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Thapa TR, Agrawal Sagtani R, Mahotra A, Mishra RK, Sharma S, Paudel S. Factors affecting postnatal care service utilization in Pyuthan district: A mixed method study. PLoS One 2024; 19:e0307772. [PMID: 39240860 PMCID: PMC11379213 DOI: 10.1371/journal.pone.0307772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/11/2024] [Indexed: 09/08/2024] Open
Abstract
The first hours, days, and weeks following childbirth are critical for the well-being of both the mother and newborn. Despite this significance, the postnatal period often receives inadequate attention in terms of quality care provision. In Nepal, the utilization of postnatal care (PNC) services remains a challenging issue. Employing a facility-based concurrent triangulation mixed-method approach, this study aimed to identify factors associated with PNC service utilization, as well as its facilitators and barriers. A quantitative survey involved 243 mothers who had given birth in the six months preceding the survey, selected using a multistage sampling technique from six health facilities of two randomly selected local levels of the Pyuthan district. Weighted multivariate logistic regression was employed to identify predictors of PNC service utilization. Additionally, qualitative analysis using Braun and Clarke's six-step thematic analysis elucidated facilitators and barriers. The study revealed a weighted prevalence of PNC service utilization as per protocol at 38.43% (95% CI: 32.48-44.74). Notably, Socioeconomic status (AOR-3.84, 95% CI: 2.40-6.15), place of delivery (AOR-1.86, 95% CI: 1.16-3.00), possessing knowledge of postnatal care (AOR = 6.75, 95% CI: 3.39-13.45) and access to a motorable road (AOR = 6.30, 95% CI: 3.94-10.08) were identified as predictors of PNC service utilization. Triangulation revealed knowledge on PNC, transportation facilities, PNC home visits, and postpartum weaknesses to visit health facility as areas of convergence. Conversely, divergent areas included the proximity of health facilities and the effect of COVID-19. The study identified a low prevalence of PNC service utilization in the district. To enhance utilization, targeted interventions to increase awareness about postnatal care, appropriate revision of existing policies, addressing wider determinants of service utilization, and ensuring effective implementation of PNC home-visit programs are of utmost importance.
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Affiliation(s)
- Tulsi Ram Thapa
- Policy, Planning and Monitoring Division, Ministry of Health and Population, Kathmandu, Nepal
- School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | | | - Anita Mahotra
- Faculty of Medicine, Public Health and Nursing, Universities Gadjah Mada, Yogyakarta, Indonesia
| | - Ravi Kanta Mishra
- Policy, Planning and Monitoring Division, Ministry of Health and Population, Kathmandu, Nepal
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Saraswati Sharma
- School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Sudarshan Paudel
- School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
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Hartner AM, Li X, Gaythorpe K. COVID-19 related disruption and resilience in immunisation activities in LMICs: a rapid review. BMJ Open 2024; 14:e076607. [PMID: 39107008 PMCID: PMC11331918 DOI: 10.1136/bmjopen-2023-076607] [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: 06/12/2023] [Accepted: 07/19/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVES We conducted a rapid review to determine the extent that immunisation services in low-income and middle-income countries (LMICs) were disrupted by the COVID-19 pandemic and synthesised the factors that can be used to build resilience in future. DESIGN Rapid review reported in accordance with the Preferred reporting for Systematic reviews and Meta-Analyses (PRISMA) guidelines. DATA SOURCES PubMed and Web of Science were searched through 6 October 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included studies that focused on disruption to immunisation activities due to the COVID-19 pandemic in LMICs. Outcomes included routine vaccine coverage, supplementary immunisation activities, vaccine doses, timing of vaccination, supply chain changes, and factors contributing to disruption or resilience. DATA EXTRACTION AND SYNTHESIS Two independent reviewers used standardised methods to search, screen and code studies. Quality assessment was performed using a modified version of the Critical Appraisal Skills Programme for qualitative research. Findings were summarised qualitatively. RESULTS Of 4978 identified studies, 85 met the eligibility criteria. Included studies showed declines in immunisation activities across LMICs related to the COVID-19 pandemic. These included reductions in achieved routine coverage, cancellation or postponement of campaigns and underimmunised cohorts. Immunisation was most disrupted in the early months of the pandemic; however, recovery varied by country, age-group and vaccine. Though many countries observed partial recovery in 2020, disruption in many countries continued into 2021. It has also been noted that clinician staff shortages and vaccine stock-outs caused by supply chain disruptions contributed to immunisation delays, but that concern over COVID-19 transmission was a leading factor. Key resiliency factors included community outreach and healthcare worker support. CONCLUSIONS There is limited information on whether reductions in vaccination coverage or delays have persisted beyond 2021. Further research is needed to assess ongoing disruptions and identify missed vaccine cohorts.
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Affiliation(s)
- Anna-Maria Hartner
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
- Centre for Artificial Intelligence in Public Health Research, Robert Koch Institute, Wildau, Germany
| | - Xiang Li
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Katy Gaythorpe
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
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Mussie KM, Setchell J, Kaba M, Elger BS. "I was afraid to go to the hospital": A qualitative analysis and ethical implications of the impacts of COVID-19 on the health and medical care of older adults in Ethiopia. SAGE Open Med 2024; 12:20503121241263305. [PMID: 39092158 PMCID: PMC11292689 DOI: 10.1177/20503121241263305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/31/2024] [Indexed: 08/04/2024] Open
Abstract
Objective The COVID-19 pandemic has brought severe health consequences among older adults and posed ethical challenges. The aim of this study was to explore the impacts of COVID-19 on the health and medical care of older adults in Ethiopia and associated ethical implications, regardless of older adults' COVID-19 infection status. Methods In this qualitative study, we followed an inductive exploratory approach based on reflexive thematic analysis. We conducted semistructured interviews between March 2021 and November 2021 with 20 older adults and 26 health professionals who were selected from healthcare facilities and communities in Ethiopia using purposive and snowball sampling techniques. We audio-recorded, transcribed, translated, and inductively analyzed the interviews using thematic analysis. Results Participants reported that the pandemic compromised the accessibility and quality of both COVID and non-COVID healthcare services for older adults, which negatively impacted older adults' health conditions and medical care. Moreover, participants elaborated on the health conditions and care of older patients with COVID-19 and highlighted that older COVID-19 patients often have severe health conditions, do not get adequate COVID-19 care, and may receive lower priority for admission to intensive care units compared to younger patients when resources are limited. Conclusions Results of this study showed that practices of COVID-19 care and measures may have led to adverse consequences such as limited availability and access to aged care in Ethiopia, which could have further health consequences on older patients. Our results contribute to a better understanding of ethical issues such as distributive justice and prioritization arising in the healthcare of older patients in times of global pandemic. It is imperative for local and international health policymakers and ethicists to further analyze and address the challenges that compromise the accessibility and continuity of quality care for older persons during a public healthcare crisis.
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Affiliation(s)
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Mirgissa Kaba
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bernice Simone Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Center for Legal Medicine, University of Geneva, Geneva, Switzerland
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Knauss S, Andriamiadana G, Leitheiser R, Rampanjato Z, Bärnighausen T, Emmrich JV. Effect of the COVID-19 Lockdown on Mobile Payments for Maternal Health: Regression Discontinuity Analysis. JMIR Public Health Surveill 2024; 10:e49205. [PMID: 39078698 PMCID: PMC11322714 DOI: 10.2196/49205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 01/24/2024] [Accepted: 05/03/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in the unprecedented popularity of digital financial services for contactless payments and government cash transfer programs to mitigate the economic effects of the pandemic. The effect of the pandemic on the use of digital financial services for health in low- and middle-income countries, however, is poorly understood. OBJECTIVE This study aimed to assess the effect of the first COVID-19 lockdown on the use of a mobile maternal health wallet, with a particular focus on delineating the age-dependent differential effects, and draw conclusions on the effect of lockdown measures on the use of digital health services. METHODS We analyzed 819,840 person-days of health wallet use data from 3416 women who used health care at 25 public sector primary care facilities and 4 hospitals in Antananarivo, Madagascar, between January 1 and August 27, 2020. We collected data on savings, payments, and voucher use at the point of care. To estimate the effects of the first COVID-19 lockdown in Madagascar, we used regression discontinuity analysis around the starting day of the first COVID-19 lockdown on March 23, 2020. We determined the bandwidth using a data-driven method for unbiased bandwidth selection and used modified Poisson regression for binary variables to estimate risk ratios as lockdown effect sizes. RESULTS We recorded 3719 saving events, 1572 payment events, and 3144 use events of electronic vouchers. The first COVID-19 lockdown in Madagascar reduced mobile money savings by 58.5% (P<.001), payments by 45.8% (P<.001), and voucher use by 49.6% (P<.001). Voucher use recovered to the extrapolated prelockdown counterfactual after 214 days, while savings and payments did not cross the extrapolated prelockdown counterfactual. The recovery duration after the lockdown differed by age group. Women aged >30 years recovered substantially faster, returning to prelockdown rates after 34, 226, and 77 days for savings, payments, and voucher use, respectively. Younger women aged <25 years did not return to baseline values. The results remained robust in sensitivity analyses using ±20 days of the optimal bandwidth. CONCLUSIONS The COVID-19 lockdown greatly reduced the use of mobile money in the health sector, affecting savings, payments, and voucher use. Savings were the most significantly reduced, implying that the lockdown affected women's expectations of future health care use. Declines in payments and voucher use indicated decreased actual health care use caused by the lockdown. These effects are crucial since many maternal and child health care services cannot be delayed, as the potential benefits will be lost or diminished. To mitigate the adverse impacts of lockdowns on maternal health service use, digital health services could be leveraged to provide access to telemedicine and enhance user communication with clear information on available health care access options and adherence to safety protocols.
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Affiliation(s)
- Samuel Knauss
- Global Digital Last Mile Health Research Lab, Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Germany, Berlin, Germany
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Gracia Andriamiadana
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Roxane Leitheiser
- Global Digital Last Mile Health Research Lab, Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Germany, Berlin, Germany
| | | | - Till Bärnighausen
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, United States
- Africa Health Research Institute, Mtubatuba, South Africa
| | - Julius Valentin Emmrich
- Global Digital Last Mile Health Research Lab, Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Germany, Berlin, Germany
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
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Amberbir A, Sayinzoga F, Mathewos K, Ntawukuriryayo JT, VanderZanden A, Hirschhorn LR, Binagwaho A. Maintaining Delivery of Evidence-Based Interventions to Reduce Under-5 Mortality During COVID-19 in Rwanda: Lessons Learned through Implementation Research. Ann Glob Health 2024; 90:47. [PMID: 39070076 PMCID: PMC11276474 DOI: 10.5334/aogh.4348] [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: 10/18/2023] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Background: The COVID-19 pandemic resulted in drops in access to and availability of a number of evidence-based interventions (EBIs) known to reduce under-5 mortality (U5M) across a wide range of countries, including Rwanda. We aimed to understand the strategies and contextual factors associated with preventing or mitigating drops nationally and subnationally, and the extent to which previous efforts to reduce U5M supported the maintenance of healthcare delivery. Methods: We used a convergent mixed methods implementation science approach, guided by hybrid implementation research and resiliency frameworks. We triangulated data from three sources: desk review of available documents, existing routine data from the health management information system, and key informant interviews (KIIs). We analyzed quantitative data through scatter plots using interrupted time series analysis to describe changes in EBI access, uptake, and delivery. We used a Poisson regression model to estimate the impact of COVID-19 on health management information system indicators, adjusting for seasonality. We used thematic analysis of coded interviews to identify emerging patterns and themes. Results: We found moderate 4% (IRR = 0.96; 95%CI: 0.93, 1.00) and 5% (IRR = 0.95; 95%CI: 0.92, 0.99) drops in pentavalent and rotavirus 2 doses vaccines administered, respectively. Nationally, there was a 5% drop in facility-based delivery (IRR = 0.95; 95%CI: 0.92, 0.99). Lockdown and movement restrictions and community and health-worker fear of COVID-19 were barriers to service delivery early in the pandemic. Key implementation strategies to prevent or respond to EBI drops included leveraging community-based healthcare delivery, data use for decision-making, mentorship and supervision, and use of digital platform. Conclusions: While Rwanda had drops in some EBIs early in the pandemic, especially during the initial lockdown, this was rapidly identified, and response implemented. The resiliency of the health system was associated with the Rwandan health system's ability to learn and adapt, encouraging a flexible response to fit the situation.
