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Hartner AM, Li X, Gaythorpe K. COVID-19 related disruption and resilience in immunisation activities in LMICs: a rapid review. BMJ Open 2024; 14:e076607. [PMID: 39107008 DOI: 10.1136/bmjopen-2023-076607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVES We conducted a rapid review to determine the extent that immunisation services in low-income and middle-income countries (LMICs) were disrupted by the COVID-19 pandemic and synthesised the factors that can be used to build resilience in future. DESIGN Rapid review reported in accordance with the Preferred reporting for Systematic reviews and Meta-Analyses (PRISMA) guidelines. DATA SOURCES PubMed and Web of Science were searched through 6 October 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included studies that focused on disruption to immunisation activities due to the COVID-19 pandemic in LMICs. Outcomes included routine vaccine coverage, supplementary immunisation activities, vaccine doses, timing of vaccination, supply chain changes, and factors contributing to disruption or resilience. DATA EXTRACTION AND SYNTHESIS Two independent reviewers used standardised methods to search, screen and code studies. Quality assessment was performed using a modified version of the Critical Appraisal Skills Programme for qualitative research. Findings were summarised qualitatively. RESULTS Of 4978 identified studies, 85 met the eligibility criteria. Included studies showed declines in immunisation activities across LMICs related to the COVID-19 pandemic. These included reductions in achieved routine coverage, cancellation or postponement of campaigns and underimmunised cohorts. Immunisation was most disrupted in the early months of the pandemic; however, recovery varied by country, age-group and vaccine. Though many countries observed partial recovery in 2020, disruption in many countries continued into 2021. It has also been noted that clinician staff shortages and vaccine stock-outs caused by supply chain disruptions contributed to immunisation delays, but that concern over COVID-19 transmission was a leading factor. Key resiliency factors included community outreach and healthcare worker support. CONCLUSIONS There is limited information on whether reductions in vaccination coverage or delays have persisted beyond 2021. Further research is needed to assess ongoing disruptions and identify missed vaccine cohorts.
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Affiliation(s)
- Anna-Maria Hartner
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
- Centre for Artificial Intelligence in Public Health Research, Robert Koch Institute, Wildau, Germany
| | - Xiang Li
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Katy Gaythorpe
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
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Lara PB, Daga G, Kossuth L, Boo FL. Do behavioral drivers matter for healthcare decision-making during crises? A study of low-income women in El Salvador during the COVID-19 pandemic. BMC Public Health 2024; 24:2122. [PMID: 39107696 PMCID: PMC11302350 DOI: 10.1186/s12889-024-19039-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 06/03/2024] [Indexed: 08/10/2024] Open
Abstract
Understanding health-seeking behaviors and their drivers is key for governments to manage health policies. A growing body of research explores the role of cognitive biases and heuristics in health and care-seeking behaviors, but little is known about how a context of heightened anxiety and uncertainty might influence these behavioral drivers. This study analyzes the association between four behavioral predictors-internal locus of control, impatience, optimism bias, and aspirations-and healthcare decisions among low-income women in El Salvador, controlling for other factors. We find positive associations between internal locus of control and preventive health behaviors during the COVID-19 pandemic. For instance, a one standard deviation increase in locus of control is associated with a 10% increase in an index measuring the use of masks, distancing, hand washing, and vaccination. Locus of control was also associated with women's use of preventive health services (one standard deviation improves the likelihood of having a hypertension test in the last six months by 5.8 percentage points). In a sub-sample of mothers, we find significant relationships between the four behavioral drivers and the decisions the mothers make for their children. However, we find these associations are less robust compared to the decisions they make for themselves. Some associations were stronger during the pandemic, suggesting that feelings of uncertainty and stress could amplify behavioral drivers' influence on health-related behaviors. This novel finding is relevant for designing policy responses for future shocks. JEL CODES: I12, D10, D91, I30.
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Affiliation(s)
- Pedro Bernal Lara
- Inter-American Development Bank, Social Protection and Health Division, 1300 New York Avenue NW, Washington, DC, USA.
| | - Giuliana Daga
- Inter-American Development Bank, Social Protection and Health Division, 1300 New York Avenue NW, Washington, DC, USA
| | - Lajos Kossuth
- Sloan School of Management, Massachusetts Institute of Technology, 100 Main St, Cambridge, MA, USA
| | - Florencia Lopez Boo
- Inter-American Development Bank, Social Protection and Health Division, 1300 New York Avenue NW, Washington, DC, USA
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Palomo-Piñón S, Antonio-Villa NE, Rangel-Zertuche RA, Berumen-Lechuga MG, Medina-Serrano JM, García-Cortés LR, Mejia-Rodríguez O, León-Vázquez MDLL, González-Dzib RDS, González-Coronado VJ, Álvarez-Aguilar C, Paniagua-Sierra JR, Alcocer L. Clinical and treatment profiles of arterial hypertension in Mexico during the COVID-19 pandemic: a cross-sectional survey endorsed by the "Collaborative Group on Arterial Hypertension". Front Public Health 2024; 12:1385349. [PMID: 39071149 PMCID: PMC11272620 DOI: 10.3389/fpubh.2024.1385349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/18/2024] [Indexed: 07/30/2024] Open
Abstract
Background Arterial hypertension is highly prevalent in Mexico; nevertheless, there are limited insights regarding its management during the COVID-19 pandemic. Here, we estimate the prevalence of clinical and treatment profiles of arterial hypertension and explore associated factors for undiagnosed and uncontrolled hypertension using a cross-sectional survey endorsed by the Collaborative Group on Arterial Hypertension from the Mexican Institute of Social Security. Methods Our survey was conducted from May to November 2021 using the May-Measurement Month 2021 protocols of the International Society of Hypertension. Arterial hypertension (defined as: blood pressure [BP] ≥140/90 mmHg, previous diagnosis, or taking antihypertensives) and its clinical and treatment profiles were classified according to the World Hypertension League Expert Committee. Mixed-effects logistic regression models were used to explore associated factors for undiagnosed and uncontrolled hypertension. Results Among 77,145 screened participants (women: 62.4%; median age: 46 [IQR: 32-59] years), the prevalence of arterial hypertension was 35.7% (95% CI: 35.3-36.0, n = 27,540). Among participants with arterial hypertension, 30.9% (95% CI: 30.4-31.5, n = 8,533) were undiagnosed, 6.6% (95% CI: 6.3%-6.9%, n = 1,806) were diagnosed but untreated, 43.4% (95% CI: 42.9-44.0, n = 11,965) had uncontrolled hypertension, and only 19% (95% CI: 18.6%-19.5%, n = 5,236) achieved hypertension control (BP < 130/80 mmHg). Explored associated factors for undiagnosed and uncontrolled hypertension include being men, living in the central and southern regions, lower educational attainments, higher use of pharmacological agents, and previous COVID-19 infection. Conclusion Our findings suggest that adverse arterial hypertension profiles, mainly undiagnosed and uncontrolled hypertension, were highly prevalent during the context of the COVID-19 pandemic in Mexico.
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Affiliation(s)
- Silvia Palomo-Piñón
- Unidad de Investigación Médica en Enfermedades Nefrológicas Siglo XXI (UIMENSXII), Unidad Médica de Alta Especialidad Hospital de Especialidades “Dr. Bernardo Sepúlveda G” Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Mexico City, Mexico
- Grupo Colaborativo en Hipertensión Arterial (GCHTA), Mexico City, Mexico
| | | | - Ricardo Alfonso Rangel-Zertuche
- Jefatura Prestaciones Médicas, Órgano de Operación Administrativa Desconcentrada, Instituto Mexicano del Seguro Social, Coahuila, Mexico
| | - María Guadalupe Berumen-Lechuga
- Jefatura de Servicios de Prestaciones Médicas, Órgano de Operación Administrativa Desconcentrada México Poniente, Toluca, Mexico
| | - Julio Manuel Medina-Serrano
- Coordinación de Planeación y Enlace Institucional, Órgano de Operación Administrativa Desconcentrada en Sinaloa, Instituto Mexicano del Seguro Social, Culiacán, Sinaloa, Mexico
| | - Luis Rey García-Cortés
- Coordinación de Planeación y Enlace Institucional, Jefatura de Servicios de Prestaciones Médicas, Órgano de Operación Administrativa Desconcentrada Regional Estado de México Oriente, Instituto Mexicano del Seguro Social, Oriente, Mexico City, Mexico
| | - Oliva Mejia-Rodríguez
- Centro de Investigación Biomédica de Michoacán del Instituto Mexicano del Seguro Social and by Escuela de Medicina, Campus Morelia, UVAQ, Michoacán, Mexico
| | - María de la Luz León-Vázquez
- Coordinación de Planeación e Enlace Institucional, Órgano Operativo de Administración Desconcentrada en Tlaxcala, Instituto Mexicano del Seguro Social, Tlaxcala, Mexico
| | | | - Vidal José González-Coronado
- Departamento de Cardiología Hospital Regional “1 Octubre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City, Mexico
| | - Cleto Álvarez-Aguilar
- Facultad de Ciencias Médicas y Biológicas “Dr. Ignacio Chávez”, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Michoacan, Mexico
| | - José Ramón Paniagua-Sierra
- Jefe de la Unidad de Investigación Médica en Enfermedades Nefrológicas Siglo XXI, Unidad Médica de Alta Especialidad Hospital de Especialidades “Dr. Bernardo Sepúlveda G” - Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Luis Alcocer
- Instituto Mexicano de Salud Cardiovascular, Mexico City, Mexico
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Zhong L, Lopez D, Pei S, Gao J. Healthcare system resilience and adaptability to pandemic disruptions in the United States. Nat Med 2024:10.1038/s41591-024-03103-6. [PMID: 38956198 DOI: 10.1038/s41591-024-03103-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/31/2024] [Indexed: 07/04/2024]
Abstract
Understanding healthcare system resilience has become paramount, particularly in the wake of the COVID-19 pandemic, which imposed unprecedented burdens on healthcare services and severely impacted public health. Resilience is defined as the system's ability to absorb, recover from and adapt to disruptions; however, despite extensive studies on this subject, we still lack empirical evidence and mathematical tools to quantify its adaptability (the ability of the system to adjust to and learn from disruptions). By analyzing millions of patients' electronic medical records across US states, we find that the COVID-19 pandemic caused two successive waves of disruptions within the healthcare systems, enabling natural experiment analysis of the adaptive capacity of each system to adapt to past disruptions. We generalized the quantification framework and found that the US healthcare systems exhibit substantial adaptability (ρ = 0.58) but only a moderate level of resilience (r = 0.70). When considering system responses across racial groups, Black and Hispanic groups were more severely impacted by pandemic disruptions than white and Asian groups. Physician abundance was the key characteristic for determining healthcare system resilience. Our results offer vital guidance in designing resilient and sustainable healthcare systems to prepare for future waves of disruptions akin to COVID-19 pandemics.
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Affiliation(s)
- Lu Zhong
- Department of Computer Science, Rensselaer Polytechnic Institute, Troy, NY, USA
- Network Science and Technology Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Dimitri Lopez
- Department of Computer Science, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Sen Pei
- Department of Environmental Health Sciences, Columbia University, New York City, NY, USA
| | - Jianxi Gao
- Department of Computer Science, Rensselaer Polytechnic Institute, Troy, NY, USA.
- Network Science and Technology Center, Rensselaer Polytechnic Institute, Troy, NY, USA.
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Doubova SV, Contreras-Sánchez SE, Ascencio-Montiel IDJ, González-León M, Krug-Llamas E, Borrayo-Sánchez G, Bonifaz LC, Aviles-Hernández R, Duque-Molina C, Robledo-Aburto Z. Strengthening Essential Health Services Recovery Policy after the COVID-19 Pandemic. Evidence from the Mexican Institute of Social Security. Arch Med Res 2024; 55:103011. [PMID: 38878448 DOI: 10.1016/j.arcmed.2024.103011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/13/2024] [Accepted: 05/21/2024] [Indexed: 07/27/2024]
Abstract
AIM To evaluate the progress of the Mexican Institute of Social Security Recovery Policy (IMSS-RP) in addressing the decline in essential health services caused by the COVID-19 pandemic. METHODS We analyzed eleven indicators of essential health services from 35 IMSS state delegations. The assessment included ambulatory and hospital care indicators such as breast and cervical cancer screening, family medicine, dental and specialty visits, diabetes and hypertension visits and health outcomes, deliveries, and elective surgeries. We analyzed the period before (January 2018-March 2021) and during (April 2021-June 2023) the implementation of the IMSS-RP. Statistical analysis to determine the association of the policy with service indicators and the change in their trends included an interrupted time series analysis and Poisson Generalized Estimating Equation models. RESULTS The volume of services showed substantial declines during the first year of the COVID-19 pandemic, reaching between 11 and 81% of pre-pandemic levels. All services increased significantly during the first 27 months of the IMSS-RP implementation; specialty visits, cervical and breast cancer screening, and diabetes control exceeded pre-pandemic levels (103%,112%,103%, and 138%, respectively). However, only deliveries and the percentage of patients with controlled diabetes and hypertension showed a stable increase following the IMSS-RP implementation, whereas the remaining services showed an initial increase but began to decrease over time. CONCLUSIONS After 27 months of implementation, IMSS-RP achieved progress in increasing the volume of essential health services and improving chronic disease control. However, declining trends in several services signal the need to focalize the policy.
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Affiliation(s)
- Svetlana V Doubova
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
| | - Saúl Eduardo Contreras-Sánchez
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Ivan de Jesús Ascencio-Montiel
- División de Análisis, Coordinación de Vigilancia Epidemiológica, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Margot González-León
- Unidad de Planeación e Innovación en Salud, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Ernesto Krug-Llamas
- Coordinación de Unidades de Primer Nivel, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Gabriela Borrayo-Sánchez
- Coordinación de Innovación en Salud, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Laura C Bonifaz
- Coordinación de Investigación en Salud, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Ricardo Aviles-Hernández
- Dirección del Hospital General del Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Célida Duque-Molina
- Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro social, Mexico City, Mexico
| | - Zoe Robledo-Aburto
- Dirección General, Instituto Mexicano del Seguro social, Mexico City, Mexico
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Doubova SV, Leslie HH, Pérez-Cuevas R, Kruk ME, Arsenault C. Users' perception of quality as a driver of private healthcare use in Mexico: Insights from the People's Voice Survey. PLoS One 2024; 19:e0306179. [PMID: 38917130 PMCID: PMC11198766 DOI: 10.1371/journal.pone.0306179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 06/11/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE The Mexican government has pursued multiple initiatives to improve healthcare coverage and financial protection. Yet, out-of-pocket health spending and use of private sector providers in Mexico remains high. In this paper, we sought to describe the characteristics of public and private healthcare users, describe recent visit quality across provider types, and to assess whether perceiving the public healthcare sector as poor quality is associated with private health sector use. METHODS AND FINDINGS We analyzed the cross-sectional People's Voice Survey conducted from December 2022 to January 2023. We used Chi-square tests to compare contextual, individual, and need-for-care factors and ratings of most recent visits between users of public (social security and other public providers) and private sector providers (stand-alone private providers and providers adjacent to pharmacies). We used a multivariable Poisson regression model to assess associations between low ratings of public healthcare sources and the use of private care. Among the 811 respondents with a healthcare visit in the past year, 31.2% used private sources. Private healthcare users were more educated and had higher incomes than public healthcare users. Quality of most recent visit was rated more highly in private providers (70.2% rating the visit as excellent or very good for stand-alone private providers and 54.3% for pharmacy-adjacent doctors) compared to social security (41.6%) and other public providers (46.6%). Those who perceived public health institutions as low quality had a higher probability of seeking private healthcare. CONCLUSION Users rated public care visits poorly relative to private care; at the population level, perceptions of poor quality care may drive private care use and hence out-of-pocket costs. Improving public healthcare quality is necessary to ensure universal health coverage.
