Disruptions in Essential Health Services During the First Five Months of COVID-19: Analysis of Facility-Reported Service Volumes in Eight Sub-Saharan African Countries

Shapira, Gil; Ahmed, Tarannum; Shp, Drouard; Pa, Fernandez; Kandpal, Eeshani; Nzelu, Charles; Cs, Wesseh; Na, Mohamud; Smart, Francis; Mwansambo, Charles; Ml, Baye; Diabate, Mamatou; Yuma, Sylvain; Ogunlayi, Munirat; Rjdd, Rusatira; Hashemi, Tawab; Vergeer, Petronella; Friedman, Jed

doi:10.2139/ssrn.3757414

Cited by 4 publications

(6 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The estimated monthly disruptions were also correlated to officially reported COVID-19 mortality rates, time since the start of the pandemic, and relative severity of mobility restrictions to determine which drivers are associated with changes in measured disruptions over time. The analysis was modeled on a previous study described elsewhere [ 27 ]. No changes to the analysis plan were made due to comments from reviewers or observations in the data.…”

Section: Methodsmentioning

confidence: 99%

Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low- and middle-income countries: An interrupted time-series analysis with mathematical modeling of administrative data

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background The Coronavirus Disease 2019 (COVID-19) pandemic has had wide-reaching direct and indirect impacts on population health. In low- and middle-income countries, these impacts can halt progress toward reducing maternal and child mortality. This study estimates changes in health services utilization during the pandemic and the associated consequences for maternal, neonatal, and child mortality. Methods and findings Data on service utilization from January 2018 to June 2021 were extracted from health management information systems of 18 low- and lower-middle-income countries (Afghanistan, Bangladesh, Cameroon, Democratic Republic of the Congo (DRC), Ethiopia, Ghana, Guinea, Haiti, Kenya, Liberia, Madagascar, Malawi, Mali, Nigeria, Senegal, Sierra Leone, Somalia, and Uganda). An interrupted time-series design was used to estimate the percent change in the volumes of outpatient consultations and maternal and child health services delivered during the pandemic compared to projected volumes based on prepandemic trends. The Lives Saved Tool mathematical model was used to project the impact of the service utilization disruptions on child and maternal mortality. In addition, the estimated monthly disruptions were also correlated to the monthly number of COVID-19 deaths officially reported, time since the start of the pandemic, and relative severity of mobility restrictions. Across the 18 countries, we estimate an average decline in OPD volume of 13.1% and average declines of 2.6% to 4.6% for maternal and child services. We projected that decreases in essential health service utilization between March 2020 and June 2021 were associated with 113,962 excess deaths (110,686 children under 5, and 3,276 mothers), representing 3.6% and 1.5% increases in child and maternal mortality, respectively. This excess mortality is associated with the decline in utilization of the essential health services included in the analysis, but the utilization shortfalls vary substantially between countries, health services, and over time. The largest disruptions, associated with 27.5% of the excess deaths, occurred during the second quarter of 2020, regardless of whether countries reported the highest rate of COVID-19-related mortality during the same months. There is a significant relationship between the magnitude of service disruptions and the stringency of mobility restrictions. The study is limited by the extent to which administrative data, which varies in quality across countries, can accurately capture the changes in service coverage in the population. Conclusions Declines in healthcare utilization during the COVID-19 pandemic amplified the pandemic’s harmful impacts on health outcomes and threaten to reverse gains in reducing maternal and child mortality. As efforts and resource allocation toward prevention and treatment of COVID-19 continue, essential health services must be maintained, particularly in low- and middle-income countries.

show abstract

Section: Methodsmentioning

confidence: 99%

Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low- and middle-income countries: An interrupted time-series analysis with mathematical modeling of administrative data

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…For example, health administrative data for five countries in South Asia (Bangladesh, India, Nepal, Pakistan, and Sri Lanka) showed declines in family planning service coverage during months with the most stringent COVID-19 restrictions compared to the same period in 2019. 77 Monthly data from public health facilities in sub-Saharan Africa found significant monthly reductions in family planning consultations in four of seven countries studied (comparing March-July 2020 to expected levels based on HMIS data from January 2018 to February 2020), 75 with Mali experiencing the largest and most persistent disruptions (consultations reduced by 11-26% each month between March and July and a cumulative reduction of 17% in the five months). Other cumulative declines were 17% in Cameroon (in number of new contraceptive acceptors) and 9% in Malawi (in number of oral contraceptive users).…”