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Affiliation(s)
| | - Felix Sayinzoga
- Maternal, Child, and Community Health Division, Rwanda Biomedical Center, Kigali, Rwanda
| | | | | | | | - Lisa R Hirschhorn
- University of Global Health Equity, Kigali, Rwanda
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Tilahun BT, Tariku Z, Alemu MK, Dejene T, Natae LA, Mohammed H, Assegid DT, Tekle MH. Maternal and Child Health Services Utilization During COVID-19 in Eastern Ethiopia. Int J Public Health 2024; 69:1606626. [PMID: 38841538 PMCID: PMC11150649 DOI: 10.3389/ijph.2024.1606626] [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: 09/14/2023] [Accepted: 04/29/2024] [Indexed: 06/07/2024] Open
Abstract
Objectives: This study aimed to describe the impact of COVID-19 on maternal and child health service utilization in the Eastern part of Ethiopia. Methods: Comparative analysis was used to examine 2 years of maternal and child health service utilization. Data were extracted from client registers. A traditional Expert Modeler and one-way Analysis of Variance were used to compare service utilization before and during the COVID-19 pandemic. Results: A total of 34,576 client records were reviewed, of which 17,100 (49.5%) and 17,476 (50.5%) had visited the MCH service before and during the COVID-19 pandemic, respectively. The total client visit has shown a 2% percentage point increase. However, postnatal care and child immunization services showed a decrease. Moreover, there was a significant difference between service visits before and during COVID-19 (f = 4.6, p < 0.04). Conclusion: Mothers and children have missed or unattended facility appointments due to protective impositions or fear of getting infected with COVID-19, which might suggest a higher proportion of MCH issues were not addressed during the pandemic. The health system should therefore improve its resilience and strengthen its access at the lowest health care inlets.
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Affiliation(s)
- Bereket Tefera Tilahun
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Zerihun Tariku
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Mesfin Kebede Alemu
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Tafese Dejene
- School of Medicine, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Legesse Abera Natae
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Hussen Mohammed
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Daniel Tadesse Assegid
- Department of Midwifery, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Mickiale Hailu Tekle
- Department of Midwifery, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
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Packham A, Taylor AE, Karangwa MP, Sherry E, Muvunyi C, Green CA. Measles Vaccine Coverage and Disease Outbreaks: A Systematic Review of the Early Impact of COVID-19 in Low and Lower-Middle Income Countries. Int J Public Health 2024; 69:1606997. [PMID: 38725903 PMCID: PMC11079172 DOI: 10.3389/ijph.2024.1606997] [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: 12/20/2023] [Accepted: 03/27/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives: We aimed to evaluate changes to measles-containing vaccine (MCV) provision and subsequent measles disease cases in low- and lower-middle income countries (LICs, LMICs) in relation to the COVID-19 pandemic. Methods: A systematic search was conducted of MEDLINE, OVID EMBASE and PubMed records. Primary quantitative and qualitative research studies published from January 2020 were included if they reported on COVID-19 impact on MCV provision and/or measles outbreak rates within LICs and LMICs. Results: 45 studies were included. The change in MCV1 vaccination coverage in national and international regions ranged -13% to +44.4% from pre-COVID time periods. In local regions, the median MCV1 and overall EPI rate changed by -23.3% and -28.5% respectively. Median MCV2 rate was disproportionally impacted in local areas during COVID-interruption time-periods (-48.2%) with ongoing disruption in early-recovery time-periods (-17.7%). 8.9% of studies reported on vaccination status of confirmed measles cases; from these, 71%-91% had received no MCV dose. Conclusion: MCV vaccination coverage experienced ongoing disruption during the recovery periods after initial COVID-19 disruption. Vaccination in local area datasets notably experienced longer-term disruption compared to nationally reported figures.
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Affiliation(s)
- Alice Packham
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Alice E. Taylor
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Emma Sherry
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Christopher A. Green
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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8
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Orji B, Bryce E, Odio B, Onuoha H, Njoku E, Anoke C, Ugwa E, Enne J, Oniyire A, Ibrahim I, Otolorin E, Afolabi K, Ogbulafor NC, Oliveras E. The COVID-19 Pandemic's Impact on Health Service Utilization Among Pregnant Women in Three Nigerian States: A Mixed Methods Study. Matern Child Health J 2024; 28:294-302. [PMID: 37975998 PMCID: PMC10901963 DOI: 10.1007/s10995-023-03820-3] [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] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE COVID-19 disrupted health service delivery and weakened global and national health systems. The objective of this study was to describe the changes in health service utilization in three local government areas (LGAs) in Nigeria and examine factors involved. METHODS A cross-sectional mixed-methods approach was used. A total of 315 pregnant women seen for antenatal care in 80 health facilities in three LGAs between October 1 and November 30, 2020, participated in exit interviews; 93 women participated in focus group discussions (FGDs). Descriptive analyses and a multivariable logistic analysis were conducted to examine associations between characteristics and decreased service utilization. Content analysis was used to identify the emerging themes related to health service utilization during the pandemic. RESULTS One quarter of women reported that they reduced or ceased health service. The biggest reported changes were in immunization (47 to 30%, p < 0.001) and a small but statistically significant decline in antenatal care (98.7 to 93.8%, p < 0.001) was observed. Qualitative findings show that lockdowns, transportation issues, increased costs and fear of contracting COVID-19 or being labeled as COVID-positive were the most common reasons for not seeking care during this period of the pandemic. CONCLUSIONS The pandemic negatively impacted health service utilization amongst pregnant women in Nigeria. A better understanding of differences in state response could help inform future actions. The findings highlight the need for health systems to consider how to facilitate service utilization during a pandemic, such as providing safe transport or increasing outreach, and to minimize stigma for those seeking care.
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Affiliation(s)
- Bright Orji
- Jhpiego-an Affiliate of Johns Hopkins University, Abuja, Nigeria.
| | - Emily Bryce
- Jhpiego-an Affiliate of Johns Hopkins University, Baltimore, MD, USA
| | - Bartholomew Odio
- Jhpiego-an Affiliate of Johns Hopkins University, Abuja, Nigeria
| | - Herbert Onuoha
- Jhpiego-an Affiliate of Johns Hopkins University, Abuja, Nigeria
| | - Elizabeth Njoku
- Jhpiego-an Affiliate of Johns Hopkins University, Abuja, Nigeria
| | - Charity Anoke
- Jhpiego-an Affiliate of Johns Hopkins University, Abuja, Nigeria
| | | | - Joseph Enne
- Jhpiego-an Affiliate of Johns Hopkins University, Abuja, Nigeria
| | | | | | - Emmanuel Otolorin
- Jhpiego-an Affiliate of Johns Hopkins University, Baltimore, MD, USA
| | - Kayode Afolabi
- Reproductive Health Division, Federal Ministry of Health, Abuja, Nigeria
| | - Nnenna C Ogbulafor
- National Malaria Elimination Program, Federal Ministry of Health, Abuja, Nigeria
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9
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Fejfar D, Andom AT, Msuya M, Jeune MA, Lambert W, Varney PF, Aron MB, Connolly E, Juárez A, Aranda Z, Niyigena A, Cubaka VK, Boima F, Reed V, Law MR, Grépin KA, Mugunga JC, Hedt-Gauthier B, Fulcher I. The impact of COVID-19 and national pandemic responses on health service utilisation in seven low- and middle-income countries. Glob Health Action 2023; 16:2178604. [PMID: 36880985 PMCID: PMC10013493 DOI: 10.1080/16549716.2023.2178604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted health services worldwide, which may have led to increased mortality and secondary disease outbreaks. Disruptions vary by patient population, geographic area, and service. While many reasons have been put forward to explain disruptions, few studies have empirically investigated their causes. OBJECTIVE We quantify disruptions to outpatient services, facility-based deliveries, and family planning in seven low- and middle-income countries during the COVID-19 pandemic and quantify relationships between disruptions and the intensity of national pandemic responses. METHODS We leveraged routine data from 104 Partners In Health-supported facilities from January 2016 to December 2021. We first quantified COVID-19-related disruptions in each country by month using negative binomial time series models. We then modelled the relationship between disruptions and the intensity of national pandemic responses, as measured by the stringency index from the Oxford COVID-19 Government Response Tracker. RESULTS For all the studied countries, we observed at least one month with a significant decline in outpatient visits during the COVID-19 pandemic. We also observed significant cumulative drops in outpatient visits across all months in Lesotho, Liberia, Malawi, Rwanda, and Sierra Leone. A significant cumulative decrease in facility-based deliveries was observed in Haiti, Lesotho, Mexico, and Sierra Leone. No country had significant cumulative drops in family planning visits. For a 10-unit increase in the average monthly stringency index, the proportion deviation in monthly facility outpatient visits compared to expected fell by 3.9% (95% CI: -5.1%, -1.6%). No relationship between stringency of pandemic responses and utilisation was observed for facility-based deliveries or family planning. CONCLUSIONS Context-specific strategies show the ability of health systems to sustain essential health services during the pandemic. The link between pandemic responses and healthcare utilisation can inform purposeful strategies to ensure communities have access to care and provide lessons for promoting the utilisation of health services elsewhere.
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Affiliation(s)
| | - Afom T Andom
- Clinical Services, Partners In Health, Maseru, Lesotho
| | - Meba Msuya
- Clinical Services, Partners In Health, Maseru, Lesotho
| | - Marc Antoine Jeune
- Department of Strategic Planning and Information Systems, Zanmi Lasante, Croix-des-Bouquets, Haiti
| | - Wesler Lambert
- Department of Strategic Planning and Information Systems, Zanmi Lasante, Croix-des-Bouquets, Haiti
| | - Prince F Varney
- Strategic Health Information Systems, Partners In Health, Monrovia, Liberia
| | - Moses Banda Aron
- Monitoring, Evaluation, and Information, Partners In Health, Neno, Malawi
| | - Emilia Connolly
- Monitoring, Evaluation, and Information, Partners In Health, Neno, Malawi
| | - Ameyalli Juárez
- Partners In Health/Compañeros en Salud, Jaltenango de la Paz, Mexico
| | - Zeus Aranda
- Partners In Health/Compañeros en Salud, Jaltenango de la Paz, Mexico
| | - Anne Niyigena
- Department of Research and Training, Partners In Health, Kigali, Rwanda
| | - Vincent K Cubaka
- Department of Research and Training, Partners In Health, Kigali, Rwanda
| | - Foday Boima
- Strategic Health Informations Systems, Partners In Health, Koidu City, Kono District, Sierra Leone
| | - Vicky Reed
- Strategic Health Informations Systems, Partners In Health, Koidu City, Kono District, Sierra Leone
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Karen A Grépin
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Isabel Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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10
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Uwimana G, Elhoumed M, Gebremedhin MA, Qi Q, Azalati MM, Wang L, Zeng L. Association between adequacy of antenatal care and neonatal outcomes in Rwanda: a cross-sectional study design using the Rwanda demographic and health surveys. BMC Health Serv Res 2023; 23:1379. [PMID: 38066497 PMCID: PMC10704762 DOI: 10.1186/s12913-023-10345-6] [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: 06/13/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Maternal and neonatal health services are life-saving interventions for neonatal health outcomes. As Rwanda endeavors to accomplish sustainable development goals, adequate ANC is essential to lessen of neonatal mortality. The utilization of ANC continues to be inadequate and high neonatal mortality rate persevere in Rwanda. Understanding the direct and indirect factors that affect newborn health outcomes is necessary for well-targeted interventions. However, few studies had been conducted in Rwanda to evaluate the importance of ANC in improving neonatal health. This study therefore assessed the association between ANC and neonatal outcomes. METHODS The Demographic and Health Surveys (DHS) are household surveys that are cross-sectional, nationally representative, and used to collect data on population, health, and nutrition. Data from the 2010,2015 and 2020 Rwanda Demographic and Health Surveys (RDHS) were used. The study involved 17,747 women between the ages of 15 and 49 who had a single live birth and at least one ANC visit in five years prior to each survey. Bivariate and multivariable logistic regression, a survey adjusted for clusters at multiple level, and the estimation of adjusted odds ratios (aOR) and 95% confidence intervals were used to evaluate the relationship between the outcome and independent variables. RESULTS Out of 17,747 women ;7638(42.91%) of the mothers had adequate ANC visits and low birth weight (LBW) was found among 833(4.63%) neonates. The birth of a LBW baby (aOR:4.64;95%CI:3.19,6.74) was directly related to increased odds of neonatal death. Mothers aged 20-34 years (aOR:0.40; 95%CI:0.20,0.81), a preceding birth interval of 24months or greater (aOR:0.41:95%CI:0.28,0.60), baby being female (aOR:0.72; 95%CI:0.54,0.96), having adequate ANC visits (aOR:0.64;95% CI:0.46,0.89) and the birth order of the newborn being ranked second or third (aOR:0.60; 95%CI:0.38,0.95) were negatively associated with neonatal death. CONCLUSION Health education programs targeting teen and primigravida mothers should be encouraged. Among the newborn survival interventions, addressing short birth intervals and the effective management of LBW cases should be explored. The findings confirm the fundamental importance of adequate ANC in the neonatal survival.
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Affiliation(s)
- Gérard Uwimana
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Mohamed Elhoumed
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
- National Institute of Public Health Research (INRSP), Nouakchott BP. 695, Nouakchott, Mauritania
| | - Mitslal Abrha Gebremedhin
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Qi Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Mougni Mohamed Azalati
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Liang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China.
- Center for Chronic Disease Control and Prevention, Global Health Institute, Xi'an Jiaotong University, Xi'an, China.
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, China.
