Study design, population and period

A prospective observational study using routinely collected health services data, from January 2012 to December 2017, was carried out. Three time periods were considered: pre-Ebola period (1 January 2012 to 30 May 2014); Ebola period (1 June 2014 to 28 February 2015); post-Ebola period (1 March 2015 to 31 December 2017). We considered the Ebola period from 1 month before the first confirmed case in the district (ie, June 2014) to 1 month after the country being declared Ebola-free (ie, February 2015). This was done because in Sierra Leone the outbreak had started in other districts of the country before the first case registered in Pujehun and continued to affect other districts until November 2015. It is realistic to assume that public fear of potential EVD cases and lack of confidence in the health services persisted in the Pujehun population during that time.¹⁴ In addition, expanding the Ebola period enabled a full assessment of the impact of the disease with an adequate comparison with the two long periods before and after the Ebola epidemic.