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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Andom AT, Gilbert HN, Ndayizigiye M, Mukherjee JS, Lively CT, Nthunya J, Marole TA, Ratsiu M, Smith Fawzi MC, Yuen CM. Understanding barriers to tuberculosis diagnosis and treatment completion in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho. PLoS One 2023; 18:e0285774. [PMID: 37167298 PMCID: PMC10174523 DOI: 10.1371/journal.pone.0285774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/28/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Lesotho is one of the 30 countries with the highest tuberculosis incidence rates in the world, estimated at 650 per 100,000 population. Tuberculosis case detection is extremely low, particularly with the rapid spread of COVID-19, dropping from an estimated 51% in 2020 to 33% in 2021. The aim of this study is to understand the barriers to tuberculosis diagnosis and treatment completion. METHODS We used a convergent mixed methods study design. We collected data on the number of clients reporting symptoms upon tuberculosis screening, their sputum test results, the number of clients diagnosed, and the number of clients who started treatment from one district hospital and one health center in Berea district, Lesotho. We conducted in-depth interviews and focus group discussions with 53 health workers and patients. We used a content analysis approach to analyze qualitative data and integrated quantitative and qualitative findings in a joint display. FINDINGS During March-August, 2019, 218 clients at the hospital and 292 clients at the health center reported tuberculosis symptoms. The full diagnostic testing process was completed for 66% of clients at the hospital and 68% at the health center. Among clients who initiated tuberculosis treatment, 68% (61/90) at the hospital and 74% (32/43) at the health center completed treatment. The main barriers to testing and treatment completion were challenges at sample collection, lack of decentralized diagnostic services, and socioeconomic factors such as food insecurity and high patient movement to search for jobs. CONCLUSIONS Tuberculosis diagnosis could be improved through the effective decentralization of laboratory services at the health facility level, and treatment completion could be improved by providing food and other forms of social support to patients.
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Affiliation(s)
- Afom T Andom
- Partners In Health-Lesotho, Maseru, Lesotho
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Hannah N Gilbert
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | | | - Joia S Mukherjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States of America
- Partners In Health, Boston, MA, United States of America
| | - Christina Thompson Lively
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | | | | | | | - Mary C Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Courtney M Yuen
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States of America
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Andom AT, Gilbert HN, Ndayizigiye M, Mukherjee JS, Nthunya J, Marole TA, Smith Fawzi MC, Yuen CM. Understanding reasons for suboptimal tuberculosis screening in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho. PLOS Glob Public Health 2022; 2:e0000249. [PMID: 36962295 PMCID: PMC10021370 DOI: 10.1371/journal.pgph.0000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/13/2022] [Indexed: 11/19/2022]
Abstract
Lesotho has one of the highest tuberculosis (TB) incidence rates in the world, estimated at 654/100,000 population. However, TB detection remains low, with only 51% of people with TB being diagnosed and treated. The aim of this study was to evaluate implementation of TB screening and identify drivers of suboptimal TB screening in Lesotho. We used a convergent mixed methods study design. We collected data on the number of health facility visits and the number of clients screened for TB during March-August, 2019 from one district hospital and one health center. We conducted interviews and focus group discussions with patients and health workers to elucidate the mechanisms associated with suboptimal screening. Out of an estimated 70,393 visitors to the two health facilities, only 22% of hospital visitors and 48% of health center visitors were asked about TB symptoms. Only 2% of those screened at each facility said that they had TB symptoms, comprising a total of 510 people. Lack of training on tuberculosis screening, overall staff shortages, barriers faced by patients in accessing care, and health care worker mistrust of tuberculosis screening procedures were identified as drivers of suboptimal TB screening. TB screening could be improved by ensuring the availability of well-trained, incentivized, and dedicated screeners at health facilities, and by providing TB screening services in community settings.
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Affiliation(s)
- Afom T Andom
- Partners In Health-Lesotho, Maseru, Lesotho
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Hannah N Gilbert
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | | | - Joia S Mukherjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States of America
- Partners in Health, Boston, MA, United States of America
| | | | | | - Mary C Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Courtney M Yuen
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States of America
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