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Singh T, Kaur R, Kant S, Mani K, Yadav K, Gupta SK. Effect of COVID-19 pandemic on utilization of maternal healthcare services in a rural area of Haryana - A record-based comparative study. J Family Med Prim Care 2023; 12:2640-2644. [PMID: 38186835 PMCID: PMC10771182 DOI: 10.4103/jfmpc.jfmpc_99_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 01/09/2024] Open
Abstract
Background The COVID-19 pandemic posed a challenge for the public health system, as all the health facilities and manpower were diverted for the delivery of COVID-19-related services. This affected the provision of routine health services, including maternal healthcare services. There is a paucity of data from rural and primary healthcare settings, as the earlier studies were either modelling-based or from tertiary care centres. Materials and Methods This record-based study was conducted in 12 subcentres in the district Faridabad of Haryana. Data of pregnant women registered during 1 April to 30 September in the years 2017-2020 were retrieved. The utilization of maternal healthcare services among women registered during 1 April 2020 to 30 September 2020 was compared with those registered in the same period during the preceding 3 years (2017-2019). Results There was a significant decline in utilization of maternal healthcare services. Services like minimum four antenatal visits declined from 67.8% to 48.3% (P < 0.0001), at least 100 iron-folic acid tablets (45.4-20.9%; P < 0.001), and examination at each visit (90.8-72.3%; P < 0.001). The proportion of pregnant women who received full antenatal care decreased from 26.0% to 10.7% (P < 0.001). There was a significant increase in delivery in private health facilities (40.9-49.9%) and delivery by caesarean section (21.6-27.3%; P = 0.002). Conclusion COVID-19 pandemic had an adverse effect on utilization of maternal healthcare services. Effective planning and coordination between different levels of government health facilities and primary care providers, including family physicians, can ensure uninterrupted provision of essential services during similar emergencies in future.
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Affiliation(s)
- Tejbeer Singh
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Ravneet Kaur
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sanjeev Kumar Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
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12
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Sudhinaraset M, Woofter R, Mboya J, Wambui S, Golub G, Mershon CH. "It is not by choice that I gave birth at home": the social determinants of home births during COVID-19 in peri-urban and urban Kenya, a qualitative study. BMC Pregnancy Childbirth 2023; 23:722. [PMID: 37821855 PMCID: PMC10566018 DOI: 10.1186/s12884-023-06038-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic significantly impacted the provision of global maternal health services, with an increase in home births. However, there are little data on women's decision-making and experiences leading up to home births during the pandemic. The objective of this study is to examine the economic, social, and health system factors associated with home births in Kenya. METHODS Community health volunteers (CHVs) and village leaders helped identify potential participants for an in-depth, one-on-one, qualitative telephone interview in Nairobi and Kiambu County in Kenya. In total, the study interviewed 28 mothers who had home births. RESULTS This study identified a number of economic, social, neighborhood, and health system factors that were associated with birthing at home during the COVID-19 pandemic. Only one woman had planned on birthing at home, while all other participants described various reasons they had to birth at home. Themes related to home births during the pandemic included: (1) unmet preferences related to location of birth; (2) burdens and fear of contracting COVID-19 leading to delayed or missed care; (3) lack of perceived community safety and fear of encounters with law enforcement; and (4) healthcare system changes and uncertainty that led to home births. CONCLUSION Addressing and recognizing women's social determinants of health is critical to ensuring that preferences on location of birth are met.
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Affiliation(s)
- May Sudhinaraset
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Rebecca Woofter
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - John Mboya
- Innovations for Poverty Action, Sandalwood Lane, Nairobi, Kenya
| | - Sarah Wambui
- Jacaranda Health Solutions Limited, San Francisco, CA, USA
| | - Ginger Golub
- Innovations for Poverty Action, Sandalwood Lane, Nairobi, Kenya
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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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14
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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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15
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Dalton M, Sanderson B, Robinson LJ, Homer CSE, Pomat W, Danchin M, Vaccher S. Impact of COVID-19 on routine childhood immunisations in low- and middle-income countries: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002268. [PMID: 37611014 PMCID: PMC10446229 DOI: 10.1371/journal.pgph.0002268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/17/2023] [Indexed: 08/25/2023]
Abstract
Routine vaccines are critical to child health. The COVID-19 pandemic significantly impacted essential health services, particularly in low-and middle-income countries (LMICs). We reviewed literature to determine the impact of COVID-19 on service delivery and uptake of routine childhood immunisation in LMICs. We reviewed papers published between March 2020 and June 2022 using a scoping review framework, and assessed each paper across the World Health Organisation health system strengthening framework. Our search identified 3,471 publications; 58 studies were included. One-quarter of studies showed routine childhood immunisation coverage declined (10% to 38%) between 2019 to 2021. Declines in the number of vaccine doses administered (25% to 51%), timeliness (6.2% to 34%), and the availability of fixed and outreach services were also reported. Strategies proposed to improve coverage included catch-up activities, strengthening supply chain and outreach services. Re-focusing efforts on increasing coverage is critical to improve child health and reduce the likelihood of disease outbreaks.
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Affiliation(s)
| | | | - Leanne J. Robinson
- Burnet Institute, Melbourne, Victoria, Australia
- Population Health & Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | | | - William Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Margie Danchin
- Department of General Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Marwa MM, Kinuthia J, Larsen A, Dettinger JC, Gomez LA, Awino P, Abuna F, Watoyi S, Ochieng B, Ngumbau N, John-Stewart G, Pintye J. COVID-19 vaccine hesitancy among pregnant and postpartum Kenyan women. Int J Gynaecol Obstet 2023; 162:147-153. [PMID: 37036449 PMCID: PMC10330087 DOI: 10.1002/ijgo.14773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/04/2023] [Accepted: 03/20/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVE The authors evaluated factors contributing to coronavirus disease 2019 (COVID-19) vaccine hesitancy among pregnant and postpartum women to inform vaccine scale-up strategies. METHODS This observational study utilized data from pregnant and postpartum women attending four public maternal child health (MCH) clinics in Western Kenya. From October 2020 to July 2022, nurses assessed COVID-19 vaccine hesitancy, defined as reporting "unlikely" or "very unlikely" to the question, "If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?" RESULTS Among 1023 women (235 pregnant, 788 postpartum), 20% reported worsened MCH care during the pandemic and most (92%) perceived themselves or family members to be at risk for COVID-19, yet 54% of women reported COVID-19 vaccine hesitancy. Vaccine hesitancy was more frequent among women reporting worsened MCH care (P < 0.001) since the pandemic and those who did not trust the government as a source of COVID-19 information (P = 0.016). Over the 2-year period, willingness to receive the vaccine almost doubled (38% to 71%, P < 0.001). CONCLUSIONS Our findings suggest that sustaining access to quality MCH services may decrease COVID-19 vaccine hesitancy. Willingness to receive the vaccine doubled over the 2-year period in our cohort, suggesting increased trust for use and acceptance in the unique context of the pregnancy/postpartum period.
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Affiliation(s)
- Mary M. Marwa
- University of Nairobi/Kenyatta National Hospital, Department of Medical Research, Nairobi, Kenya
| | - John Kinuthia
- University of Nairobi/Kenyatta National Hospital, Department of Medical Research, Nairobi, Kenya
- University of Washington Department of Global Health
| | - Ann Larsen
- University of Washington, Department of Epidemiology
| | | | | | - Pascal Awino
- University of Washington Department of Global Health
| | - Felix Abuna
- University of Nairobi/Kenyatta National Hospital, Department of Medical Research, Nairobi, Kenya
| | - Salphine Watoyi
- University of Nairobi/Kenyatta National Hospital, Department of Medical Research, Nairobi, Kenya
| | - Ben Ochieng
- University of Nairobi/Kenyatta National Hospital, Department of Medical Research, Nairobi, Kenya
| | - Nancy Ngumbau
- University of Nairobi/Kenyatta National Hospital, Department of Medical Research, Nairobi, Kenya
| | - Grace John-Stewart
- University of Washington, Department of Epidemiology
- University of Washington Department of Global Health
- University of Washington, School of Medicine, Department of Pediatrics
- University of Washington, School of Medicine, Department of Psychiatry & Behavioral Services
| | - Jillian Pintye
- University of Washington Department of Global Health
- University of Washington, Department of Biobehavioral Nursing and Health Informatics
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Angeles G, Silverstein H, Worges M, Hotchkiss DR, Wisniewski JM, Lusamba Dikassa PS, Weiss W, Ahsan KZ. Area-specific covid-19 effects on health services utilization in the Democratic Republic of the Congo using routine health information system data. BMC Health Serv Res 2023; 23:575. [PMID: 37270545 DOI: 10.1186/s12913-023-09547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/14/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Since March 2020, the COVID-19 pandemic has shocked health systems worldwide. This analysis investigated the effects of the pandemic on basic health services utilization in the Democratic Republic of the Congo (DRC) and examined the variability of COVID effects in the capital city Kinshasa, in other urban areas, and in rural areas. METHODS We estimated time trends models using national health information system data to replicate pre-COVID-19 (i.e., January 2017-February 2020) trajectories of health service utilization, and then used those models to estimate what the levels would have been in the absence of COVID-19 during the pandemic period, starting in March 2020 through March 2021. We classified the difference between the observed and predicted levels as the effect of COVID-19 on health services. We estimated 95% confidence intervals and p-values to examine if the effect of the pandemic, nationally and within specific geographies, was statistically significant. RESULTS Our results indicate that COVID-19 negatively impacted health services and subsequent recovery varied by service type and by geographical area. COVID-19 had a lasting impact on overall service utilization as well as on malaria and pneumonia-related visits among young children in the DRC. We also found that the effects of COVID-19 were even more immediate and stronger in the capital city of Kinshasa compared with the national effect. Both nationally and in Kinshasa, most affected services had slow and incomplete recovery to expected levels. Therefore, our analysis indicates that COVID-19 continued to affect health services in the DRC throughout the first year of the pandemic. CONCLUSIONS The methodology used in this article allows for examining the variability in magnitude, timing, and duration of the COVID effects within geographical areas of the DRC and nationally. This analytical procedure based on national health information system data could be applied to surveil health service disruptions and better inform 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, USA
| | - Hannah Silverstein
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Matt Worges
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - David R Hotchkiss
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Janna M Wisniewski
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Paul Samson Lusamba Dikassa
- Tulane International LLC, Kinshasa, Democratic Republic of the Congo
- Kinshasa School of Public Health, The University of Kinshasa, DRC, Kinshasa, Democratic Republic of the Congo
| | - William Weiss
- Department of International Health, The John Hopkins University, Baltimore, MD, USA
| | - Karar Zunaid Ahsan
- Public Health Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
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Kasonia K, Tindanbil D, Kitonsa J, Baisley K, Zalwango F, Enria L, Mansaray A, James M, Nije Y, Tata DT, Lawal BJ, Drammeh A, Lowe B, Mukadi-Bamuleka D, Mounier-Jack S, Nakiyimba F, Obady P, Muhavi J, Bangura JS, Greenwood B, Samai M, Leigh B, Watson-Jones D, Kavunga-Membo H, Ruzagira E, Gallagher KE. The impact of the COVID-19 pandemic on the provision & utilisation of primary health care services in Goma, Democratic Republic of the Congo, Kambia district, Sierra Leone & Masaka district, Uganda. PLoS One 2023; 18:e0286295. [PMID: 37267240 PMCID: PMC10237403 DOI: 10.1371/journal.pone.0286295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 05/12/2023] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION This study aimed to determine whether the COVID-19 pandemic had an impact on essential primary healthcare services at public primary healthcare facilities. METHODS The number of weekly consultations for antenatal care (ANC), outpatient (OPD), immunisations (EPI), family planning (FP) and HIV services, between January 2018 and December 2020, were collected from 25 facilities in Masaka district, Uganda, 21 in Goma, and 29 in Kambia district, Sierra Leone. Negative binomial regression models accounting for clustering and season were used to analyse changes in activity levels between 2018, 2019 and 2020. RESULTS In Goma, we found no change in OPD, EPI or ANC consultations, FP was 17% lower in March-July 2020 compared to 2019, but this recovered by December 2020. New diagnoses of HIV were 34% lower throughout 2020 compared to 2019. In Sierra Leone, compared to the same periods in 2019, facilities had 18-29% fewer OPD consultations throughout 2020, and 27% fewer DTP3 doses in March-July 2020. There was no evidence of differences in other services. In Uganda there were 20-35% fewer under-5 OPD consultations, 21-66% fewer MCV1 doses, and 48-51% fewer new diagnoses of HIV throughout 2020, compared to 2019. There was no difference in the number of HPV doses delivered. CONCLUSIONS The level of disruption varied across the different settings and qualitatively appeared to correlate with the strength of lockdown measures and reported attitudes towards the risk posed by COVID-19. Mitigation strategies such as health communications campaigns and outreach services may be important to limit the impact of lockdowns on primary healthcare services.
