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Offosse MJ, Yameogo P, Ouedraogo AL, Traoré Z, Banke-Thomas A. Has the Gratuité policy reduced inequities in geographic access to antenatal care in Burkina Faso? Evidence from facility-based data from 2014 to 2022. Front Glob Womens Health 2024; 5:1345438. [PMID: 38585342 PMCID: PMC10996443 DOI: 10.3389/fgwh.2024.1345438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Background Evidence shows that user fee exemption policies improve the use of maternal, newborn, and child health (MNCH) services. However, addressing the cost of care is only one barrier to accessing MNCH services. Poor geographic accessibility relating to distance is another. Our objective in this study was to assess the effect of a user fee exemption policy in Burkina Faso (Gratuité) on antenatal care (ANC) use, considering distance to health facilities. Methods We conducted a cross-sectional study with sub-analysis by intervention period to compare utilization of ANC services (outcome of interest) in pregnant women who used the service in the context of the Gratuité user fee exemption policy and those who did not, in Manga district, Burkina Faso. Dependent variables included were socio-demographic characteristics, obstetric history, and distance to the lower-level health facility (known as Centre de Santé et Promotion Sociale) in which care was sort. Univariate, bivariate, and multivariate analyses were performed across the entire population, within those who used ANC before the policy and after its inception. Results For women who used services before the Gratuité policy was introduced, those living 5-9 km were almost twice (OR = 1.94; 95% CI: 1.17-3.21) more likely to have their first ANC visit (ANC1) in the first trimester compared to those living <5 km of the nearest health facility. After the policy was introduced, women living 5-9 km and >10 km from the nearest facility were almost twice (OR = 1.86; 95% CI: 1.14-3.05) and over twice (OR = 2.04; 95% CI: 1.20-3.48) more likely respectively to use ANC1 in the first trimester compared to those living within 5 km of the nearest health facility. Also, women living over 10 km from the nearest facility were 1.29 times (OR = 1.29; 95% CI: 1.00-1.66) more likely to have 4+ ANC than those living less than 5 km from the nearest health facility. Conclusions Insofar as the financial barrier to ANC has been lifted and the geographical barrier reduced for the populations that live farther away from services through the Gratuité policy, then the Burkinabé government must make efforts to sustain the policy and ensure that benefits of the policy reach the targeted and its gains maximized.
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Affiliation(s)
| | - Pierre Yameogo
- Technical Secretariat for Health Financing Reforms, Ministry of Health, Ouagadougou, Burkina Faso
| | - André Lin Ouedraogo
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Zanga Traoré
- Country Office, ThinkWell Institute, Ouagadougou, Burkina Faso
| | - Aduragbemi Banke-Thomas
- Country Office, ThinkWell Institute, Ouagadougou, Burkina Faso
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Kitil GW, Wedajo LF, Feyisa GT, Degefa BD, Marami SN, Walle AD, Chereka AA, Dinagde DD. Exploring the interplay between food security and antenatal care utilization among pregnant women in Southern Ethiopia: Insights from an institution-based cross-sectional study. Eur J Obstet Gynecol Reprod Biol X 2024; 21:100288. [PMID: 38406607 PMCID: PMC10891321 DOI: 10.1016/j.eurox.2024.100288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
Background Ensuring the satisfaction of pregnant women with antenatal care is crucial for positive pregnancy outcomes and their engagement with emerging technologies and alternative care models. Maintaining high satisfaction during the antenatal period significantly impacts the well-being of both the expectant mother and the unborn child. Despite the recognized importance of antenatal care satisfaction, comprehensive information on satisfaction levels and influencing factors in the specific study area is lacking. Therefore, this study aims to assess antenatal care service satisfaction and associated factors among pregnant women in Arba Minch town, southern Ethiopia. Methods We conducted an institution-based cross-sectional study among 418 pregnant women from December 2022 to January 30, 2023, using a systematic sampling method. Data were collected using the Kobo Toolbox and analyzed with SPSS Version 26. The threshold for statistical significance was set at a p-value of less than 0.05. Results Out of 418 participants, 54.3% (95% CI=49.4-60.4) expressed satisfaction with antenatal care services. Factors significantly associated with women's satisfaction included: being unable to read and write (AOR=2.37; 95% CI: 1.97-3.80), being aged 25-29 years (AOR=3.20; 95% CI: 1.65-6.22), receiving antenatal care at a hospital (AOR=1.81; 95% CI: 1.05-3.12), having a previous history of antenatal visits (AOR=2.59; 95% CI: 1.26-5.30), a monthly income of 2500-5000 ETB (AOR=1.44; 95% CI: 1.21-3.94), waiting times of less than 30 min (AOR=2.59; 95% CI: 1.52-4.41), maintaining a positive attitude towards antenatal care (AOR=2.50; 95% CI: 1.05-3.65), and having a secure food source (AOR=2.06; 95% CI: 1.13-3.78). Conclusion Over 54% of participants were satisfied with antenatal care services. To improve satisfaction levels, recommended strategies include enhancing healthcare infrastructure, establishing maternity waiting areas, reducing waiting times, and expanding services to remote areas.
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Affiliation(s)
- Gemeda Wakgari Kitil
- Departments of Midwifery, College of Health Sciences, Mattu University, Metu, Ethiopia
| | - Lema Fikadu Wedajo
- Departments of midwifery, College Medicine and Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Gizu Tola Feyisa
- Departments of Midwifery, College of Health Sciences, Mattu University, Metu, Ethiopia
| | - Bekem Dibaba Degefa
- Departments of Midwifery, College of Health Sciences, Mattu University, Metu, Ethiopia
| | - Shambel Negese Marami
- Departments of Midwifery, College of Health Sciences, Mattu University, Metu, Ethiopia
| | - Agmasie Damtew Walle
- Departments of Health Informatics, College of Health Sciences, Mattu University, Metu, Ethiopia
| | - Alex Ayenew Chereka
- Departments of Health Informatics, College of Health Sciences, Mattu University, Metu, Ethiopia
| | - Dagne Deresa Dinagde
- Departments of Midwifery, College of Health Sciences, Mattu University, Metu, Ethiopia
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Dioubaté N, Diallo MC, Maomou C, Niane H, Millimouno TM, Camara BS, Sy T, Diallo IS, Semaan A, Delvaux T, Beňová L, Béavogui AH, Delamou A. Perspectives and experiences of healthcare providers on the response to the COVID-19 pandemic in three maternal and neonatal referral hospitals in Guinea in 2020: a qualitative study. BMC Health Serv Res 2024; 24:226. [PMID: 38383409 PMCID: PMC10882787 DOI: 10.1186/s12913-024-10670-4] [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: 03/03/2023] [Accepted: 01/31/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has adversely affected access to essential healthcare services. This study aimed to explore healthcare providers' perceptions and experiences of the response to the COVID-19 pandemic in three referral maternal and neonatal hospitals in Guinea. METHODS We conducted a longitudinal qualitative study between June and December 2020 in two maternities and one neonatology referral ward in Conakry and Mamou. Participants were purposively recruited to capture diversity of professional cadres, seniority, and gender. Four rounds of in-depth interviews (46 in-depth interviews with 18 respondents) were conducted in each study site, using a semi-structured interview guide that was iteratively adapted. We used both deductive and inductive approaches and an iterative process for content analysis. RESULTS We identified four themes and related sub-themes presented according to whether they were common or specific to the study sites, namely: 1) coping strategies & care reorganization, which include reducing staffing levels, maintaining essential healthcare services, suspension of staff daily meetings, insertion of a new information system for providers, and co-management with COVID-19 treatment center for caesarean section cases among women who tested positive for COVID-19; 2) healthcare providers' behavior adaptations during the response, including infection prevention and control measures on the wards and how COVID-19-related information influenced providers' daily work; 3) difficulties encountered by providers, in particular unavailability of personal protective equipment (PPE), lack of financial motivation, and difficulties reducing crowding in the wards; 4) providers perceptions of healthcare service use, for instance their fear during COVID-19 response and perceived increase in severity of complications received and COVID-19 cases among providers and parents of newborns. CONCLUSION This study provides insights needed to be considered to improve the preparedness and response of healthcare facilities and care providers to future health emergencies in similar contexts.
