Abstract
The recent Ebola outbreak in West Africa was an exemplar for the need to rapidly measure population-level health-seeking behaviors, in order to understand healthcare utilization during emergency situations. Taking advantage of the high prevalence of mobile phones, we deployed a national SMS-poll and collected data about individual-level health and health-seeking behavior throughout the outbreak from 6694 individuals from March to June 2015 in Liberia. Using propensity score matching to generate balanced subsamples, we compared outcomes in our survey to those from a recent household survey (the 2013 Liberian Demographic Health Survey). We found that the matched subgroups had similar patterns of delivery location in aggregate, and utilizing data on the date of birth, we were able to show that facility-based deliveries were significantly decreased during, compared to after the outbreak (p < 0.05) consistent with findings from retrospective studies using healthcare-based data. Directly assessing behaviors from individuals via SMS also enabled the measurement of public and private sector facility utilization separately, which has been a challenge in other studies in countries including Liberia which rely mainly on government sources of data. In doing so, our data suggest that public facility-based deliveries returned to baseline values after the outbreak. Thus, we demonstrate that with the appropriate methodological approach to account for different population denominators, data sourced via mobile tools such as SMS polling could serve as an important low-cost complement to existing data collection strategies especially in situations where higher-frequency data than can be feasibly obtained through surveys is useful.
Highlights
As the recent Ebola virus disease (EVD) outbreak in West Africa highlighted, collecting data on health and health seeking behavior in places with an existing weak health system using traditional public health sources, especially in the midst of an acute public health emergency or other humanitarian crises, can be challenging or impossible
In particular for maternal health in Liberia, with the closure of healthcare facilities and the loss of health workers there was a risk of reversing important gains this country had made in the lead up to the outbreak in maternal and newborn health.[1]
It is reported that there is no knowledge of the quality of this health information data over time pre- and post-EVD, which was likely adversely affected by the health system disruption during the outbreak.[8,10]
Summary
As the recent Ebola virus disease (EVD) outbreak in West Africa highlighted, collecting data on health and health seeking behavior in places with an existing weak health system using traditional public health sources, especially in the midst of an acute public health emergency or other humanitarian crises, can be challenging or impossible. Software) which mainly represents public-sector institutions, while other work using surveys assessed facility-based deliveries without explicitly distinguishing public and private institution use.[1,10] there exist numerous for-profit, religious, and not-forprofit clinics operating in Liberia, especially in urban areas like Montserrado County, which do not report to the Ministry of Health and would not be captured in health information system data.[10] It is reported that there is no knowledge of the quality of this health information data over time pre- and post-EVD, which was likely adversely affected by the health system disruption during the outbreak.[8,10] Though other studies have used community-based household surveys to obtain data outside the reporting system, surveys have been limited in their reach; only focusing on specific places in Liberia such as River Cess, Margibi. The lessons from our study in Liberia, we believe, are likely to be useful in many contexts using mobile phone data to collect data complimentary to surveys at scale and at high frequency, during regular or acute emergency situations
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
