”For this one, let me take the risk”: why surgical staff continued to perform caesarean sections during the 2014–2016 Ebola epidemic in Sierra Leone

Drevin, Gustaf; Mölsted Alvesson, Helle; van Duinen, Alex; Bolkan, Håkon A; Koroma, Alimamy P; Von Schreeb, Johan

Transcripts were imported to the qualitative software NVivo V.11.4.1 (QSR International) and read for immersion into data. Framework analysis was used to initially code transcripts into the predetermined categories made up of the WHO building blocks. 37 In a second step, the content was revisited and thematically coded to capture the specific changes that occurred during the outbreak. Thematic coding included identification of meaning units, combination of meaning units into broader categories and horizontal analysis of categories to identify overarching main themes. We then developed themes that capture how CS volumes at public hospitals continued during and despite EVD, in the perception and lived experience of surgical care providers. Data trustworthiness was safeguarded using a frequently revisited codebook and cross-checking of identified categories by GD, HMA and JVS until thematic consensus occurred. When available, raw quantitative data were used to triangulate statements from participants, for example, concerning increased or decreased healthcare utilisation. Whenever a transcription's meaning was unclear, the original audio file was revisited.