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Affiliation(s)
- Nafissatou Dioubaté
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.
| | | | - Cécé Maomou
- Service de Maternité de l'Hôpital Régional de Mamou, Mamou, Guinea
| | - Harissatou Niane
- Institut de Nutrition et de Santé de l'Enfant, Hôpital National Donka, Conakry, Guinea
| | - Tamba Mina Millimouno
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea; Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Faculté des Sciences et Techniques de la Santé, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Bienvenu Salim Camara
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Telly Sy
- Service de Maternité de l'Hôpital National Ignace Deen, Conakry, Guinea
| | - Ibrahima Sory Diallo
- Institut de Nutrition et de Santé de l'Enfant, Hôpital National Donka, Conakry, Guinea
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Abdoul Habib Béavogui
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea; Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Faculté des Sciences et Techniques de la Santé, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
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Altare C, Kostandova N, Hasan MA, Agbogan JA, Miah ML, Crockett H, Bates M, Leslie S, Tonon B, Antoine C, Spiegel P. Health care utilisation in Cox's Bazar district, Bangladesh, during the first year of the COVID-19 pandemic: A mixed-methods study among host communities. Glob Public Health 2024; 19:2305364. [PMID: 38252791 DOI: 10.1080/17441692.2024.2305364] [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: 08/08/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
To respond to the COVID-19 pandemic, countries introduced public health and social measures that had indirect societal, economic consequences. Concerns during epidemics include continuity of routine health services. We investigate how healthcare utilisation and healthcare seeking behaviour changed during the first year of the COVID-19 pandemic among host communities in Cox's Bazar, Bangladesh. This mixed-methods study combines quantitative analyses of routine health data and population-based findings about healthcare seeking behaviours. Trends in consultations changed according to facility level (higher-level facilities included Upazila Health Complexes and District Hospitals; lower-level facilities included Community Clinics and Union Health and Family Welfare Centers). At the pandemic's beginning, drops were seen at higher-level health facilities for outpatient department (OPD) consultations, respiratory infections, and antenatal care. Minor reductions or increases were seen at lower-level facilities for the same services. Half of the subdistricts reported a cumulative increase in OPD and respiratory tract infection consultations. Most subdistricts reported a cumulative decrease in antenatal care. Child vaccinations dropped in all subdistricts, half of which did not catch-up, resulting in a cumulative decrease of delivered doses. Fear of contracting COVID-19 and financial constraints were the main reasons for decreased access. Drivers of healthcare seeking behaviours should be better understood to guide preparedness and service delivery modalities at primary and secondary levels.
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Affiliation(s)
- Chiara Altare
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| | | | | | | | | | - Hannah Crockett
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| | - Madison Bates
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| | - Sharon Leslie
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| | | | | | - Paul Spiegel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
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Steege R, Mwaniki H, Ogueji IA, Baraka J, Salimu S, Kumar MB, Kawaza K, Odedere O, Shamba D, Bokea H, Chiume M, Adudans S, Ezeaka C, Paul C, Banyira L, Lungu G, Salim N, Zimba E, Ngwala S, Tarus A, Bohne C, Gathara D, Lawn JE. Protecting small and sick newborn care in the COVID-19 pandemic: multi-stakeholder qualitative data from four African countries with NEST360. BMC Pediatr 2023; 23:572. [PMID: 37974092 PMCID: PMC10655439 DOI: 10.1186/s12887-023-04358-7] [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] [Received: 01/23/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Health system shocks are increasing. The COVID-19 pandemic resulted in global disruptions to health systems, including maternal and newborn healthcare seeking and provision. Yet evidence on mitigation strategies to protect newborn service delivery is limited. We sought to understand what mitigation strategies were employed to protect small and sick newborn care (SSNC) across 65 facilities Kenya, Malawi, Nigeria and Tanzania, implementing with the NEST360 Alliance, and if any could be maintained post-pandemic. METHODS We used qualitative methods (in-depth interviews n=132, focus group discussions n=15) with purposively sampled neonatal health systems actors in Kenya, Malawi, Nigeria and Tanzania. Data were collected from September 2021 - August 2022. Topic guides were co-developed with key stakeholders and used to gain a detailed understanding of approaches to protect SSNC during the COVID-19 pandemic. Questions explored policy development, collaboration and investments, organisation of care, human resources, and technology and device innovations. Interviews were conducted by experienced qualitative researchers and data were collected until saturation was reached. Interviews were digitally recorded and transcribed verbatim. A common coding framework was developed, and data were coded via NVivo and analysed using a thematic framework approach. FINDINGS We identified two pathways via which SSNC was strengthened. The first pathway, COVID-19 specific responses with secondary benefit to SSNC included: rapid policy development and adaptation, new and collaborative funding partnerships, improved oxygen systems, strengthened infection prevention and control practices. The second pathway, health system mitigation strategies during the pandemic, included: enhanced information systems, human resource adaptations, service delivery innovations, e.g., telemedicine, community engagement and more emphasis on planned preventive maintenance of devices. Chronic system weaknesses were also identified that limited the sustainability and institutionalisation of actions to protect SSNC. CONCLUSION Innovations to protect SSNC in response to the COVID-19 pandemic should be maintained to support resilience and high-quality routine SSNC delivery. In particular, allocation of resources to sustain high quality and resilient care practices and address remaining gaps for SSNC is critical.
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Affiliation(s)
- Rosie Steege
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
- Liverpool School of Tropical Medicine, Liverpool, UK.
| | | | | | - Jitihada Baraka
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Sangwani Salimu
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Meghan Bruce Kumar
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Kenya Medical Research Institute, Wellcome Trust Research Program, Nairobi, Kenya
| | - Kondwani Kawaza
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Opeyemi Odedere
- Rice360 Institute for Global Health Technologies, Houston, Texas, USA
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Helen Bokea
- Rice360 Institute for Global Health Technologies, Houston, Texas, USA
| | - Msandeni Chiume
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Kamuzu Central Hospital, Lilongwe, Malawi
| | - Steve Adudans
- Academy for Novel Channels in Health and Operations Research (ACANOVA Africa), Nairobi, Kenya
| | - Chinyere Ezeaka
- College of Medicine, University of Lagos, Lagos State, Nigeria
| | - Catherine Paul
- Rice360 Institute for Global Health Technologies, Houston, Texas, USA
| | | | - Gaily Lungu
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Evelyn Zimba
- Rice360 Institute for Global Health Technologies, Houston, Texas, USA
| | - Samuel Ngwala
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Alice Tarus
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Christine Bohne
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
- Rice360 Institute for Global Health Technologies, Houston, Texas, USA
| | - David Gathara
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
- Kenya Medical Research Institute, Wellcome Trust Research Program, Nairobi, Kenya.
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
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Semaan A, Annerstedt KS, Beňová L, Dossou JP, Boyi Hounsou C, Agballa G, Namazzi G, Kandeya B, Meja S, Ally Mkoka D, Asefa A, El-halabi S, Hanson C. Provision and utilization of maternal health services during the COVID-19 pandemic in 16 hospitals in sub-Saharan Africa. Front Glob Womens Health 2023; 4:1192473. [PMID: 38025986 PMCID: PMC10644718 DOI: 10.3389/fgwh.2023.1192473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Maintaining provision and utilization of maternal healthcare services is susceptible to external influences. This study describes how maternity care was provided during the COVID-19 pandemic and assesses patterns of service utilization and perinatal health outcomes in 16 referral hospitals (four each) in Benin, Malawi, Tanzania and Uganda. Methods We used an embedded case-study design and two data sources. Responses to open-ended questions in a health-facility assessment survey were analyzed with content analysis. We described categories of adaptations and care provision modalities during the pandemic at the hospital and maternity ward levels. Aggregate monthly service statistics on antenatal care, delivery, caesarean section, maternal deaths, and stillbirths covering 24 months (2019 and 2020; pre-COVID-19 and COVID-19) were examined. Results Declines in the number of antenatal care consultations were documented in Tanzania, Malawi, and Uganda in 2020 compared to 2019. Deliveries declined in 2020 compared to 2019 in Tanzania and Uganda. Caesarean section rates decreased in Benin and increased in Tanzania in 2020 compared to 2019. Increases in maternal mortality ratio and stillbirth rate were noted in some months of 2020 in Benin and Uganda, with variability noted between hospitals. At the hospital level, teams were assigned to respond to the COVID-19 pandemic, routine meetings were cancelled, and maternal death reviews and quality improvement initiatives were interrupted. In maternity wards, staff shortages were reported during lockdowns in Uganda. Clinical guidelines and protocols were not updated formally; the number of allowed companions and visitors was reduced. Conclusion Varying approaches within and between countries demonstrate the importance of a contextualized response to the COVID-19 pandemic. Maternal care utilization and the ability to provide quality care fluctuated with lockdowns and travel bans. Women's and maternal health workers' needs should be prioritized to avoid interruptions in the continuum of care and prevent the deterioration of perinatal health outcomes.
