustainable Development Goal (SDG) targets. This study assesses wealth-based inequalities in coverage of maternal continuum of care in 16 SSA countries with the objective of informing targeted policies to ensure maternal health equity in the region. Methods: We conducted a secondary analysis of Demographic and Health Survey (DHS) data from 16 SSA countries (Angola, Benin, Burundi, Cameroon, Ethiopia, Gambia, Guinea, Liberia, Malawi, Mali, Nigeria, Sierra Leone, South Africa, Tanzania, Uganda, and Zambia). A total of 133,709 women aged 15-49 years who reported a live birth in the five years preceding the survey were included. We defined and measured completion of maternal continuum of care as having had at least one antenatal care (ANC) visit, birth in a health facility, and postnatal care (PNC) by a skilled provider within two days of birth. We used concentration index analysis to measure wealth-based inequality in maternal continuum of care and conducted decomposition analysis to estimate the contributions of sociodemographic and obstetric factors to the observed inequality. Results: The percentage of women who had 1) at least one ANC visit was lowest in Ethiopia (62.3%) and highest in Burundi (99.2%), 2) birth in a health facility was less than 50% in Ethiopia and Nigeria, and 3) PNC within two days was less than 50% in eight countries (Angola, Burundi, Ethiopia, Gambia, Guinea, Malawi, Nigeria, and Tanzania). Completion of maternal continuum of care was highest in South Africa (81.4%) and below 50% in nine of the 16 countries (Angola, Burundi, Ethiopia, Guinea, Malawi, Mali, Nigeria, Tanzania, and Uganda), the lowest being in Ethiopia (12.5%). There was pro-rich wealth-based inequality in maternal continuum of care in all 16 countries, the lowest in South Africa and Liberia (concentration index = 0.04) and the highest in Nigeria (concentration index = 0.34). Our decomposition analysis showed that in 15 of the 16 countries, wealth index was the largest contributor to inequality in primary maternal continuum of care. In Malawi, geographical region was the largest contributor. Conclusions: Addressing the coverage gap in maternal continuum of care in SSA using multidimensional and people-centred approaches remains a key strategy needed to realise the SDG3. The pro-rich wealth-based inequalities observed show that bespoke pro-poor or population-wide approaches are needed.

Setting: All health centres in Macenta District, rural Guinea. Objective: To compare stock-outs of vaccines, vaccine stock cards and the administration of various childhood vaccines across the pre-Ebola, Ebola and post-Ebola virus disease periods. Design: This was an ecological study. Results: Similar levels of stock-outs were observed for all vaccines (bacille Calmette–Guérin [BCG], pentavalent, polio, measles, yellow fever) in the pre-Ebola and Ebola periods (respectively 2760 and 2706 facility days of stock-outs), with some variation by vaccine. Post-Ebola, there was a 65-fold reduction in stock-outs compared to pre-Ebola. Overall, 24 facility-months of vaccine stock card stock-outs were observed during the pre-Ebola period, which increased to 65 facility-months of stock-outs during the Ebola outbreak period; no such stock-out occurred in the post-Ebola period. Apart from yellow fever and measles, vaccine administration declined universally during the peak outbreak period (August–November 2014). Complete cessation of vaccine administration for BCG and a prominent low for polio (86% decrease) were observed in April 2014, corresponding to vaccine stock-outs. Post-Ebola, overall vaccine administration did not recover to pre-Ebola levels, with the highest gaps seen in polio and pentavalent vaccines, which had shortages of respectively 40% and 38%. Conclusion: These findings highlight the need to sustain vaccination activities in Guinea so that they remain resilient and responsive, irrespective of disease outbreaks.

In this study, we assessed the geographic accessibility, coverage and wealth-based inequities in childbirth care in the Grand Conakry conurbation, Guinea. We assembled administrative boundaries, locations of health facilities, socio-economic indicators, road networks, land cover features and travel speeds. Using a least-cost path algorithm, we computed travel times to the nearest childbirth care facility by type and ownership (public and private). We measured the percentage of women of childbearing age (WoCBA) living within 15, 30 and 60 minutes of their nearest facility and its variation by socio-economic status. On average, travel speeds ranged from 14 to 28 km h⁻¹. Travel to any facility required an average of 8 minutes, increasing to 22 minutes for public hospitals, with notable variation across communes. While nearly all WoCBA (100%) lived within 30 minutes of any facility, coverage dropped to 82% for public hospitals. Traffic congestion substantially increased travel time and reduced coverage. Our findings reveal disparities favoring wealthier women, particularly in peri-urban communes with longer average travel times. Targeted interventions, such as building new roads and enhancing public transportation, are needed in peri-urban areas to improve access to and equity in childbirth care.

