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Gadsden T, Sood T, Purwar P, Peiris D, Nambiar D, Downey LE. Impact of COVID-19 on essential service provision for reproductive, maternal, neonatal, and child health in the Southeast Asia region: a systematic review. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 25:100357. [PMID: 39021483 PMCID: PMC467076 DOI: 10.1016/j.lansea.2024.100357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/16/2023] [Accepted: 01/12/2024] [Indexed: 07/20/2024]
Abstract
Background There is increasing evidence that the COVID-19 pandemic has impacted adversely on the provision of essential health services globally. The Southeast Asia region (SEAR) has experienced extremely high rates of COVID-19 infection, with potential adverse impacts on provision of reproductive, maternal, neonatal, and child health (RMNCH) services. Methods We conducted a systematic literature review of quantitative evidence to characterise the impact of COVID-19 on the provision of essential RMNCH services across the SEAR. Studies published between December 2019 and May 2022 were included in the study. The quality of studies was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist. Findings We reviewed 1924 studies and analysed data from 20 peer-reviewed studies and three reports documenting quantitative pre-post estimates of RMNCH service disruption because of the COVID-19 pandemic. Eleven studies were of low methodological quality, in addition to seven and five studies of moderate and high methodological qualities respectively. Six countries in the region were represented in the included studies: India (11 studies), Bangladesh (4), Nepal (3), Sri Lanka (1), Bhutan (1) and Myanmar (1). These countries demonstrated a wide reduction in antenatal care services (-1.6% to -69.6%), facility-based deliveries (-2.3% to -52.4%), child immunisation provision (-13.5% to -87.7%), emergency obstetric care (+4.0% to -76.6%), and family planning services (-4.2% to -100%). Interpretation There have been large COVID-19 pandemic related disruptions for a wide range of RMNCH essential health service indicators in several SEAR countries. Notably, we found a higher level of service disruption than the WHO PULSE survey estimates. If left unaddressed, such disruptions may set back hard-fought gains in RMNCH outcomes across the region. The absence of studies in five SEAR countries is a priority evidence gap that needs addressing to better inform policies for service protection. Funding WHO Sri Lanka Country Office.
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Affiliation(s)
- Thomas Gadsden
- The George Institute for Global Health, Sydney, Australia
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Tushar Sood
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Parnika Purwar
- The George Institute for Global Health, New Delhi, India
| | - David Peiris
- The George Institute for Global Health, Sydney, Australia
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Devaki Nambiar
- The George Institute for Global Health, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Karnataka, India
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Laura E. Downey
- The George Institute for Global Health, Sydney, Australia
- School of Public Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
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Dandona R, Kumar GA, Majumder M, Akbar M, Prasad Dora SS, Dandona L. Poor coverage of quality-adjusted antenatal care services: a population-level assessment by visit and source of antenatal care services in Bihar state of India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 25:100332. [PMID: 39021484 PMCID: PMC467073 DOI: 10.1016/j.lansea.2023.100332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 07/20/2024]
Abstract
Background Despite the evidence on the poor quality of antenatal care (ANC) services, significant gap remains in the understanding of quality-adjusted coverage at the population-level for each ANC visit and by the source of ANC services, and in equity in this coverage. Methods All births between July 2020 and June 2021 were listed from 261,124 households (91.5% participation) representative of the Bihar state. Mothers of all stillbirths and neonatal deaths, and of 25% random sample of livebirths who survived the neonatal period provided data on each ANC visit up to a maximum of first 4 ANC visits, including the source of ANC services and the services received (weight measurement, blood pressure checked, abdomen checked, urine sample taken, and blood sample taken). An ANC visit was deemed of quality if all of these services were received in that visit. We report the coverage of quality-adjusted ANC services (Q-ANC) for ANC visits 1-4 disaggregated by source of ANC services and wealth index (WI). Weighted proportions are reported to take into account the sampling design. Findings A total of 30,412 births were reported by 29,517 women, and 7270 (82.1%) of the 8853 eligible women participated. Overall, 19,950 unique ANC visits from 6929 women were available for analysis, of which 41.7%, 13.8% and 44.5% were at Village Health and Nutrition Day (VNHD), public facility, and with a private provider, respectively. A total of 4409 (65.3%) of the 1st ANC visits were undertaken at VHND, with the proportion of private provider ANC visits increasing significantly from ANC visit 1 to ANC visit 4 (p < 0.001). Q-ANC coverage considering all ANC visits was 20.9% (95% CI 20.7-21.2); and was 0.9% (95% CI 0.8-1.0), 29.9% (95% CI 29.2-30.7) and 36.9% (95% CI 36.5-37.4) for ANC visits in VHND, public facilities, and with private provider, respectively. Q-ANC coverage in the public facility was significantly lower in the 4th ANC visit (25.1%; 95% CI 23.4-26.9) as compared with visits 1 to 3, whereas it was the highest for 1st ANC visit with private provider (50.2%; 95% CI 49.2-51.1) and then dropped for visits 2 to 4. Irrespective of the source of ANC services, Q-ANC coverage increased significantly with increasing WI quartile for ANC visits 1 and 2, with WI quartile 3 women having significantly less coverage for ANC visit 3 compared to the rest, and no significant difference seen in the coverage of ANC 4 visit. Varied pattern of Q-ANC coverage by WI for each ANC visit was seen for public facility and private provider visits. Interpretation With only 2 of 10 ANC visits deemed of adequate quality, sustainable delivery of quality ANC services are needed for every pregnant woman through-out the pregnancy irrespective of gestation period, number of ANC visit, and source of ANC services. Funding The funding was provided by the India office of the Bill & Melinda Gates Foundation, USA.