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Affiliation(s)
- Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jean-Paul Dossou
- Department of Health Policy and Systems, Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Christelle Boyi Hounsou
- Department of Health Policy and Systems, Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Gottfried Agballa
- Department of Health Policy and Systems, Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Gertrude Namazzi
- Centre of Excellence for Maternal Newborn and Child Health, Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Bianca Kandeya
- College of Medicine, the Centre for Reproductive Health, University of Malawi, Blantyre, Malawi
| | - Samuel Meja
- College of Medicine, the Centre for Reproductive Health, University of Malawi, Blantyre, Malawi
| | - Dickson Ally Mkoka
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Soha El-halabi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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7
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Beňová L, Semaan A, Afolabi BB, Amongin D, Babah OA, Dioubate N, Harissatou N, Kikula AI, Nakubulwa S, Ogein O, Adroma M, Anzo Adiga W, Diallo A, Diallo IS, Diallo L, Cellou Diallo M, Maomou C, Mtinangi N, Sy T, Delvaux T, Delamou A, Nakimuli A, Pembe AB, Banke-Thomas AO. Obstetric referrals, complications and health outcomes in maternity wards of large hospitals during the COVID-19 pandemic: a mixed methods study of six hospitals in Guinea, Nigeria, Uganda and Tanzania. BMJ Open 2023; 13:e076364. [PMID: 37730410 PMCID: PMC10514648 DOI: 10.1136/bmjopen-2023-076364] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic and elucidates pathways to these changes. DESIGN Prospective observational mixed-methods study, combining monthly routine data (March 2019-February 2021) and qualitative data from prospective semi-structured interviews. Data were analysed separately, triangulated during synthesis and presented along three country-specific pandemic periods: first wave, slow period and second wave. SETTING Six referral maternities in four sub-Saharan African countries: Guinea, Nigeria, Tanzania and Uganda. PARTICIPANTS 22 skilled health personnel (SHP) working in the maternity wards of various cadres and seniority levels. RESULTS Percentages of obstetric complications were constant in four of the six hospitals. The percentage of obstetric referrals received was stable in Guinea and increased at various times in other hospitals. SHP reported unpredictability in the number of referrals due to changing referral networks. All six hospitals registered a slight increase in stillbirths during the study period, the highest increase (by 30%-40%) was observed in Uganda. Four hospitals registered increases in facility maternal mortality ratio; the highest increase was in Guinea (by 158%), which had a relatively mild COVID-19 epidemic. These increases were not due to mortality among women with COVID-19. The main pathways leading to these trends were delayed care utilisation and disruptions in accessing care, including sub-optimal referral linkages and health service closures. CONCLUSIONS Maternal and perinatal survival was negatively affected in referral hospitals in sub-Saharan Africa during COVID-19. Routine data systems in referral hospitals must be fully used as they hold potential in informing adaptations of maternal care services. If combined with information on women's and care providers' needs, this can contribute to ensuring continuation of essential care provision during emergency.
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Affiliation(s)
- Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Bosede Bukola Afolabi
- Department of Obstetrics and Gynaecology, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Dinah Amongin
- Department of Health Policy Planning and Management, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ochuwa Adiketu Babah
- Department of Obstetrics and Gynaecology, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Nafissatou Dioubate
- Département de santé publique, Centre National de Formation et de Recherche en Santé Rurale, Maférinyah, Forécariah, Guinea
| | | | - Amani Idris Kikula
- Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Sarah Nakubulwa
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynaecology, Kawempe National Referral Hospital, Kampala, Uganda
| | - Olubunmi Ogein
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Moses Adroma
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - William Anzo Adiga
- Department of Obstetrics and Gynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | | | | | - Lamine Diallo
- Service de la maternité, Hôpital Régional de Mamou, Mamou, Guinea
| | | | - Cécé Maomou
- Service de la maternité, Hôpital Régional de Mamou, Mamou, Guinea
| | - Nathanael Mtinangi
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Telly Sy
- Service de la maternité, Hôpital National Ignace Deen, Conakry, Guinea
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Alexandre Delamou
- Département de santé publique, Centre National de Formation et de Recherche en Santé Rurale, Maférinyah, Forécariah, Guinea
| | - Annettee Nakimuli
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrea Barnabas Pembe
- Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
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Mzembe T, Chikwapulo V, Kamninga TM, Vellemu R, Mohamed S, Nthakomwa L, Chifungo C, Wazny K, Musau K, Abdullahi L, Peterson M, Madise N, Chipeta MG. Interventions to enhance healthcare utilisation among pregnant women to reduce maternal mortality in low- and middle-income countries: a review of systematic reviews. BMC Public Health 2023; 23:1734. [PMID: 37674154 PMCID: PMC10481488 DOI: 10.1186/s12889-023-16558-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Maternal mortality in low- and middle-income countries (LMIC) has reduced considerably over the past three decades, but it remains high. Effective interventions are available, but their uptake and coverage remain low. We reviewed and synthesised evidence from systematic reviews on interventions to increase healthcare services utilisation to reduce maternal mortality in LMICs. METHODS We searched Medline PubMed and Cochrane Library databases for systematic reviews published between January 2014 and December 2021, investigating interventions to increase healthcare services uptake among pregnant women in LMICs. We used the AMSTAR tool (A Measurement Tool to Assess Systematic Reviews) to assess the methodological quality of the included reviews. We extracted data on the interventions and their effects and grouped them into broad groups based on the outcomes reported in each systematic review. RESULTS We retrieved 4,022 articles. After removing duplicates and screening, we included 14 systematic reviews. Male-partner interventions were effective in increasing skilled birth attendance (SBA) postnatal visits and maternal antiretroviral (ART) uptake for HIV-positive pregnant women. However, there was no evidence of their effectiveness on increased early ANC initiation or adequate ANC visits. Mobile health interventions were effective in increasing adequate ANC visits, SBA, facility-based service utilisation, early ANC initiation, and adherence to nutritional supplements. Incentive-based interventions, particularly financial incentives, were effective in increasing the number of ANC visits but not postnatal visits. Facility-based interventions were effective in increasing postnatal visits, maternal ART initiation and uptake, immunisation uptake and follow-up ANC visits. None of the reviews assessed their impact on SBA or adequate ANC visits. Community-based interventions were effective in increasing SBA, ANC service utilisation, ART initiation and uptake, and nutritional supplements and immunisation uptake. CONCLUSION Our findings show that the different interventions effectively improved different outcomes on the maternal healthcare continuum. Implementing these interventions in combination has the potential to enhance healthcare service uptake further.