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Affiliation(s)
- K. Kasonia
- LSHTM-INRB Research Partnership, Goma, Democratic Republic of the Congo
| | - D. Tindanbil
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - J. Kitonsa
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - K. Baisley
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - F. Zalwango
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - L. Enria
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - A. Mansaray
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - M. James
- LSHTM-INRB Research Partnership, Goma, Democratic Republic of the Congo
| | - Y. Nije
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - D. Tetsa Tata
- LSHTM-INRB Research Partnership, Goma, Democratic Republic of the Congo
| | - B. J. Lawal
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - A. Drammeh
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - B. Lowe
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - D. Mukadi-Bamuleka
- Laboratoire Rodolphe-Merieux, Institut National de Recherche Biomédicale (INRB-Goma), Goma, Democratic Republic of the Congo
| | - S. Mounier-Jack
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - F. Nakiyimba
- Ministry of Health, Masaka, Masaka District, Uganda
| | - P. Obady
- Ministry of Health, Goma, Democratic Republic of Congo
| | - J. Muhavi
- Ministry of Health, Goma, Democratic Republic of Congo
| | - J. S. Bangura
- University of Sierra Leone College of Medicine and Allied Health Sciences (COMAHS), Freetown, Sierra Leone
- Ministry of Health, Kambia, Kambia District, Sierra Leone
| | - B. Greenwood
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - M. Samai
- University of Sierra Leone College of Medicine and Allied Health Sciences (COMAHS), Freetown, Sierra Leone
| | - B. Leigh
- University of Sierra Leone College of Medicine and Allied Health Sciences (COMAHS), Freetown, Sierra Leone
| | - D. Watson-Jones
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - H. Kavunga-Membo
- Laboratoire Rodolphe-Merieux, Institut National de Recherche Biomédicale (INRB-Goma), Goma, Democratic Republic of the Congo
| | - E. Ruzagira
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - K. E. Gallagher
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
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19
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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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20
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Mekonnen BD, Yirdaw BW. Impact of COVID-19 pandemic on utilization of essential maternal healthcare services in Ethiopia: A systematic review and meta-analysis. PLoS One 2023; 18:e0281260. [PMID: 36749776 PMCID: PMC9904479 DOI: 10.1371/journal.pone.0281260] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 01/19/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has a significant challenge for countries to maintain the provision of essential maternity services. Many women could experience difficulties in accessing maternal healthcare due to transport problems, anxiety, and fear of infection. A reduction in the utilization of maternity services has been suggested as a possible cause of worsened maternal health outcomes. Thus, this study aimed to determine the impact of the COVID-19 pandemic on the utilization of maternal healthcare services in Ethiopia. METHODS Searching of articles was conducted from PubMed, Science Direct, Cochrane Library, Web of Science, Scopus, and Google scholar. The quality of studies was evaluated using the Newcastle-Ottawa scale. Inspection of the Funnel plot and Egger's test were used to evaluate the evidence of publication bias. Heterogeneity was evaluated using Cochran's Q statistic and quantified by I2. A random-effects model was used to determine pooled estimates using STATA 14. RESULTS After reviewing 41,188 articles, 21 studies were included in this systematic review and meta-analysis. The pooled reduction was 26.62% (95% CI: 13.86, 39.37) for family planning, 19.30% (95% CI: 15.85, 22.76) for antenatal care, 12.82% (95% CI: 7.29, 18.34) for institutional delivery, 17.82% (95% CI: 8.32, 27.32) for postnatal care, and 19.39% (95% CI: 11.29, 27.49) for abortion care. This study also demonstrated that maternal perception of poor quality of care and fear of infection, lack of transport, cultural events, diversion of resources, lack of essential drugs, and lack of personal protective equipment and sanitizer were identified as the main challenges faced during the pandemic. CONCLUSION This study revealed that the utilization of maternal healthcare services in Ethiopia significantly decreased during the COVID-19 pandemic. Government measures, health facility-related barriers, and maternal-related factors were identified as challenges faced during the pandemic. Thus, service providers, policy-makers, and other relevant stakeholders should prioritize maternity care as an essential core healthcare service. Besides, increasing awareness of women through mass media, and making maternity services more accessible and equitable would likely increase the utilization of maternal healthcare services. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021293681.
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21
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Chippaux JP. [Impact of COVID-19 on public health in sub-Saharan Africa]. BULLETIN DE L'ACADEMIE NATIONALE DE MEDECINE 2023; 207:150-164. [PMID: 36628105 PMCID: PMC9816877 DOI: 10.1016/j.banm.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/27/2022] [Indexed: 01/09/2023]
Abstract
Objective This work aimed to assess the impact of COVID-19 on healthcare supply in sub-Saharan Africa except South Africa. Method A search through PubMed® between April 2020 and August 2022 selected 135 articles. The impact of COVID-19 was assessed on comparisons with the months prior to the onset of COVID-19 or an identical season in previous years. Results The decline of health services, associated with a reduction in their quality, and the closure of specialized health units have been reported. Many control programs and public health interventions have been interrupted, with the risk of an increase of the corresponding diseases. Social disorganization has generated mental health issues among the population, including health personnel. The impact was heterogeneous in space and time. The main causes were attributed to containment measures (transport restrictions, trade closures) and the lack of human and material resources. The increase in costs, in addition to the impoverishment of the population, and the fear of being contaminated or stigmatized have discouraged patients from going to health centres. The studies mention the gradual return to normal after the first epidemic wave and the resilience of the healthcare system. Conclusion Several articles make recommendations aimed at reducing the impact of future epidemics: support for community workers, training of health workers and reorganization of services to improve the reception and care of patients, technological innovations (use of telephones, drones, etc.) and better information monitoring.
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22
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El Salih I, Njuguna FM, Widjajanto PH, Kaspers G, Bailey A, Mostert S. Impact of COVID-19 measures on the health and healthcare of children in East-Africa: Scoping review. Int J Health Plann Manage 2023; 38:579-598. [PMID: 36691260 DOI: 10.1002/hpm.3612] [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: 03/22/2022] [Revised: 11/29/2022] [Accepted: 12/22/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic is of grave concern. As scientific data is being collected about the nature of COVID-19, government leaders and policy makers are challenged. They might feel pressured to take strong measures to stop virus spread. However, decisions could cause more harm than do good. This study maps all existing literature regarding the impact of COVID-19 containment measures on the health and healthcare of children in East-Africa. METHODS This scoping review follows Population Concept Context guidelines of Arksey and O'Malley and PRISMA 2020 checklist. PubMed, Web of Science, and Embase were searched. All peer-reviewed literature published in English between January 2020 and October 2022 was considered. Initial screening of titles and abstracts was undertaken independently by two reviewers, with a third available in case of doubt. This was followed by full-text screening involving two independent reviewers. RESULTS In total, 70 studies were included. Eight containment measures affecting children's health and healthcare were distinguished: lockdowns, school closures, physical distancing, travel restrictions, business closures, stay-at-home orders, curfews, quarantine measures with contact tracing. The consensus in the studies is that containment measures could minimise COVID-19 spread but have adverse indirect effects on children in East-Africa. Seven indirect effects were distinguished: economic damage, limited education access, food insecurity, child abuse, limited healthcare access, disrupted health-programs, and mental health challenges. CONCLUSION Government leaders and policy makers should take adverse indirect effects of COVID-19 measures into account, particularly in resource-limited regions such as East-Africa, apply a holistic approach, and strengthen socioeconomic and health-systems to protect the most vulnerable.
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Affiliation(s)
- Ibrahim El Salih
- International Development Studies, Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands
| | - Festus Muigai Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
| | - Pudjo Hagung Widjajanto
- Department of Pediatric Oncology, Dr Sardjito General Hospital, Gadjah Mada University, Yogyakarta, Indonesia
| | - Gertjan Kaspers
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ajay Bailey
- International Development Studies, Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands
| | - Saskia Mostert
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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23
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Sharma S, Aggarwal S, Kulkarni R, Kumar D, Mishra BK, Dwivedi GR, Devi KR, Mamidi RS, Singh KJ, Singh L, Sahu D, Adhikari T, Nair S, Kumar A, Juneja A, Sharma A, Begum S, Surve S, Prusty RK, Kumar S, Geddam JJB, Meur G, Mummadi MK, Kailash U, Palo SK, Kanungo S, Kshatri JS, Behera AK, Swain S, Singh R, Zaman K, Deval H, Pandey AK, Sarkar A, Kant R, Narain K, D’Aquino L, Gaym A, Singh VV, Rao MVV. Challenges in Accessing and Delivering Maternal and Child Health Services during the COVID-19 Pandemic: A Cross-Sectional Rapid Survey from Six States of India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1538. [PMID: 36674296 PMCID: PMC9865999 DOI: 10.3390/ijerph20021538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND/OBJECTIVES Globally, the COVID-19 pandemic and its prevention and control policies have impacted maternal and child health (MCH) services. This study documents the challenges faced by patients in accessing MCH services, and the experiences of health care providers in delivering those services during the COVID-19 outbreak, explicitly focusing on the lockdown period in India. METHODS A cross-sectional study (rapid survey) was conducted in 18 districts from 6 states of India during March to June, 2020. The sample size included 540 MCH patients, 18 gynaecologists, 18 paediatricians, 18 district immunisation officers and 108 frontline health workers. Bivariate analysis and multivariable analysis were used to assess the association between sociodemographic characteristics, and challenges faced by the patients. RESULTS More than one-third of patients (n = 212; 39%) reported that accessing MCH services was a challenge during the lockdown period, with major challenges being transportation-related difficulties (n = 99; 46%) unavailability of hospital-based services (n = 54; 23%) and interrupted outreach health services (n = 39; 18.4%). The supply-side challenges mainly included lack of infrastructural preparedness for outbreak situations, and a shortage of human resources. CONCLUSIONS/RECOMMENDATIONS A holistic approach is required that focuses on both preparedness and response to the outbreak, as well reassignment and reinforcement of health care professionals to continue catering to and maintaining essential MCH services during the pandemic.
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Affiliation(s)
- Saurabh Sharma
- National Institute of Medical Statistics, Ansari Nagar, New Delhi 110029, India
| | - Sumit Aggarwal
- Indian Council of Medical Research, Ansari Nagar, New Delhi 110029, India
| | - Ragini Kulkarni
- National Institute for Research in Reproductive Health, Mumbai 400012, India
| | - Dinesh Kumar
- National Institute for Research in Tribal Health, Jabalpur 482003, India
| | | | | | - K. Rekha Devi
- Regional Medical Research Centre, NE Region, Dibrugarh 751023, India
| | | | | | - Lucky Singh
- National Institute of Medical Statistics, Ansari Nagar, New Delhi 110029, India
| | - Damodar Sahu
- National Institute of Medical Statistics, Ansari Nagar, New Delhi 110029, India
| | - Tulsi Adhikari
- National Institute of Medical Statistics, Ansari Nagar, New Delhi 110029, India
| | - Saritha Nair
- National Institute of Medical Statistics, Ansari Nagar, New Delhi 110029, India
| | - Anil Kumar
- National Institute of Medical Statistics, Ansari Nagar, New Delhi 110029, India
| | - Atul Juneja
- National Institute of Medical Statistics, Ansari Nagar, New Delhi 110029, India
| | - Anshita Sharma
- National Institute of Medical Statistics, Ansari Nagar, New Delhi 110029, India
| | - Shahina Begum
- National Institute for Research in Reproductive Health, Mumbai 400012, India
| | - Suchitra Surve
- National Institute for Research in Reproductive Health, Mumbai 400012, India
| | - Ranjan Kumar Prusty
- National Institute for Research in Reproductive Health, Mumbai 400012, India
| | - Surendra Kumar
- National Institute for Research in Reproductive Health, Mumbai 400012, India
| | | | - Gargi Meur
- National Institute of Nutrition, Hyderabad 500007, India
| | | | - Uma Kailash
- National Institute of Nutrition, Hyderabad 500007, India
| | | | | | | | | | | | - Rajeev Singh
- Regional Medical Research Centre, Gorakhpur 273013, India
| | - Kamran Zaman
- Regional Medical Research Centre, Gorakhpur 273013, India
| | - Hirawati Deval
- Regional Medical Research Centre, Gorakhpur 273013, India
| | | | - Abu Sarkar
- Regional Medical Research Centre, NE Region, Dibrugarh 751023, India
| | - Rajni Kant
- Regional Medical Research Centre, Gorakhpur 273013, India
| | - Kanwar Narain
- Regional Medical Research Centre, NE Region, Dibrugarh 751023, India
| | | | - Asheber Gaym
- UNICEF, India Country Office, New Delhi 110003, India
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24
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Senkyire EK, Ewetan O, Azuh D, Asiedua E, White R, Dunlea M, Barger M, Ohaja M. An integrative literature review on the impact of COVID-19 on maternal and child health in Africa. BMC Pregnancy Childbirth 2023; 23:6. [PMID: 36600225 PMCID: PMC9811037 DOI: 10.1186/s12884-022-05339-x] [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: 07/20/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023] Open
Abstract
Africa has the highest rates of maternal deaths globally which have been linked to poorly functioning health care systems. The pandemic revealed already known weaknesses in the health systems in Africa, such as workforce shortages, lack of equipment and resources. The aim of this paper is to review the published literature on the impact of the COVID-19 pandemic on maternal and child health in Africa. The integrative review process delineated by Whittemore and Knafl (2005) was used to meet the study aims. The literature search of Ovid Medline, CINAHL, PubMed, WHO, Google and Google scholar, Africa journals online, MIDIRS was limited to publications between March 2020 and May 2022. All the studies went through the PRISMA stages, and 179 full text papers screened for eligibility, 36 papers met inclusion criteria. Of the studies, 6 were qualitative, 25 quantitative studies, and 5 mixed methods. Thematic analysis according to the methods of Braun and Clark (2006) were used to synthesize the data. From the search the six themes that emerged include: effects of lockdown measures, COVID concerns and psychological stress, reduced attendance at antenatal care, childhood vaccination, reduced facility-based births, and increase maternal and child mortality. A review of the literature revealed the following policy issues: The need for government to develop robust response mechanism to public health emergencies that negatively affect maternal and child health issues and devise health policies to mitigate negative effects of lockdown. In times of pandemic there is need to maintain special access for both antenatal care and child delivery services and limit a shift to use of untrained birth attendants to reduce maternal and neonatal deaths. These could be achieved by soliciting investments from various sectors to provide high-quality care that ensures sustainability to all layers of the population.