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Affiliation(s)
- Svetlana V. Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Hannah H. Leslie
- Division of Prevention Science, University of California San Francisco, San Francisco, California, United States of America
| | - Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Interamerican Development Bank, Washington, DC, United States of America
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Catherine Arsenault
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
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Miranda SP, Owais A, Lopez MV, Herrera EK, Unar-Munguía M, Rodriguez FM, Merritt CE, Lee C, Rattan P, Ataullahjan A, Dommarco JR, Arenas AB, Neufeld LM, Bhutta ZA. Factors Affecting Anemia among Women of Reproductive Age in Mexico: A Mixed-Methods Country Case Study. Am J Clin Nutr 2024:S0002-9165(24)00531-8. [PMID: 38914225 DOI: 10.1016/j.ajcnut.2024.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/24/2024] [Accepted: 05/30/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND In Mexico, anemia prevalence among women of reproductive age (WRA) decreased from 16.4% in 2006 to 11.6% in 2012, only to increase to 18.3% in 2016. The factors associated with this fluctuation are uncertain. OBJECTIVE We conducted a systematic in-depth assessment of the quantitative and qualitative determinants of anemia among WRA in Mexico between 2006 and 2018. METHODS Using multivariate stepwise linear regression, we analyzed Mexico's Encuesta Nacional de Salud y Nutrición (ENSANUT) surveys from 2006, 2012, and 2018 to identify determinants of WRA anemia. We also conducted a review of anemia-relevant programs and policies, including financing documents, and conducted in-depth interviews and focus group discussions with key stakeholders in Mexico. RESULTS Among non-pregnant women (NPW) 15-49 years, mean hemoglobin (Hb) increased from 13.8 g/dL in 2006 to 14.0 g/dL in 2012, decreasing to 13.2 g/dL in 2018 (p<0.001). Inequities by geographical region and household wealth persisted throughout this period, with household wealth, urban residence and gravidity emerging as significant predictors of Hb among NPW. Qualitative analyses generally supported these findings. The most discussed program was Progresa-Oportunidades-Prospera (POP), where most resources for health were invested and most participants acknowledged that its cancellation in 2019 would lead to worsening in health and nutrition among the poor. Financing analyses showed a drop of funding for nutrition-related programs between 2014 and 2018. Cultural norms around gender roles were still prevalent, along with increasing rates of teenage pregnancy. CONCLUSIONS Anemia prevention efforts need to refocus on poverty alleviation, continuity of adequate coverage and financing of nutrition programs, especially with safety nets, and increase in uptake of family planning, especially among adolescent girls.
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Affiliation(s)
| | - Aatekah Owais
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | | | | | | | | | | | - Christopher Lee
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Preety Rattan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | | | | | | | - Lynnette M Neufeld
- Food and Nutrition Division, Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Centre of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan.
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Clark P, Cruz-Priego GA, Rascón-Pacheco RA, Bremer A, Borja-Aburto VH. Incidence of hip fractures in Mexico 2006-2019: increasing numbers but decreasing rates. Osteoporos Int 2024; 35:1041-1048. [PMID: 38459139 DOI: 10.1007/s00198-024-07045-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
This study, characterizing the incidence of hip fractures in Mexico, showed not only that the crude number of fractures has increased, but also there has been a decrease in fracture rates. Nonetheless, as the population ages in the coming decades, the current declines rate of could be expected to reverse. PURPOSE This study is to examine the incidence, rates, and time trends of hip fractures from 2006 to 2019 in Mexico. Additionally, an analysis of the follow-up of the birth cohorts was carried out. METHODS Hip fractures registered during the period of the study were obtained through the Mexican Social Security Institute (IMSS) national discharge records. The incidence per 100,000 individuals was calculated from the IMSS population at risk. A time trend analysis was conducted using linear regression, and the identification of breakpoints in linear trends. RESULTS There was an increase of hip fractures for both sexes ≥ 60 years (43% for women and 41%, for men). However, the rates diminished from 167.8/100,000 in 2006 to 138.5 /100,000 in the population 60 and over (1.9% and 0.9% per year in women and men respectively). When the information was analyzed by age groups, hip fracture rates were similar in both sexes but higher in women. The most significant contribution to the total number of fractures is due to the groups ≥ 70 years; people born before 1937 are accounting for the burden of fractures over the total data. In contrast, the younger generations appear to have lower rates. CONCLUSION Rates of hip fracture have steadily declined in Mexico since 2006; however, with the population aging in the coming decades, current rates declines could be expected to reverse.
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Affiliation(s)
- Patricia Clark
- Clinical Epidemiology Research Unit, Hospital Infantil de Mexico "Federico Gomez", Mexico City, Mexico
- Faculty of Medicine of National Autonomous University of Mexico (Universidad, Nacional Autónoma de México), Mexico City, Mexico
| | - Griselda-Adriana Cruz-Priego
- Clinical Epidemiology Research Unit, Hospital Infantil de Mexico "Federico Gomez", Mexico City, Mexico.
- Faculty of Medicine of National Autonomous University of Mexico (Universidad, Nacional Autónoma de México), Mexico City, Mexico.
| | | | - Alhelí Bremer
- Faculty of Medicine and Psychology, Autonomous University of Baja California (UABC), Tijuana, Baja California, Mexico
| | - Víctor Hugo Borja-Aburto
- Teaching and Research Unit, Directorate of Medical Benefits, Mexican Institute of Social Security, IMSS, Mexico City, Mexico
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Marian M, Barker KM, Reed E, McClain AC, Lundgren R, Hurst S, Pérez RL. Prevalence of different variations of non-consented care during the childbirth process in Mexico by geographical regions: comparing ENDIREH survey data from 2016 to 2021. BMC Pregnancy Childbirth 2024; 24:353. [PMID: 38741050 DOI: 10.1186/s12884-024-06549-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Non-consented care, a form of obstetric violence involving the lack of informed consent for procedures, is a common but little-understood phenomenon in the global public health arena. The aim of this secondary analysis was to measure the prevalence and assess change over time of non-consented care during childbirth in Mexico in 2016 and 2021, as well as to examine the association of sociodemographic, pregnancy-, and childbirth-factors with this type of violence. METHODS We measured the prevalence of non-consented care and three of its variations, forced sterilization or contraception, forced cesarean section, and forced consent on paperwork, during childbirth in Mexico for 2016 (N = 24,036) and 2021 (N = 19,322) using data from Mexico's cross-sectional National Survey on the Dynamics of Household Relationships (ENDIREH). Weighted data were stratified by geographical regions. We performed adjusted logistic regression analyses to explore associations. RESULTS The national prevalence of non-consented care and one of its variations, pressure to get a contraceptive method, increased from 2016 to 2021. A decrease in the prevalence was observed for forced contraception or sterilization without knowledge, forcing women to sign paperwork, and non-consented cesarean sections nationally and in most regions. Women between the ages of 26 and 35 years, married, cohabiting with partner, living in urban settings, who do not identify as Indigenous, and who received prenatal services or gave birth at the Mexican Institute of Social Security (IMSS) facilities experienced a higher prevalence of non-consented care. Being 26 years of age and older, living in a rural setting, experiencing stillbirths in the last five years, having a vaginal delivery, receiving prenatal services at IMSS, or delivering at a private facility were significantly associated with higher odds of reporting non-consented care. CONCLUSION While a decrease in most of the variations of non-consented care was found, the overall prevalence of non-consented care and, in one of its variations, pressure to get contraceptives, increased at a national and regional level. Our findings suggest the need to enforce current laws and strengthen health systems, paying special attention to the geographical regions and populations that have experienced higher reported cases of this structural problem.
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Affiliation(s)
- Marian Marian
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.
- San Diego State University School of Public Health, San Diego, CA, USA.
| | - Kathryn M Barker
- Center on Gender Equity and Health, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Elizabeth Reed
- San Diego State University School of Public Health, San Diego, CA, USA
| | - Amanda C McClain
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Rebecka Lundgren
- Center on Gender Equity and Health, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Samantha Hurst
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA
| | - Ramona L Pérez
- Department of Anthropology, San Diego State University, San Diego, CA, USA
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Kassa ZY, Scarf V, Turkmani S, Fox D. Impact of COVID-19 on antenatal care provision at public hospitals in the Sidama region, Ethiopia: A mixed methods study. PLoS One 2024; 19:e0301994. [PMID: 38635578 PMCID: PMC11025829 DOI: 10.1371/journal.pone.0301994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) continues to pose a global public health threat. The pandemic overstretched already weak health systems in low- and low-middle-income countries, including Ethiopia. There is a paucity of studies on the impact of COVID-19 on antenatal care access, uptake, and provision in Ethiopia. This study examines the impact of COVID-19 on antenatal care provision in the Sidama region, Ethiopia. METHODS A concurrent mixed-methods study was conducted between 14 February and 10 May 2022 at 15 public hospitals in the Sidama region. An interrupted times series design was applied for a quantitative study, which included data from all pregnant women who attended antenatal care before COVID-19 (12 months, March 2019 to February 2020) and during COVID-19 (six months, March to August 2020) at 15 public hospitals in the region. The total numbers in the antenatal care 1 cohort (at least one antenatal care contact) and antenatal care 4 cohort (at least four antenatal care contacts) were 15,150 and 5,850, respectively, forming a combined final dataset of 21,000 women. Routinely collected monthly data were derived from the hospitals' health management information system and imported into Stata version 17 for analysis. The mean monthly incidence rate ratio of antenatal care uptake was calculated using a Poisson regression model with a 95% confidence interval. Simultaneously, an exploratory study design was conducted for qualitative using in-depth interviews to explore maternity care providers' perceptions of the impact of COVID-19 on antenatal care access, uptake, and provision. Qualitative data were thematically analysed. The quantitative and qualitative findings were then integrated using the joint display technique. RESULTS Our findings indicate a significant monthly decrease of 0.7% in antenatal care 1 and 1.8% in antenatal care 4 during the first six months of the pandemic. A lack of medical supplies, fear of contracting COVID-19, inadequate personal protective equipment, discrimination against those attending the hospital, and the absence of antenatal care guidelines for care provision, COVID-19 vaccine hesitancy and long waiting times for ANC led to disrupted access, uptake, and provision of antenatal care during COVID-19. CONCLUSION AND RECOMMENDATIONS Our findings demonstrate that the COVID-19 pandemic affected antenatal care access, uptake, and provision in the study area from March to August 2020. To mitigate disrupted antenatal care access, uptake and provision, antenatal care clinics should be equipped with medical supplies. It is crucial to maintain rapport between the community and maternity care providers and provide training for maternity care providers regarding the adapted/adopted guidelines during COVID-19 at the hospital grassroots level for use in the current and future pandemics. Pregnant women should have timely access to maternity care providers in order to maintain at least a minimum standard of care in current and future pandemics.
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Affiliation(s)
- Zemenu Yohannes Kassa
- Collaborative of Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Vanessa Scarf
- Collaborative of Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Sabera Turkmani
- Collaborative of Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Deborah Fox
- Collaborative of Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Ranjbar M, Mousavi SM, Madadizadeh F, Dargani NH, Iraji S, Angell B, Assefa Y. Effect of the COVID-19 pandemic on utilization of essential health services in Iran evidence from an interrupted time series analysis. BMC Public Health 2024; 24:1006. [PMID: 38605406 PMCID: PMC11008029 DOI: 10.1186/s12889-024-18537-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The COVID-19 disrupted the provision of essential health services in numerous countries, potentially leading to outbreaks of deadly diseases. This study aims to investigate the effect of the COVID-19 pandemic on the utilization of essential health services in Iran. METHODS An analytical cross-sectional study was conducted using interrupted time series (ITS) analysis. Data about five indicators, including 'childhood vaccination, infant care, hypertension screening, diabetes screening, and breast cancer screening,' were obtained from the electronic health record System in two-time intervals: 15 months before (November 2018 to January 2020) and 15 months after (January 2020 to May 2021) the onset of the COVID-19 pandemic. The data were analyzed by utilizing ITS. In addition, a Poisson model was employed due to the usage of count data. The Durbin-Watson (DW) test was used to identify the presence of lag-1 autocorrelation in the time series data. All statistical analysis was performed using R 4.3.1 software, considering a 5% significance level. RESULTS The ITS analysis showed that the COVID-19 pandemic significantly affected the utilization of all essential health services (P < 0.0001). The utilization of hypertension screening (RR = 0.51, p < 0.001), diabetes screening (RR = 0.884, p < 0.001), breast cancer screening (RR = 0.435, p < 0.001), childhood vaccination (IRR = 0.947, p < 0.001), and infant care (RR = 1.666, p < 0.001), exhibited a significant decrease in the short term following the pandemic (P < 0.0001). However, the long-term trend for all service utilization, except breast cancer screening (IRR = 0.952, p < 0.001), demonstrated a significant increase. CONCLUSIONS The COVID-19 pandemic affected utilization of essential health care in Iran. It is imperative to utilize this evidence to develop policies that will be translated into targeted planning and implementation to sustain provision and utilization of essential health services during public health emergencies. It is also vital to raise awareness and public knowledge regarding the consequences of interruptions in essential health services. In addition, it is important to identify the supply- and demand-side factors contributing to these disruptions.
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Affiliation(s)
- Mohammad Ranjbar
- Department of Health Management and Economics, Health Policy & Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Masood Mousavi
- Department of Health Management and Economics, Health Policy & Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farzan Madadizadeh
- Department of Biostatistics and Epidemiology, Center for Healthcare Data Modeling, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nahid Hosseini Dargani
- Department of Health Management and Economics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Samaneh Iraji
- Yazd Health District, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Blake Angell
- Centre for Health Systems Science, the George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Yibeltal Assefa
- School of Public Health, the University of Queensland, Brisbane, Australia
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12
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Acosta E, Hug L, Cruz-Castanheira H, Sharrow D, Monteiro da Silva JH, You D. Changes in stillbirths and child and youth mortality in 2020 and 2021 during the COVID-19 pandemic. Int J Epidemiol 2024; 53:dyae057. [PMID: 38622491 PMCID: PMC11018542 DOI: 10.1093/ije/dyae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 04/10/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has been extensively studied for its impact on mortality, particularly in older age groups. However, the pandemic effects on stillbirths and mortality rates in neonates, infants, children and youth remain poorly understood. This study comprehensively analyses the pandemic influence on young mortality and stillbirths across 112 countries and territories in 2020 and 104 in 2021. METHODS Using data from civil registers and vital statistics systems (CRVS) and the Health Management Information System (HMIS), we estimate expected mortality levels in a non-pandemic setting and relative mortality changes (p-scores) through generalized linear models. The analysis focuses on the distribution of country-specific mortality changes and the proportion of countries experiencing deficits, no changes and excess mortality in each age group. RESULTS Results show that stillbirths and under-25 mortality were as expected in most countries during 2020 and 2021. However, among countries with changes, more experienced deficits than excess mortality, except for stillbirths, neonates and those aged 10-24 in 2021, where, despite the predominance of no changes, excess mortality prevailed. Notably, a fifth of examined countries saw increases in stillbirths and a quarter in young adult mortality (20-24) in 2021. Our findings are highly consistent between females and males and similar across income levels. CONCLUSION Despite global disruptions to essential services, stillbirths and youth mortality were as expected in most observed countries, challenging initial hypotheses. However, the study suggests the possibility of delayed adverse effects that require more time to manifest at the population level. Understanding the lasting impacts of the COVID-19 pandemic requires ongoing, long-term monitoring of health and deaths among children and youth, particularly in low- and lower-middle-income countries.
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Affiliation(s)
- Enrique Acosta
- Centre d’Estudis Demogràfics (CED), Barcelona, Spain
- Laboratory of Population Health, Max Planck Institute for Demographic Research (MPIDR), Rostock, Germany
| | - Lucia Hug
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, USA
| | | | - David Sharrow
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, USA
| | | | - Danzhen You
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, USA
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13
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Kuandyk (Sabitova) A, Ortega MA, Ntegwa MJ, Sarria-Santamera A. Impact of the COVID-19 pandemic on access to and delivery of maternal and child healthcare services in low-and middle-income countries: a systematic review of the literature. Front Public Health 2024; 12:1346268. [PMID: 38655525 PMCID: PMC11036866 DOI: 10.3389/fpubh.2024.1346268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
Background The COVID-19 pandemic has had a multifaceted impact on maternal and child services and adversely influenced pregnancy outcomes. This systematic review aims to determine the impact of the COVID-19 pandemic on access to and delivery of maternal and child healthcare services in low- and middle-income countries. Methods The review was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A primary search of electronic databases was performed using a combination of search terms related to the following areas of interest: "impact' AND 'COVID-19' AND 'maternal and child health services' AND 'low- and middle-income countries. A narrative synthesis approach was used to analyse and integrate the results. Results Overall, 45 unique studies conducted across 28 low- and middle-income countries met the inclusion criteria for the review. The findings suggest the number of family planning visits, antenatal and postnatal care visits, consultations for sick children, paediatric emergency visits and child immunisation levels decreased compared to the pre-pandemic levels in the majority of included studies. An analytical framework including four main categories was developed based on the concepts that emerged from included studies: the anxiety of not knowing (1), overwhelmed healthcare systems (2), challenges perceived by healthcare professionals (3) and difficulties perceived by service users (4). Conclusion The COVID-19 pandemic disrupted family planning services, antenatal and postnatal care coverage, and emergency and routine child services. Generalised conclusions are tentative due to the heterogeneity and inconsistent quality of the included studies. Future research is recommended to define the pandemic's impact on women and children worldwide and prepare healthcare systems for future resurgences of COVID-19 and potential challenges beyond. Systematic review registration PROSPERO (CRD42021285178).