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Affiliation(s)
- Themba Mzembe
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi.
| | | | | | - Ruth Vellemu
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi
| | - Sahra Mohamed
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi
| | | | | | - Kerri Wazny
- The Children's Investment Fund Foundation, London, UK
| | - Kelvin Musau
- The Children's Investment Fund Foundation, Nairobi, Kenya
| | - Leila Abdullahi
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi
| | - Maame Peterson
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi
| | - Nyovani Madise
- African Institute for Development Policy (AFIDEP), Lilongwe, Malawi
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Murewanhema G, Mpabuka E, Moyo E, Tungwarara N, Chitungo I, Mataruka K, Gwanzura C, Musuka G, Dzinamarira T. Accessibility and utilization of antenatal care services in sub-Saharan Africa during the COVID-19 pandemic: A rapid review. Birth 2023; 50:496-503. [PMID: 36877622 DOI: 10.1111/birt.12719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 03/07/2023]
Abstract
Control measures for the COVID-19 pandemic brought unprecedented challenges to health care delivery. Some countries in sub-Saharan Africa (SSA) stopped the provision of essential health care except for those services that were deemed emergencies or life-threatening. A rapid review was conducted on March 18, 2022, on the accessibility and utilization of antenatal care services in sub-Saharan Africa during the COVID-19 pandemic. PubMed, Google Scholar, SCOPUS, and the World Health Organization library databases were searched for relevant studies. A modified Population, Intervention, Control, and Outcomes (PICO) framework informed the development of the search strategy. The review included studies conducted within Africa that described the availability, access, and utilization of antenatal services during the COVID-19 pandemic. Eighteen studies met the inclusion criteria. This review revealed a reduction in access to ANC services, an increase in the number of home deliveries, and a reduction in the number of women attending ANC visits during the COVID-19 pandemic. A decrease in ANC service utilization was reported in some studies in the review. Barriers to ANC access and utilization during the COVID-19 pandemic included movement restrictions, limited transport access, fear of contracting COVID-19 at the health facilities, and facility barriers. The use of telemedicine needs to be improved in African countries to allow for the continued provision of health services during pandemics. In addition, there should strengthening of community involvement in the provision of maternal health services post-COVID-19 so that services may be able to better withstand future public health emergencies.
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Affiliation(s)
- Grant Murewanhema
- Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Enos Moyo
- Medical Centre Oshakati, Oshakati, Namibia
| | - Nigel Tungwarara
- Department of Health Studies, University of South Africa, Pretoria, South Africa
| | - Itai Chitungo
- Chemical Pathology Unit, Department of Laboratory Diagnostic and Investigative Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Kidson Mataruka
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chipo Gwanzura
- Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Tafadzwa Dzinamarira
- ICAP at Columbia University, Kigali, Rwanda
- ICAP at Columbia University, Harare, Zimbabwe
- School of Health Systems & Public Health, University of Pretoria, Pretoria, South Africa
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10
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Conboy NE, Nickow A, Awoonor-Williams JK, Hirschhorn LR. Self-reported delays in care-seeking in West Africa during the first wave of the COVID-19 pandemic. BMC Health Serv Res 2023; 23:785. [PMID: 37481561 PMCID: PMC10363320 DOI: 10.1186/s12913-023-09812-x] [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: 12/19/2022] [Accepted: 07/13/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic caused delays in care-seeking due to fears of infection and decreased healthcare access globally. These delays have been linked in some countries to COVID-19 perceptions, decreased income, and food insecurity, but little is known about patient-level factors for decreased care-seeking specifically at the beginning of COVID-19 in West Africa. Understanding these factors is important to identify those at highest risk and address healthcare-related barriers. METHODS This study used self-reported data from telephone surveys in a population-based sample in Burkina Faso (n = 1352), Ghana (n = 1621), and Sierra Leone (n = 1301) in May-June 2020. Questions assessed delays in care-seeking, sociodemographic variables, COVID-19 beliefs, and food insecurity. Bivariate analyses using chi-square and multivariate analyses using logistic regression were used to explore associations between factors and delays in care-seeking by country. Independent variables were chosen based on prior research suggesting that financial insecurity, older age, female sex, rural location, and COVID-related concerns are associated with delays. RESULTS Between March-June 2020, 9.9%, 10.6%, and 5.7% of participants in Burkina Faso, Ghana, and Sierra Leone, respectively, delayed care-seeking. Food insecurity was prevalent (21.8-46.1%) and in bivariate analyses was associated with delays in care-seeking in Burkina Faso and Ghana. Concern about risk of household contraction of COVID-19 was common (18.1-36.0%) and in Ghana and Sierra Leone was associated with delays in care-seeking in both bivariate and multivariate analyses. In bivariate analyses, females showed more delays in Burkina Faso, while age above 30 and urban location were associated with delays in Ghana. In multivariate analyses, food insecurity was associated with increased delayed care-seeking in Burkina Faso. CONCLUSIONS Multiple factors were associated with delays in care-seeking early in the COVID-19 pandemic, with food insecurity and concerns about infection showing significant associations in multiple countries. These findings highlight the need to invest in clinic accessibility, community education, and financial assistance to address barriers in healthcare. While many delays have subsided since the initial phase of the COVID-19 pandemic, understanding factors associated with early disruptions of care-seeking at the patient and household level will inform strategies for maintaining healthcare access during future pandemics in West Africa.
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Affiliation(s)
- Natalie E Conboy
- Northwestern University Feinberg School of Medicine, IL, Chicago, USA.
| | - Andre Nickow
- Northwestern University Global Poverty Research Lab, Evanston, IL, USA
| | - John Koku Awoonor-Williams
- Formerly of the Department of Policy, Planning, Monitoring and Evaluation, Ghana Health Service, Accra, Ghana
| | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, IL, Chicago, USA
- Robert J. Havey Institute of Global Health, Chicago, IL, USA
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11
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Offosse MJ, Avoka C, Yameogo P, Manli AR, Goumbri A, Eboreime E, Boxshall M, Banke-Thomas A. Effectiveness of the Gratuité user fee exemption policy on utilization and outcomes of maternal, newborn and child health services in conflict-affected districts of Burkina Faso from 2013 to 2018: a pre-post analysis. Confl Health 2023; 17:33. [PMID: 37415179 DOI: 10.1186/s13031-023-00530-z] [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: 01/20/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Evidence on effectiveness of user fee exemption policies targeting maternal, newborn, and child health (MNCH) services is limited for conflict-affected settings. In Burkina Faso, a country that has had its fair share of conflicts, user fee exemption policies have been piloted since 2008 and implemented along with a national government-led user fee reduction policy ('SONU': Soins Obstétricaux et Néonataux d'Urgence). In 2016, the government transitioned the entire country to a user fee exemption policy known as Gratuité. Our study objective was to assess the effect of the policy on the utilization and outcomes of MNCH services in conflict-affected districts of Burkina Faso. METHODS We conducted a quasi-experimental study comparing four conflict-affected districts which had the user fee exemption pilot along with SONU before transitioning to Gratuité (comparator) with four other districts with similar characteristics, which had only SONU before transitioning (intervention). A difference-in-difference approach was initiated using data from 42 months before and 30 months after implementation. Specifically, we compared utilization rates for MNCH services, including antenatal care (ANC), facility delivery, postnatal care (PNC) and consultation for malaria. We reported the coefficient, including a 95% confidence interval (CI), p value, and the parallel trends test. RESULTS Gratuité led to significant increases in rates of 6th day PNC visits for women (Coeff 0.15; 95% CI 0.01-0.29), new consultations in children < 1 year (Coeff 1.80; 95% CI 1.13-2.47, p < 0.001), new consultations in children 1-4 years (Coeff 0.81; 95% CI 0.50-1.13, p = 0.001), and uncomplicated malaria cases treated in children < 5 years (Coeff 0.59; 95% CI 0.44-0.73, p < 0.001). Other service utilization indicators investigated, including ANC1 and ANC5+ rates, did not show any statistically significant positive upward trend. Also, the rates of facility delivery, 6th hour and 6th week postnatal visits were found to have increased more in intervention areas compared to control areas, but these were not statistically significant. CONCLUSIONS Our study shows that, even in conflict-affected areas, the Gratuité policy significantly influences MNCH service utilization. There is a strong case for continued funding of the user fee exemption policy to ensure that gains are not reversed, especially if the conflict ceases to abate.