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Affiliation(s)
| | | | | | | | | | | | - Mary Barger
- University of California, San Francisco, California, USA
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25
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Habinshuti P, Nshimyiryo A, Fejfar DL, Niyigena A, Cubaka VK, Karema N, Bigirimana JB, Shyirambere C, Barnhart DA, Kateera F, Fulcher I. Impact of COVID-19 on access to cancer care in Rwanda: a retrospective time-series study using electronic medical records data. BMJ Open 2022; 12:e065398. [PMID: 36535717 PMCID: PMC9764097 DOI: 10.1136/bmjopen-2022-065398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has caused disruptions in access to routine healthcare services worldwide, with a particularly high impact on chronic care patients and low and middle-income countries. In this study, we used routinely collected electronic medical records data to assess the impact of the COVID-19 pandemic on access to cancer care at the Butaro Cancer Center of Excellence (BCCOE) in rural Rwanda. METHODS We conducted a retrospective time-series study among all Rwandan patients who received cancer care at the BCCOE between 1 January 2016 and 31 July 2021. The primary outcomes of interest included a comparison of the number of patients who were predicted based on time-series models of pre-COVID-19 trends versus the actual number of patients who presented during the COVID-19 period (between March 2020 and July 2021) across four key indicators: the number of new patients, number of scheduled appointments, number of clinical visits attended and the proportion of scheduled appointments completed on time. RESULTS In total, 8970 patients (7140 patients enrolled before COVID-19 and 1830 patients enrolled during COVID-19) were included in this study. During the COVID-19 period, enrolment of new patients dropped by 21.7% (95% prediction interval (PI): -31.3%, -11.7%) compared with the pre-COVID-19 period. Similarly, the number of clinical visits was 25.0% (95% PI: -31.1%, -19.1%) lower than expected and the proportion of scheduled visits completed on time was 27.9% (95% PI: -39.8%, -14.1%) lower than expected. However, the number of scheduled visits did not deviate significantly from expected. CONCLUSION Although scheduling procedures for visits continued as expected, our findings reveal that the COVID-19 pandemic interrupted patients' ability to access cancer care and attend scheduled appointments at the BCCOE. This interruption in care suggests delayed diagnosis and loss to follow-up, potentially resulting in a higher rate of negative health outcomes among cancer patients in Rwanda.
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Affiliation(s)
- Placide Habinshuti
- Informatics Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Alphonse Nshimyiryo
- Research and Training Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Anne Niyigena
- Research and Training Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Vincent K Cubaka
- Research and Training Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Nadine Karema
- Informatics Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | - Dale A Barnhart
- Research and Training Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Fredrick Kateera
- Clinical Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Isabel Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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26
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Zewdie A, Mose A, Yimer A, Melis T, Muhamed AN, Jemal AK. Essential maternal health service disruptions in Ethiopia during COVID 19 pandemic: a systematic review. BMC Womens Health 2022; 22:496. [PMID: 36474256 PMCID: PMC9724383 DOI: 10.1186/s12905-022-02091-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION COVID 19 pandemic has challenged the resilience of the most effective health systems in the world. The Ethiopian Ministry of health tried to ensure the continuation of essential maternal health services during the pandemic. Despite several individual studies conducted on the impact of COVID 19 on maternal health services, no evidence can summarize the extent of impact as a nation and which essential maternal health service is most affected. METHOD A systematic review was conducted to summarize the extent of disruption of essential maternal health services and identify the most affected service in the era of the COVID pandemic in Ethiopia. Preferred Reporting Items for Systematic Review and Meta-analysis guidelines were followed. Comprehensive literature was searched using international databases PubMed, Google scholar, and African Online Journal to retrieve related articles. Descriptive analysis was made to answer the review objective. RESULT Overall, 498 articles were retrieved using our search strategy and finally 8 articles were included in the review. We found, ANC (26.35%), skilled birth attendance (23.46%), PNC (30%), family planning (14%), and abortion care (23.7%) maximum disruption of service utilization due to the pandemic. PNC service was the most significantly affected service unit followed by the ANC unit. CONCLUSION Essential maternal health services have been significantly disrupted due to COVID 19 pandemic in Ethiopia. It is expected from all stakeholders to prioritize safe and accessible maternity care during the pandemic and the aftermath and take lesson to reduce maternal and infant morbidity and mortality.
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Affiliation(s)
- Amare Zewdie
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Ayenew Mose
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Ali Yimer
- Department of Public Health, College of Medicine and Health Science, Weldia University, Weldia, Ethiopia
| | - Tamirat Melis
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Ahmed Nuru Muhamed
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Abdurezak Kemal Jemal
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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27
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Kouyate M, Barry L, Sow A, De Maesschalck J, De Put WV, Sidibé S, Adrianaivo N, Kolié D, Delamou A. Improving access to and use of maternal health services during COVID-19: Experience from a health system strengthening project in Guinea. Front Public Health 2022; 10:1004134. [PMID: 36353275 PMCID: PMC9639210 DOI: 10.3389/fpubh.2022.1004134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/21/2022] [Indexed: 01/27/2023] Open
Abstract
The purpose of this study was to document the experience of health providers' capacity strengthening during health crises and the contribution of such to the health system and the population resilience in the face of the COVID-19 pandemic in Guinea. We conducted a cross-sectional study using routine data collected from 41 health facilities in the project intervention areas, including associative health centers, community health centers, and district hospitals,. These data covered the period between 2019 and 2021. Results showed that all the community health centers (CMCs) had a clean internal and external environment, compared to health centers (95.2%) and district hospitals (33.3%). Hand washing was systematic among visitors attending CMCs and district hospitals (HPs). However, 28.6% of visitors attending associative health centers (AHCs) did not wash their hands. Temperature taking for visitors was not carried out in all CMCs and in 90.5% of the AHCs; unlike in the HC and HP where the temperature of each patient was taken before entering the consultation room. The obligation to wear masks was higher in the HP and in the HC, compared to the CMC and AHC where the order of non-compliance with the wearing of masks was, respectively 36.4 and 19%. Non-compliance with social distancing in the waiting rooms and between users was observed in all facilities. The project's interventions mainly contributed to improving the utilization of prenatal consultation and institutional delivery services; the beginning of the interventions was marked by an increase of an average of 17 ANC1 per month in CMCs and 116 ANC1 in health centers. Ongoing training on capacity strengthening for providers in infection prevention and control, followed by the offering of delivery kits and materials during epidemics, would contribute to the improvement and utilization of health facilities by the population.
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Affiliation(s)
- Mariama Kouyate
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea,*Correspondence: Mariama Kouyate
| | - Lansana Barry
- National Center for Training and Research in Rural Health of Maferinyah, Forecariah, Guinea
| | | | | | | | - Sidikiba Sidibé
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | | | - Delphin Kolié
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Alexandre Delamou
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea,National Center for Training and Research in Rural Health of Maferinyah, Forecariah, Guinea
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Kumurenzi A, Richardson J, Thabane L, Kagwiza J, Musabyemariya I, Bosch J. Provision and use of physical rehabilitation services for adults with disabilities in Rwanda: A descriptive study. Afr J Disabil 2022; 11:1004. [PMID: 36092478 PMCID: PMC9453115 DOI: 10.4102/ajod.v11i0.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background Physical rehabilitation interventions address functional deficits caused by impairments that affect someone’s performance. Whilst rehabilitation is important, it is assumed that these services are either minimal or nonexistent in low-resource settings. Our data expand on the data from the Situation Assessment of Rehabilitation in the Republic of Rwanda report to describe rehabilitation services and who access them at public and semiprivate facilities (primarily funded by the private sector). Objectives This article describes the use of the outpatient physical rehabilitation services across nine health facilities, the characteristics of adults attending these health facilities and some of the facilitators and barriers they encounter when attending rehabilitation. Method Data were collected between September and December 2018 from the heads of departments and adult patients attending outpatient rehabilitation services funded by the government, international nongovernmental organisations or faith-based organisations. Results Two hundred and thirteen adults were recruited from nine facilities. There is a sixfold difference in the number of rehabilitation personnel between public and semiprivate hospitals in these facilities’ catchment areas. However, most participants were recruited at public facilities (186 [87%]), primarily with physical disorders. Patients reported that family support (94%) was the most crucial facilitator for attending rehabilitation, whilst transportation cost (96%) was a significant barrier. Conclusion Rehabilitation service availability for Rwandan adults with disabilities is limited. Whilst family support helps patients attend rehabilitation, transportation costs remain a significant barrier to people attending rehabilitation. Strategies to address these issues include developing triage protocols, training community health workers and families. Contribution Data on rehabilitation service provision in Rwanda and most African countries are either non-existent or very limited. These data contain important information regarding the services provided and the people who used them across different health facilities (public versus private) and urban versus rural settings). To improve rehabilitation service provision, we first need to understand the current situation. These data are an important step to better understanding rehabilitation in Rwanda.
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Affiliation(s)
- Anne Kumurenzi
- Department of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Physiotherapy, Faculty of Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Julie Richardson
- Department of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Jeanne Kagwiza
- Department of Physiotherapy, Faculty of Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Ines Musabyemariya
- Functional Rehabilitation Programme, Humanity and Inclusion, Kigali, Rwanda
| | - Jackie Bosch
- Department of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Population Health Research Institute, McMaster University, Hamilton, Canada
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Makuza JD, Soe P, Jeong D, Nisingizwe MP, Dushimiyimana D, Umutesi J, Nshimiyimana L, Maliza C, Serumondo J, Remera E, Rwibasira GN, Tuyishime A, Riedel DJ. Epidemiology of sexually transmitted infections: trends among patients screened for sexually transmitted infections in rwandan health facilities 2014–2020. BMC Infect Dis 2022; 22:701. [PMID: 35987614 PMCID: PMC9392439 DOI: 10.1186/s12879-022-07685-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background Sexually Transmitted Infections (STIs) are of great global health concern. Currently, there are limited epidemiological data characterizing STIs in the general population in Rwanda. We assessed the national and regional epidemiology of STIs in Rwanda from 2014–2020 among patients syndromically screened for STIs in all health facilities in Rwanda. Methods This is a retrospective analysis of the trend of STIs epidemiology among screened patients at all health facilities in Rwanda using data from the Health Management Information System (HMIS) reporting. Adult patients (15 years and over) screened for STIs between July 2014 and June 2020 were included in the analysis. Outcomes of interest were the number of individuals screened for STIs and individuals diagnosed with at least one STI with a syndromic approach only or plus a test together. Results Overall, the number of individuals screened for STIs over the study period was 5.3 million (M) in 2014–2015, 6.6 M in 2015–2016, 6.3 M in 2016–2017, 6.7 M in 2017–2018, 6.2 M in 2018–2019, and 4.9 M in 2019–2020. There was a modest increase in the number of individuals diagnosed and treated for STIs from 139,357 in 2014–15 to 202,294 (45% increase) in 2019–2020. At the national level, the prevalence of STI syndromes amongst individuals screened at health facilities in Rwanda varied between 2.37% to 4.16% during the study period. Among the provinces, Kigali city had the highest prevalence for the whole 6 years ranging from 3.46% (95%CI: 3.41, 3.51) in 2014–2015 to 8.23% (95%CI: 8.15, 8.31) in 2019–2020. Conclusion From 2014 to 2020, the number of patients screened for STI syndromes in Rwanda varied between 4.9 M and 6.7 M. However, the prevalence of STIs among screened patients increased considerably over time, which could be associated with public awareness and improved data recording. The highest prevalence of all STIs was observed in urban areas and near borders, and private clinics reported more cases, suggesting the need to improve awareness in these settings and increase confidentiality and trust in public health clinics.