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Affiliation(s)
- Alina Kuandyk (Sabitova)
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Miguel-Angel Ortega
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | | | - Antonio Sarria-Santamera
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
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14
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Konu YR, Dogo F, Dagnra CA, Atcha-Oubou T, Gbeasor-Komlanvi FA, Afanvi KA, Diallo FBT, Teouri M, Mijiyawa M, Ekouevi DK. Effect of the COVID-19 pandemic on HIV, malaria and tuberculosis indicators in Togo: an interrupted time series analysis. BMJ Glob Health 2024; 9:e013679. [PMID: 38569659 PMCID: PMC11002417 DOI: 10.1136/bmjgh-2023-013679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Limited data are available on the effects of the COVID-19 pandemic on health-related indicators in sub-Saharan Africa. This study aimed to estimate the effect of the COVID-19 pandemic on nine indicators of HIV, malaria and tuberculosis (TB) in Togo. METHODS For this interrupted time series analysis, national health information system data from January 2019 to December 2021 and TB programmatic data from the first quarter of 2018 to the fourth quarter of 2022 were analysed. Nine indicators were included. We used Poisson segmented regression to estimate the immediate impact of the pandemic and per-pandemic period trends through incidence rate ratios (IRRs) with 95% CIs. RESULTS Overall, there was a decrease in six of the nine indicators, ranging from 19.3% (IRR 0.807, 95% CI 0.682 to 0.955, p=0.024) for the hospitalisation of patients for malaria to 36.9% (IRR 0.631, 95% CI 0.457 to 0.871, p=0.013) for TB diagnosis by Mycobacterium tuberculosis Xpert immediately after the declaration of the COVID-19 pandemic. A comparison of the observed and predicted trends showed that the trend remained constant between the prepandemic and pandemic periods of COVID-19 for all malaria indicators. A significant downward monthly trend was observed in antiretroviral therapy initiation (IRR 0.909, 95% CI 0.892 to 0.926, p<0.001) and positive TB microscopy (IRR 0.919, 95% CI 0.880 to 0.960, p=0.002). CONCLUSION HIV, malaria and TB services were generally maintained over time in Togo despite the COVID-19 pandemic. However, given the decline in levels immediately after the onset of the pandemic, there is an urgent need to improve the preparedness of the healthcare system.
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Affiliation(s)
- Yao Rodion Konu
- Département de Santé Publique, Université de Lomé, Lome, Togo
- Centre Africain de Recherche en Epidemiologie et en Santé Publique (CARESP), Lomé, Togo
- Global Health in the Global South (Inserm UMR 1219, IRD EMR 271), Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
| | - Fall Dogo
- Programme national de lutte contre la tuberculose (PNLT), Lomé, Togo
| | - Claver Anoumou Dagnra
- Programme national de lutte contre le sida, les hépatites virales et les infections sexuellement transmissibles (PNLS-HV-IST), Lomé, Togo
| | | | - Fifonsi Adjidossi Gbeasor-Komlanvi
- Département de Santé Publique, Université de Lomé, Lome, Togo
- Centre Africain de Recherche en Epidemiologie et en Santé Publique (CARESP), Lomé, Togo
| | | | | | - Mahmoud Teouri
- Direction du système national d'information sanitaire et l'informatique (DSNSI), Lomé, Togo
| | - Moustafa Mijiyawa
- Ministère de la Santé, de l'Hygiène Publique et de l'Accès Universel aux Soins, Lomé, Togo
| | - Didier Koumavi Ekouevi
- Département de Santé Publique, Université de Lomé, Lome, Togo
- Centre Africain de Recherche en Epidemiologie et en Santé Publique (CARESP), Lomé, Togo
- Global Health in the Global South (Inserm UMR 1219, IRD EMR 271), Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
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15
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Ruiz OA, Ancira-Moreno M, Omaña-Guzmán I, Cordero SH, Morales ACB, Navarro CP, Méndez SB, Flores EM, Trejo A, Kaufer-Horwitz M, Cajero A, Sánchez B, Bernat C, Salgado-Amador E, Hoyos-Loya E, Mazariegos M, Manrique CM, Cruz RP, Mendoza E, Brero M, Sachse M, Armijo FC. Low quality of maternal and child nutritional care at the primary care in Mexico: an urgent call to action for policymakers and stakeholders. Int J Equity Health 2024; 23:35. [PMID: 38388936 PMCID: PMC10885649 DOI: 10.1186/s12939-024-02129-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Maternal and child malnutrition represents a public health problem in Mexico Primary care (PC) is responsible for introducing women and children under five to the health system, detecting diseases on time, and providing medical services, including pharmacological treatment if necessary. Providing these services with quality is essential to improve maternal and child health. This study evaluated the quality of nutritional care during preconception, pregnancy, postpartum, infancy, and preschool age at the PC health units across six Mexican states between 2020 and 2021. METHODS We conducted a cross-sectional study with a mixed approach in units of the Secretary of Health to assess the quality of nutritional care during preconception, pregnancy, postpartum, childhood, and preschool age. The level of quality was calculated by the percentage of compliance with 16 indicators that integrated a Quality Index of Maternal and Child Nutritional Care (ICANMI, by its Spanish acronym). Compliance by indicator, by life stage, and overall was categorized using the following cut-off points: poor quality (≤ 70%), insufficient quality (71-89%), and good quality (≥ 90%). The perceptions of the barriers and facilitators that affect maternal and child nutrition were evaluated through semi-structured interviews with health professionals (HP) and users. All qualitative instruments were developed with a gender and intercultural perspective. RESULTS Considering the whole sample studied, maternal and child nutritional care quality during the five life stages evaluated was bad (compliance: ≤12%), reflected in the ICANMI, which had a compliance of 8.3%. Principal barriers identified to providing high-quality nutritional care were the lack of knowledge and training of health professionals, shortages of equipment, medicine, personnel, and materials, the disappearance of the social cash transfer program Prospera, the absence of local indigenous language translators to support communication between doctor and patient, and the persistence of machismo and other practices of control over women. CONCLUSIONS These findings underscore the need for initiatives to improve the quality of nutritional care in PC facilities across Chihuahua, State of Mexico, Veracruz, Oaxaca, Chiapas, and Yucatan. It is necessary for government and health authorities, along with various stakeholders, to collaboratively devise, implement, and assess intercultural and gender-oriented policies and programs geared towards ensuring the health infrastructure and enhancing the training of health professionals to diagnose and treat the prevalence and occurrence of diverse forms of malnutrition in both maternal and child populations.
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Affiliation(s)
- Omar Acosta Ruiz
- Center for Research in Evaluation and Surveys, National Institute of Public Health, Cuernavaca, Mexico
| | - Monica Ancira-Moreno
- Health Department, Universidad Iberoamericana, Mexico City, Mexico.
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico.
| | - Isabel Omaña-Guzmán
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
- Pediatric Obesity Clinic and Wellness Unit, Hospital General de México, "Dr. Eduardo Liceaga,", Mexico City, Mexico
| | - Sonia Hernández Cordero
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | | | | | - Soraya Burrola Méndez
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
| | - Eric Monterrubio Flores
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Alejandra Trejo
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Martha Kaufer-Horwitz
- Dirección de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ariana Cajero
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Belén Sánchez
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Constanza Bernat
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Elder Salgado-Amador
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
| | - Elizabeth Hoyos-Loya
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
| | - Mónica Mazariegos
- Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Cinthya Muñoz Manrique
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Royer Pacheco Cruz
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
- Instituto de Nutrición, Universidad de la Sierra Sur, Oaxaca, México
| | - Elvia Mendoza
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Mauro Brero
- United Nations International Children's Emergency Fund (UNICEF), Mexico City, México
| | - Matthias Sachse
- United Nations International Children's Emergency Fund (UNICEF), Mexico City, México
| | - Fernanda Cobo Armijo
- United Nations International Children's Emergency Fund (UNICEF), Mexico City, México
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16
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Silverio-Murillo A, Hoehn-Velasco L, Balmori de la Miyar J, Méndez Méndez JS. The COVID-19 pandemic and non-COVID-19 healthcare utilization in Mexico. Public Health 2024; 226:99-106. [PMID: 38042128 DOI: 10.1016/j.puhe.2023.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/15/2023] [Accepted: 10/24/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVES This study aimed to analyze the effects of the COVID-19 pandemic on non-COVID-19 healthcare utilization in Mexico, including oral health, mental health, communicable disease visits, health checkups, chronic degenerative disease visits, postpartum care, prenatal care, and family planning visits. STUDY DESIGN This was a retrospective ecological analysis during the COVID-19 pandemic. During the pandemic, the Mexican government recommended non-essential consultations be suspended or rescheduled to accommodate the new demand for healthcare services from COVID-19 patients. METHODS This study uses administrative data from Mexico's Ministry of Health from January 2017 to December 2022. These data cover 14,299 consultation units and 775 hospitals from the 32 Mexican States, all of which are public institutions. A difference-in-differences strategy and an event study specification are used to study the impacts of the pandemic on non-COVID-19 healthcare utilization. RESULTS The findings reveal a decrease in the utilization of all healthcare services: oral health (69%), mental health (27%), communicable diseases (46%), chronic degenerative diseases (36%), health checkups (62%), family planning (45%), prenatal care (36%), and postpartum care (44%). Furthermore, the event study indicates that most services follow a U-shaped trend, although only mental health services clearly return to prepandemic levels. The remainder of services remain below prepandemic levels at the end of 2022. CONCLUSIONS The 2020 pandemic had detrimental effects on non-COVID-19 healthcare utilization. The healthcare interruptions will likely impact short- and long-term morbidity and mortality. Programs intended to remediate these negative consequences may be of interest to public health policymakers.
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Affiliation(s)
| | - L Hoehn-Velasco
- Andrew Young School of Policy Studies, Georgia State University, USA.
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17
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Fejfar D, Andom AT, Msuya M, Jeune MA, Lambert W, Varney PF, Aron MB, Connolly E, Juárez A, Aranda Z, Niyigena A, Cubaka VK, Boima F, Reed V, Law MR, Grépin KA, Mugunga JC, Hedt-Gauthier B, Fulcher I. The impact of COVID-19 and national pandemic responses on health service utilisation in seven low- and middle-income countries. Glob Health Action 2023; 16:2178604. [PMID: 36880985 PMCID: PMC10013493 DOI: 10.1080/16549716.2023.2178604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted health services worldwide, which may have led to increased mortality and secondary disease outbreaks. Disruptions vary by patient population, geographic area, and service. While many reasons have been put forward to explain disruptions, few studies have empirically investigated their causes. OBJECTIVE We quantify disruptions to outpatient services, facility-based deliveries, and family planning in seven low- and middle-income countries during the COVID-19 pandemic and quantify relationships between disruptions and the intensity of national pandemic responses. METHODS We leveraged routine data from 104 Partners In Health-supported facilities from January 2016 to December 2021. We first quantified COVID-19-related disruptions in each country by month using negative binomial time series models. We then modelled the relationship between disruptions and the intensity of national pandemic responses, as measured by the stringency index from the Oxford COVID-19 Government Response Tracker. RESULTS For all the studied countries, we observed at least one month with a significant decline in outpatient visits during the COVID-19 pandemic. We also observed significant cumulative drops in outpatient visits across all months in Lesotho, Liberia, Malawi, Rwanda, and Sierra Leone. A significant cumulative decrease in facility-based deliveries was observed in Haiti, Lesotho, Mexico, and Sierra Leone. No country had significant cumulative drops in family planning visits. For a 10-unit increase in the average monthly stringency index, the proportion deviation in monthly facility outpatient visits compared to expected fell by 3.9% (95% CI: -5.1%, -1.6%). No relationship between stringency of pandemic responses and utilisation was observed for facility-based deliveries or family planning. CONCLUSIONS Context-specific strategies show the ability of health systems to sustain essential health services during the pandemic. The link between pandemic responses and healthcare utilisation can inform purposeful strategies to ensure communities have access to care and provide lessons for promoting the utilisation of health services elsewhere.
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Affiliation(s)
| | - Afom T Andom
- Clinical Services, Partners In Health, Maseru, Lesotho
| | - Meba Msuya
- Clinical Services, Partners In Health, Maseru, Lesotho
| | - Marc Antoine Jeune
- Department of Strategic Planning and Information Systems, Zanmi Lasante, Croix-des-Bouquets, Haiti
| | - Wesler Lambert
- Department of Strategic Planning and Information Systems, Zanmi Lasante, Croix-des-Bouquets, Haiti
| | - Prince F Varney
- Strategic Health Information Systems, Partners In Health, Monrovia, Liberia
| | - Moses Banda Aron
- Monitoring, Evaluation, and Information, Partners In Health, Neno, Malawi
| | - Emilia Connolly
- Monitoring, Evaluation, and Information, Partners In Health, Neno, Malawi
| | - Ameyalli Juárez
- Partners In Health/Compañeros en Salud, Jaltenango de la Paz, Mexico
| | - Zeus Aranda
- Partners In Health/Compañeros en Salud, Jaltenango de la Paz, Mexico
| | - Anne Niyigena
- Department of Research and Training, Partners In Health, Kigali, Rwanda
| | - Vincent K Cubaka
- Department of Research and Training, Partners In Health, Kigali, Rwanda
| | - Foday Boima
- Strategic Health Informations Systems, Partners In Health, Koidu City, Kono District, Sierra Leone
| | - Vicky Reed
- Strategic Health Informations Systems, Partners In Health, Koidu City, Kono District, Sierra Leone
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Karen A Grépin
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Isabel Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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18
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Doubova SV, Bhadelia A, Pérez-Moran D, Martinez-Vega IP, García-Cervantes N, Knaul F. Dimensions of suffering and the need for palliative care: experiences and expectations of patients living with cancer and diabetes and their caregivers in Mexico - a qualitative study. BMJ Open 2023; 13:e075691. [PMID: 38101838 PMCID: PMC10729252 DOI: 10.1136/bmjopen-2023-075691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/16/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES Over 40 million people in low-income and middle-income countries (LMICs) experience serious health-related suffering (SHS) annually and require palliative care. Patient and caregiver experiences of SHS in LMICs are understudied despite their importance in guiding palliative care provision. Diabetes and cancer are the second-leading and third-leading causes of death in Mexico, causing a significant SHS burden on patients, families and health systems. This study examines SHS and palliative care from the point of view of patients with cancer and diabetes and their caregivers. DESIGN A qualitative descriptive study based on in-depth telephone interviews was conducted between August 2021 and February 2022. Data were analysed through inductive thematic analysis. PARTICIPANTS Overall, 20 patients with end-stage cancer, 13 patients with diabetes and 35 family caregivers were interviewed individually. SETTING Participants were recruited from two family medicine clinics and a pain clinic in Mexico City. RESULTS Seven themes emerged: (1) suffering as a multifaceted phenomenon, (2) diversity in perceptions of suffering, (3) different coping strategies, (4) need and perceived importance of relief from suffering, (5) barriers to accessing services to relieve suffering, (6) demand for the health sector's active and humane role in addressing suffering and (7) preferences and need for comprehensive care for relief from suffering. The primary coping strategies included family companionship, protective buffering and faith-based support. Participants lacked knowledge of palliative care. They expressed the importance of relief from suffering, viewing it as the health sector's responsibility and requesting more humane, personalised care and access to medicines and pain clinics. CONCLUSIONS The multifaceted nature of SHS highlights the health system's responsibility to provide high-quality palliative care. Policies to enhance access to palliative care should integrate it into primary care, redesigning services towards patient and caregiver biopsychosocial and spiritual needs and ensuring access to medicines and competent health personnel.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit, CMN Siglo XXI, Mexican Social Security Institute, Mexico City, Mexico
| | - Afsan Bhadelia
- Department of Public Health. College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Diana Pérez-Moran
- Epidemiology and Health Services Research Unit, CMN Siglo XXI, Mexican Social Security Institute, Mexico City, Mexico
| | - Ingrid Patricia Martinez-Vega
- Epidemiology and Health Services Research Unit, CMN Siglo XXI, Mexican Social Security Institute, Mexico City, Mexico
| | | | - Felicia Knaul
- Sylvester Comprehensive Cancer Centre, University of Miami, Miami, Florida, USA
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, USA
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
- Tómatelo a Pecho, Mexico City, CDMX, Mexico
- Fundación Mexicana para la Salud, Mexico City, CDMX, Mexico
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19
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Bernal Lara P, Savedoff WD, García Agudelo MF, Bernal C, Goyeneche L, Sorio R, Pérez-Cuevas R, da Rocha MG, Shibata LG, San Roman Vucetich C, Bauhoff S. Disruption Of Non-COVID-19 Health Care In Latin America During The Pandemic: Effects On Health, Lessons For Policy. Health Aff (Millwood) 2023; 42:1657-1666. [PMID: 38048496 DOI: 10.1377/hlthaff.2023.00720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
COVID-19 had severe direct and indirect effects on health and well-being in Latin America. To understand the extent to which disruptions among non-COVID-19-related health services affected population health, we used administrative data from the period 2015-21 to examine public hospital discharges and mortality for conditions amenable to health care in four Latin American countries: Brazil, Ecuador, Mexico, and Peru. Between March 2020 and December 2021, hospitalization rates for these conditions declined by 28 percent and mortality rates increased by 15 percent relative to prepandemic years. Noncommunicable diseases accounted for 89 percent of this rise in mortality. The poorest states in each country experienced relatively larger increases in mortality. Our results, which focus on the health effects of service disruption, suggest that maintaining health care services in this region during the pandemic could have avoided at least 96,000 deaths. Policies should focus on maintaining essential health care services during emergencies, particularly for patients with noncommunicable diseases, and on minimizing negative consequences by ensuring coordinated and continuous care; leveraging alternative modalities of care, such as telemedicine; broadening the role of nonphysician health care workers; and expanding options for medication delivery.