Background. Motorcycle road traffic accidents (RTA) constitute an increasing public health challenge with victims more likely to sustain fatal injuries compared with other types of RTA. The aim of this study was to analyze motorcycle RTA-related morbidity and mortality among victims admitted to hospitals in Guinea from 2015 to 2017. Materials and Methods. This was a cross-sectional study based on hospital records from six districts (Boké, Kindia, Mamou, Faranah, N’Zérékoré, and Siguiri) from January 1, 2015, to December 31, 2017. Bivariate analysis and multivariate logistic regression were used to explore associations between RTA types and mortality. Results. There were 14,962 RTA victims with motorcycle RTA accounting for 58.3% and other RTA 45.3% of hospital admissions. Overall, motorcycle RTA accounted for 77.7%, with young adults (96.2%) and males (73.5%) more affected when compared to victims of other types of RTA. Median age of motorcycle RTA victims was 23 years (IQR: 17–33 years). Students (29.7%), employees (23.6%), and farmers/housewives (23.3%) were the commonest groups affected by motorcycle RTA. The highest burden of motorcycle RTA occurred in the mining zones (Boké and Siguiri). Wounds (39.2% and 27.3%) and multiple injuries (43.8% and 43.8%) were the commonest types of injury sustained by victims of both motorcycle and other types of RTA, respectively. Motorcycle RTA accounted for 54% of overall deaths. Using multivariate logistic regression analysis, sustaining a motorcycle RTA in N’Zérékoré (AOR: 4.2; 95% CI: 1.6–11.2) and being admitted with mild (AOR: 7.4; 95% CI 2.1–25.8) and heavy or deep coma (AOR: 776.1; 95% CI: 340.2–1770.7) were significantly associated with mortality. Conclusions. Motorcycle RTA are an important cause of morbidity and mortality in Guinea. Males, young adult users, students, employees, and people from mining zones are the most affected. Better law enforcement and awareness raising among Guinean young adults are promising prevention strategies.

Introduction: Maternal mortality remains very high in Sub-Saharan African countries and the risk is higher among adolescent girls. Maternal mortality occurs in these settings mainly around the time of childbirth and the first 24 hours after birth. Therefore, skilled attendance in an enabling environment is essential to reduce the occurrence of adverse outcomes for both women and their children. This study aims to analyze the determinants of facility childbirth among adolescents and young women in Guinea. Methods: We used the Guinea Demographic and Health Survey (DHS) conducted in 2018. All females who were adolescents (15–19) or young women (20–24 years) at the time of their most recent live birth in the five years before the survey were included. We examined the use of health facilities for childbirth and its determinants selected through the Andersen health-seeking model using descriptive analysis and multilevel multivariable logistic regression. All descriptive and analytical estimated were produced by adjusting for the survey sampling using the svy option, including adjustment for clustering, stratification and unequal probability of selection and non-response (individual sample weights). The subpopulation option was also used to account for the variance of estimations. Results: Overall, 58% of adolescents and 57% of young women gave birth in a health facility. Young women were more likely to have used private sector facilities compared to adolescents (p<0.001). Factors significantly associated with a facility birth in multivariable regression included: secondary or higher educational level (aOR = 1.86; 95%CI:1.24–2.78) compared to no formal education; receipt of 1–3 antenatal visits (aOR = 9.33; 95%CI: 5.07–17.16) and 4+ visits (aOR = 16.67; 95%CI: 8.82–31.48) compared to none; living in urban (aOR = 2.50; 95%CI: 1.57–3,98) compared to rural areas. Women from poorest households had lower odds of facility-based childbirth. There was substantial variation in the likelihood of birth in a health facility by region, with highest odds in N’Zérékoré and lowest in Labé. Conclusion: The percentage of births in health facilities among adolescents and young women in Guinea was 58%. This remains suboptimal regarding the challenges associated maternal mortality and morbidity issues in Guinea. Socio-economic characteristics, region of residence and antenatal care use were the main determinants of its use. Efforts to improve maternal health among this group should target care discontinuation between antenatal care and childbirth (primarily by removing financial barriers) and increasing the demand for facility-based childbirth services in communities, while paying attention to the quality and respectful nature of healthcare services provided there.