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Cardoso Pinto AM, Ranasinghe L, Dodd PJ, Budhathoki SS, Seddon JA, Whittaker E. Disruptions to routine childhood vaccinations in low- and middle-income countries during the COVID-19 pandemic: A systematic review. Front Pediatr 2022; 10:979769. [PMID: 36034563 PMCID: PMC9403570 DOI: 10.3389/fped.2022.979769] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background The COVID-19 pandemic has disrupted routine childhood vaccinations worldwide with low- and middle-income countries (LMICs) most affected. This study aims to quantify levels of disruption to routine vaccinations in LMICs. Methods A systematic review (PROSPERO CRD42021286386) was conducted of MEDLINE, Embase, Global Health, CINAHL, Scopus and MedRxiv, on the 11th of February 2022. Primary research studies published from January 2020 onwards were included if they reported levels of routine pediatrics vaccinations before and after March 2020. Study appraisal was performed using NHLBI tool for cross-sectional studies. Levels of disruption were summarized using medians and interquartile ranges. Results A total of 39 cross-sectional studies were identified. These showed an overall relative median decline of -10.8% [interquartile range (IQR) -27.6%, -1.4%] across all vaccines. Upper-middle-income countries (upper-MICs) (-14.3%; IQR -24.3%, -2.4%) and lower-MICs (-18.0%; IQR -48.6%, -4.1%) showed greater declines than low-income countries (-3.1%; IQR -12.8%, 2.9%), as did vaccines administered at birth (-11.8%; IQR -27.7%, -3.5%) compared to those given after birth (-8.0%; IQR -28.6%, -0.4%). Declines during the first 3 months of the pandemic (-8.1%; IQR -35.1%, -1.4%) were greater than during the remainder of 2020 (-3.9%; IQR -13.0%, 11.4%) compared to baseline. Conclusion There has been a decline in routine pediatric vaccination, greatest in MICs and for vaccines administered at birth. Nations must prioritize catch-up programs alongside public health messaging to encourage vaccine uptake. Systematic review registration Identifier: CRD42021286386.
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Affiliation(s)
| | - Lasith Ranasinghe
- Academic Foundation Doctor, Imperial College London, London, United Kingdom
| | - Peter J Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Shyam Sundar Budhathoki
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - James A Seddon
- Department of Infectious Disease, Imperial College London, London, United Kingdom
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Elizabeth Whittaker
- Department of Infectious Disease, Imperial College London, London, United Kingdom
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Dzinamarira T, Moyo E, Moyo P, Pierre G, Mpabuka E, Kahere M, Tungwarara N, Chitungo I, Murewanhema G, Musuka G. Childhood immunization services accessibility and utilization during the COVID-19 pandemic in Africa. J Infect 2022; 85:436-480. [PMID: 35914610 PMCID: PMC9338170 DOI: 10.1016/j.jinf.2022.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
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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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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Bekele C, Bekele D, Hunegnaw BM, Van Wickle K, Gebremeskel FA, Korte M, Tedijanto C, Taddesse L, Chan GJ. Impact of the COVID-19 pandemic on utilisation of facility-based essential maternal and child health services from March to August 2020 compared with pre-pandemic March-August 2019: a mixed-methods study in North Shewa Zone, Ethiopia. BMJ Open 2022; 12:e059408. [PMID: 36437538 PMCID: PMC9170798 DOI: 10.1136/bmjopen-2021-059408] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/09/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Health systems are often weakened by public health emergencies that make it harder to access health services. We aimed to assess maternal, newborn and child health (MNCH) service utilisation during the first 6 months of the COVID-19 pandemic compared with prior to the pandemic. METHODS We conducted a mixed study design in eight health facilities that are part of the Birhan field site in Amhara, Ethiopia and compared the trend of service utilisation in the first 6 months of COVID-19 with the corresponding time and data points of the preceding year. RESULT New family planning visits (43.2 to 28.5/month, p=0.014) and sick under 5 child visits (225.0 to 139.8/month, p=0.007) declined over the first 6 months of the pandemic compared with the same period in the preceding year. Antenatal (208.9 to 181.7/month, p=0.433) and postnatal care (26.6 to 19.8/month, p=0.155) visits, facility delivery rates (90.7 to 84.2/month, p=0.776), and family planning visits (313.3 to 273.4/month, p=0.415) declined, although this did not reach statistical significance. Routine immunisation visits (37.0 to 36.8/month, p=0.982) for children were maintained. Interviews with healthcare providers and clients highlighted several barriers to service utilisation during COVID-19, including fear of disease transmission, economic hardship, and transport service disruptions and restrictions. Enablers of service utilisation included communities' decreased fear of COVID-19 and awareness-raising activities. CONCLUSION We observed a decline in essential MNCH services particularly in sick children and new family planning visits. To improve the resiliency of fragile health systems, resources are needed to continuously monitor service utilisation and clients' evolving concerns during public health emergencies.
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Affiliation(s)
- Chalachew Bekele
- HaSET MNCH Research Program, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Delayehu Bekele
- Department of Obstetrics and Gynecology, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bezawit Mesfin Hunegnaw
- Department of Pediatrics and Child Health, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Kimiko Van Wickle
- Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Michelle Korte
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Christine Tedijanto
- Francis I Proctor Foundation, University of San Francisco, San Francisco, California, USA
| | | | - Grace J Chan
- Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Amouzou A, Maïga A, Faye CM, Chakwera S, Melesse DY, Mutua MK, Thiam S, Abdoulaye IB, Afagbedzi SK, Ag Iknane A, Ake-Tano OS, Akinyemi JO, Alegana V, Alhassan Y, Sam AE, Atweam DK, Bajaria S, Bawo L, Berthé M, Blanchard AK, Bouhari HA, Boulhassane OMA, Bulawayo M, Chooye O, Coulibaly A, Diabate M, Diawara F, Esleman O, Gajaa M, Garba KHA, Getachew T, Jacobs C, Jacobs GP, James F, Jegede AS, Joachim C, Kananura RM, Karimi J, Kiarie H, Kpebo D, Lankoandé B, Lawanson AO, Mahamadou Y, Mahundi M, Manaye T, Masanja H, Millogo MR, Mohamed AK, Musukuma M, Muthee R, Nabié D, Nyamhagata M, Ogwal J, Orimadegun A, Ovuoraye A, Pongathie AS, Sable SP, Saydee GS, Shabini J, Sikapande BM, Simba D, Tadele A, Tadlle T, Tarway-Twalla AK, Tassembedo M, Tehoungue BZ, Terera I, Traoré S, Twalla MP, Waiswa P, Wondirad N, Boerma T. Health service utilisation during the COVID-19 pandemic in sub-Saharan Africa in 2020: a multicountry empirical assessment with a focus on maternal, newborn and child health services. BMJ Glob Health 2022; 7:bmjgh-2021-008069. [PMID: 35501068 PMCID: PMC9062456 DOI: 10.1136/bmjgh-2021-008069] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/04/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION There are concerns about the impact of the COVID-19 pandemic on the continuation of essential health services in sub-Saharan Africa. Through the Countdown to 2030 for Women's, Children's and Adolescents' Health country collaborations, analysts from country and global public health institutions and ministries of health assessed the trends in selected services for maternal, newborn and child health, general service utilisation. METHODS Monthly routine health facility data by district for the period 2017-2020 were compiled by 12 country teams and adjusted after extensive quality assessments. Mixed effects linear regressions were used to estimate the size of any change in service utilisation for each month from March to December 2020 and for the whole COVID-19 period in 2020. RESULTS The completeness of reporting of health facilities was high in 2020 (median of 12 countries, 96% national and 91% of districts ≥90%), higher than in the preceding years and extreme outliers were few. The country median reduction in utilisation of nine health services for the whole period March-December 2020 was 3.9% (range: -8.2 to 2.4). The greatest reductions were observed for inpatient admissions (median=-17.0%) and outpatient admissions (median=-7.1%), while antenatal, delivery care and immunisation services generally had smaller reductions (median from -2% to -6%). Eastern African countries had greater reductions than those in West Africa, and rural districts were slightly more affected than urban districts. The greatest drop in services was observed for March-June 2020 for general services, when the response was strongest as measured by a stringency index. CONCLUSION The district health facility reports provide a solid basis for trend assessment after extensive data quality assessment and adjustment. Even the modest negative impact on service utilisation observed in most countries will require major efforts, supported by the international partners, to maintain progress towards the SDG health targets by 2030.
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Affiliation(s)
- Agbessi Amouzou
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abdoulaye Maïga
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cheikh Mbacké Faye
- African Population Health Research Centre, Dakar, Senegal.,School of Public Health, University of Witwatersrand, Johannesburg, Gauteng, South Africa
| | | | - Dessalegn Y Melesse
- Community Health Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Sokhna Thiam
- African Population Health Research Centre, Dakar, Senegal
| | | | | | | | | | | | - Victor Alegana
- School of Geography and Environmental Sciences, University of Southampton, Southampton, UK.,Kenya Medical Research Institute, Nairobi, Kenya
| | - Yakubu Alhassan
- University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | | | | | - Shraddha Bajaria
- Ifakara Health Institute, Ifakara, Morogoro, Tanzania, United Republic of
| | - Luke Bawo
- Ministry of Health, Monrovia, Montserrado, Liberia
| | | | | | | | | | - Maio Bulawayo
- Department of Health Policy and Management, University of Zambia, Lusaka, Zambia
| | | | - Amed Coulibaly
- Institut National de Santé Publique, Abidjan, Côte d'Ivoire
| | - Mamatou Diabate
- Ministère de la Santé et de l'Hygiène Publique du Mali, Bamako, Mali
| | | | | | - Mulugeta Gajaa
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Oromia, Ethiopia
| | | | - Theodros Getachew
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Oromia, Ethiopia.,College of Medicine and Health Science, Institute of Public Health, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Choolwe Jacobs
- Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia
| | | | | | | | | | | | | | | | - Denise Kpebo
- Institut National de Santé Publique, Abidjan, Côte d'Ivoire
| | - Bruno Lankoandé
- Institut Superieur des Sciences de la Population, Ouagadougou, Centre, Burkina Faso
| | | | | | - Masoud Mahundi
- University of Dar es Salaam, Dar es Salaam, Tanzania, United Republic of
| | | | - Honorati Masanja
- Ifakara Health Institute, Ifakara, Morogoro, Tanzania, United Republic of
| | | | | | - Mwiche Musukuma
- University of Zambia School of Public Health, Lusaka, Zambia
| | | | - Douba Nabié
- Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | | | | | - Adebola Orimadegun
- Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | | | | | | | | | - Josephine Shabini
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamayo, Tanzania, United Republic of
| | | | - Daudi Simba
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Ashenif Tadele
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Oromia, Ethiopia
| | - Tefera Tadlle
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Oromia, Ethiopia
| | | | | | | | | | | | - Musu P Twalla
- University of Liberia, Monrovia, Montserrado, Liberia
| | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
| | - Naod Wondirad
- Federal Ministry of Health, Addis Ababa, Ethiopia.,Clinical Services Directorate, Ethiopia Ministry of Health, Addis Ababa, Lideta, Ethiopia
| | - Ties Boerma
- Community Health Science, University of Manitoba, Winnipeg, Manitoba, Canada
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Quaglio G, Cavallin F, Nsubuga JB, Lochoro P, Maziku D, Tsegaye A, Azzimonti G, Kamunga AM, Manenti F, Putoto G. The impact of the COVID-19 pandemic on health service use in sub-Saharan Africa. Public Health Action 2022; 12:34-39. [DOI: 10.5588/pha.21.0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING: Six hospitals in four sub-Saharan African countries.OBJECTIVE: To examine the indirect effects of COVID-19 on health service utilisation and to explore the risk of bias in studies on prediction models.DESIGN: Monthly data were analysed using interrupted
time-series modelling. We used linear mixed-effect models for the analysis of antenatal care visits, institutional deliveries, vaccinations, outpatient visits and hospital admissions, and generalised linear mixed-effect models for hospital mortality.RESULTS: During 2018–2020,
the six hospitals recorded a total of 57,075 antenatal care visits, 38,706 institutional deliveries, 312,961 vaccinations, 605,925 out-patient visits and 143,915 hospital admissions. The COVID-19 period was associated with decreases in vacci-nations (− 575 vaccinations, P <
0.0001), outpatient visits (− 700 visits, P < 0.0001) and hospital admission (− 102 admission, P = 0.001); however, no statistically significant effects were found for antenatal care visits (P = 0.71) or institutional deliveries (P = 0.14). Mortality
rate increased by 2% per month in the pre-COVID-19 period; however, a decreasing trend (by 2% per month) was observed during the COVID-19 period (P = 0.004). Subgroup and sensitivity analyses broadly confirmed the main findings with only minor inconsistencies. A reduction in outpatient
visits was also observed in hospitals from countries with a higher Stringency Index and in urban hospitals.CONCLUSIONS: The pandemic resulted in a reduction in health service utilisation. The decreases were less than anticipated from modelling studies.