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Affiliation(s)
- Pedro Bernal Lara
- Pedro Bernal Lara , Inter-American Development Bank, Washington, D.C
| | | | | | - Carolina Bernal
- Carolina Bernal, Inter-American Development Bank, Bogota, Colombia
| | - Laura Goyeneche
- Laura Goyeneche, Inter-American Development Bank, Washington, D.C
| | - Rita Sorio
- Rita Sorio, Inter-American Development Bank, Lima, Peru
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20
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Komasawa M, Aung MN, Nsereko C, Ssekitoleko R, Isono M, Saito K, Nantume J, Shirayama Y, Chandani S, Yuasa M. Impact of Hospital Closure on Patients with Communicable and Non-Communicable Diseases During the COVID-19 Pandemic in Uganda: A Cross-Sectional and Mixed-Methods Study. Risk Manag Healthc Policy 2023; 16:2593-2607. [PMID: 38045563 PMCID: PMC10691269 DOI: 10.2147/rmhp.s419969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/28/2023] [Indexed: 12/05/2023] Open
Abstract
Background The COVID-19 pandemic and its measures have had a profound impact on universal access to health services. We investigated the impact of the closure of the Entebbe Regional Referral Hospital (ERRH) for two years on the accessibility to necessary healthcare among non-COVID-19 patients. Methods This mixed-methods study focused on ERRH patients with tuberculosis (TB), human immunodeficiency virus (HIV), diabetes/hypertension, and mental illness. A quantitative study used a structured-questionnaire with a primary outcome measure to assess the discontinuation of healthcare accessibility. A qualitative study with a focus group discussion (FGD) was conducted on eight patients. Results Of the 202 quantitative survey participants, 17.8% discontinued necessary healthcare due to the ERRH closure, and the discontinuation rates differed by disease: 48.1% of TB patients, 16.0% of HIV patients, 7.8% of diabetes/hypertension patients, and 4.0% of mental health patients (P < 0.001). Almost 90% of the patients reported a worsened health condition, regardless of the disease. Multivariable logistic regression analysis showed that patients with diabetes/hypertension (adjusted odds ratio [AOR], 12.69; 95% confidence interval [CI], 2.57-62.52) and HIV (AOR, 7.52; 95% CI, 1.37-41.27) were more likely to discontinue healthcare than those with mental illness. The factors associated with discontinued healthcare included age ≥50 years vs ≤30 years (AOR, 4.88; 95% CI, 1.07-22.34), and high transportation cost vs low cost (AOR, 3.15; 95% CI, 1.13-8.75). The FGD also identified difficulties in obtaining medication, especially for TB, even though ERRH provided the outreach services. Conclusion Our study revealed that the ERRH closure and lockdowns had an overall profound negative impact on access to healthcare and health conditions. Younger patients and those with TB were the most affected patients. This study provides practical suggestions from the field for policy makers to strengthen universal health access during health crises in Uganda and other sub-Saharan countries.
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Affiliation(s)
- Makiko Komasawa
- Ogata Sadako Research Institute for Peace and Development, Japan International Cooperation Agency, Tokyo, Japan
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Myo Nyein Aung
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Christopher Nsereko
- Department of Internal Medicine, Entebbe Regional Referral Hospital, Entebbe, Uganda
| | | | - Mitsuo Isono
- Department of Human Development, Japan International Cooperation Agency, Tokyo, Japan
| | - Kiyoko Saito
- Ogata Sadako Research Institute for Peace and Development, Japan International Cooperation Agency, Tokyo, Japan
| | - Jesca Nantume
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Yoshihisa Shirayama
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Shrestha Chandani
- Ogata Sadako Research Institute for Peace and Development, Japan International Cooperation Agency, Tokyo, Japan
| | - Motoyuki Yuasa
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan
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21
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Heunis C, Chikobvu P, Muteba M, Kigozi-Male G, Engelbrecht M, Mushori P. Impact of COVID-19 on selected essential public health services - lessons learned from a retrospective record review in the Free State, South Africa. BMC Health Serv Res 2023; 23:1244. [PMID: 37951875 PMCID: PMC10640739 DOI: 10.1186/s12913-023-10166-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND In an attempt to discern lessons to improve future pandemic responses, this study measured the effects of the COVID-19 pandemic on essential public health services (EPHSs) related to primary health care (PHC) and outpatient department (OPD) utilisation, antiretroviral treatment (ART) commencement, drug-susceptible tuberculosis (DS-TB) confirmation and treatment commencement, and Bacillus Calmette-Guérin (BCG) coverage, in the Free State province of South Africa during January 2019 to March 2021. METHODS A pre-post study design comparing EPHS performance between 2019 and 2020/21 was employed. Routinely collected data were analysed. An interrupted time series analysis was used to measure changes in service use and outcomes from January 2019 to March 2021. Median changes were compared using Wilcoxon rank-sum tests. A 5% statistical significance level was considered. RESULTS Over the study period, the median values for the annual number of PHC visits was 1.80, 55.30% for non-referred OPD visits, 69.40% for ART commencement, 95.10% and 18.70% for DS-TB confirmation and treatment commencement respectively, and 93.70% for BCG coverage. While BCG coverage increased by 5.85% (p = 0.010), significant declines were observed in PHC utilisation (10.53%; p = 0.001), non-referred OPD visits (12.05%; p < 0.001), and ART commencement (9.53%; p = 0.017) rates. Given the importance of PHC in addressing a new pandemic, along with the existing HIV and TB epidemics - as well as the entire quadruple burden of disease - in South Africa, the finding that the PHC utilisation rate statistically significantly decreased in the Free State post-COVID-19 commencement is particularly concerning. CONCLUSIONS The lessons learned from this retrospective review attest to a measure of resilience in EPHS delivery in the Free State in as far as a significant hike in BCG vaccination over the study period, 2019-2020/21 was observed. As evidenced by a decline in PHC service utilisation and the decreased numbers of new patients commencing ART, we also learned that EPHS delivery in the province was fragile.
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Affiliation(s)
- Christo Heunis
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa.
| | - Perpetual Chikobvu
- Free State Department of Health, Bloemfontein, South Africa
- Department of Community Health, University of the Free State, Bloemfontein, South Africa
| | - Michel Muteba
- World Health Organization, Bloemfontein, South Africa
| | - Gladys Kigozi-Male
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Michelle Engelbrecht
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
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22
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Afolabi RF, Salawu MM, Bamgboye EA, Bello S, Adebowale AS, Dairo MD, Kabwama SN, Wanyana I, Kizito S, Ndejjo R, Wanyenze RK, Fawole OI. Regional differences in the utilisation of antenatal care and skilled birth attendant services during the COVID-19 pandemic in Nigeria: an interrupted time series analysis. BMJ Glob Health 2023; 8:e012464. [PMID: 37865400 PMCID: PMC10603444 DOI: 10.1136/bmjgh-2023-012464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/01/2023] [Indexed: 10/23/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has had a substantial negative impact on the utilisation of essential health services (EHS) globally, especially in resource-limited settings such as Nigeria. High maternal deaths associated with low access to and utilisation of EHS such as antenatal care (ANC) and skilled birth attendants (SBAs) remain a concern during the COVID-19 era. The study assessed the COVID-19 pandemic effects on ANC and SBA utilisation across regions in Nigeria. METHODS Monthly data on ANC and SBA between January 2017 and July 2021 were obtained from the Federal Ministry of Health database. An interrupted time-series analysis, implemented using the Prophet model, was conducted to compare the regional variation of outcomes during the COVID-19 pandemic. Average percentage changes (PC) between the observed and predicted outcomes including their 95% CI were reported. RESULTS From March 2020 to July 2021, the number of ANC visits was significantly lower than expected by a 16%-43% change in five of the six regions in Nigeria. The highest significant reduction was in North-West (PC=-43.4; 95% CI: -52.6 to -34.1) and the least in South-West (PC=-15.5; 95% CI: -24.8 to -6.1), with no significant change in the South-East. The number of deliveries by SBA was significantly lower than expected by a 18%-43% change in all the regions (p<0.01). North-East (PC=-43.3; 95% CI: -51.7 to -34.9) and South-West (PC=-18.3; 95% CI: -25.2 to -11.5), respectively, had the highest and the least decline in SBA utilisation. Overall, ANC and SBA patterns of change were relatively similar across the north-south divide though the change effect was considerably pronounced in the north. CONCLUSION There was a substantial reduction in ANC and SBA utilisation due to the COVID-19 pandemic in Nigeria, especially in the northern regions. Targeted and contextually relevant interventions should be implemented to alleviate the impact of emergency response on access to EHS and promote access to care during the pandemic.
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Affiliation(s)
- Rotimi Felix Afolabi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mobolaji M Salawu
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Eniola A Bamgboye
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Segun Bello
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayo Stephen Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Population and Health Research Entity, Faculty of Humanity, North-West University, Mafikeng, South Africa
| | - Magbagbeola David Dairo
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Steven N Kabwama
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Irene Wanyana
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Susan Kizito
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Olufunmilayo Ibitola Fawole
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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23
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Haakenstad A, Bintz C, Knight M, Bienhoff K, Chacon-Torrico H, Curioso WH, Dieleman JL, Gage A, Gakidou E, Hay SI, Henry NJ, Hernández-Vásquez A, Méndez Méndez JS, Villarreal HJ, Lozano R. Catastrophic health expenditure during the COVID-19 pandemic in five countries: a time-series analysis. Lancet Glob Health 2023; 11:e1629-e1639. [PMID: 37734805 PMCID: PMC10522803 DOI: 10.1016/s2214-109x(23)00330-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/12/2023] [Accepted: 07/10/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The COVID-19 pandemic disrupted health systems in 2020, but it is unclear how financial hardship due to out-of-pocket (OOP) health-care costs was affected. We analysed catastrophic health expenditure (CHE) in 2020 in five countries with available household expenditure data: Belarus, Mexico, Peru, Russia, and Viet Nam. In Mexico and Peru, we also conducted an analysis of drivers of change in CHE in 2020 using publicly available data. METHODS In this time-series analysis, we defined CHE as when OOP health-care spending exceeds 10% of consumption expenditure. Data for 2004-20 were obtained from individual and household level survey microdata (available for Mexico and Peru only), and tabulated data from the National Statistical Committee of Belarus and the World Bank Health Equity and Financial Protection Indicator database (for Viet Nam and Russia). We compared 2020 CHE with the CHE predicted from historical trends using an ensemble model. This method was also used to assess drivers of CHE: insurance coverage, OOP expenditure, and consumption expenditure. Interrupted time-series analysis was used to investigate the role of stay-at-home orders in March, 2020 in changes in health-care use and sector (ie, private vs public). FINDINGS In Mexico, CHE increased to 5·6% (95% uncertainty interval [UI] 5·1-6·2) in 2020, higher than predicted (3·2%, 2·5-4·0). In Belarus, CHE was 13·5% (11·8-15·2) in 2020, also higher than predicted (9·7%, 7·7-11·3). CHE was not different than predicted by past trends in Russia, Peru, and Viet Nam. Between March and April, 2020, health-care visits dropped by 4·6 (2·6-6·5) percentage points in Mexico and by 48·3 (40·6-56·0) percentage points in Peru, and the private share of health-care visits increased by 7·3 (4·3-10·3) percentage points in Mexico and by 20·7 (17·3-24·0) percentage points in Peru. INTERPRETATION In three of the five countries studied, health systems either did not protect people from the financial risks of health care or did not maintain health-care access in 2020, an indication of health systems failing to maintain basic functions. If the 2020 response to the COVID-19 pandemic accelerated shifts to private health-care use, policies to cover costs in that sector or motivate patients to return to the public sector are needed to maintain financial risk protection. FUNDING The Bill & Melinda Gates Foundation.
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Affiliation(s)
- Annie Haakenstad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA.
| | - Corinne Bintz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Megan Knight
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kelly Bienhoff
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Horacio Chacon-Torrico
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Faculty of Health Sciences, Southern Scientific University, Lima, Peru
| | - Walter H Curioso
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA; Vice Rectorate for Research, Continental University, Lima, Peru
| | - Joseph L Dieleman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Anna Gage
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Nathaniel J Henry
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Akram Hernández-Vásquez
- Center of Excellence in Economic and Social Research in Health, San Ignacio de Loyola University, Lima, Peru
| | - Judith S Méndez Méndez
- School of Government and Public Transformation, Monterrey Institute of Technology, Mexico City, Mexico
| | - Héctor J Villarreal
- School of Government and Public Transformation, Monterrey Institute of Technology, Mexico City, Mexico
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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24
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Endehabtu BF, Angaw DA, Gonete TZ, Jisso M, Abera N, Alemayehu A, Fikre R, Abdissa B, Umer A, Kebede M, Mohammed H, Yazie B, Dessie K, Tamiso A, Sime H, Yesuf EA, Gurmu KK, Tilahun B. Availability of Maternal, Newborn care and Child Health Services at Primary Health Care Unit during COVID-19 Outbreak in Ethiopia. Ethiop J Health Sci 2023; 33:117-126. [PMID: 38352671 PMCID: PMC10859739 DOI: 10.4314/ejhs.v33i2.5s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/09/2023] [Indexed: 02/16/2024] Open
Abstract
Background The COVID-19 pandemic is putting a pressure on global health systems. The disruption of essential health services (EHS) has an impact on the health of mothers, neonate and children in developing countries. Therefore, the main aim of this study was assessing the availability of Maternal, Newborn care and Child health (MNCHS) services at primary health care unit during COVID-19 outbreak. Methods A cross-sectional survey was conducted in five regions of Ethiopia in 2021. Descriptive analyses were undertaken using STATA 16 software and the results presented using tables and different graphs. A continuity of EHS assessment tool adopted from WHO was used for data collection. Result During COVID -19 pandemic, 30 (69.8%) of woreda health offices, 52 (56.5%) of health centers (HCs), 7 (44.4%) of hospitals, and 165 (48%) of health posts (HPs) had a defined list of EHS. In comparison with other EHS, family planning is the least available service in all regions. At HPs level care for sick children and antenatal care (ANC) were available at 59.1 and 58.82% respectively. Except immunization services at SNNP, all other maternal, newborn, and child health EHS were not available to all HPs at full scale. Conclusion Immunization services were most available, while ANC and care for sick children were least available during COVID-19 at the HPs level. There was regional variation in MNCH EHS service availability at all levels.