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Affiliation(s)
- Marie-Jeanne Offosse
- ThinkWell, 11 B.P. 1255 CMS 11 Ouagadougou - Quartier Ouaga 2000, près de la fondation Kimi, à 500 du boulevard Muammar Kadaffi, Ouagadougou, Burkina Faso
| | - Cephas Avoka
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Astrid Raissa Manli
- ThinkWell, 11 B.P. 1255 CMS 11 Ouagadougou - Quartier Ouaga 2000, près de la fondation Kimi, à 500 du boulevard Muammar Kadaffi, Ouagadougou, Burkina Faso
| | - Aude Goumbri
- ThinkWell, 11 B.P. 1255 CMS 11 Ouagadougou - Quartier Ouaga 2000, près de la fondation Kimi, à 500 du boulevard Muammar Kadaffi, Ouagadougou, Burkina Faso
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Matt Boxshall
- ThinkWell, 11 B.P. 1255 CMS 11 Ouagadougou - Quartier Ouaga 2000, près de la fondation Kimi, à 500 du boulevard Muammar Kadaffi, Ouagadougou, Burkina Faso
| | - Aduragbemi Banke-Thomas
- ThinkWell, 11 B.P. 1255 CMS 11 Ouagadougou - Quartier Ouaga 2000, près de la fondation Kimi, à 500 du boulevard Muammar Kadaffi, Ouagadougou, Burkina Faso.
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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12
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Bah A, Russo G. Factors that influenced utilization of antenatal and immunization services in two local government areas in The Gambia during COVID-19: An interview-based qualitative study. PLoS One 2023; 18:e0276357. [PMID: 37384645 PMCID: PMC10309596 DOI: 10.1371/journal.pone.0276357] [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: 10/10/2022] [Accepted: 06/08/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION Evidence is being consolidated that shows that the utilization of antenatal and immunization services has declined in low-income countries (LICs) during the COVID-19 pandemic. Very little is known about the effects of the pandemic on antenatal and immunization service utilization in The Gambia. We set out to explore the COVID-19-related factors affecting the utilization of antenatal and immunization services in two Local Government Areas (LGAs) in The Gambia. METHODS A qualitative methodology was used to explore patients' and providers' experiences of antenatal and immunization services during the pandemic in two LGAs in The Gambia. Thirty-one study participants were recruited from four health facilities, applying a theory-driven sampling framework, including health workers as well as female patients. Qualitative evidence was collected through theory-driven semi-structured interviews, and was recorded, translated into English, transcribed, and analysed thematically, applying a social-ecological framework. RESULTS In our interviews, we identified themes at five different levels: individual, interpersonal, community, institutional and policy factors. Individual factors revolved around patients' fear of being infected in the facilities, and of being quarantined, and their anxiety about passing on infections to family members. Interpersonal factors involved the reluctance of partners and family members, as well as perceived negligence and disrespect by health workers. Community factors included misinformation within the community and mistrust of vaccines. Institutional factors included the shortage of health workers, closures of health facilities, and the lack of personal protective equipment (PPEs) and essential medicines. Finally, policy factors revolved around the consequences of COVID-19 prevention measures, particularly the shortage of transport options and mandatory wearing of face masks. CONCLUSIONS Our findings suggest that patients' fears of contagion, perceptions of poor treatment in the health system, and a general anxiety around the imposing of prevention measures, undermined the uptake of services. In future emergencies, the government in The Gambia, and governments in other LICs, will need to consider the unintended consequences of epidemic control measures on the uptake of antenatal and immunization services.
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Affiliation(s)
- Abdourahman Bah
- The Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Giuliano Russo
- The Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Andia-Biraro I, Baluku JB, Olum R, Bongomin F, Kyazze AP, Ninsiima S, Ssekamatte P, Kibirige D, Biraro S, Seremba E, Kabugo C. Effect of COVID-19 pandemic on inpatient service utilization and patient outcomes in Uganda. Sci Rep 2023; 13:9693. [PMID: 37322097 PMCID: PMC10272226 DOI: 10.1038/s41598-023-36877-9] [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: 08/20/2022] [Accepted: 06/12/2023] [Indexed: 06/17/2023] Open
Abstract
COVID-19 has had devastating effects on health systems but reports from sub-Saharan Africa are few. We compared inpatient admissions, diagnostic tests performed, clinical characteristics and inpatient mortality before and during the COVID-19 pandemic at an urban tertiary facility in Uganda. We conducted a retrospective chart review of patients admitted at Kiruddu National Referral Hospital in Uganda between January-July 2019 (before the pandemic) and January-July 2020 (during the pandemic). Of 3749 inpatients, 2014 (53.7%) were female, and 1582 (42.2%) had HIV. There was a 6.1% decline in admissions from 1932 in 2019 to 1817 in 2020. There were significantly fewer diagnostic tests performed in 2020 for malaria, tuberculosis, and diabetes. Overall, 649 (17.3%) patients died. Patients admitted during the COVID-19 pandemic (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 1.04-1.5, p = 0.018), patients aged ≥ 60 years (aOR 1.6, 95% CI 1.2-2.1, p = 0.001), HIV co-infected (aOR 1.5, 95% CI 1.2-1.9, p < 0.001), and those admitted as referrals (aOR 1.5, 95% CI 1.2-1.9, p < 0.001) had higher odds of dying. The COVID-19 pandemic disrupted inpatient service utilization and was associated with inpatient mortality. Policy makers need to build resilience in health systems in Africa to cope with future pandemics.
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Affiliation(s)
- Irene Andia-Biraro
- Makerere University College of Health Sciences, Kampala, Uganda
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Joseph Baruch Baluku
- Kiruddu National Referral Hospital, Kampala, Uganda.
- Makerere University Lung Institute, PO Box 26343, Kampala, Uganda.
| | - Ronald Olum
- Department of Medicine, St Francis Hospital Nsambya, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | - Sandra Ninsiima
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Samuel Biraro
- Clockworks Research Company Limited, Kampala, Uganda
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Bello K, George A, De Jong M, Adeyera O, Faye C, Oyelade T, Mathews K, Binagwaho A. African governments must build on covid-19 responses to advance gender equality. BMJ 2023; 381:e072239. [PMID: 37286224 PMCID: PMC10242614 DOI: 10.1136/bmj-2022-072239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Kéfilath Bello
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Asha George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Michelle De Jong
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | | - Cheikh Faye
- African Population and Health Research Center, West Africa Regional Office, Dakar, Senegal
| | - Taiwo Oyelade
- World Health Organization Regional Office for Africa, Brazzaville, Congo
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Gunarathna SP, Wickramasinghe ND, Agampodi TC, Prasanna IR, Agampodi SB. Impact of COVID-19 pandemic on health service utilisation and household economy of pregnant and postpartum women: a cross-sectional study from rural Sri Lanka. BMJ Open 2023; 13:e070214. [PMID: 37247958 PMCID: PMC10230333 DOI: 10.1136/bmjopen-2022-070214] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/16/2023] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES This study aims to describe how household economies and health service utilisation of pregnant and postpartum women were affected during the pandemic. DESIGN A cross-sectional study. SETTING This study was conducted in the Anuradhapura district, Sri Lanka. PARTICIPANTS The study participants were 1460 pregnant and postpartum women recruited for the Rajarata Pregnancy Cohort during the initial stage of the COVID-19 pandemic. PRIMARY AND SECONDARY OUTCOME MEASURES Household economic (income, poverty, nutritional and health expenditures) and health service utilisation details during the COVID-19 pandemic were gathered through telephone interviews. Sociodemographic and economic data were obtained from the cohort baseline and analysed with descriptive and non-parametric analysis. RESULTS Out of the 1460 women in the sample, 55.3% (n=807) were pregnant and 44.7% (n=653) were postpartum women. Of the total sample, 1172 (80.3%) women participated in the economic component. The monthly household income (median (IQR)=212.39 (159.29-265.49)) reduced (median (IQR)=159.29 (106.20-212.39)) in 50.5% (n=592) families during the pandemic (Z=-8.555, p<0.001). Only 10.3% (n=61) of affected families had received financial assistance from the government, which was only 46.4% of the affected income. The nutritional expenditure of pregnant women was reduced (Z=-2.023, p=0.043) by 6.7%. During the pandemic, 103 (8.8%) families with pregnant or postpartum women were pushed into poverty, and families who were pushed into poverty did not receive any financial assistance. The majority of women (n=1096, 83.3%) were satisfied with the free public health services provided by the public health midwife during the pandemic. CONCLUSION During the early stages of the pandemic, healthcare utilisation of pregnant women was minimally affected. Even before the country's current economic crisis, the household economies of pregnant women in rural Sri Lanka were severely affected, pushing families into poverty due to the pandemic. The impact of COVID-19 and the aftermath on pregnant women will have many consequences if the policies and strategies are not revised to address this issue.