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Affiliation(s)
- Rakhi Dandona
- Public Health Foundation of India, Gurugram, National Capital Region, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - G Anil Kumar
- Public Health Foundation of India, Gurugram, National Capital Region, India
| | - Moutushi Majumder
- Public Health Foundation of India, Gurugram, National Capital Region, India
| | - Md Akbar
- Public Health Foundation of India, Gurugram, National Capital Region, India
| | - S Siva Prasad Dora
- Public Health Foundation of India, Gurugram, National Capital Region, India
| | - Lalit Dandona
- Public Health Foundation of India, Gurugram, National Capital Region, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - ENHANCE 2020 team
- Public Health Foundation of India, Gurugram, National Capital Region, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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Kuandyk (Sabitova) A, Ortega MA, Ntegwa MJ, Sarria-Santamera A. Impact of the COVID-19 pandemic on access to and delivery of maternal and child healthcare services in low-and middle-income countries: a systematic review of the literature. Front Public Health 2024; 12:1346268. [PMID: 38655525 PMCID: PMC11036866 DOI: 10.3389/fpubh.2024.1346268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
Background The COVID-19 pandemic has had a multifaceted impact on maternal and child services and adversely influenced pregnancy outcomes. This systematic review aims to determine the impact of the COVID-19 pandemic on access to and delivery of maternal and child healthcare services in low- and middle-income countries. Methods The review was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A primary search of electronic databases was performed using a combination of search terms related to the following areas of interest: "impact' AND 'COVID-19' AND 'maternal and child health services' AND 'low- and middle-income countries. A narrative synthesis approach was used to analyse and integrate the results. Results Overall, 45 unique studies conducted across 28 low- and middle-income countries met the inclusion criteria for the review. The findings suggest the number of family planning visits, antenatal and postnatal care visits, consultations for sick children, paediatric emergency visits and child immunisation levels decreased compared to the pre-pandemic levels in the majority of included studies. An analytical framework including four main categories was developed based on the concepts that emerged from included studies: the anxiety of not knowing (1), overwhelmed healthcare systems (2), challenges perceived by healthcare professionals (3) and difficulties perceived by service users (4). Conclusion The COVID-19 pandemic disrupted family planning services, antenatal and postnatal care coverage, and emergency and routine child services. Generalised conclusions are tentative due to the heterogeneity and inconsistent quality of the included studies. Future research is recommended to define the pandemic's impact on women and children worldwide and prepare healthcare systems for future resurgences of COVID-19 and potential challenges beyond. Systematic review registration PROSPERO (CRD42021285178).
