Early indirect impact of COVID-19 pandemic on utilization and outcomes of reproductive, maternal, newborn, child and adolescent health services in Kenya

Abstract

Background: The COVID-19 global pandemic is expected to result in 8.3-38.6% additional maternal deaths in many low-income countries. The objective of this paper was to determine the initial impact of COVID-19 pandemic on reproductive, maternal, newborn, child and adolescent health (RMNCAH) services in Kenya. Methods: Data for the first four months (March-June) of the pandemic and the equivalent period in 2019 were extracted from Kenya Health Information System. Two-sample test of proportions for hospital attendance for select RMNCAH services between the two periods were computed. Results: There were no differences in monthly mean (±SD) attendance between March-June 2019 vs 2020 for antenatal care (400,191.2±12,700.0 vs 384,697.3±20,838.6), hospital births (98,713.0±4,117.0 vs 99,634.5±3,215.5), family planning attendance (431,930.5±19,059.9 vs 448,168.3±31,559.8), post-abortion care (3,206.5±111.7 vs 448,168.3±31,559.8) and pentavalent 1 immunisation (114,701.0±3,701.1 vs 110,915.8±7,209.4), p>0.05. However, there were increasing trends for adolescent pregnancy rate, significant increases in FP utilization among young people (25.7% to 27.0%), injectable (short-term) FP method uptake (58.2% to 62.3%), caesarean section rate (14.6% to 15.8%), adolescent maternal deaths (6.2% to 10.9%) and fresh stillbirths (0.9% to 1.0%) with a reduction in implants (long-term) uptake (16.5% to 13.0%) (p<0.05). No significant change in maternal mortality ratio between the two periods (96.6 vs 105.8/100,000 live births, p=0.1023) although the trend was increasing. Conclusion: COVID-19 may have contributed to increased adolescent pregnancy, adolescent maternal death and stillbirth rates in Kenya. If this trend persists, recent gains achieved in maternal and perinatal health in Kenya will be lost. With uncertainty around the duration of the pandemic, strategies to mitigate against catastrophic indirect maternal health outcomes are urgently needed. Key words: COVID-19, maternal, reproductive, stillbirths, family planning, adolescent, mortality, Kenya.

Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis

“…However, our findings are particularly concerning because these areas already carry the majority of the global burden of maternal mortality. This finding is supported by national data from Kenya not yet formally published, 50 and we call for further investigation of maternal mortality as a matter of urgency, particularly in LMIC settings. Data from the MBRRACE-UK rapid report are reassuring; in the first wave of the pandemic (March–May, 2020), there were 16 maternal deaths (ten associated with SARS-CoV-2) of an estimated 162 344 births, corresponding to a maternal mortality rate of 9·9 per 100 000, 51 compared with a pre-pandemic rate of 9·7 per 100 000 in 2016–18.…”

Competing Health Risks Associated with the COVID-19 Pandemic and Early Response: A Scoping Review

“…[92] In India, Marie Stopes International reported serving 1.3 million fewer women with contraceptive and abortion services than expected. [93] To date, research studies have documented mixed results in terms of the impact of COVID-19 on service delivery outcomes [94-96]. Decreases in access to and use of contraceptives, antenatal care, safe abortion, and institutional delivery have been documented across different health systems and income contexts, including Kenya,[97, 98] Ethiopia,[99] Turkey,[100] Italy,[101], UK,[102] and the US.…”

The COVID-19 Pandemic and Adolescents’ Experience in Sub-Saharan Africa: A Cross-Country Study Using a Telephone Survey

“…11 In addition to the direct loss of formal education, the critical social protective functions of schools are lost with school closure, which may result in increased child labor, early marriages, adolescent pregnancies, transactional sex, genderbased violence, mental health issues, or exposures to risky behaviors such as tobacco smoking and drug use. 13,[28][29][30][31][32][33] Recently, a survey in Kampala, Uganda, reported that COVID-19 lockdowns were associated with a higher prevalence of unhealthy behaviors such as tobacco smoking/chewing, alcohol drinking, and substance use (such as marijuana). 14 Due to the increased risks of such issues and the direct deprivation of educational opportunities, many adolescents in SSA may not go back to school even after schools reopen after a crisis like the COVID-19 pandemic.…”