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Affiliation(s)
- Sajan Praveena Gunarathna
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
| | - Nuwan Darshana Wickramasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
| | - Thilini Chanchala Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
| | - Indika Ruwan Prasanna
- Department of Economics, Faculty of Social Sciences and Humanities, Rajarata University of Sri Lanka, Mihintale, Anuradhapura, Sri Lanka
| | - Suneth Buddhika Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
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Yeboah H, Yaya S. Health and economic implications of the ongoing coronavirus disease (COVID-19) pandemic on women and children in Africa. Reprod Health 2023; 20:70. [PMID: 37158924 PMCID: PMC10165567 DOI: 10.1186/s12978-023-01616-w] [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: 03/07/2023] [Accepted: 04/29/2023] [Indexed: 05/10/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic continues to pose major health and economic challenges for many countries worldwide. Particularly for countries in the African region, the existing precarious health status resulting from weak health systems have made the impact of the pandemic direr. Although the number of the COVID-19 infections in Africa cannot be compared to that of Europe and other parts of the world, the economic and health ramifications cannot be overstated. Significant impacts of the lockdowns during the onset of the pandemic caused disruptions in the food supply chain, and significant declines in income which decreased the affordability and consumption of healthy diets among the poor and most vulnerable. Access and utilization of essential healthcare services by women and children were also limited because of diversion of resources at the onset of the pandemic, limited healthcare capacity, fear of infection and financial constraint. The rate of domestic violence against children and women also increased, which further deepened the inequalities among these groups. While all African countries are out of lockdown, the pandemic and its consequent impacts on the health and socio-economic well-being of women and children persist. This commentary discusses the health and economic impact of the ongoing pandemic on women and children in Africa, to understand the intersectional gendered implications within socio-economic and health systems and to highlight the need for a more gender-based approach in response to the consequences of the pandemic in the Africa region.
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Affiliation(s)
- Helena Yeboah
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada.
- The George Institute for Global Health, Imperial College London, London, UK.
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Dzinamarira T, Moyo E, Pierre G, Mpabuka E, Kahere M, Tungwarara N, Chitungo I, Murewanhema G, Musuka G. Postnatal care services availability and utilization during the COVID-19 era in sub-Saharan Africa: A rapid review. Women Birth 2023; 36:e295-e299. [PMID: 36253282 PMCID: PMC9550672 DOI: 10.1016/j.wombi.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/09/2022] [Accepted: 10/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Considerable progress has been made globally in improving maternal and newborn babies' health. The COVID-19 pandemic has posed considerable challenges for countries to maintain the provision of high-quality, essential maternal and newborn healthcare services. METHODS A rapid review was carried out on 20 March 2022 on postnatal care (PNC) services availability and utilization during the COVID-19 era in sub-Saharan Africa. PubMed, Google Scholar, and Africa Journals Online (AJOL) databases were searched for relevant studies. Studies included in the review utilized both primary data and secondary data. FINDINGS Nineteen studies met the inclusion criteria. The review revealed that there were significant declines in the availability and utilization of PNC services during and after the COVID-19 lockdown. Several reasons were found to contribute to the decline. DISCUSSION New, innovative strategies are therefore required to ensure that mothers and their newborn babies receive essential PNC to reduce maternal and neonatal morbidity and mortality in sub-Saharan Africa. Some of the strategies that can be used include home-based PNC visits, the use of telemedicine, phone-based referral networks, social media, and community radios.
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Affiliation(s)
| | - Enos Moyo
- Oshakati Medical Centre, Oshakati, Namibia
| | - Gashema Pierre
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Morris Kahere
- College of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Nigel Tungwarara
- College of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Itai Chitungo
- College of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Grant Murewanhema
- College of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Millimouno TM, Dioubaté N, Niane H, Diallo MC, Maomou C, Sy T, Diallo IS, Semaan A, Delvaux T, Beňová L, Delamou A. Effect of the COVID-19 pandemic on maternal and neonatal health services in three referral hospitals in Guinea: an interrupted time-series analysis. Reprod Health 2023; 20:50. [PMID: 36966343 PMCID: PMC10039677 DOI: 10.1186/s12978-023-01599-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/21/2023] [Indexed: 03/27/2023] Open
Abstract
INTRODUCTION In sub-Saharan Africa, there is limited evidence on the COVID-19 health-related effect from front-line health provision settings. Therefore, this study aimed to analyse the effect of the COVID-19 pandemic on routine maternal and neonatal health services in three referral hospitals. MATERIALS AND METHODS We conducted an observational study using aggregate monthly maternal and neonatal health services routine data for two years (March 2019-February 2021) in three referral hospitals including two maternities: Hôpital National Ignace Deen (HNID) in Conakry and Hôpital Regional de Mamou (HRM) in Mamou and one neonatology ward: Institut de Nutrition et de Santé de l'Enfant (INSE) in Conakry. We compared indicators of health service utilisation, provision and health outcomes before and during the COVID-19 pandemic periods. An interrupted time-series analysis (ITSA) was performed to assess the relationship between changes in maternal and neonatal health indicators and COVID-19 through cross-correlation. RESULTS During COVID-19, the mean monthly number (MMN) of deliveries decreased significantly in HNID (p = 0.039) and slightly increased in HRM. In the two maternities, the change in the MMN of deliveries were significantly associated with COVID-19. The ITSA confirmed the association between the increase in the MMN of deliveries and COVID-19 in HRM (bootstrapped F-value = 1.46, 95%CI [0.036-8.047], p < 0.01). We observed an increasing trend in obstetric complications in HNID, while the trend declined in HRM. The MMN of maternal deaths increased significantly (p = 0.011) in HNID, while it slightly increased in HRM. In INSE, the MMN of neonatal admissions significantly declined (p < 0.001) and this decline was associated with COVID-19. The MMN of neonatal deaths significantly decreased (p = 0.009) in INSE and this decrease was related to COVID-19. CONCLUSION The pandemic negatively affected the maternal and neonatal care provision, health service utilisation and health outcomes in two referral hospitals located in Conakry, the COVID-19 most-affected region.
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Affiliation(s)
- Tamba Mina Millimouno
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.
- Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Faculté des Sciences et Techniques de la Santé, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea.
