IntroductionThere 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.MethodsMonthly 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.ResultsThe 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.ConclusionThe 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.

Introduction Described as a global epidemic, overweight and obesity could soon overwhelm both developed and developing countries [1, 2]. In 2014, 39% of adults were overweight, and 11% of men and 15% of women were obese [3]. In sub-Saharan Africa, where approximately 35% of adult women are either overweight or obese, overweight and obesity are estimated to increase by about 35% within the next 10 years at a rate of about 25% per year [4, 5]. The reasons for this rapid growth include globalization, increase in wealth and urbanization that leads to changes in food supply systems, changes in diets, declining levels of physical activity, and changes in the gut microbiome [6]. Furthermore, the health and economic implications of overweight or obesity are severe, since they constitute a major risk factor for many non-communicable diseases (NCDs) like arthritis, cancers, diabetes mellitus, hypertension, and cardiovascular diseases, which were leading major causes of death in 2012 [7, 8]. In 2010, overweight and obesity were estimated to cause 3.4 million deaths, 3.9% of years of life loss, and 3.8% of disability-adjusted life years (DALYs) globally [9]. Peeters et al. concluded that obesity in adulthood is associated with a decrease in life expectancy of about seven years, in both men and women, and is a powerful predictor of death at older ages [10]. Estimates of non-communicable disease-related mortality in Africa indicate that there were approximately 2.1 million deaths in 2010, up by 46% from 1990 and most are associated with obesity [11]. Current projections indicate that the largest increase in non-communicable disease-related deaths will occur in Africa by 2020 and by 2030, and these deaths are projected to exceed the combined deaths from communicable and nutritional diseases, and maternal and perinatal deaths [7]. Concerning the economic implications, the costs generated by obesity

More intensive sexual education, access to modern methods of contraception, awareness campaigns concerning the risks related to unwanted pregnancies and abortions performed by non-medical personnel need to be implemented to prevent school abortions. The quality and accessibility of post-abortion services also need to be reinforced.

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