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Affiliation(s)
- Berhanu Fikadie Endehabtu
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
- eHealthLab Ethiopia, University of Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
| | - Tajebew Zayede Gonete
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
| | - Meskerem Jisso
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | - Netsanet Abera
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | | | - Rekiku Fikre
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | - Biru Abdissa
- Jimma University, Institute of Health, Jimma, Ethiopia
| | - Abdurezak Umer
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Mesfin Kebede
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Hussen Mohammed
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Bekele Yazie
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Kassahun Dessie
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
| | - Alemu Tamiso
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | - Habtamu Sime
- Jimma University, Institute of Health, Jimma, Ethiopia
| | | | - Kassu Ketema Gurmu
- World Health Organization Country Office for Ethiopia, Universal Health Coverage/Life Course, Health System Strengthening Team, Ethiopia
| | - Binyam Tilahun
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
- eHealthLab Ethiopia, University of Gondar, Ethiopia
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25
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Shami E, Gholipour K, Naghibi D, Azami-Aghdash S. The roles and challenges of the primary health care systems in epidemic management: a scoping review. Prim Health Care Res Dev 2023; 24:e55. [PMID: 37705282 PMCID: PMC10539738 DOI: 10.1017/s1463423623000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/21/2023] [Accepted: 08/02/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND AND AIM During the early stage of pandemics, primary health care (PHC) is the first point of contact with the health system for people. This study aimed to find the leading roles and challenges of the PHC system in dealing with the outbreak of infectious diseases. METHODS The current scoping review was conducted in 2022 using the Arkesy and O'Malley framework. A bibliographic search was conducted in PubMed, Web of Science, and Scopus databases. Following a Google Scholar search, a manual search in some journals, reference checks for articles, and a review of organizational reports, websites, and other sources of information were also conducted. Data were analyzed using the content-analysis method. FINDINGS Finally, 65 documents (42 articles and 23 reports, books, and news) were included in the study. Initially, 626 codes were extracted, and 132 final codes were categorized into eight main themes and 44 sub-themes. The main themes for the roles of PHC included: service provision, education and knowledge, surveillance, access, coordination and communication, management and leadership, infrastructure change and rapid preparation, and patient and community management. Regarding the challenges faced by PHC in the epidemic of infectious diseases, 24 key challenges were identified and categorized into four major areas. CONCLUSIONS Based on the results of the present study, there is a need for further studies to formulate and theorize the specific roles of PHC in managing infectious disease epidemics. The results of this study can be utilized by researchers and officials to inform their efforts in addressing this purpose.
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Affiliation(s)
- Elham Shami
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamal Gholipour
- Social Determinants of Health Research Center, Department of Health Service Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Deniz Naghibi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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26
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Lee R, Xu W, Dozier M, McQuillan R, Theodoratou E, Figueroa J. A rapid review of COVID-19's global impact on breast cancer screening participation rates and volumes from January to December 2020. eLife 2023; 12:e85680. [PMID: 37698273 PMCID: PMC10569787 DOI: 10.7554/elife.85680] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/20/2023] [Indexed: 09/13/2023] Open
Abstract
COVID-19 has strained population breast mammography screening programs that aim to diagnose and treat breast cancers earlier. As the pandemic has affected countries differently, we aimed to quantify changes in breast screening volume and uptake during the first year of COVID-19 . We systematically searched Medline, the World Health Organization (WHO) COVID-19 database, and governmental databases. Studies covering January 2020 to March 2022 were included. We extracted and analyzed data regarding study methodology, screening volume, and uptake. To assess for risk of bias, we used the Joanna Briggs Institute (JBI) Critical Appraisal Tool. Twenty-six cross-sectional descriptive studies (focusing on 13 countries/nations) were included out of 935 independent records. Reductions in screening volume and uptake rates were observed among eight countries. Changes in screening participation volume in five nations with national population-based screening ranged from -13 to -31%. Among two countries with limited population-based programs, the decline ranged from -61 to -41%. Within the USA, population participation volumes varied ranging from +18 to -39%, with suggestion of differences by insurance status (HMO, Medicare, and low-income programs). Almost all studies had high risk of bias due to insufficient statistical analysis and confounding factors. The extent of COVID-19-induced reduction in breast screening participation volume differed by region and data suggested potential differences by healthcare setting (e.g., national health insurance vs. private healthcare). Recovery efforts should monitor access to screening and early diagnosis to determine whether prevention services need strengthening to increase the coverage of disadvantaged groups and reduce disparities.
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Affiliation(s)
- Reagan Lee
- Usher Institute, University of EdinburghEdinburghUnited Kingdom
| | - Wei Xu
- Usher Institute, University of EdinburghEdinburghUnited Kingdom
- Centre for Global Health, University of EdinburghEdinburghUnited Kingdom
| | - Marshall Dozier
- Information Services, University of EdinburghEdinburghUnited Kingdom
| | - Ruth McQuillan
- Usher Institute, University of EdinburghEdinburghUnited Kingdom
| | - Evropi Theodoratou
- Centre for Global Health, University of EdinburghEdinburghUnited Kingdom
| | - Jonine Figueroa
- Centre for Global Health, University of EdinburghEdinburghUnited Kingdom
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteBethesdaUnited States
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Dalton M, Sanderson B, Robinson LJ, Homer CSE, Pomat W, Danchin M, Vaccher S. Impact of COVID-19 on routine childhood immunisations in low- and middle-income countries: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002268. [PMID: 37611014 PMCID: PMC10446229 DOI: 10.1371/journal.pgph.0002268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/17/2023] [Indexed: 08/25/2023]
Abstract
Routine vaccines are critical to child health. The COVID-19 pandemic significantly impacted essential health services, particularly in low-and middle-income countries (LMICs). We reviewed literature to determine the impact of COVID-19 on service delivery and uptake of routine childhood immunisation in LMICs. We reviewed papers published between March 2020 and June 2022 using a scoping review framework, and assessed each paper across the World Health Organisation health system strengthening framework. Our search identified 3,471 publications; 58 studies were included. One-quarter of studies showed routine childhood immunisation coverage declined (10% to 38%) between 2019 to 2021. Declines in the number of vaccine doses administered (25% to 51%), timeliness (6.2% to 34%), and the availability of fixed and outreach services were also reported. Strategies proposed to improve coverage included catch-up activities, strengthening supply chain and outreach services. Re-focusing efforts on increasing coverage is critical to improve child health and reduce the likelihood of disease outbreaks.
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Affiliation(s)
| | | | - Leanne J. Robinson
- Burnet Institute, Melbourne, Victoria, Australia
- Population Health & Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | | | - William Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Margie Danchin
- Department of General Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Binyaruka P, Mtenga S. Catastrophic health care spending in managing type 2 diabetes before and during the COVID-19 pandemic in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002180. [PMID: 37607181 PMCID: PMC10443863 DOI: 10.1371/journal.pgph.0002180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/20/2023] [Indexed: 08/24/2023]
Abstract
COVID-19 disrupted health care provision and access and reduced household income. Households with chronically ill patients are more vulnerable to these effects as they access routine health care. Yet, a few studies have analysed the effect of COVID-19 on household income, health care access costs, and financial catastrophe due to health care among patients with type 2 diabetes (T2D), especially in developing countries. This study fills that knowledge gap. We used data from a cross-sectional survey of 500 people with T2D, who were adults diagnosed with T2D before COVID-19 in Tanzania (March 2020). Data were collected in February 2022, reflecting the experience before and during COVID-19. During COVID-19, household income decreased on average by 16.6%, while health care costs decreased by 0.8% and transport costs increased by 10.6%. The overall financing burden for health care and transport relative to household income increased by 32.1% and 45%, respectively. The incidences of catastrophic spending above 10% of household income increased by 10% (due to health care costs) and by 55% (due to transport costs). The incidences of catastrophic spending due to health care costs were higher than transport costs, but the relative increase was higher for transport than health care costs (10% vs. 55% change from pre-COVID-19). The likelihood of incurring catastrophic health spending was lower among better educated patients, with health insurance, and from better-off households. COVID-19 was associated with reduced household income, increased transport costs, increased financing burden and financial catastrophe among patients with T2D in Tanzania. Policymakers need to ensure financial risk protection by expanding health insurance coverage and removing user fees, particularly for people with chronic illnesses. Efforts are also needed to reduce transport costs by investing more in primary health facilities to offer quality services closer to the population and engaging multiple sectors, including infrastructure and transportation.
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Affiliation(s)
- Peter Binyaruka
- Department of Health System, Impact Evaluation, and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Sally Mtenga
- Department of Health System, Impact Evaluation, and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
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Peters MA, Ahmed T, Azais V, Amor Fernandez P, Baral P, Drouard S, Neill R, Bachir K, Bassounda P, Dube Q, Flora S, Montufar E, Nzelu C, Tassembedo M, Sanford Wesseh C, Alam B, Rusatira JDD, Hashemi T, Karibwami AD, Moscosco V, Ogunlayi M, Ortiz de Zunigalo T, Ruel-Bergeron J, Sieleunou I, Hansen PM, Shapira G. Resilience of front-line facilities during COVID-19: evidence from cross-sectional rapid surveys in eight low- and middle-income countries. Health Policy Plan 2023; 38:789-798. [PMID: 37256762 PMCID: PMC11318646 DOI: 10.1093/heapol/czad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/17/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
Responsive primary health-care facilities are the foundation of resilient health systems, yet little is known about facility-level processes that contribute to the continuity of essential services during a crisis. This paper describes the aspects of primary health-care facility resilience to coronavirus disease 2019 (COVID-19) in eight countries. Rapid-cycle phone surveys were conducted with health facility managers in Bangladesh, Burkina Faso, Chad, Guatemala, Guinea, Liberia, Malawi and Nigeria between August 2020 and December 2021. Responses were mapped to a validated health facility resilience framework and coded as binary variables for whether a facility demonstrated capacity in eight areas: removing barriers to accessing services, infection control, workforce, surge capacity, financing, critical infrastructure, risk communications, and medical supplies and equipment. These self-reported capacities were summarized nationally and validated with the ministries of health. The analysis of service volume data determined the outcome: maintenance of essential health services. Of primary health-care facilities, 1,453 were surveyed. Facilities maintained between 84% and 97% of the expected outpatient services, except for Bangladesh, where 69% of the expected outpatient consultations were conducted between March 2020 and December 2021. For Burkina Faso, Chad, Guatemala, Guinea and Nigeria, critical infrastructure was the largest constraint in resilience capabilities (47%, 14%, 51%, 9% and 29% of facilities demonstrated capacity, respectively). Medical supplies and equipment were the largest constraints for Liberia and Malawi (15% and 48% of facilities demonstrating capacity, respectively). In Bangladesh, the largest constraint was workforce and staffing, where 44% of facilities experienced moderate to severe challenges with human resources during the pandemic. The largest constraints in facility resilience during COVID-19 were related to health systems building blocks. These challenges likely existed before the pandemic, suggesting the need for strategic investments and reforms in core capacities of comprehensive primary health-care systems to improve resilience to future shocks.
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Affiliation(s)
- Michael A Peters
- The Global Financing Facility for Women, Children, and
Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Tashrik Ahmed
- The Global Financing Facility for Women, Children, and
Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Viviane Azais
- The Global Financing Facility for Women, Children, and
Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Pablo Amor Fernandez
- The Global Financing Facility for Women, Children, and
Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Prativa Baral
- The Global Financing Facility for Women, Children, and
Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Salomé Drouard
- The Global Financing Facility for Women, Children, and
Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Rachel Neill
- The Global Financing Facility for Women, Children, and
Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Kante Bachir
- Ministère de la Sante de la Guinea, Blvd de Commerce,
Conakry, Guinea
| | | | - Queen Dube
- Ministry of Health of Malawi, Capital Hill Circle, Lilongwe,
Malawi
| | - Sabrina Flora
- Government of Bangladesh Ministry of Health and Family
Welfare, Abdul Gani Road, Dhaka 1000, Bangladesh
| | - Edwin Montufar
- Ministerio de Salud Pública y Asistencia Social de Guatemala,
Avenida 3-45, Cdad. de Guatemala, Guatemala
| | - Charles Nzelu
- Federal Ministry of Health of Nigeria, Federal Secretariat
Complex, Phase III, Shehu Shagari Way, Central Business District, Abuja, Nigeria
| | - Mahamadi Tassembedo
- Ministère de la Santé et de l’Hygiène Publique du Burkina
Faso, Ave du Burkina, Koulouba, Ouagadougou, Burkina Faso
| | | | - Bushra Alam
- The World Bank, 1818 H St NW, Washington, DC 20433, USA
| | - Jean de Dieu Rusatira
- The Global Financing Facility for Women, Children, and
Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Tawab Hashemi
- The Global Financing Facility for Women, Children, and
Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Alain-Desire Karibwami
- The Global Financing Facility for Women, Children, and
Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Virginia Moscosco
- The Global Financing Facility for Women, Children, and
Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Munirat Ogunlayi
- The Global Financing Facility for Women, Children, and
Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Tania Ortiz de Zunigalo
- The Global Financing Facility for Women, Children, and
Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Julie Ruel-Bergeron
- The Global Financing Facility for Women, Children, and
Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Isidore Sieleunou
- The Global Financing Facility for Women, Children, and
Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Peter M Hansen
- The Global Financing Facility for Women, Children, and
Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Gil Shapira
- The World Bank, 1818 H St NW, Washington, DC 20433, USA
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Lozano-Corona R, Reyes-Monroy JA, Lara-González V, Anaya-Ayala JE, Dardik A, Hinojosa CA. Revascularization prevents amputation among patients with diabetic foot during the COVID-19 era. Vascular 2023; 31:729-736. [PMID: 35311392 DOI: 10.1177/17085381221079108] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has led to significant changes in healthcare systems that impact the management of chronic diseases such as diabetic foot (DF). We hypothesized that lack of access to healthcare would increase the severity of disease and lead to worse outcomes. METHODS The medical records of patients with DF were reviewed to determine demographic data and outcomes including wound healing, major amputation (MA), and death. Groups were divided into the pre-COVID-19 era (15 March 2019-15 March 2020) and the COVID-19 era (16 March 2020-16 March 2021); multivariable logistic analysis was performed to identify risk factors for MA. RESULTS 261 patients with DF were included, 163 in the pre-COVID-19 era and 98 during the COVID-19 era. Patients in the COVID-19 presented with increased cardiovascular disease (19 vs 7%, p = 0.01), increased mean HbA1C (9.1 ± 2.1 vs 8.2 ± 2.1, p = 0.008) and higher WIFI-IV stage (78 vs 53%, p ≤ 0.0001). Patients with DF in the COVID-19 era were more likely to require MA (41 vs 21%, p ≤ 0.0001). Revascularization (OR = 0.12; 95% CI, 0.038-0.38) was a protective factor to reduce MA. CONCLUSIONS MA among DF patients increased two-fold during the COVID-19 era. Revascularization avoids MA in diabetic patients even during the COVID-19 pandemic, suggesting that revascularization should be performed when possible.
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Affiliation(s)
- Rodrigo Lozano-Corona
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
- Department of Surgery, Hospital Regional Licenciado Adolfo Lopez Mateos (Instituto de Seguridad y Servicios de Salud de los Trabajadores del Estado), Mexico City, Mexico
| | - José A Reyes-Monroy
- Department of Surgery, Hospital Regional Licenciado Adolfo Lopez Mateos (Instituto de Seguridad y Servicios de Salud de los Trabajadores del Estado), Mexico City, Mexico
| | - Viridiana Lara-González
- Department of Surgery, Hospital Regional Licenciado Adolfo Lopez Mateos (Instituto de Seguridad y Servicios de Salud de los Trabajadores del Estado), Mexico City, Mexico
| | - Javier E Anaya-Ayala
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Carlos A Hinojosa
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
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Patel S, Trujillo Rivera EA, Raman VK, Faselis C, Wang V, Fink JC, Roseman JM, Morgan CJ, Zhang S, Sheriff HM, Heimall MS, Wu WC, Zeng-Treitler Q, Ahmed A. Impact of the COVID-19 Pandemic on the Provision of Dialysis Service and Mortality in Veterans Receiving Maintenance Hemodialysis in the VA: An Interrupted Time-Series Analysis. Am J Nephrol 2023; 54:508-515. [PMID: 37524062 PMCID: PMC10959175 DOI: 10.1159/000532105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION According to the US Renal Data System (USRDS), patients with end-stage kidney disease (ESKD) on maintenance dialysis had higher mortality during early COVID-19 pandemic. Less is known about the effect of the pandemic on the delivery of outpatient maintenance hemodialysis and its impact on death. We examined the effect of pandemic-related disruption on the delivery of dialysis treatment and mortality in patients with ESKD receiving maintenance hemodialysis in the Veterans Health Administration (VHA) facilities, the largest integrated national healthcare system in the USA. METHODS Using national VHA electronic health records data, we identified 7,302 Veterans with ESKD who received outpatient maintenance hemodialysis in VHA healthcare facilities during the COVID-19 pandemic (February 1, 2020, to December 31, 2021). We estimated the average change in the number of hemodialysis treatments received and deaths per 1,000 patients per month during the pandemic by conducting interrupted time-series analyses. We used seasonal autoregressive moving average (SARMA) models, in which February 2020 was used as the conditional intercept and months thereafter as conditional slope. The models were adjusted for seasonal variations and trends in rates during the pre-pandemic period (January 1, 2007, to January 31, 2020). RESULTS The number (95% CI) of hemodialysis treatments received per 1,000 patients per month during the pre-pandemic and pandemic periods were 12,670 (12,525-12,796) and 12,865 (12,729-13,002), respectively. Respective all-cause mortality rates (95% CI) were 17.1 (16.7-17.5) and 19.6 (18.5-20.7) per 1,000 patients per month. Findings from SARMA models demonstrate that there was no reduction in the dialysis treatments delivered during the pandemic (rate ratio: 0.999; 95% CI: 0.998-1.001), but there was a 2.3% (95% CI: 1.5-3.1%) increase in mortality. During the pandemic, the non-COVID hospitalization rate was 146 (95% CI: 143-149) per 1,000 patients per month, which was lower than the pre-pandemic rate of 175 (95% CI: 173-176). In contrast, there was evidence of higher use of telephone encounters during the pandemic (3,023; 95% CI: 2,957-3,089), compared with the pre-pandemic rate (1,282; 95% CI: 1,241-1,324). CONCLUSIONS We found no evidence that there was a disruption in the delivery of outpatient maintenance hemodialysis treatment in VHA facilities during the COVID-19 pandemic and that the modest rise in deaths during the pandemic is unlikely to be due to missed dialysis.
