”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

Participant inclusion criteria were ≥6 months of work experience related to emergency obstetrics and obstetric surgery during the EVD outbreak (defined as week 21 of 2014 to week 20 of 2015). Surgically skilled providers were healthcare workers with surgical operating skills: specialised surgeons, non-specialised medical officers and SACHOs. 33 Malterud's theory on information power guided the sample size estimation. 34 CapaCare is a non-governmental organisation that offers surgical training nationwide in Sierra Leone and had studied hospital function during EVD. 35 Staff from CapaCare introduced the researchers to a suitable physician or other senior staff (medical superintendent or head nurse) at the selected hospitals. Participants were identified to reflect a broad variety of professions involved with performing CS. To secure a multidisciplinary sample, we purposively identified and invited surgeons, medical officers, midwives, surgical and anaesthesia nurses, and SACHOs to be interviewed on arrival to each hospital. We interviewed at least one physician and two other cadres per hospital. Apart from the medical officer or medical superintendents interviewed, participants were sequentially recruited following advice from those interviewed (snowball sampling).