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Affiliation(s)
- G. Quaglio
- European Parliamentary Research Services, European Parliament, Brussels, Belgium, Department of International Health, Care and Public Health Research Institute (CAPHRI), University of Maastricht, Maastricht, The Netherlands
| | | | | | - P. Lochoro
- Doctors with Africa Cuamm, Aber Hospital, Jaber, Uganda
| | - D. Maziku
- Tosamaganga Hospital, Iringa, United Republic of Tanzania
| | - A. Tsegaye
- Doctors with Africa Cuamm, Addis Ababa, Ethiopia
| | | | - A. M. Kamunga
- Doctors with Africa Cuamm, Pujehun Hospital, Sierra Leone
| | | | - G. Putoto
- Doctors with Africa Cuamm, Padua, Italy
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Wambua S, Malla L, Mbevi G, Kandiah J, Nwosu AP, Tuti T, Paton C, Wambu B, English M, Okiro EA. Quantifying the indirect impact of COVID-19 pandemic on utilisation of outpatient and immunisation services in Kenya: a longitudinal study using interrupted time series analysis. BMJ Open 2022; 12:e055815. [PMID: 35273053 PMCID: PMC8914407 DOI: 10.1136/bmjopen-2021-055815] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/31/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE In this study, we assess the indirect impact of COVID-19 on utilisation of immunisation and outpatient services in Kenya. DESIGN Longitudinal study. SETTING Data were analysed from all healthcare facilities reporting to Kenya's health information system from January 2018 to March 2021. Multiple imputation was used to address missing data, interrupted time series analysis was used to quantify the changes in utilisation of services and sensitivity analysis was carried out to assess robustness of estimates. EXPOSURE OF INTEREST COVID-19 outbreak and associated interventions. OUTCOME MEASURES Monthly attendance to health facilities. We assessed changes in immunisation and various outpatient services nationally. RESULTS Before the first case of COVID-19 and pursuant intervention measures in March 2020, uptake of health services was consistent with historical levels. There was significant drops in attendance (level changes) in April 2020 for overall outpatient visits for under-fives (rate ratio, RR 0.50, 95% CI 0.44 to 0.57), under-fives with pneumonia (RR 0.43, 95% CI 0.38 to 0.47), overall over-five visits (RR 0.65, 95% CI 0.57 to 0.75), over-fives with pneumonia (RR 0.62, 95% CI 0.55 to 0.70), fourth antenatal care visit (RR 0.86, 95% CI 0.80 to 0.93), total hypertension (RR 0.89, 95% CI 0.82 to 0.96), diabetes cases (RR 0.95 95% CI, 0.93 to 0.97) and HIV testing (RR 0.97, 95% CI 0.94 to 0.99). Immunisation services, first antenatal care visits, new cases of hypertension and diabetes were not affected. The post-COVID-19 trend was increasing, with more recent data suggesting reversal of effects and health services reverting to expected levels as of March 2021. CONCLUSION COVID-19 pandemic has had varied indirect effects on utilisation of health services in Kenya. There is need for proactive and targeted interventions to reverse these effects as part of the pandemic's response to avert non-COVID-19 indirect mortality.
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Affiliation(s)
- Steven Wambua
- Population Health Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Lucas Malla
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - George Mbevi
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Joel Kandiah
- Mathematics Institute, University of Warwick, Coventry, UK
| | - Amen-Patrick Nwosu
- Nuffield Department of Clinical Medicine, Oxford Centre for Global Health Research, Oxford, UK
| | - Timothy Tuti
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Chris Paton
- Nuffield Department of Clinical Medicine, Oxford Centre for Global Health Research, Oxford, UK
| | - Bernard Wambu
- Division of Neonatal and Child Health, Kenya Ministry of Health, Nairobi, Kenya
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, Oxford Centre for Global Health Research, Oxford, UK
| | - Emelda A Okiro
- Population Health Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, Oxford Centre for Global Health Research, Oxford, UK
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Shuka Z, Mebratie A, Alemu G, Rieger M, Bedi AS. Use of healthcare services during the COVID-19 pandemic in urban Ethiopia: evidence from retrospective health facility survey data. BMJ Open 2022; 12:e056745. [PMID: 35197352 PMCID: PMC8882656 DOI: 10.1136/bmjopen-2021-056745] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES In recent years, Ethiopia has made enormous strides in enhancing access to healthcare, especially, maternal and child healthcare. With the onset and spread of COVID-19, the attention of the healthcare system has pivoted to handling the disease, potentially at the cost of other healthcare needs. This paper explores whether this shift has come at the cost of non-Covid related healthcare, especially the use of maternal and child health (MCH) services. SETTING Data covering a 24-month period are drawn from 59 health centres and 29 public hospitals located in urban Ethiopia. PRIMARY AND SECONDARY OUTCOMES MEASURES The primary outcome measures are the use of MCH services including family planning, antenatal and postnatal care, abortion care, delivery and immunisation. The secondary outcome measures are the use of health services by adults including antiretroviral therapy (ART), tuberculosis (TB) and leprosy and dental services RESULTS: There is a sharp reduction in the use of both inpatient (20%-27%, p<0.001) and outpatient (27%-34%, p<0.001) care, particularly in Addis Ababa, which has been most acutely affected by the virus. This decline does not come at the cost of MCH services. The use of several MCH components (skilled birth attendant deliveries, immunisation, postnatal care) remains unaffected throughout the period while others (family planning services, antenatal care) experience a decline (8%-17%) in the immediate aftermath but recover soon after. CONCLUSION Concerns about the crowding out of MCH services due to the focus on COVID-19 are unfounded. Proactive measures taken by the government and healthcare facilities to ring-fence the use of essential healthcare services have mitigated service disruptions. The results underline the resilience and agility displayed by one of the world's most resource-constrained healthcare systems. Further research on the approaches used to mitigate disruptions is needed.
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Affiliation(s)
- Zemzem Shuka
- Institute of Development and Policy Research, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
- International Institute for Social Studies, Erasmus Universiteit, Rotterdam, The Netherlands
| | - Anagaw Mebratie
- School of Public Health, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Getnet Alemu
- Institute of Development and Policy Research, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Matthias Rieger
- International Institute for Social Studies, Erasmus Universiteit, Rotterdam, The Netherlands
| | - Arjun S Bedi
- International Institute for Social Studies, Erasmus Universiteit, Rotterdam, The Netherlands
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Hakizimana D, Ntizimira C, Mbituyumuremyi A, Hakizimana E, Mahmoud H, Birindabagabo P, Musanabaganwa C, Gashumba D. The impact of Covid-19 on malaria services in three high endemic districts in Rwanda: a mixed-method study. Malar J 2022; 21:48. [PMID: 35164781 PMCID: PMC8845295 DOI: 10.1186/s12936-022-04071-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Rwanda has achieved impressive reductions in malaria morbidity and mortality over the past two decades. However, the disruption of essential services due to the current Covid-19 pandemic can lead to a reversal of these gains in malaria control unless targeted, evidence-based interventions are implemented to mitigate the impact of the pandemic. The extent to which malaria services have been disrupted has not been fully characterized. This study was conducted to assess the impact of Covid-19 on malaria services in Rwanda. Methods A mixed-methods study was conducted in three purposively selected districts in Rwanda. The quantitative data included malaria aggregated data reported at the health facility level and the community level. The data included the number of malaria tests, uncomplicated malaria cases, severe malaria cases, and malaria deaths. The qualitative data were collected using focus group discussions with community members and community health workers, as well as in-depth interviews with health care providers and staff working in the malaria programme. Interrupted time series analysis was conducted to compare changes in malaria presentations between the pre-Covid-19 period (January 2019 to February 2020) and Covid-19 period (from March 2020 to November 2020). The constant comparative method was used in qualitative thematic analysis. Results Compared to the pre-Covid-19 period, there was a monthly reduction in patients tested in health facilities of 4.32 per 1000 population and a monthly increase in patients tested in the community of 2.38 per 1000 population during the Covid-19 period. There was no change in the overall presentation rate for uncomplicated malaria. The was a monthly reduction in the proportion of severe malaria of 5.47 per 100,000 malaria cases. Additionally, although healthcare providers continued to provide malaria services, they were fearful that this would expose them and their families to Covid-19. Covid-19 mitigation measures limited the availability of transportation options for the community to seek care in health facilities and delayed the implementation of some key malaria interventions. The focus on Covid-19-related communication also reduced the amount of health information for other diseases provided to community members. Conclusion The Covid-19 pandemic resulted in patients increasingly seeking care in the community and poses challenges to maintaining delivery of malaria services in Rwanda. Interventions to mitigate these challenges should focus on strengthening programming for the community and home-based care models and integrating malaria messages into Covid-19-related communication. Additionally, implementation of the interrupted interventions should be timed and overlap with the malaria transmission season to mitigate Covid-19 consequences on malaria.
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Banke-Thomas A, Semaan 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. A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the COVID-19 pandemic. BMJ Glob Health 2022; 7:e008064. [PMID: 35173022 PMCID: PMC8852239 DOI: 10.1136/bmjgh-2021-008064] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [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: 12/26/2022] Open
Abstract
INTRODUCTION In sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic. METHODS Mixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019-February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020-February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting. RESULTS Three periods including a first wave, slow period and second wave were identified. Maternal health service utilisation was lower during the pandemic compared with the prepandemic year in all but one selected referral hospital. During the pandemic, service utilisation was particularly lower during the waves and higher or stable during the slow period. Fear of being infected in hospitals, lack of transportation, and even when available, high cost of transportation and service closures were key reasons affecting utilisation during the waves. However, community perception that the pandemic was over or insinuation by Government of the same appeared to stabilise use of referral hospitals for childbirth. CONCLUSION Utilisation of maternal health services across the continuum of care varied through the different periods and across countries. In crisis situations such as COVID-19, restrictions and service closures need to be implemented with consideration given to alternative options for women to access and use services. Information on measures put in place for safe hospital use should be communicated to women.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- School of Human Sciences, University of Greenwich, London, UK
- LSE Health, London School of Economics and Political Science, London, UK
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - 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
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Nafissatou Dioubate
- Centre National de Formation et de Recherche en Santé Rurale de Maférinyah, Forécariah, Guinea
| | - Amani Kikula
- 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
- Kawempe National Referral Hospital, Kampala, Uganda
| | - Olubunmi Ogein
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Moses Adroma
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | - Lamine Diallo
- Maternité de l'Hôpital Régional de Mamou, Mamou, Guinea
| | | | - Cécé Maomou
- Maternité de l'Hôpital Régional de Mamou, Mamou, Guinea
| | - Nathanael Mtinangi
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Dar es Salaam, Tanzania, United Republic of
| | - Telly Sy
- Maternité de l'Hôpital National Ignace Deen de Conakry, Conakry, Guinea
| | - Therese Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Bosede Bukola Afolabi
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maférinyah, Forécariah, Guinea
- Centre d'Excellence Africain pour la Prévention et le Contrôle des Maladies Transmissibles, 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 Barnabas Pembe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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Aranda Z, Binde T, Tashman K, Tadikonda A, Mawindo B, Maweu D, Boley EJ, Mphande I, Dumbuya I, Montaño M, Clisbee M, Mvula MG, Ndayizigiye M, Casella Jean-Baptiste M, Varney PF, Anyango S, Grépin KA, Law MR, Mugunga JC, Hedt-Gauthier B, Fulcher IR. Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries. BMJ Glob Health 2022; 7:bmjgh-2021-007247. [PMID: 35012970 PMCID: PMC8753094 DOI: 10.1136/bmjgh-2021-007247] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/10/2021] [Indexed: 01/01/2023] Open
Abstract
The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-based deliveries in all countries except Malawi from March to December 2020. Different strategies were adopted to maintain continuity of maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure compliance with international and national guidelines for front-line health workers, adapting spaces for safe distancing and ensuring the availability of personal protective equipment. We employ a local lens, providing prepandemic context and reporting results and strategies by country, to highlight the importance of developing context-specific interventions to design effective mitigation strategies.
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Affiliation(s)
- Zeus Aranda
- Compañeros En Salud/Partners In Health-Mexico, Ángel Albino Corzo, Mexico
| | - Thierry Binde
- Partners In Health-Sierra Leone, Koidu, Sierra Leone
| | - Katherine Tashman
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Data Science Initiative, Boston, Massachusetts, USA
| | - Ananya Tadikonda
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bill Mawindo
- Partners In Health-Sierra Leone, Koidu, Sierra Leone
| | | | | | - Isaac Mphande
- Abwenzi Pa Za Umoyo/Partners In Health-Malawi, Neno, Malawi
| | - Isata Dumbuya
- Partners In Health-Sierra Leone, Koidu, Sierra Leone
| | - Mariana Montaño
- Compañeros En Salud/Partners In Health-Mexico, Ángel Albino Corzo, Mexico
| | - Mary Clisbee
- Zanmi Lasante/Partners In Health-Haiti, Croix-des-Bouquets, Haiti
| | | | | | | | | | | | - Karen Ann Grépin
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Michael R Law
- Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Claude Mugunga
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Partners In Health, Boston, Massachusetts, USA
| | - Bethany Hedt-Gauthier
- Harvard Medical School, Boston, Massachusetts, USA.,Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Isabel R Fulcher
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Data Science Initiative, Boston, Massachusetts, USA
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Carneiro LL, Vieira EWR, Duarte ED, da Rocha NB, Velasquez-Melendez G, Caminhas W. COVID-19 pandemic impact on follow-up of child growth and development in Brazil. Front Pediatr 2022; 10:947493. [PMID: 36405844 PMCID: PMC9669785 DOI: 10.3389/fped.2022.947493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES This study investigated the impact of the COVID-19 pandemic on the primary health care (PHC) services to follow-up the child growth and development (CGD) in Brazil. METHODS A cross-sectional study was conducted using secondary data related visits to assess the growth and development of children up to five years between Apr-2017 to Mar-2021. Differences between monthly rate of visits (per thousand inhabitants up to five) during the pandemic (Apr-2020 to Mar-2021) and before (Apr-2017 to Mar-2020) were analyzed using paired t test and control diagrams (averages ± 1.96 standard deviation). RESULTS A total of 39,599,313 visits for monitoring CGD was studied. The average monthly rate of visits dropped from 61.34 (per thousand) before the pandemic to 39.70 in the first 12 months of the pandemic (p < 0.001). In all states, except Rio Grande do Sul, there was a significant reduction, with differences ranging from -14.21% in São Paulo to -59.66% in Ceará. The Northeast region was the most impacted, being lower than expected in all 12 first months of pandemic. CONCLUSIONS The number of visits to follow-up the CGD in PHC in Brazil decreased during the first year of the COVID-19 pandemic, varying over the months and between states and regions.