| | - Nafissatou Dioubaté
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Harissatou Niane
- Institut de Nutrition et de Santé de l'Enfant, Hôpital National Donka, Conakry, Guinea
| | | | - Cécé Maomou
- Service de Maternité de l'Hôpital Régional de Mamou, Mamou, Guinea
| | - Telly Sy
- Service de Maternité de l'Hôpital National Ignace Deen, Conakry, Guinea
| | - Ibrahima Sory Diallo
- Institut de Nutrition et de Santé de l'Enfant, Hôpital National Donka, Conakry, Guinea
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
- Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Faculté des Sciences et Techniques de la Santé, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
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Bekele GG, Seifu B, Roga EY. Determinants of maternal satisfaction with focused antenatal care services rendered at public health facilities in the West Shewa Zone, Central Ethiopia: A multicentre cross-sectional study. Front Glob Womens Health 2023; 3:902876. [PMID: 36793359 PMCID: PMC9922752 DOI: 10.3389/fgwh.2022.902876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 12/23/2022] [Indexed: 02/01/2023] Open
Abstract
Background Every woman has the right to receive quality care during pregnancy. It is proven that antenatal care (ANC) reduces maternal and perinatal morbidity and mortality. The government of Ethiopia is also making intense efforts to increase the coverage of ANC. However, among pregnant women, the levels of satisfaction with the care provided are overlooked, as the percentage of women who complete all ANC visits is below 50. Therefore, this study aims to assess maternal satisfaction with ANC services rendered at public health facilities in the West Shewa Zone, Ethiopia. Methods A facility-based cross-sectional study was conducted among women who were receiving ANC in public health facilities in Central Ethiopia between September 1 and October 15, 2021. A total of 411 women were selected using the systematic random sampling method. The questionnaire was pretested and the data were collected electronically using CSEntry. The collected data were exported to SPSS version 26. The characteristics of the study participants were described using frequency and percentage. Bivariate and multivariate logistic regression were used to identify the factors associated with maternal satisfaction with focused ANC service. Result This study revealed that 46.7% [95% confidence interval (CI) (41.7%-51.6%)] of women were satisfied with ANC service. Factors such as the quality of the health institution [adjusted odd ratio (AOR) = 5.10, (95% CI: 3.33-7.75)], place of residence [AOR = 2.38, (95% CI: 1.21-4.70)], history of abortion [AOR = 0.19, (95% CI: 0.07-0.49)], and previous mode of delivery [AOR = 0.30, (95% CI: 0.15-0.60)] were significantly associated with women's satisfaction with focused ANC service. Conclusion More than half of pregnant women who received ANC were dissatisfied with the service they received. This should be a cause for concern, as the level of satisfaction is lower than that of the findings of previous studies conducted in Ethiopia. Institutional variables, interactions with patients, and previous experiences of pregnant women have an impact on the level of satisfaction. Due attention should be paid to primary health and communication of health professionals with pregnant women to improve the levels of satisfaction with focused ANC service.
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Macharia PM, Joseph NK, Nalwadda GK, Mwilike B, Banke-Thomas A, Benova L, Johnson O. Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens. BMC Pregnancy Childbirth 2022; 22:908. [PMID: 36474193 PMCID: PMC9724345 DOI: 10.1186/s12884-022-05238-1] [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: 06/07/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pregnant women in sub-Saharan Africa (SSA) experience the highest levels of maternal mortality and stillbirths due to predominantly avoidable causes. Antenatal care (ANC) can prevent, detect, alleviate, or manage these causes. While eight ANC contacts are now recommended, coverage of the previous minimum of four visits (ANC4+) remains low and inequitable in SSA. METHODS We modelled ANC4+ coverage and likelihood of attaining district-level target coverage of 70% across three equity stratifiers (household wealth, maternal education, and travel time to the nearest health facility) based on data from malaria indicator surveys in Kenya (2020), Uganda (2018/19) and Tanzania (2017). Geostatistical models were fitted to predict ANC4+ coverage and compute exceedance probability for target coverage. The number of pregnant women without ANC4+ were computed. Prediction was at 3 km spatial resolution and aggregated at national and district -level for sub-national planning. RESULTS About six in ten women reported ANC4+ visits, meaning that approximately 3 million women in the three countries had 20,000 women having CONCLUSIONS These findings will be invaluable to policymakers for annual appropriations of resources as part of efforts to reduce maternal deaths and stillbirths.
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Affiliation(s)
- Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Noel K. Joseph
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | - Beatrice Mwilike
- Community Health Nursing Department, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Olatunji Johnson
- Department of Mathematics, The University of Manchester, Manchester, UK
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21
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Ridde V, Kane B, Mbow NB, Senghor I, Faye A. The resilience of two departmental health insurance units during the COVID-19 pandemic in Senegal. BMJ Glob Health 2022; 7:e010062. [PMID: 36526299 PMCID: PMC9764624 DOI: 10.1136/bmjgh-2022-010062] [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: 07/05/2022] [Accepted: 10/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In its pursuit of solutions for universal health coverage (UHC), Senegal has set up two departmental health insurance units (UDAMs) since 2014. Few studies on the resilience of health systems in Africa have examined health insurance organisations. This article aims to understand how these two UDAMs have been resilient during the COVID-19 pandemic and the restrictive measures imposed by the State to maintain services to their members and reimbursements to healthcare providers. METHODS This study was a multicase study with multiple levels of analysis using a conceptual framework of resilience and analysis of organisational configurations. Empirical data are derived from document analysis, observations for 6 months and 17 qualitative in-depth interviews. RESULTS The results identified three main configurations concerning (1) safety and hygiene, (2) organisation and planning and (3) communication for sustainable payment. The UDAM faced the pandemic with resilience processes to absorb the shock and maintain service to their members. The UDAM learnt positive lessons from crisis management, such as remote work or the ability to support members in their care in hospitals away from their headquarters. They have innovated (transformative resilience) with the organisation of electronic payment and the use of social networks to raise funds and communicate with members. Strengthening their effectiveness after the shock of the departure of the donors in 2017 contributed to the adaptation and even transformation from the pandemic shock of 2020 and 2021. The study shows that leadership, team dynamics and adaptation to contexts are drivers of resilience processes. CONCLUSION Both UDAMs adapted to the shocks of the pandemic and government measures to maintain the services of their members and their organisational routine. This resilience confirms that UDAMs are one of the possible solutions for UHC in the Sahel.
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Affiliation(s)
- Valéry Ridde
- Université Paris Cité, IRD, Ceped, Paris, France
- Université Cheikh Anta Diop, Institut de santé et developpement, Dakar, Senegal
| | - Babacar Kane
- Université Cheikh Anta Diop, Institut de santé et developpement, Dakar, Senegal
| | - Ndeye Bineta Mbow
- Foundiougne, Sénégal, Departmental Health Insurance Unit, Foundiougne, Senegal
| | - Ibrahima Senghor
- Koungheul, Sénégal, Departmental Health Insurance Unit, Koungheul, Senegal
| | - Adama Faye
- Université Cheikh Anta Diop, Institut de santé et developpement, Dakar, Senegal
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22
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Adu PA, Stallwood L, Adebola SO, Abah T, Okpani AI. The direct and indirect impact of COVID-19 pandemic on maternal and child health services in Africa: a scoping review. Glob Health Res Policy 2022; 7:20. [PMID: 35854345 PMCID: PMC9296365 DOI: 10.1186/s41256-022-00257-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The novel coronavirus disease 2019 (COVID-19) continues to disrupt the availability and utilization of routine and emergency health care services, with differing impacts in jurisdictions across the world. In this scoping review, we set out to synthesize documentation of the direct and indirect effect of the pandemic, and national responses to it, on maternal, newborn and child health (MNCH) in Africa.
Methods A scoping review was conducted to provide an overview of the most significant impacts identified up to March 15, 2022. We searched MEDLINE, Embase, HealthSTAR, Web of Science, PubMed, and Scopus electronic databases. We included peer reviewed literature that discussed maternal and child health in Africa during the COVID-19 pandemic, published from January 2020 to March 2022, and written in English. Papers that did not focus on the African region or an African country were excluded. A data-charting form was developed by the two reviewers to determine which themes to extract, and narrative descriptions were written about the extracted thematic areas.
Results Four-hundred and seventy-eight articles were identified through our literature search and 27 were deemed appropriate for analysis. We identified three overarching themes: delayed or decreased care, disruption in service provision and utilization and mitigation strategies or recommendations. Our results show that minor consideration was given to preserving and promoting health service access and utilization for mothers and children, especially in historically underserved areas in Africa. Conclusions Reviewed literature illuminates the need for continued prioritization of maternity services, immunization, and reproductive health services. This prioritization was not given the much-needed attention during the COVID-19 pandemic yet is necessary to shield the continent’s most vulnerable population segments from the shocks of current and future global health emergencies. Supplementary Information The online version contains supplementary material available at 10.1186/s41256-022-00257-z.
