COVID-19-related healthcare impacts: an uncontrolled, segmented time-series analysis of tuberculosis diagnosis services in Mozambique, 2017–2020

Abstract

IntroductionCurrently, COVID-19 dominates the public health agenda and poses a permanent threat, leading to health systems’ exhaustion and unprecedented service disruption. Primary healthcare services, including tuberculosis services, are at increased risk of facing severe disruptions, particularly in low-income and middle-income countries. Indeed, corroborating model-based forecasts, there is increasing evidence of the COVID-19 pandemic’s negative impact on tuberculosis case detection.MethodsApplying a segmented time-series analysis, we assessed the effects of COVID-19-related measures on tuberculosis diagnosis service across districts in Mozambique. Ministry health information system data were used from the first quarter of 2017 to the end of 2020. The model, performed under the Bayesian premises, was estimated as a negative binomial with random effects for districts and provinces.ResultsA total of 154 districts were followed for 16 consecutive quarters. Together, these districts reported 96 182 cases of all forms of tuberculosis in 2020. At baseline (first quarter of 2017), Mozambique had an estimated incidence rate of 283 (95% CI 200 to 406) tuberculosis cases per 100 000 people and this increased at a 5% annual rate through the end of 2019. We estimated that 17 147 new tuberculosis cases were potentially missed 9 months after COVID-19 onset, resulting in a 15.1% (95% CI 5.9 to 24.0) relative loss in 2020. The greatest impact was observed in the southern region at 40.0% (95% CI 30.1 to 49.0) and among men at 15% (95% CI 4.0 to 25.0). The incidence of pulmonary tuberculosis increased at an average rate of 6.6% annually; however, an abrupt drop (15%) was also observed immediately after COVID-19 onset in March 2020.ConclusionThe most significant impact of the state of emergency was observed between April and June 2020, the quarter after COVID-19 onset. Encouragingly, by the end of 2020, clear signs of health system recovery were visible despite the initial shock.

Impact of the COVID-19 pandemic on tuberculosis notification in Brazil

“…The impact on national-level TB notifications in 2020 (14.4%) was similar to that reported in Mozambique (15.1%) 3 , but lower than in India, that had a relative loss of cases of 63.3% during the period from March 2020 through April 2021. 16 Other studies estimated the effect of the pandemic on TB case notifications with different approaches and also have found an immediate impact.…”

“…Furthermore, the majority of the prison population in Brazil are young men, and although the number of TB cases in this population had been increasing in the country, a Brazilian TB Bulletin launched in the TB World Day in 2022 reported a decrease of TB case notification in prison population during the pandemic years 26 , suggesting that TB case finding in this population may also have suffered the impacts of the pandemic.Similar to ours findings, in the first year of the pandemic a study in Mozambique found that men were the most affected in terms of TB notification, resulting in a 15% (95% CI 4.0 to 25.0) relative loss, and suggested that this was due to the privileges that women and children had in the country to access health services 3. On the other hand, a study in Zambia found that the proportional distribution of TB notifications according to sex did not significantly differ over the pandemic period 27.…”

“…Similar to ours findings, in the first year of the pandemic a study in Mozambique found that men were the most affected in terms of TB notification, resulting in a 15% (95% CI 4.0 to 25.0) relative loss, and suggested that this was due to the privileges that women and children had in the country to access health services. 3 On the other hand, a study in Zambia found that the proportional distribution of TB notifications according to sex did not significantly differ over the pandemic period. 27 Considering that just a few studies analyzed the pandemic COVID-19 impact on TB case notification by population group, the understanding of this association requires further investigation.…”

“…1,2 Number of patients initiating treatment declined precipitously, and preventive therapy enrolment and care-seeking initiatives were compromised. 1–3…”

“…1,2 Number of patients initiating treatment declined precipitously, and preventive therapy enrolment and care-seeking initiatives were compromised. [1][2][3] Before the pandemic, Brazil was known to have a decentralized TB care network, which placed it in the world ranking of countries with the highest TB case detection rates. 4 However, like many other countries, it was affected by COVID-19 in early 2020 (first case reported on 26 February 2020), and had to deal with three waves, being the second one the deadliest, and the Omicron-dominated wave the most transmissible one.…”