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Affiliation(s)
- Samir Patel
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, George Washington University, Washington, DC, USA
| | - Eduardo A. Trujillo Rivera
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Pediatrics, Georgetown University, Washington, DC, USA
| | - Venkatesh K. Raman
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - Charles Faselis
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, George Washington University, Washington, DC, USA
- Department of Medicine, Uniformed Services University, Washington, DC, USA
| | - Virginia Wang
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Departments of Population Health Sciences and Medicine, Duke University, Baltimore, MD, USA
| | - Jeffrey C. Fink
- Veterans Affairs Medical Center, Baltimore, MD, USA
- Department of Medicine, University of Maryland, Baltimore, MD, USA
| | - Jeffrey M. Roseman
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Charity J. Morgan
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sijian Zhang
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
| | - Helen M. Sheriff
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- Clinical Research and Leadership and Biomedical Informatics Center, George Washington University, Washington, DC, USA
| | - Michael S. Heimall
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
| | - Wen-Chih Wu
- Medical service, Veterans Affairs Medical Center, Providence, RI, USA
- Department of Medicine, Brown University, Providence, RI, USA
| | - Qing Zeng-Treitler
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- Clinical Research and Leadership and Biomedical Informatics Center, George Washington University, Washington, DC, USA
| | - Ali Ahmed
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, George Washington University, Washington, DC, USA
- Department of Medicine, Georgetown University, Washington, DC, USA
- Clinical Research and Leadership and Biomedical Informatics Center, George Washington University, Washington, DC, USA
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Dehghani Tafti A, Fatehpanah A, Salmani I, Bahrami MA, Tavangar H, Fallahzadeh H, Tehrani AA, Bahariniya S, Tehrani GA. COVID-19 pandemic has disrupted the continuity of care for chronic patients: evidence from a cross-sectional retrospective study in a developing country. BMC PRIMARY CARE 2023; 24:137. [PMID: 37393225 PMCID: PMC10314396 DOI: 10.1186/s12875-023-02086-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Any disruption in continuity of care for patients with chronic conditions can lead to poor outcomes for the patients as well as great damage for the community and the health system. This study aims to determine the continuity of care for patients with chronic conditions such as hypertension and diabetes during COVID-19 pandemic. METHODS Through a cross-sectional retrospective study, data registered in six health centers in Yazd, Iran were analyzed. Data included the number of patients with chronic conditions (hypertension and diabetes) and average daily admission during a year before COVID-19 pandemic and the similar period after COVID-19 outbreak. The experience of continuity of care was assessed applying a validated questionnaire from a sample of 198 patients. Data analysis was done using SPSS version 25. Descriptive statistics, independent T-Test and Multivariable regression were used for analysis. FINDINGS Results indicate that both visit load of the patients with chronic conditions (hypertension and diabetes) and their average daily admission were decreased significantly during a year after COVID-19 pandemic compared to the similar period before COVID-19 outbreak. The moderate average score of the patients` experience towards continuity of care during the pandemic was also reported. Regression analysis showed that age for the diabetes patients and insurance status for the hypertension patients affect the COC mean scores. CONCLUSION COVID-19 pandemic causes serious decline in the continuity of care for patients with chronic conditions. Such a deterioration not only can lead to make these patients` condition worse in a long-term period but also it can make irreparable damages to the whole community and the health system. To make the health systems resilient particularly in disasters, serious attention should be taken into consideration among them, developing the tele-health technologies, improving the primary health care capacity, designing the applied responsive models of continuity of care, making multilateral participations and inter-sectoral collaborations, allocating sustainable resources, and enabling the patients with selfcare skills are more highlighted.
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Affiliation(s)
- Abbasali Dehghani Tafti
- Department of Health in Disater and Emergencies, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Azadeh Fatehpanah
- Department of Health in Disater and Emergencies, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ibrahim Salmani
- Department of Health in Disater and Emergencies, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Amin Bahrami
- Healthcare Management Department, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossien Tavangar
- School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Shahid Sadoughi University of Medical Science, Yazd, Iran
| | - Hossien Fallahzadeh
- Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Ahmadi Tehrani
- Pharmaceutical Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sajjad Bahariniya
- Health Services Management Department, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Chabba R, Allen C, Yaqub N, Lattof SR, Ganesan R, Maliqi B. Delivering quality care to all mothers and newborns requires governments to engage the private sector. BMJ 2023; 381:e071650. [PMID: 37147005 PMCID: PMC10161077 DOI: 10.1136/bmj-2022-071650] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Affiliation(s)
- Rajat Chabba
- Market Solutions, Jhpiego, Baltimore, Maryland, USA
| | | | - Nuhu Yaqub
- Department of Maternal, Newborn, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | | | | | - Blerta Maliqi
- Department of Maternal, Newborn, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
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Sharma S, Singh L, Yadav J, Gupta U, Singh KJ, Rao MVV. Impact of COVID-19 on utilization of maternal and child health services in India: Health management information system data analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023; 21:101285. [PMID: 37064822 PMCID: PMC10063524 DOI: 10.1016/j.cegh.2023.101285] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 02/23/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Background/Objectives Studies globally have documented the impact of COVID 19 on maternal and newborn health services. This study assesses the impact of COVID-19 on essential maternal and child health (MCH) services in India based on the national Health Management Information System (HMIS). Methods Present retrospective study used secondary data analysis upon the routinely collected data accessed from Health Management Information System. Microdata on maternal and newborn indicators was extracted for all states between April and June during 2019, 2020 and 2021. Relative change for each indicator were taken into consideration for the year 2020 and 2021; with respect to the outcomes in 2019. Results Compared to 2019, antenatal care registrations saw a decline in all states for both periods in 2020 and 2021 except for Sikkim, Telangana, Maharashtra and Andhra Pradesh. Similarly, the relative changes in 2019 pertaining to the proportion of pregnant women provided with emergency obstetric care for pregnancy complications registered a decline in all states except for Himachal Pradesh, Telangana and Arunachal Pradesh. There was a decreasing trend noted in institutional deliveries in 2020 and 2021 among all major states. However, an increasing trend was seen in the number of immunization sessions held among all major states. Conclusion The study demonstrates a disruption in service delivery during the lockdown period in the first wave and the peak of the second wave. Further qualitative studies need to be undertaken to generate evidence for maintaining continuum of care during a pandemic situation.
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Affiliation(s)
- Saurabh Sharma
- ICMR-National Institute of Medical Statistics, Ansari Nagar, New Delhi, 110029, India
| | - Lucky Singh
- ICMR-National Institute of Medical Statistics, Ansari Nagar, New Delhi, 110029, India
| | - Jeetendra Yadav
- ICMR-National Institute of Medical Statistics, Ansari Nagar, New Delhi, 110029, India
| | - Urvashi Gupta
- ICMR-National Institute of Medical Statistics, Ansari Nagar, New Delhi, 110029, India
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López EP, González S, Sánchez M. Educational intervention for the main caregiver of primiparous women to promote breastfeeding and the association between prolactin and nutritional parameters. J Glob Health 2023; 13:04046. [PMID: 37083003 PMCID: PMC10119807 DOI: 10.7189/jogh.13.04046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Background In the last two years, breastfeeding rates have experienced a notable decline worldwide. Only 46% of women breastfeed their children, the figure being much lower in primiparous women. Breastfed milk is the ideal food for babies; its benefits for the health of mothers and babies are scientifically proven. Several studies show that babies who are not breastfed have a higher risk of getting sick. This fact gives rise to an important public health problem. The aim of this paper is to describe the association between presence of the caregiver in health education and increasing rates of breastfeeding. Methods We conducted an observational study (cohort) in a population of primiparous pregnant women (n = 88), and their main caregivers belonging to a region of central Spain. The development, content and implementation of the intervention consisted of: 1) obtaining the blood levels of pregnant women (prolactin, folic acid, vitamin B12 and transferrin) before health education (13-26 weeks of pregnancy), 2) carry out health education with two groups: A (44 pregnant women with caregivers) and B (44 without caregivers), 3) obtain the same blood levels as in the first intervention, 15 days after delivery, and finally the evaluation of the intervention with breastfeeding rates. Results The levels of prolactin (288.57 ± 107.46 nanogrammes per millilitre (ng / ml)), folic acid (16.93 ± 4.09 ng / ml), vitamin B12 (505.05 ± 213.97 picogrammes (pg) / ml) and transferrin (296.82 ± 67.61 milligrammmes per decilitre (mg / dl)) were higher in pregnant women who attended the health education program with a caregiver than in pregnant women who attended alone: prolcoactin (103.61 ± 45.48 ng / ml), folic acid (7.16 ± 5.88 ng / ml), vitamin B12 (160.59 ± 36.92 pg / ml) and transferrin (223.86 ± 44.14 mg / dl). Of the sample size of 44 primiparous people who attended the talks with caregivers, 35 (79.54%) breastfed their babies, while the other 44 primiparous women who attended alone, only seven (15.91%) established breastfeeding successfully. Conclusions The implications for public health research are that the presence of a caregiver in health education programs modifies levels of prolactin, folic acid, vitamin B12, and transferrin, as well as increasing breastfeeding rates.
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Affiliation(s)
- Eva Pilar López
- Doctoral School in translational Medicine San Pablo CEU University, Madrid, Spain
| | - Sergio González
- Department of Nursing, Santa Teresa de Jesus, Catholic University, Avila, Spain
| | - Mercedes Sánchez
- Department of Preventive Medicine and Public Health, Santa Teresa de Jesus, Catholic University, Avila, Spain
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Reddy T, Kapoor NR, Kubota S, Doubova SV, Asai D, Mariam DH, Ayele W, Mebratie AD, Thermidor R, Sapag JC, Bedregal P, Passi-Solar Á, Gordon-Strachan G, Dulal M, Gadeka DD, Mehata S, Margozzini P, Leerapan B, Rittiphairoj T, Kaewkamjornchai P, Nega A, Awoonor-Williams JK, Kruk ME, Arsenault C. Associations between the stringency of COVID-19 containment policies and health service disruptions in 10 countries. BMC Health Serv Res 2023; 23:363. [PMID: 37046260 PMCID: PMC10096103 DOI: 10.1186/s12913-023-09363-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Disruptions in essential health services during the COVID-19 pandemic have been reported in several countries. Yet, patterns in health service disruption according to country responses remain unclear. In this paper, we investigate associations between the stringency of COVID-19 containment policies and disruptions in 31 health services in 10 low- middle- and high-income countries in 2020. METHODS Using routine health information systems and administrative data from 10 countries (Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, South Korea, and Thailand) we estimated health service disruptions for the period of April to December 2020 by dividing monthly service provision at national levels by the average service provision in the 15 months pre-COVID (January 2019-March 2020). We used the Oxford COVID-19 Government Response Tracker (OxCGRT) index and multi-level linear regression analyses to assess associations between the stringency of restrictions and health service disruptions over nine months. We extended the analysis by examining associations between 11 individual containment or closure policies and health service disruptions. Models were adjusted for COVID caseload, health service category and country GDP and included robust standard errors. FINDINGS Chronic disease care was among the most affected services. Regression analyses revealed that a 10% increase in the mean stringency index was associated with a 3.3 percentage-point (95% CI -3.9, -2.7) reduction in relative service volumes. Among individual policies, curfews, and the presence of a state of emergency, had the largest coefficients and were associated with 14.1 (95% CI -19.6, 8.7) and 10.7 (95% CI -12.7, -8.7) percentage-point lower relative service volumes, respectively. In contrast, number of COVID-19 cases in 2020 was not associated with health service disruptions in any model. CONCLUSIONS Although containment policies were crucial in reducing COVID-19 mortality in many contexts, it is important to consider the indirect effects of these restrictions. Strategies to improve the resilience of health systems should be designed to ensure that populations can continue accessing essential health care despite the presence of containment policies during future infectious disease outbreaks.
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Affiliation(s)
- Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu Natal, Durban, South Africa
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Shogo Kubota
- World Health Organization, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Daisuke Asai
- World Health Organization, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | - Damen Haile Mariam
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondimu Ayele
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Anagaw Derseh Mebratie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Roody Thermidor
- Studies and Planning Unit, Ministry of Public Health and Population, Port-Au-Prince, Haiti
| | - Jaime C Sapag
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Bedregal
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Álvaro Passi-Solar
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Mahesh Dulal
- Office of the Member of Federal Parliament Gagan Kumar Thapa, Kathmandu, Nepal
| | | | - Suresh Mehata
- Ministry of Health, Koshi Province, Biratnagar, Nepal
| | - Paula Margozzini
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Borwornsom Leerapan
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Adiam Nega
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Catherine Arsenault
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, USA.
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Ogallo W, Wanyana I, Tadesse GA, Wanjiru C, Akinwande V, Kabwama S, Remy SL, Wachira C, Okwako S, Kizito S, Wanyenze R, Kiwanuka S, Walcott-Bryant A. Quantifying the impact of COVID-19 on essential health services: a comparison of interrupted time series analysis using Prophet and Poisson regression models. J Am Med Inform Assoc 2023; 30:634-642. [PMID: 36534893 PMCID: PMC10018265 DOI: 10.1093/jamia/ocac223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/06/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) altered healthcare utilization patterns. However, there is a dearth of literature comparing methods for quantifying the extent to which the pandemic disrupted healthcare service provision in sub-Saharan African countries. OBJECTIVE To compare interrupted time series analysis using Prophet and Poisson regression models in evaluating the impact of COVID-19 on essential health services. METHODS We used reported data from Uganda's Health Management Information System from February 2018 to December 2020. We compared Prophet and Poisson models in evaluating the impact of COVID-19 on new clinic visits, diabetes clinic visits, and in-hospital deliveries between March 2020 to December 2020 and across the Central, Eastern, Northern, and Western regions of Uganda. RESULTS The models generated similar estimates of the impact of COVID-19 in 10 of the 12 outcome-region pairs evaluated. Both models estimated declines in new clinic visits in the Central, Northern, and Western regions, and an increase in the Eastern Region. Both models estimated declines in diabetes clinic visits in the Central and Western regions, with no significant changes in the Eastern and Northern regions. For in-hospital deliveries, the models estimated a decline in the Western Region, no changes in the Central Region, and had different estimates in the Eastern and Northern regions. CONCLUSIONS The Prophet and Poisson models are useful in quantifying the impact of interruptions on essential health services during pandemics but may result in different measures of effect. Rigor and multimethod triangulation are necessary to study the true effect of pandemics on essential health services.