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Affiliation(s)
- Alina Kuandyk (Sabitova)
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Miguel-Angel Ortega
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | | | - Antonio Sarria-Santamera
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
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Ahmed J, Kumar R, Mehraj V, Almarabheh A, Khowaja SA, Khan SA, Naeem N, Pongpanich S. Perceptions of health care workers on maternal and child health services in Pakistan during COVID-19: A cross-sectional study. DIALOGUES IN HEALTH 2023; 3:100145. [PMID: 38510919 PMCID: PMC10292912 DOI: 10.1016/j.dialog.2023.100145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 03/22/2024]
Abstract
Background Maternal and child healthcare service delivery in vulnerable and fragile health systems has suffered a tremendous impact owing to the shift in focus to curtail the COVID-19 pandemic. We aimed to evaluate the impact of the COVID-19 pandemic on maternal and child healthcare services to inform policy advice for a more resilient maternal and child healthcare service delivery in Pakistan. Methods A descriptive cross-sectional study was conducted. A structured and validated questionnaire was transformed into an online version and a link was first sent to about 300 healthcare professionals to achieve a sample size of 203, including medical doctors, nurses, and other paramedical staff working in public sector health facilities of the four provinces of Pakistan. The questionnaire was responded to by 195 participants. The Chi-Square test was used to determine the statistical differences between the categorical variables. Results Although about two-thirds of the participants reported a moderate adherence to protocols and procedures to prevent COVID-19 in their health facilities, the maternal and child health service delivery-related indicators declined during the pandemic. For instance, 66.8% and 62.4% of the participants, respectively, did not agree that a Neonatal Intensive Care Unit and an Intensive Care Unit to admit sick newborns and women with obstetric complications during the COVID-19 pandemic were available during the COVID-19 pandemic. In addition, 23% and 20% of the participants, respectively, reported that staff availability and the provision of cesarean section were moderate to extremely affected. The association between job designation and the impact of COVID-19 was statistically significant (χ2 p = 0.038). Conclusions The study suggests that maternal and child healthcare services including C-Section, perinatal care, and inpatient care of newborns in Pakistan may have been moderately affected by the COVID-19 pandemic.
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Affiliation(s)
- Jamil Ahmed
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Bahrain
| | - Ramesh Kumar
- Department of Public Health, Health Services Academy, Islamabad, Pakistan
- College of Public Health Sciences, Chulalongkorn University, Thailand
| | - Vikram Mehraj
- Department of Public Health, Health Services Academy, Islamabad, Pakistan
| | - Amer Almarabheh
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Bahrain
| | | | - Shahzad Ali Khan
- Department of Public Health, Health Services Academy, Islamabad, Pakistan
| | - Nawal Naeem
- Fellow Public Health, Health Services Academy Islamabad, Pakistan
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Angeles G, Silverstein H, Ahsan KZ, Kibria MG, Rakib NA, Escudero G, Singh K, Mpiima J, Simmons E, Weiss W. Estimating the effects of COVID-19 on essential health services utilization in Uganda and Bangladesh using data from routine health information systems. Front Public Health 2023; 11:1129581. [PMID: 37829090 PMCID: PMC10564984 DOI: 10.3389/fpubh.2023.1129581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 08/31/2023] [Indexed: 10/14/2023] Open
Abstract
Background Since March 2020, the coronavirus disease 2019 (COVID-19) pandemic has been a major shock to health systems across the world. We examined national usage patterns for selected basic, essential health services, before and during the COVID-19 pandemic in Uganda and Bangladesh, to determine whether COVID-19 affected reporting of service utilization and the use of health services in each country. Methods We used routine health information system data since January 2017 to analyze reporting and service utilization patterns for a variety of health services. Using time series models to replicate pre-COVID-19 trajectories over time we estimated what levels would have been observed if COVID-19 had not occurred during the pandemic months, starting in March 2020. The difference between the observed and predicted levels is the COVID-19 effect on health services. Results The time trend models for Uganda and Bangladesh closely replicated the levels and trajectories of service utilization during the 38 months prior to the COVID-19 pandemic. Our results indicate that COVID-19 had severe effects across all services, particularly during the first months of the pandemic, but COVID-19 impacts on health services and subsequent recovery varied by service type. In general, recovery to expected levels was slow and incomplete across the most affected services. Conclusion Our analytical approach based on national information system data could be very useful as a form of surveillance for health services disruptions from any cause leading to rapid responses from health service managers and policymakers.
