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

Abstract

IntroductionIn 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.MethodsMixed-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.ResultsThree 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.ConclusionUtilisation 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.

An Integrative Literature Review on the Impact of COVID-19 on Maternal Health in Africa

“…A study using a similar design in Ghana, documented a 25% reduction in women attending at least 4 ANC visits during the pandemic compared to pre-pandemic [23]. A similar pattern was identi ed by Banke-Thomas and colleagues [22] among four sub-Saharan countries but mostly during the rst wave (March to June 2020) and the second wave (from last quarter of 2020 through Feb 2021).…”

“…Several studies con rmed a decrease in ANC and skilled birth attendants leading to an increase in pregnancyrelated problems and decrease in immunizations [21,22,23,31,40,42]. Reduced attendance at ANC was a reality due to the public health concerns of the disease being spread among groups of people.…”

‘We are not going to shut down, because we cannot postpone pregnancy’: a mixed-methods study of the provision of maternal healthcare in six referral maternity wards in four sub-Saharan African countries during the COVID-19 pandemic

“…Such measures include service closures, referrals to other facilities including COVID-19 treatment centres, new guidelines on changes in visiting rules, on mask wearing mandates, on patients paying PPE costs, among others. These hospital-level mitigation measures were also factors in determining trends in utilisation of maternity healthcare services including antenatal and postnatal care 49. Unlike national-level key events for which a number of databases were set up immediately, hospital and maternity ward-level events do not seem to be reported or recorded systematically.…”

The direct and indirect impact of COVID-19 pandemic on maternal and child health services in Africa: a scoping review

“…The findings from this review highlight the importance of identifying strategies and guidelines that will allow MNCH services to remain accessible during emerging infectious diseases to protect the health of women and their babies. Further research on the short-term and long-term effects of the COVID-19 pandemic, and approaches to address barriers to MNCH services during the COVID-19 pandemic should address this gap [ 28 , 42 , 50 , 56 ].…”