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Affiliation(s)
| | - Irene Wanyana
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Victor Akinwande
- IBM Research Africa, Nairobi, Kenya
- Carnegie Mellon University, Pittsburgh, USA
| | - Steven Kabwama
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | | | - Susan Kizito
- Makerere University School of Public Health, Kampala, Uganda
| | - Rhoda Wanyenze
- Makerere University School of Public Health, Kampala, Uganda
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Cruz-Valdez A, Palacio-Mejía LS, Quezada-Sánchez AD, Hernández-Ávila JE, Galicia-Carmona T, Cetina-Pérez LDC, Arango-Bravo EA, Isla-Ortiz D, Aranda-Flores CE, Uscanga-Sánchez SR, Madrid-Marina V, Torres-Poveda K. Cervical cancer prevention program in Mexico disrupted due to COVID-19 pandemic: Challenges and opportunities. Front Oncol 2023; 13:1008560. [PMID: 36969022 PMCID: PMC10034019 DOI: 10.3389/fonc.2023.1008560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
Introduction The COVID-19 pandemic disrupted the preventive services for cervical cancer (CC) control programs in Mexico, which will result in increased mortality. This study aims to assess the impact of the pandemic on the interruption of three preventive actions in the CC prevention program in Mexico. Methods This study is a retrospective time series analysis based on administrative records for the uninsured population served by the Mexican Ministry of Health. Patient data were retrieved from the outpatient service information system and the hospital discharge database for the period 2017-2021. Data were aggregated by month, distinguishing a pre-pandemic and a pandemic period, considering April 2020 as the start date of the pandemic. A Poisson time series analysis was used to model seasonal and secular trends. Five process indicators were selected to assess the disruption of the CC program, these were analyzed as monthly data (N=39 pre-pandemic, N=21 during the pandemic). HPV vaccination indicators (number of doses and coverage) and diagnostic characteristics of CC cases were analyzed descriptively. The time elapsed between diagnosis and treatment initiation in CC cases was modeled using restricted cubic splines from robust regression. Results Annual HPV vaccination coverage declined dramatically after 2019 and was almost null in 2021. The number of positive Papanicolaou smears decreased by 67.8% (90%CI: -72.3, -61.7) in April-December 2020, compared to their expected values without the pandemic. The immediate pandemic shock (April 2020) in the number of first-time and recurrent colposcopies was -80.5% (95%CI:-83.5, -77.0) and -77.9% (95%CI: -81.0, -74.4), respectively. An increasing trend was observed in the proportion of advanced stage and metastatic CC cases. The fraction of CC cases that did not receive medical treatment or surgery increased, as well as CC cases that received late treatment after diagnosis. Conclusions Our analyses show significant impact of the COVID-19 pandemic with declines at all levels of CC prevention and increasing inequalities. The restarting of the preventive programs against CC in Mexico offers an opportunity to put in place actions to reduce the disparities in the burden of disease between socioeconomic levels.
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Affiliation(s)
- Aurelio Cruz-Valdez
- Center for Population Health Research, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
| | - Lina Sofia Palacio-Mejía
- Consejo Nacional de Ciencia y Tecnología (CONACYT)—Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
| | - Amado D. Quezada-Sánchez
- Center for Evaluation and Surveys Research, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
| | | | - Tatiana Galicia-Carmona
- Department of Clinical Research and Medical Oncology, Instituto Nacional de Cancerología (INCAN), Mexico City, Mexico
| | | | - Eder A. Arango-Bravo
- Department of Clinical Research and Medical Oncology, Instituto Nacional de Cancerología (INCAN), Mexico City, Mexico
| | - David Isla-Ortiz
- Department of Oncology Gynecology, Instituto Nacional de Cancerología (INCAN), Mexico City, Mexico
| | | | | | - Vicente Madrid-Marina
- Chronic Infections and Cancer Division, Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
| | - Kirvis Torres-Poveda
- Consejo Nacional de Ciencia y Tecnología (CONACYT)—Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
- Chronic Infections and Cancer Division, Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
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Baatiema L, Sanuade OA, Allen LN, Abimbola S, Hategeka C, Koram KA, Kruk ME. Health system adaptions to improve care for people living with non-communicable diseases during COVID-19 in low-middle income countries: A scoping review. J Glob Health 2023; 13:06006. [PMID: 36862142 PMCID: PMC9980283 DOI: 10.7189/iogh.13.06006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Background During the COVID-19 pandemic, access to health care for people living with non-communicable diseases (NCDs) has been significantly disrupted. Calls have been made to adapt health systems and innovate service delivery models to improve access to care. We identified and summarized the health systems adaptions and interventions implemented to improve NCD care and their potential impact on low- and middle-income countries (LMICs). Methods We comprehensively searched Medline/PubMed, Embase, CINAHL, Global Health, PsycINFO, Global Literature on coronavirus disease, and Web of Science for relevant literature published between January 2020 and December 2021. While we targeted articles written in English, we also included papers published in French with abstracts written in English. Results After screening 1313 records, we included 14 papers from six countries. We identified four unique health systems adaptations/interventions for restoring, maintaining, and ensuring continuity of care for people living with NCDs: telemedicine or teleconsultation strategies, NCD medicine drop-off points, decentralization of hypertension follow-up services and provision of free medication to peripheral health centers, and diabetic retinopathy screening with a handheld smartphone-based retinal camera. We found that the adaptations/interventions enhanced continuity of NCD care during the pandemic and helped bring health care closer to patients using technology and easing access to medicines and routine visits. Telephonic aftercare services appear to have saved a significant amount of patients' time and funds. Hypertensive patients recorded better blood pressure controls over the follow-up period. Conclusions Although the identified measures and interventions for adapting health systems resulted in potential improvements in access to NCD care and better clinical outcomes, further exploration is needed to establish the feasibility of these adaptations/interventions in different settings given the importance of context in their successful implementation. Insights from such implementation studies are critical for ongoing health systems strengthening efforts to mitigate the impact of COVID-19 and future global health security threats for people living with NCDs.
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Affiliation(s)
- Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Olutobi A Sanuade
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Luke N Allen
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Seye Abimbola
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Celestin Hategeka
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kwadwo A Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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40
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Turcotte-Tremblay AM, Leerapan B, Akweongo P, Amponsah F, Aryal A, Asai D, Awoonor-Williams JK, Ayele W, Bauhoff S, Doubova SV, Gadeka DD, Dulal M, Gage A, Gordon-Strachan G, Haile-Mariam D, Joseph JP, Kaewkamjornchai P, Kapoor NR, Gelaw SK, Kim MK, Kruk ME, Kubota S, Margozzini P, Mehata S, Mthethwa L, Nega A, Oh J, Park SK, Passi-Solar A, Perez Cuevas RE, Reddy T, Rittiphairoj T, Sapag JC, Thermidor R, Tlou B, Arsenault C. Tracking health system performance in times of crisis using routine health data: lessons learned from a multicountry consortium. Health Res Policy Syst 2023; 21:14. [PMID: 36721180 PMCID: PMC9888332 DOI: 10.1186/s12961-022-00956-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/28/2022] [Indexed: 02/02/2023] Open
Abstract
COVID-19 has prompted the use of readily available administrative data to track health system performance in times of crisis and to monitor disruptions in essential healthcare services. In this commentary we describe our experience working with these data and lessons learned across countries. Since April 2020, the Quality Evidence for Health System Transformation (QuEST) network has used administrative data and routine health information systems (RHIS) to assess health system performance during COVID-19 in Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, Republic of Korea and Thailand. We compiled a large set of indicators related to common health conditions for the purpose of multicountry comparisons. The study compiled 73 indicators. A total of 43% of the indicators compiled pertained to reproductive, maternal, newborn and child health (RMNCH). Only 12% of the indicators were related to hypertension, diabetes or cancer care. We also found few indicators related to mental health services and outcomes within these data systems. Moreover, 72% of the indicators compiled were related to volume of services delivered, 18% to health outcomes and only 10% to the quality of processes of care. While several datasets were complete or near-complete censuses of all health facilities in the country, others excluded some facility types or population groups. In some countries, RHIS did not capture services delivered through non-visit or nonconventional care during COVID-19, such as telemedicine. We propose the following recommendations to improve the analysis of administrative and RHIS data to track health system performance in times of crisis: ensure the scope of health conditions covered is aligned with the burden of disease, increase the number of indicators related to quality of care and health outcomes; incorporate data on nonconventional care such as telehealth; continue improving data quality and expand reporting from private sector facilities; move towards collecting patient-level data through electronic health records to facilitate quality-of-care assessment and equity analyses; implement more resilient and standardized health information technologies; reduce delays and loosen restrictions for researchers to access the data; complement routine data with patient-reported data; and employ mixed methods to better understand the underlying causes of service disruptions.
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Affiliation(s)
- Anne-Marie Turcotte-Tremblay
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 401 Park Drive, 3Rd Floor East, room L3-015A5, Landmark Center, Boston, MA, 02215, USA. .,Université Laval, Québec, Canada.
| | - Borwornsom Leerapan
- grid.10223.320000 0004 1937 0490Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Patricia Akweongo
- grid.8652.90000 0004 1937 1485School of Public Health, University of Ghana, Accra, Ghana
| | - Freddie Amponsah
- Policy, Planning, Monitoring and Evaluation, Ghana Health Services, Accra, Ghana
| | - Amit Aryal
- grid.6612.30000 0004 1937 0642Swiss TPH, University of Basel, Basel, Switzerland
| | - Daisuke Asai
- World Health Organization, Vientiane, Lao People’s Democratic Republic
| | | | - Wondimu Ayele
- grid.7123.70000 0001 1250 5688School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sebastian Bauhoff
- grid.38142.3c000000041936754XDepartment of Global Health and Population, Harvard University, Boston, USA
| | - Svetlana V. Doubova
- grid.419157.f0000 0001 1091 9430Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | | | - Mahesh Dulal
- Office of the Member of Federal Parliament Gagan Kumar Thapa, Kathmandu, Nepal
| | - Anna Gage
- grid.38142.3c000000041936754XDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, 401 Park Drive, 3Rd Floor East, room L3-015A5, Landmark Center, Boston, MA 02215 USA
| | - Georgiana Gordon-Strachan
- grid.461576.70000 0000 8786 7651Caribbean Institute for Health Research, University of West Indies, Kingston, Jamaica
| | - Damen Haile-Mariam
- grid.7123.70000 0001 1250 5688School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jean Paul Joseph
- Hôpital Universitaire de Mirebalais, Zanmi Lasante, Arrondissement de Mirebalais, Haïti
| | - Phanuwich Kaewkamjornchai
- grid.10223.320000 0004 1937 0490Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Neena R. Kapoor
- grid.38142.3c000000041936754XDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, 401 Park Drive, 3Rd Floor East, room L3-015A5, Landmark Center, Boston, MA 02215 USA
| | | | - Min Kyung Kim
- Tufts Clinical and Translational Science Institute, Boston, USA
| | - Margaret E. Kruk
- grid.38142.3c000000041936754XDepartment of Global Health and Population, Harvard University, Boston, USA
| | - Shogo Kubota
- World Health Organization, Vientiane, Lao People’s Democratic Republic
| | - Paula Margozzini
- grid.7870.80000 0001 2157 0406Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Suresh Mehata
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Londiwe Mthethwa
- grid.16463.360000 0001 0723 4123School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Adiam Nega
- grid.7123.70000 0001 1250 5688School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Juhwan Oh
- Tufts Clinical and Translational Science Institute, Boston, USA ,grid.31501.360000 0004 0470 5905Seoul National University College of Medicine, Seoul, South Korea
| | - Soo Kyung Park
- Korea National Health Insurance Services, Health Insurance Research Institute, Wonju, Gangwon-Do South Korea
| | - Alvaro Passi-Solar
- grid.7870.80000 0001 2157 0406Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Tarylee Reddy
- grid.415021.30000 0000 9155 0024Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Thanitsara Rittiphairoj
- grid.10223.320000 0004 1937 0490Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jaime C. Sapag
- grid.7870.80000 0001 2157 0406Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roody Thermidor
- Studies and Planning Unit, Ministry of Public Health and Population, Port-Au-Prince, Haiti
| | - Boikhutso Tlou
- grid.16463.360000 0001 0723 4123School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Catherine Arsenault
- grid.38142.3c000000041936754XDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, 401 Park Drive, 3Rd Floor East, room L3-015A5, Landmark Center, Boston, MA 02215 USA
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Mohammadpour M, Delavari S, Kavosi Z, Peyravi M, Izadi R, Bastani P. The necessity revealed by COVID-19 pandemic: Paradigm shift of Iran's healthcare system. Front Public Health 2023; 11:1041123. [PMID: 36761138 PMCID: PMC9902771 DOI: 10.3389/fpubh.2023.1041123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/04/2023] [Indexed: 01/26/2023] Open
Abstract
Background COVID-19 pandemic has resulted in drastic changes around the world, revealing vulnerable aspects of healthcare systems. This study aimed to explore how Iranian healthcare system experienced the paradigm shift during the pandemic and determine the aspects that need improvement during the pandemic era. Method This qualitative study was conducted in 2021. A framework analysis approach was used to analyze the content of the 19 semi-structured interviews with the healthcare system experts from Shiraz University of Medical Sciences (SUMS). The interviews' audio files changed into transcript after each session and data was saturated at the 19 interview. To increase the trustworthiness of the study, Guba and Lincoln's criteria including credibility, transferability, dependability, and confirmability were used. Goldsmith's five-step framework analysis was used applying MAX QDA version 10 software. Result Eight main themes and 20 subthemes were explored. The main themes included "strengthening the electronic health infrastructure," "research for evidence-based decision making," "dedicated financing to the pandemic," "prevention of disruption in the effective provision of services and medicines," "enriching the authority of the Ministry of Health by focusing on interactions," "recruiting, managing and empowering health human resources with attention to financial and non-financial incentives," "reforming educational approaches in training students in medical universities," as well as "lessons learned from neglected aspects." Conclusion To be ready to respond to a possible future pandemic and for a paradigm shift, bold steps must be taken to make fundamental changes in various aspects of the healthcare system including e-health development, evidence-based decision making, dedicated budgets for pandemics, reinforcement of interactions at the national and international level, as well as sufficient attention to healthcare workers from all financial, non-financial and educational aspects.
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Affiliation(s)
- Mohammadtaghi Mohammadpour
- Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajad Delavari
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Kavosi
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmoudreza Peyravi
- Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reyhane Izadi
- Department of Health Care Management, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peivand Bastani
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Picó-Guzmán FJ, Martínez-Montañez OG, Ruelas-Barajas E, Hernández-Ávila M. [The estimated economic impact of cardiovascular and diabetes mellitus complications 2019-2028]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2022; 60:S86-S95. [PMID: 36795992 PMCID: PMC10629407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 02/18/2023]
Abstract
Background In Mexico, diabetes mellitus (DM) and diseases cardiovascular, register an upward trend. Objective To estimate the number of complications due to cardiovascular events (CVD) and complications derived from DM (CDM) accumulated in beneficiaries of the Mexican Institute of Social Security (IMSS) from 2019 to 2028, as well as the expense for medical and economic benefits in a scenario baseline and one of change in metabolic profile due to lack of medical follow-up during the COVID-19 pandemic. Material and methods The number of CVD and CDM was estimated from 2019, with a 10-year risk projection using the ESC CVD Risk Calculator and United Kingdom Prospective Diabetes Study, considering risk factors registered in the institutional databases. Results From 2019 to 2028, cumulative CVD cases were estimated at 2 million and those of CDM in 960 thousand, with an impact on medical spending of 439,523 million pesos and on the economic benefits of 174,085 millions. When considering the COVID-19 pandemic, CVD events and CDM increased by 589 thousand, with an increase in spending of 93,787 million pesos for medical care and 41,159 million for economic benefits. Conclusions Without a comprehensive intervention in the management of CVD and CDM, the cost by both diseases will continue to increase, with financial pressures getting older.
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Affiliation(s)
| | - Olga Georgina Martínez-Montañez
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Económicas y Sociales, Coordinación Normativa. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Enrique Ruelas-Barajas
- Instituto Internacional de Futuros para la Salud. Ciudad de México, MéxicoInstituto Internacional de Futuros para la SaludMéxico
| | - Mauricio Hernández-Ávila
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Económicas y Sociales. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Habinshuti P, Nshimyiryo A, Fejfar DL, Niyigena A, Cubaka VK, Karema N, Bigirimana JB, Shyirambere C, Barnhart DA, Kateera F, Fulcher I. Impact of COVID-19 on access to cancer care in Rwanda: a retrospective time-series study using electronic medical records data. BMJ Open 2022; 12:e065398. [PMID: 36535717 PMCID: PMC9764097 DOI: 10.1136/bmjopen-2022-065398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has caused disruptions in access to routine healthcare services worldwide, with a particularly high impact on chronic care patients and low and middle-income countries. In this study, we used routinely collected electronic medical records data to assess the impact of the COVID-19 pandemic on access to cancer care at the Butaro Cancer Center of Excellence (BCCOE) in rural Rwanda. METHODS We conducted a retrospective time-series study among all Rwandan patients who received cancer care at the BCCOE between 1 January 2016 and 31 July 2021. The primary outcomes of interest included a comparison of the number of patients who were predicted based on time-series models of pre-COVID-19 trends versus the actual number of patients who presented during the COVID-19 period (between March 2020 and July 2021) across four key indicators: the number of new patients, number of scheduled appointments, number of clinical visits attended and the proportion of scheduled appointments completed on time. RESULTS In total, 8970 patients (7140 patients enrolled before COVID-19 and 1830 patients enrolled during COVID-19) were included in this study. During the COVID-19 period, enrolment of new patients dropped by 21.7% (95% prediction interval (PI): -31.3%, -11.7%) compared with the pre-COVID-19 period. Similarly, the number of clinical visits was 25.0% (95% PI: -31.1%, -19.1%) lower than expected and the proportion of scheduled visits completed on time was 27.9% (95% PI: -39.8%, -14.1%) lower than expected. However, the number of scheduled visits did not deviate significantly from expected. CONCLUSION Although scheduling procedures for visits continued as expected, our findings reveal that the COVID-19 pandemic interrupted patients' ability to access cancer care and attend scheduled appointments at the BCCOE. This interruption in care suggests delayed diagnosis and loss to follow-up, potentially resulting in a higher rate of negative health outcomes among cancer patients in Rwanda.