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Affiliation(s)
- Gustavo Angeles
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Hannah Silverstein
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Karar Zunaid Ahsan
- Public Health Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mohammad Golam Kibria
- Carolina Health Informatics Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Nibras Ar Rakib
- Carolina Health Informatics Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gabriela Escudero
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kavita Singh
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Elizabeth Simmons
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - William Weiss
- Department of International Health, Johns Hopkins University, Baltimore, MD, United States
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Dandona R, Kumar GA, Akbar M, Dora SSP, Dandona L. Substantial increase in stillbirth rate during the COVID-19 pandemic: results from a population-based study in the Indian state of Bihar. BMJ Glob Health 2023; 8:e013021. [PMID: 37491108 PMCID: PMC10373740 DOI: 10.1136/bmjgh-2023-013021] [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: 03/30/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION We report on the stillbirth rate (SBR) and associated risk factors for births during the COVID-19 pandemic, and change in SBR between prepandemic (2016) and pandemic periods in the Indian state of Bihar. METHODS Births between July 2020 and June 2021 (91.5% participation) representative of Bihar were listed. Stillbirth was defined as fetal death with gestation period of ≥7 months where the fetus did not show any sign of life. Detailed interviews were conducted for all stillbirths and neonatal deaths, and for 25% random sample of surviving live births. We estimated overall SBR, and during COVID-19 peak and non-peak periods per 1000 births. Multiple logistic regression models were run to assess risk factors for stillbirth. The change in SBR for Bihar from 2016 to 2020-2021 was estimated. RESULTS We identified 582 stillbirths in 30 412 births with an estimated SBR of 19.1 per 1000 births (95% CI 17.7 to 20.7); SBR was significantly higher in private facility (38.4; 95% CI 34.3 to 43.0) than in public facility (8.6; 95% CI 7.3 to 10.1) births, and for COVID-19 peak (21.2; 95% CI 19.2 to 23.4) than non-peak period (16.3; 95% CI 14.2 to 18.6) births. Pregnancies with the last pregnancy trimester during the COVID-19 peak period had 40.4% (95% CI 10.3% to 70.4%) higher SBR than those who did not. Risk factor associations for stillbirths were similar between the COVID-19 peak and non-peak periods, with gestation age of <8 months with the highest odds of stillbirth followed by referred deliveries and deliveries in private health facilities. A statistically significant increase of 24.3% and 68.9% in overall SBR and intrapartum SBR was seen between 2016 and 2020-2021, respectively. CONCLUSIONS This study documented an increase in SBR during the COVID-19 pandemic as compared with the prepandemic period, and the varied SBR based on the intensity of the COVID-19 pandemic and by the place of delivery.
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Affiliation(s)
- Rakhi Dandona
- Public Health Foundation of India, New Delhi, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
| | - Md Akbar
- Public Health Foundation of India, New Delhi, India
| | | | - Lalit Dandona
- Public Health Foundation of India, New Delhi, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Chabba R, Allen C, Yaqub N, Lattof SR, Ganesan R, Maliqi B. Delivering quality care to all mothers and newborns requires governments to engage the private sector. BMJ 2023; 381:e071650. [PMID: 37147005 PMCID: PMC10161077 DOI: 10.1136/bmj-2022-071650] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Affiliation(s)
- Rajat Chabba
- Market Solutions, Jhpiego, Baltimore, Maryland, USA
| | | | - Nuhu Yaqub
- Department of Maternal, Newborn, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | | | | | - Blerta Maliqi
- Department of Maternal, Newborn, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
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Gaitán-Rossi P, Vilar-Compte M, Cruz-Villalba V, Sabina N, Villar-Uribe M. A Qualitative Assessment of the Essential Health and Nutrition Service Delivery in the Context of COVID-19 in Bangladesh: The Perspective of Divisional Directors. Healthcare (Basel) 2022; 10:healthcare10091619. [PMID: 36141231 PMCID: PMC9498609 DOI: 10.3390/healthcare10091619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
Bangladesh suffered disruptions in the utilization of essential health and nutrition services (EHNS) during the COVID-19 pandemic. The magnitude of the pandemic has been documented, but little is known from the perspectives of health administrators. A rapid qualitative assessment of division-level capacity identified successes and bottlenecks in providing EHNS- and COVID-19-related services during the first months of the pandemic in Bangladesh. Semi-structured interviews were held with the Health and Family Planning Divisional Directors of the Ministry of Health and Family Welfare. The Primary Health Care System Framework guided the content analysis, focusing on (i) service delivery, (ii) communication and community outreach, and (iii) surveillance and service monitoring. Our findings identified low care seeking due to fears of getting infected and unawareness that EHNS were still available. Adaptations to telemedicine were highly heterogeneous between divisions, but collaboration with NGOs were fruitful in reinstating outreach activities. Guidelines were centered on COVID-19 information and less so on EHNS. The inflexibility of spending capacities at divisional and clinic levels hindered service provision. Misinformation and information voids were difficult to handle all around the country. Community health workers were useful for outreach communication. EHNS must be guaranteed during sanitary emergencies, and Bangladesh presented with both significant efforts and areas of opportunity for improvement.