Section: Resultsmentioning

confidence: 99%

“…Other cumulative declines were 17% in Cameroon (in number of new contraceptive acceptors) and 9% in Malawi (in number of oral contraceptive users). 75 …”

Section: Resultsmentioning

confidence: 99%

Impacts of COVID-19 on contraceptive and abortion services in low- and middle-income countries: a scoping review

Polis

Biddlecom

Singh

et al. 2022

Sexual and Reproductive Health Matters

View full text Add to dashboard Cite

The COVID-19 pandemic has disproportionate effects on people living in low- and middle-income countries (LMICs), exacerbating weak health systems. We conducted a scoping review to identify, map, and synthesise studies in LMICs that measured the impact of COVID-19 on demand for, provision of, and access to contraceptive and abortion-related services, and reproductive outcomes of these impacts. Using a pre-established protocol, we searched bibliographic databases (December 2019–February 2021) and key grey literature sources (December 2019–April 2021). Of 71 studies included, the majority (61%) were not peer-reviewed, and 42% were based in Africa, 35% in Asia, 17% were multi-region, and 6% were in Latin America and the Caribbean. Most studies were based on data through June 2020. The magnitude of contraceptive service-related impacts varied widely across 55 studies (24 of which also included information on abortion). Nearly all studies assessing changes over time to contraceptive service provision noted declines of varying magnitude, but severe disruptions were relatively uncommon or of limited duration. Twenty-six studies addressed the impacts of COVID-19 on abortion and postabortion care (PAC). Overall, studies found increases in demand, reductions in provision and increases in barriers to accessing these services. The use of abortion services declined, but the use of PAC was more mixed with some studies finding increases compared to pre-COVID-19 levels. The impacts of COVID-19 varied substantially, including the country context, health service, and population studied. Continued monitoring is needed to assess impacts on these key health services, as the COVID-19 pandemic evolves.

show abstract

“…Third and overall, we present an analysis that can inform a whole-of-system strategy. While a growing body of literature on the effect of COVID-19 on health care utilization has been reported by HICs and other LMICs 3 , 5 , 32 , 33 , 34 , they sought trends in one or a few diseases or disease areas like maternal care. Meanwhile, there has been no LMIC in Southeast Asia with similar research on a national scale focusing on the country's most burdensome diseases and looking across lockdown stringency over time, levels of care, and equity in patient access.…”

Section: Discussionmentioning

confidence: 99%

“…The Philippines is an LMIC where COVID-19 remains a continuing public health crisis with over 2.4 million confirmed cases and 37 thousand deaths as of 22 September 2021 - the highest in the Western-Pacific region 2 . Evidence shows that the COVID-19 pandemic, which precipitated state-imposed lockdowns and negative health system changes in many countries, have led to declining use of essential healthcare and deteriorating population health-status and well-being 3 , 4 , 5 . Better understanding of the indirect consequences of the pandemic in LMICs would assist global and local decision-makers in implementing a more holistic and calibrated response, particularly while LMICs continue to have limited access to effective vaccines and where their capacity for pandemic control has varied based on public trust, government resources, and health system weaknesses 6 , 7 , 8 .…”

Section: Introductionmentioning

confidence: 99%

The Impact of COVID-19 on Hospital Admissions for Twelve High-Burden Diseases and Five Common Procedures in the Philippines: A National Health Insurance Database Study 2019-2020

Uy¹,

Van²,

Ulep³

et al. 2022

The Lancet Regional Health - Western Pacific

View full text Add to dashboard Cite

Disruptions in Essential Health Services During the First Five Months of COVID-19: Analysis of Facility-Reported Service Volumes in Eight Sub-Saharan African Countries

Cited by 4 publications

References 0 publications

Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low- and middle-income countries: An interrupted time-series analysis with mathematical modeling of administrative data

Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low- and middle-income countries: An interrupted time-series analysis with mathematical modeling of administrative data

Impacts of COVID-19 on contraceptive and abortion services in low- and middle-income countries: a scoping review

The Impact of COVID-19 on Hospital Admissions for Twelve High-Burden Diseases and Five Common Procedures in the Philippines: A National Health Insurance Database Study 2019-2020

Contact Info

Product

Resources

About