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Affiliation(s)
- Placide Habinshuti
- Informatics Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Alphonse Nshimyiryo
- Research and Training Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Anne Niyigena
- Research and Training Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Vincent K Cubaka
- Research and Training Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Nadine Karema
- Informatics Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | - Dale A Barnhart
- Research and Training Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Fredrick Kateera
- Clinical Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Isabel Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Duque-Molina C, Borrayo-Sánche G, Avilés-Hernández R, Herrera-Reyna P. [PRIISMA Project: Transformation into a more preventive, resilient, comprehensive, innovative, sustainable, modern and accessible IMSS]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2022; 60:S54-S64. [PMID: 36795956 PMCID: PMC10627496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/05/2022] [Indexed: 02/18/2023]
Abstract
Two years after the onset of the COVID-19 pandemic, the Mexican Institute for Social Security (IMSS, according to its initials in Spanish) rethought new projects focused on the new needs of the population and social security organizations and institutions. The Institute, as a cornerstone in the search for the wellbeing of Mexicans, aligned with the National Development Plan and the Strategic Health for Wellbeing Program, sought to direct its transformation towards a preventive, resilient, comprehensive, innovative, sustainable, modern and accessible IMSS. For this reason, the Medical Services Director designed the PRIISMA Project, as the one that over the next three years could make possible to innovate and improve its medical care processes, starting with the recovery of medical services and identifying those groups of beneficiaries who experience the most vulnerable circumstances. The PRIISMA project consisted of five sub-projects: 1. Vulnerable groups; 2. Efficient and effective care; 3. Prevent IMSS plus; 4 IMSS University and 5. Recovery of medical services. The strategies of each project seek to improve medical care for all IMSS beneficiaries and users with a human rights perspective and by priority groups; the goal is reducing the gaps in access to health care, leaving no one behind and leaving no one out; and to surpass the goals for medical services provided before the pandemic. This document provides an overview of strategies and progress of the PRIISMA sub-projects achieved during 2022.
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Affiliation(s)
- Célida Duque-Molina
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Gabriela Borrayo-Sánche
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas, Coordinación de Innovación en Salud. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Ricardo Avilés-Hernández
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas, Unidad de Planeación e Innovación en Salud. Ciudad de México, México Instituto Mexicano del Seguro SocialMéxico
| | - Paulina Herrera-Reyna
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas, Coordinación de Innovación en Salud. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Bello-Chavolla OY, Antonio-Villa NE, Fermín-Martínez CA, Fernández-Chirino L, Vargas-Vázquez A, Ramírez-García D, Basile-Alvarez MR, Hoyos-Lázaro AE, Carrillo-Larco RM, Wexler DJ, Manne-Goehler J, Seiglie JA. Diabetes-Related Excess Mortality in Mexico: A Comparative Analysis of National Death Registries Between 2017-2019 and 2020. Diabetes Care 2022; 45:2957-2966. [PMID: 36286591 PMCID: PMC7613876 DOI: 10.2337/dc22-0616] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/27/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate diabetes-related mortality in Mexico in 2020 compared with 2017-2019 after the onset of the coronavirus disease 2019 (COVID-19) pandemic. RESEARCH DESIGN AND METHODS This retrospective, state-level study used national death registries of Mexican adults aged ≥20 years for the 2017-2020 period. Diabetes-related death was defined using ICD-10 codes listing diabetes as the primary cause of death, excluding certificates with COVID-19 as the primary cause of death. Spatial and negative binomial regression models were used to characterize the geographic distribution and sociodemographic and epidemiologic correlates of diabetes-related excess mortality, estimated as increases in diabetes-related mortality in 2020 compared with average 2017-2019 rates. RESULTS We identified 148,437 diabetes-related deaths in 2020 (177 per 100,000 inhabitants) vs. an average of 101,496 deaths in 2017-2019 (125 per 100,000 inhabitants). In-hospital diabetes-related deaths decreased by 17.8% in 2020 versus 2017-2019, whereas out-of-hospital deaths increased by 89.4%. Most deaths were attributable to type 2 diabetes (130 per 100,000 inhabitants). Compared with 2018-2019 data, hyperglycemic hyperosmolar state and diabetic ketoacidosis were the two contributing causes with the highest increase in mortality (128% and 116% increase, respectively). Diabetes-related excess mortality clustered in southern Mexico and was highest in states with higher social lag, rates of COVID-19 hospitalization, and prevalence of HbA1c ≥7.5%. CONCLUSIONS Diabetes-related deaths increased among Mexican adults by 41.6% in 2020 after the onset of the COVID-19 pandemic, occurred disproportionately outside the hospital, and were largely attributable to type 2 diabetes and hyperglycemic emergencies. Disruptions in diabetes care and strained hospital capacity may have contributed to diabetes-related excess mortality in Mexico during 2020.
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Affiliation(s)
| | - Neftali Eduardo Antonio-Villa
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Carlos A. Fermín-Martínez
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Luisa Fernández-Chirino
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Química, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Arsenio Vargas-Vázquez
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Daniel Ramírez-García
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Martín Roberto Basile-Alvarez
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ana Elena Hoyos-Lázaro
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Rodrigo M. Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, U.K
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Deborah J. Wexler
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Jennifer Manne-Goehler
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jacqueline A. Seiglie
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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Wei X, Yuan H, Sun Y, Zhang J, Wang Q, Fu Y, Wang Q, Sun L, Yang L. Health Services Utilization in China during the COVID-19 Pandemic: Results from a Large-Scale Online Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15892. [PMID: 36497964 PMCID: PMC9739892 DOI: 10.3390/ijerph192315892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Timely access to essential health services is a concern as COVID-19 continues. This study aimed to investigate health services utilization during the first wave of the pandemic in China. A cross-sectional online survey was conducted using a self-administrated questionnaire in March 2020. Descriptive statistics and logistic regression were used for data analysis. A total of 4744 respondents were included, with 52.00% reporting affected services utilization. Clinical testing (68.14%) and drug purchase (49.61%) were the most affected types. Higher education level, being married, chronic disease, frequently visiting a provincial medical institution, spending more time on pandemic-related information, perception of high-risk of infection, perception of large health impact of the pandemic, and anxiety/depression were significant predictors for reporting affected services utilization. For the 431 chronic disease respondents, 62.18% reported interruption, especially for drug purchase (58.58%). Affected health services utilization was reported during the first wave of the pandemic in China, especially for those with higher education level, chronic diseases, and COVID-19 related concerns. Enhancing primary healthcare, use of telehealth, extended prescription, and public communication were countermeasures undertaken by China during the rapid rise period. As COVID-19 progresses, the changing disease characteristics, adapted health system, along with enhanced public awareness/knowledge should be considered for the evolution of health services utilization, and further investigation is needed.
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Affiliation(s)
- Xia Wei
- School of Public Health, Peking University, Beijing 100191, China
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Haowen Yuan
- School of Public Health, Peking University, Beijing 100191, China
| | - Yan Sun
- School of Public Health, Peking University, Beijing 100191, China
| | - Jiawei Zhang
- School of Public Health, Peking University, Beijing 100191, China
| | - Qingbo Wang
- School of Public Health, Peking University, Beijing 100191, China
| | - Yaqun Fu
- School of Public Health, Peking University, Beijing 100191, China
| | - Quan Wang
- School of Public Health, Peking University, Beijing 100191, China
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Li Sun
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Li Yang
- School of Public Health, Peking University, Beijing 100191, China
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Kapoor NR, Aryal A, Mehata S, Dulal M, Kruk ME, Bauhoff S, Arsenault C. Effect of lifting COVID-19 restrictions on utilisation of primary care services in Nepal: a difference-in-differences analysis. BMJ Open 2022; 12:e061849. [PMID: 36446449 PMCID: PMC9709811 DOI: 10.1136/bmjopen-2022-061849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION An increasing number of studies have reported disruptions in health service utilisation due to the COVID-19 pandemic and its associated restrictions. However, little is known about the effect of lifting COVID-19 restrictions on health service utilisation. The objective of this study was to estimate the effect of lifting COVID-19 restrictions on primary care service utilisation in Nepal. METHODS Data on utilisation of 10 primary care services were extracted from the Health Management Information System across all health facilities in Nepal. We used a difference-in-differences design and linear fixed effects regressions to estimate the effect of lifting COVID-19 restrictions. The treatment group included palikas that had lifted restrictions in place from 17 August 2020 to 16 September 2020 (Bhadra 2077) and the control group included palikas that had maintained restrictions during that period. The pre-period included the 4 months of national lockdown from 24 March 2020 to 22 July 2020 (Chaitra 2076 to Ashar 2077). Models included month and palika fixed effects and controlled for COVID-19 incidence. RESULTS We found that lifting COVID-19 restrictions was associated with an average increase per palika of 57.5 contraceptive users (95% CI 14.6 to 100.5), 15.6 antenatal care visits (95% CI 5.3 to 25.9) and 1.6 child pneumonia visits (95% CI 0.2 to 2.9). This corresponded to a 9.4% increase in contraceptive users, 34.2% increase in antenatal care visits and 15.6% increase in child pneumonia visits. Utilisation of most other primary care services also increased after lifting restrictions, but coefficients were not statistically significant. CONCLUSIONS Despite the ongoing pandemic, lifting restrictions can lead to an increase in some primary care services. Our results point to a causal link between restrictions and health service utilisation and call for policy makers in low- and middle-income countries to carefully consider the trade-offs of strict lockdowns during future COVID-19 waves or future pandemics.
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Affiliation(s)
- Neena R Kapoor
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Amit Aryal
- Swiss TPH, University of Basel, Basel, Switzerland
| | - Suresh Mehata
- Ministry of Health, Government of Nepal, Biratnagar, Province 1, Nepal
| | - Mahesh Dulal
- Office of the Member of Federal Parliament Nepal, Gagan Kumar Thapa, Kathmandu, Nepal
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sebastian Bauhoff
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Catherine Arsenault
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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Melgoza E, Beltrán-Sánchez H, Vargas Bustamante A. Injury-Related Emergency Medical Service Calls, Traffic Accidents, and Crime in Mexico City Before and During the COVID-19 Pandemic. Prehosp Disaster Med 2022; 38:1-8. [PMID: 36440645 PMCID: PMC9885436 DOI: 10.1017/s1049023x22002230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic had detrimental impacts across multiple sectors of the Mexican health care system. The prehospital care system, however, remains largely under-studied. The first objective of this study was to calculate the monthly per capita rates of injury-related 9-1-1 calls, traffic accidents, and crime at the state-level (Mexico City) during the early pandemic period (January 1 through June 30, 2020), while the second objective was to conduct these calculations at the borough-level for the same outcomes and time period. The third objective was to compare monthly per capita rates of injury-related 9-1-1 calls, traffic accidents, and crime at the state-level (Mexico City) during the pre-pandemic (January 1 through June 30, 2019), early pandemic (January 1 through June 30, 2020), and later pandemic periods (January 1 through June 30, 2021). METHODS A retrospective analysis was conducted to examine injury-related 9-1-1 calls, traffic accidents, and crime at the state-level (Mexico City) and borough-levels. Monthly per capita rates were calculated using four datasets, including Mexico City's Public Release 9-1-1 Emergency Calls, National Institute of Statistics and Geography's (INEGI) Traffic Accidents Micro-Dataset, Mexico City's Attorney General's Office Crime Dataset, and Projections of the Population of the Municipalities of Mexico, 2015 to 2030. All statistical analyses were conducted using STATA 17.0. RESULTS During the early pandemic period, injury-related 9-1-1 emergency calls, traffic accidents, and crime experienced similar trends in monthly per capita rates at the state-level and borough-levels. While the monthly per capita rates remained constant from January to March 2020, starting in March, there was a precipitous decrease across all three outcomes, although decline rates varied across boroughs. The monthly per capita rates across the three outcomes were higher during the pre-pandemic period compared to the early pandemic period. As the COVID-19 pandemic progressed, the monthly per capita rates during the later pandemic period increased across the three outcomes compared to the early pandemic period, although they did not reach pre-pandemic levels during the study period. CONCLUSION The precipitous decline in injury-related 9-1-1 calls, traffic accidents, and crime in Mexico City occurred at the same time as the issuance of the first wave of public health orders in March 2020. The largest decrease across the three outcomes occurred one to two months post-issuance of the orders.
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Affiliation(s)
- Esmeralda Melgoza
- Jonathan and Karin Fielding School of Public Health, University of California-Los Angeles (UCLA), Los Angeles, CaliforniaUSA
| | - Hiram Beltrán-Sánchez
- Jonathan and Karin Fielding School of Public Health, University of California-Los Angeles (UCLA), Los Angeles, CaliforniaUSA
- California Center for Population Research, University of California-Los Angeles (UCLA), Los Angeles, CaliforniaUSA
| | - Arturo Vargas Bustamante
- Jonathan and Karin Fielding School of Public Health, University of California-Los Angeles (UCLA), Los Angeles, CaliforniaUSA
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COVID-19 related decline in cancer screenings most pronounced for elderly patients and women in Germany: a claims data analysis. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04433-z. [DOI: 10.1007/s00432-022-04433-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/18/2022] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose
This study aimed to analyze the utilization of cancer screenings in Germany before and during the COVID-19 pandemic in 2020. The objective of the analysis was to identify the population at particular risk and to derive recommendations for the future use of resources to prevent long-term deteriorations in health outcomes.
Methods
The analysis was conducted based on claims data of all preventive health services for 15,833,662 patients from the largest statutory health insurance fund in Germany. Utilization of general female cancer screening, general male cancer screening, general health checkup, colorectal cancer screening stool test, colorectal cancer screening consultation, colonoscopy, skin cancer screening, and mammography screening was compared before (2017–2019) and during (2020) the pandemic.
Results
Data of a total of 42,046,078 observed screenings showed that the utilization of the individual screenings developed differently, but that the overall utilization decreased significantly by 21.46% during the COVID-19 pandemic (p < 0.001). At the same time, no catch-up effects were detected for total screenings throughout the entire year 2020. The highest decline in screenings was found for the elderly (p < 0.001) and women (p < 0.001).
Conclusion
Because the elderly are at higher risk for cancer, the omission of early detection might lead to higher treatment costs, reduced quality of life, and higher mortality. In addition, women's medical care in particular has been negatively affected, for example, by the interruption of mammography screenings and the lack of catch-up effects. Therefore, resources must be targeted to reduce burdens on health outcomes and public health in the long term.
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Ferrara P, Dallagiacoma G, Alberti F, Gentile L, Bertuccio P, Odone A. Prevention, diagnosis and treatment of cervical cancer: A systematic review of the impact of COVID-19 on patient care. Prev Med 2022; 164:107264. [PMID: 36150446 PMCID: PMC9487163 DOI: 10.1016/j.ypmed.2022.107264] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/07/2022] [Accepted: 09/17/2022] [Indexed: 11/30/2022]
Abstract
Worldwide, the COVID-19 pandemic disrupted healthcare services, including cervical cancer management, and an increased burden for this condition is expected. This systematic review synthetizes the available evidence on the impact of the pandemic on prevention, diagnosis and treatment of cervical cancer. Searches were performed on PubMed, Embase, and Scopus for relevant studies on these topics with the purpose of comparing service access and care delivery before and during COVID-19 pandemic. Due to the methodological heterogeneity among the studies, findings were narratively discussed. Of the 715 screened titles and abstracts, 33 articles were included, corresponding to 42 reports that covered the outcomes of interest: vaccination against human papillomavirus (HPV) (6 reports), cancer screening (19), diagnosis (8), and treatment (8). Seven studies observed reductions in HPV vaccination uptake and coverage during COVID-19. Reports on cervical screening and cancer diagnosis activities showed a substantial impact of the pandemic on access to screening services and diagnostic procedures. All but one study that investigated cervical cancer treatment reported changes in the number of women with cervical lesions who received treatments, as well as treatment delay and interruption. With a major impact during the first wave in 2020, COVID-19 and restriction measures resulted in a substantial disruption in cervical cancer prevention and management, with declines in screening and delays in treatment. Taken together, findings from this systematic review calls for urgent policy interventions for recovering cervical cancer prevention and care.
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Affiliation(s)
- Pietro Ferrara
- Center for Public Health Research, University of Milan-Bicocca, 20900 Monza, Italy; IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy
| | - Giulia Dallagiacoma
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Federica Alberti
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Leandro Gentile
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy.
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