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Affiliation(s)
- Prince A Adu
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. .,British Columbia Centre for Disease Control, Vancouver, BC, Canada.
| | - Lisa Stallwood
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Stephen O Adebola
- Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Ogbomoso, Nigeria.,St Paul's Sinus Centre, St Paul's Hospital, Burrard St, Vancouver, BC, Canada
| | - Theresa Abah
- California State University, Sacramento, CA, USA
| | - Arnold Ikedichi Okpani
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,National Primary Health Care Development Agency, Abuja, Nigeria
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Aye YM, Kim SJ, Suriyawongpaisal W, Hong SA, Chang YS. Utilization of Postnatal Care Services among Thai Women during the COVID-19 Pandemic: Results of a Web-Based Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6536. [PMID: 35682122 PMCID: PMC9179996 DOI: 10.3390/ijerph19116536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022]
Abstract
The postnatal period is an underserved aspect of maternity care, potentially worsened by the COVID-19 pandemic. This study aims to identify postnatal care (PNC) use by health personnel within the 42 days of childbirth among postpartum mothers in Thailand. This web-based, cross-sectional study was conducted from July to October 2021 (n = 840). Multiple binary and ordinal logistic regressions were conducted to predict three outcome variables (≥2 times, ≥3 times, or level of PNC use). Women who received PNC were in low numbers (≥2: 30.7% and (≥3: 12.9%), while 54.4% of women reported no barriers to access PNC, and 31.9% reported barriers, including worries over COVID-19 infection, followed by movement restrictions imposed by the government (11.7%) and the closure of healthcare centers (10%). Women working in a self-employed capacity, living in urban areas, and undergoing a Caesarean section with no/less worry about COVID-19 infection were more likely to utilize postnatal care (≥2 or number of PNC). This study provides timely information, revealing that a relatively low percentage of postpartum women received PNC, particularly among the socially deprived group. Since the fear of COVID infection is listed as a major barrier, the provision of PNC services, including a telehealth program should be considered.
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Affiliation(s)
- Yin Min Aye
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom 73170, Thailand; (Y.M.A.); (W.S.)
| | - Soo Jung Kim
- Department of Health Sciences, Hamburg University of Applied Sciences, 20099 Hamburg, Germany;
| | - Wichukorn Suriyawongpaisal
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom 73170, Thailand; (Y.M.A.); (W.S.)
| | - Seo Ah Hong
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom 73170, Thailand; (Y.M.A.); (W.S.)
| | - Yan-Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London SE1 8WA, UK;
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Balogun M, Dada FO, Oladimeji A, Gwacham-Anisiobi U, Sekoni A, Banke-Thomas A. Leading in a time of crisis: exploring early experiences of health facility leaders during the COVID-19 pandemic in Nigeria's epicentre. Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print. [PMID: 35543177 DOI: 10.1108/lhs-02-2022-0017] [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: 11/17/2022]
Abstract
PURPOSE The COVID-19 pandemic has had a disruptive effect on the health system. Health facility leaders were at the forefront of maintaining service delivery and were exposed to varied stressors in the early phase of the pandemic. This study aims to explore the leadership experiences of health facility leaders during the early phase of the COVID-19 pandemic in Nigeria's epicentre. DESIGN/METHODOLOGY/APPROACH This study conducted an exploratory descriptive qualitative study. To achieve this, 33 health facility leaders of different cadres across primary, secondary, and tertiary levels of the public health care system in Lagos, Nigeria, were remotely interviewed. The key informant interviews were transcribed verbatim and were analysed by using thematic analysis. FINDINGS The health facility leaders experienced heightened levels of fear, anxiety and stressors during the early phase of the pandemic. They also had genuine concerns about exposing their family members to the virus and had to manage some health-care workers who were afraid for their lives and reluctant. Coping mechanisms included psychological and social support, innovative hygiene measures at health facility and at home, training and staff welfare in more ways than usual. They were motivated to continue rendering services during the crisis because of their passion, their calling, the Hippocratic oath and support from the State government. ORIGINALITY/VALUE The experiences of health facility leaders from different parts of the world have been documented. However, to the best of the authors' knowledge, this is one of the first studies that specifically report multi-layer leadership experiences of health facility leaders during the early phase of the COVID-19 pandemic in sub-Saharan Africa.
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Affiliation(s)
- Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Festus Opeyemi Dada
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Adetola Oladimeji
- Solina Center for International Development and Research, Abuja, Nigeria
| | | | - Adekemi Sekoni
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Aduragbemi Banke-Thomas
- School of Human Sciences, University of Greenwich, London, UK and LSE Health, The London School of Economics and Political Science, London, UK
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25
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Semaan A, Banke-Thomas A, Amongin D, Babah O, Dioubate N, Kikula A, Nakubulwa S, Ogein O, Adroma M, Anzo Adiga W, Diallo A, Diallo L, Cellou Diallo M, Maomou C, Mtinangi N, Sy T, Delvaux T, Afolabi BB, Delamou A, Nakimuli A, Pembe AB, Benova L. 'We are not going to shut down, because we cannot postpone pregnancy': a mixed-methods study of the provision of maternal healthcare in six referral maternity wards in four sub-Saharan African countries during the COVID-19 pandemic. BMJ Glob Health 2022; 7:e008063. [PMID: 35144921 PMCID: PMC8844957 DOI: 10.1136/bmjgh-2021-008063] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/20/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Referral hospitals in sub-Saharan Africa are located in crowded urban areas, which were often epicentres of the COVID-19 pandemic. This paper prospectively assesses how maternal healthcare was provided in six referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the COVID-19 pandemic. METHODS Mixed-methods design using three data sources: (1) qualitative data from repeated rounds of semi-structured interviews conducted between July 2020 and February 2021 with 22 maternity skilled heath personnel (SHP) on perceptions of care provision; (2) quantitative monthly routine data on caesarean section and labour induction from March 2019 to February 2021; and (3) timeline data of COVID-19 epidemiology, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on timeline analysis, and triangulated during reporting. RESULTS We identified three periods: first wave, slow period and second wave. The first wave was challenging for SHP given little knowledge about COVID-19, lack of infection prevention and control training, and difficulties reaching workplace. Challenges that persisted beyond the first wave were shortage of personal protective equipment and no rapid testing for women suspected with COVID-19. We noted no change in the proportion of caesarean sections during the pandemic, and a small increase in the proportion of labour inductions. All hospitals arranged isolation areas for women suspected/confirmed with COVID-19 and three hospitals provided care to women with suspected/confirmed COVID-19. Breastfeeding was not discouraged and newborns were not separated from mothers confirmed with COVID-19. Care provision was maintained through dedication of SHP, support from hospital management and remote communication between SHP. CONCLUSION Routine maternal care provision was maintained in referral hospitals, despite first wave challenges. Referral hospitals and SHP contributed to guideline development for pregnant women suspected/confirmed with COVID-19. Maternity SHP, women and pregnancy must always be included in priority setting when responding to health system shocks, including outbreaks.
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Affiliation(s)
- Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Aduragbemi Banke-Thomas
- LSE Health, The London School of Economics and Political Science, London, UK
- School of Human Sciences, University of Greenwich, London, UK
| | - Dinah Amongin
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Health Policy Planning and Management, Makerere University, School of Public Health, Kampala, Uganda
| | - Ochuwa Babah
- College of Medicine, University of Lagos, Akoka, Lagos, Nigeria
| | - Nafissatou Dioubate
- Département de Santé Publique, Centre National de Formation et de Recherche en Santé Rurale de Maférinyah, Maférinyah, Forécariah, Guinea
| | - Amani Kikula
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Sarah Nakubulwa
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynaecology, Kawempe National Referral Hospital, Kampala, Uganda
| | - Olubunmi Ogein
- College of Medicine, University of Lagos, Akoka, Lagos, Nigeria
| | - Moses Adroma
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - William Anzo Adiga
- Department of Obstetrics and Gynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Abdourahmane Diallo
- Maternité Ignace Deen, Hôpital National Ignace Deen de Conakry, Conakry, Guinea
| | | | | | - Cécé Maomou
- Maternité, Hôpital Régional de Mamou, Mamou, Guinea
| | - Nathanael Mtinangi
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania, United Republic of
| | - Telly Sy
- Maternité Ignace Deen, Hôpital National Ignace Deen de Conakry, Conakry, Guinea
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bosede Bukola Afolabi
- Department of Obstetrics and Gynaecology, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Alexandre Delamou
- Département de Santé Publique, Centre National de Formation et de Recherche en Santé Rurale de Maférinyah, Maférinyah, Forécariah, Guinea
- Department of Public Health, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Annettee Nakimuli
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania, United Republic of
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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