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Affiliation(s)
- Pablo Gaitán-Rossi
- Instituto de Investigaciones para el Desarrollo con Equidad, EQUIDE, Universidad Iberoamericana, Ciudad de México 01219, Mexico
| | - Mireya Vilar-Compte
- Department of Public Health, Montclair State University, Montclair, NJ 07043, USA
- Correspondence:
| | - Valeria Cruz-Villalba
- Instituto de Investigaciones para el Desarrollo con Equidad, EQUIDE, Universidad Iberoamericana, Ciudad de México 01219, Mexico
| | | | - Manuela Villar-Uribe
- Health, Nutrition and Population Global Practice of the World Bank Group, Washington, DC 20433, USA
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Naqvi S, Naqvi F, Saleem S, Thorsten VR, Figueroa L, Mazariegos M, Garces A, Patel A, Das P, Kavi A, Goudar SS, Esamai F, Mwenchanya M, Chomba E, Lokangaka A, Tshefu A, Yousuf S, Bauserman M, Bose CL, Liechty EA, Krebs NF, Derman RJ, Carlo WA, Hibberd PL, Billah SM, Peres-da-Silva N, Haque R, Petri WA, Koso-Thomas M, Nolen T, McClure EM, Goldenberg RL. Health care in pregnancy during the COVID-19 pandemic and pregnancy outcomes in six low- and-middle-income countries: Evidence from a prospective, observational registry of the Global Network for Women's and Children's Health. BJOG 2022; 129:1298-1307. [PMID: 35377514 PMCID: PMC9111322 DOI: 10.1111/1471-0528.17175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/19/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022]
Abstract
Objective To assess, on a population basis, the medical care for pregnant women in specific geographic regions of six countries before and during the first year of the coronavirus disease 2019 (COVID‐19) pandemic in relationship to pregnancy outcomes. Design Prospective, population‐based study. Setting Communities in Kenya, Zambia, the Democratic Republic of the Congo, Pakistan, India and Guatemala. Population Pregnant women enrolled in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry. Methods Pregnancy/delivery care services and pregnancy outcomes in the pre‐COVID‐19 time‐period (March 2019–February 2020) were compared with the COVID‐19 time‐period (March 2020–February 2021). Main outcome measures Stillbirth, neonatal mortality, preterm birth, low birthweight and maternal mortality. Results Across all sites, a small but statistically significant increase in home births occurred between the pre‐COVID‐19 and COVID‐19 periods (18.9% versus 20.3%, adjusted relative risk [aRR] 1.12, 95% CI 1.05–1.19). A small but significant decrease in the mean number of antenatal care visits (from 4.1 to 4.0, p = <0.0001) was seen during the COVID‐19 period. Of outcomes evaluated, overall, a small but significant decrease in low‐birthweight infants in the COVID‐19 period occurred (15.7% versus 14.6%, aRR 0.94, 95% CI 0.89–0.99), but we did not observe any significant differences in other outcomes. There was no change observed in maternal mortality or antenatal haemorrhage overall or at any of the sites. Conclusions Small but significant increases in home births and decreases in the antenatal care services were observed during the initial COVID‐19 period; however, there was not an increase in the stillbirth, neonatal mortality, maternal mortality, low birthweight, or preterm birth rates during the COVID‐19 period compared with the previous year. Further research should help to elucidate the relationship between access to and use of pregnancy‐related medical services and birth outcomes over an extended period.
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Affiliation(s)
| | | | | | | | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Manolo Mazariegos
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Ana Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India.,Datta Meghe Institute of Medical, Sciences, Sawangi, India
| | - Prabir Das
- Lata Medical Research Foundation, Nagpur, India
| | - Avinash Kavi
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Belagavi, Karnataka, India
| | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Belagavi, Karnataka, India
| | | | | | - Elwyn Chomba
- University of Zambia University Teaching Hospital, Lusaka, Zambia
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Melissa Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carl L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, Indiana, USA
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, Colorado, USA
| | | | | | | | - Sk Masum Billah
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.,University of Sydney, Sydney, New South Wales, Australia
| | | | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Tracy Nolen
- RTI International, Durham, North Carolina, USA
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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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