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Affiliation(s)
- Lucas Lima Carneiro
- Department of Electrical Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ed Wilson Rodrigues Vieira
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Elysângela Dittz Duarte
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Najara Barbosa da Rocha
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gustavo Velasquez-Melendez
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Walmir Caminhas
- Department of Electrical Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Atim MG, Kajogoo VD, Amare D, Said B, Geleta M, Muchie Y, Tesfahunei HA, Assefa DG, Manyazewal T. COVID-19 and Health Sector Development Plans in Africa: The Impact on Maternal and Child Health Outcomes in Uganda. Risk Manag Healthc Policy 2021; 14:4353-4360. [PMID: 34703344 PMCID: PMC8541793 DOI: 10.2147/rmhp.s328004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/08/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Health Sector Development Plans (HSDPs) aim to accelerate movement towards achieving sustainable development goals for health, reducing inequalities, and ending poverty. Reproductive, maternal, newborn and child health (RMNCH) services are vulnerable to economic imbalances, including health insecurity, unmet need for healthcare, and low health expenditure. The same vulnerability influences the potential of a country to combat global outbreaks such as the COVID-19. We aimed to provide some important insights into the impacts of COVID-19 on RMNCH indicators and outcomes of the HSDP in Uganda. METHODS We conducted a descriptive study of secondary data obtained from the Ugandan government-led portals, supplemented by analyses of relevant articles published up to 06 May 2021 and deposited in PubMed. RESULTS Through synthesizing actionable and relevant evidence, we realized that RMNCH in Uganda is highly affected by the COVID-19 pandemic and the lockdown measures. The impact was across immunization, antenatal, sexual and reproductive health, emergency and obstetric, and postnatal care services. There was a decline sharply by 9.6% for under-five vitamin A coverage, 9% for DPT3HibHeb3 coverage, 6.8% for measles vaccination coverage, 6% for isoniazid preventive therapy coverage, and 3% for facility-based deliveries. Maternal and under-five deaths increased by 7.6% and 4%, respectively. Outreaches were rarely conducted in the lockdown period. CONCLUSION The COVID-19 pandemic has created a multitude of questions regarding the optimal policies to mitigate the disease while minimizing the unintended detrimental consequences of RMNCH. The lockdown restrictions threatened to reverse the progress made on the national HSDP for RMNCH. In Uganda, where young women are vulnerable to early marriage, unintended pregnancies, and unsafe abortion, access to RMNCH services should continue regardless of the COVID-19 status in the country. We urge that Uganda and other African countries should build resilient and sustainable health systems that can withstand emerging diseases like the COVID-19.
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Affiliation(s)
- Mary Gorret Atim
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Violet Dismas Kajogoo
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Mafie District Hospital, Mafia Island, Pwani Region, Tanzania
| | - Demeke Amare
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Ethiopian Food and Drug Administration Authority (EFDA), Addis Ababa, Ethiopia
| | - Bibie Said
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Kibong’oto National Tuberculosis Hospital, Kilimanjaro, Tanzania
| | - Melka Geleta
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Yilkal Muchie
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- All Africa Leprosy and Rehabilitation Training (ALERT) Centre, Addis Ababa, Ethiopia
| | - Hanna Amanuel Tesfahunei
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Hager Biomedical Research Institute, Asmara, Eritrea
| | - Dawit Getachew Assefa
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Nursing, College of Medical and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Burt JF, Ouma J, Lubyayi L, Amone A, Aol L, Sekikubo M, Nakimuli A, Nakabembe E, Mboizi R, Musoke P, Kyohere M, Namara Lugolobi E, Khalil A, Le Doare K. Indirect effects of COVID-19 on maternal, neonatal, child, sexual and reproductive health services in Kampala, Uganda. BMJ Glob Health 2021; 6:e006102. [PMID: 34452941 PMCID: PMC8406460 DOI: 10.1136/bmjgh-2021-006102] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/08/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND COVID-19 impacted global maternal, neonatal and child health outcomes. We hypothesised that the early, strict lockdown that restricted individuals' movements in Uganda limited access to services. METHODS An observational study, using routinely collected data from Electronic Medical Records, was carried out, in Kawempe district, Kampala. An interrupted time series analysis assessed the impact on maternal, neonatal, child, sexual and reproductive health services from July 2019 to December 2020. Descriptive statistics summarised the main outcomes before (July 2019-March 2020), during (April 2020-June 2020) and after the national lockdown (July 2020-December 2020). RESULTS Between 1 July 2019 and 31 December 2020, there were 14 401 antenatal clinic, 33 499 deliveries, 111 658 childhood service and 57 174 sexual health attendances. All antenatal and vaccination services ceased in lockdown for 4 weeks.During the 3-month lockdown, the number of antenatal attendances significantly decreased and remain below pre-COVID levels (370 fewer/month). Attendances for prevention of mother-to-child transmission of HIV dropped then stabilised. Increases during lockdown and immediately postlockdown included the number of women treated for high blood pressure, eclampsia and pre-eclampsia (218 more/month), adverse pregnancy outcomes (stillbirths, low-birth-weight and premature infant births), the rate of neonatal unit admissions, neonatal deaths and abortions. Maternal mortality remained stable. Immunisation clinic attendance declined while neonatal death rate rose (from 39 to 49/1000 livebirths). The number of children treated for pneumonia, diarrhoea and malaria decreased during lockdown. CONCLUSION The Ugandan response to COVID-19 negatively impacted maternal, child and neonatal health, with an increase seen in pregnancy complications and fetal and infant outcomes, likely due to delayed care-seeking behaviour. Decreased vaccination clinic attendance leaves a cohort of infants unprotected, affecting all vaccine-preventable diseases. Future pandemic responses must consider impacts of movement restrictions and access to preventative services to protect maternal and child health.
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Affiliation(s)
- Jessica Florence Burt
- School of Medicine, University of Leeds, Leeds, UK
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Joseph Ouma
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Lawrence Lubyayi
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
| | - Alexander Amone
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Lorna Aol
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Musa Sekikubo
- Obstetrics and Gynecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - Annettee Nakimuli
- Obstetrics and Gynecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - Eve Nakabembe
- Obstetrics and Gynecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - Robert Mboizi
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Philippa Musoke
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Mary Kyohere
- Makerere University Johns Hopkins University, Kampala, Uganda
| | | | - Asma Khalil
- Infection and Immunity, St. George's, University of London, London, UK
| | - Kirsty Le Doare
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
- Infection and Immunity, St. George's, University of London, London, UK
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Townsend R, Chmielewska B, Barratt I, Kalafat E, van der Meulen J, Gurol-Urganci I, O'Brien P, Morris E, Draycott T, Thangaratinam S, Doare KL, Ladhani S, Dadelszen PV, Magee LA, Khalil A. Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis. EClinicalMedicine 2021; 37:100947. [PMID: 34195576 PMCID: PMC8233134 DOI: 10.1016/j.eclinm.2021.100947] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a profound impact on healthcare systems globally, with a worrying increase in adverse maternal and foetal outcomes. We aimed to assess the changes in maternity healthcare provision and healthcare-seeking by pregnant women during the COVID-19 pandemic. METHODS We performed a systematic review and meta-analysis of studies of the effects of the pandemic on provision of, access to and attendance at maternity services (CRD42020211753). We searched MEDLINE and Embase in accordance with PRISMA guidelines from January 1st, 2020 to April 17th 2021 for controlled observational studies and research letters reporting primary data comparing maternity healthcare-seeking and healthcare delivery during compared to before the COVID-19 pandemic. Case reports and series, systematic literature reviews, and pre-print studies were excluded. Meta-analysis was performed on comparable outcomes that were reported in two or more studies. Data were combined using random-effects meta-analysis, using risk ratios (RR) or incidence rate ratios (IRR) with 95% confidence intervals (CI). FINDINGS Of 4743 citations identified, 56 were included in the systematic review, and 21 in the meta-analysis. We identified a significant decrease in the number of antenatal clinic visits (IRR 0614, 95% CI 0486-0776, P<00001, I2=54.6%) and unscheduled care visits (IRR 0741, 95% CI 0602-0911, P = 00046, I2=00%) per week, and an increase in virtual or remote antenatal care (IRR 4656 95% CI 7762-2794, P<00001, I2=90.6%) and hospitalisation of unscheduled attendees (RR 1214, 95% CI 1118-1319, P<00001, I2=00%). There was a decrease in the use of GA for category 1 Caesarean sections (CS) (RR 0529, 95% CI 0407-0690, P<00001, I2=00%). There was no significant change in intrapartum epidural use (P = 00896) or the use of GA for elective CS (P = 079). INTERPRETATION Reduced maternity healthcare-seeking and healthcare provision during the COVID-19 pandemic has been global, and must be considered as potentially contributing to worsening of pregnancy outcomes observed during the pandemic.
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Affiliation(s)
- Rosemary Townsend
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom
| | - Barbara Chmielewska
- Fetal Medicine Unit, St George's Hospital, St George's University of London, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, United Kingdom
| | - Imogen Barratt
- Fetal Medicine Unit, St George's Hospital, St George's University of London, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, United Kingdom
| | - Erkan Kalafat
- Middle East Technical University, Faculty of Arts and Sciences, Department of Statistics, Ankara, Turkey
- Koc University, School of Medicine, Department of Obstetrics and Gynaecology, Istanbul, Turkey
| | - Jan van der Meulen
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Ipek Gurol-Urganci
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Pat O'Brien
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
- The Royal College of Obstetricians and Gynaecologists, London, United Kingdom
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Edward Morris
- The Royal College of Obstetricians and Gynaecologists, London, United Kingdom
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, United Kingdom
| | - Tim Draycott
- The Royal College of Obstetricians and Gynaecologists, London, United Kingdom
- North Bristol NHS Trust Department of Women's Health, Westbury on Trym, United Kingdom
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, WHO Collaborating Centre for Women's Health, University of Birmingham, Birmingham, United Kingdom
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, London, United Kingdom
| | - Shamez Ladhani
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, London, United Kingdom
- Immunisation and Countermeasures Division, Public Health England, United Kingdom
- British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, United Kingdom
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Asma Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom
- Fetal Medicine Unit, St George's Hospital, St George's University of London, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, United Kingdom
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Kassie A, Wale A, Yismaw W. Impact of Coronavirus Diseases-2019 (COVID-19) on Utilization and Outcome of Reproductive, Maternal, and Newborn Health Services at Governmental Health Facilities in South West Ethiopia, 2020: Comparative Cross-Sectional Study. Int J Womens Health 2021; 13:479-488. [PMID: 34040456 PMCID: PMC8141395 DOI: 10.2147/ijwh.s309096] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/27/2021] [Indexed: 12/22/2022] Open
Abstract
Background In low-and middle-income countries, it is challenging to provide basic health-care services even before the COVID-19 pandemic outbreak. The purpose of this study was to evaluate the early indirect impact of COVID-19 on the utilization of reproductive, maternal, and newborn health services at government health facilities in South West Ethiopia, and its consequences. Methods A comparative cross-sectional study was employed. The collected data were entered into Microsoft excel 2010 and then exported to SPSS 25 and R3.5.0 software for analysis. Independent sample t-test and two-sample test of proportion were computed, and the results were presented in text, tables, and graphs. P-value <0.05 was considered statistically significant. Results This study showed that there was a significant reduction in mean utilization of antenatal care (943.25 visits vs 694.75 visits), health facility birth (808.75 births vs 619 births), family planning (4744.5 visits vs 3991.25 visits), and newborn immunization (739.5 given vs 528.5 given) between March–June 2019 and March–June 2020. However, there were significant increases in proportion of teenage pregnancy (7.5% vs 13.1%), teenage abortion care user (21.3% vs 28.5%), institutional stillbirth (14% vs 21.8%) and neonatal death (33.1% vs 46.2%) during the same period. Conclusion and Recommendation This study showed that utilization of reproductive, maternal, and newborn health-care services was affected by the pandemic with deterioration of maternal and perinatal outcomes. An increase in the proportion of teenage pregnancy who seeks abortion care and the rising cesarean section rate with no improvement in perinatal outcome is a great concern that needs further investigation. Further research is also needed to explore the main reason for an increase in teenage pregnancy, abortion care users, stillbirth, and neonatal death during COVID-19.
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Affiliation(s)
- Aychew Kassie
- Department of Nursing, College of Medicine and Health Science, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Alemnew Wale
- Department of Midwifery, College of Medicine and Health Science, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Worke Yismaw
- Department of Nursing, College of Medicine and Health Science, Mettu University, Mettu, Ethiopia
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