Effect of the COVID-19 pandemic on maternal healthcare indices in Southern Iran: an interrupted time series analysis

Abstract

ObjectivesEpidemics are anticipated to influence the coverage of health services. We assessed the impact of the COVID-19 pandemic on maternal healthcare indices and care providers’ performance.Setting1801 maternal healthcare centres under the auspices of Shiraz University of Medical Sciences, Shiraz, Southern Iran.ParticipantsApproximately 63 000 pregnant women.Primary and secondary outcome measuresIn this prospective ecological study, interrupted time series analysis was used to model and compare the trend of maternal healthcare indices before and after the COVID-19 pandemic announcement.ResultsThe results showed a significant drop in count of preconception healthcare visits, first routine laboratory tests, first trimester prenatal care, first trimester sonography, prenatal screening for birth defects at weeks 11–13, prenatal care visits at weeks 16–20, second routine laboratory tests, second trimester sonography, prenatal care visits at weeks 24–30, prenatal care visits at weeks 31–34, postpartum care visits at days 10–15 and postpartum care visits at days 30–42 with the start of the COVID-19 pandemic (−50% (95% CI −48.68% to –51.36%), −19.67% (95% CI −22.12% to –17.15%), −25.88% (95% CI −28.46% to –23.21%), −23.84% (95% CI −26.26% to –21.34%), −20.16% (95% CI −23.01% to –17.20%), −18.53% (95% CI −21.25% to –15.71%), −28.63% (95% CI −31.03% to –26.14%), −27.48% (95% CI −30.07% to –24.79%), −31.08% (95% CI −33.43% to –28.61%), −31.84% (95% CI −34.35% to –29.23%), 32.55% (95% CI −35.12% to –29.89%) and −39.28% (95% CI −41.59% to –36.88%), respectively). Nevertheless, the trend in coverage of these services showed recovery in the subsequent months (8.36%, 10.55%, 5.74%, 8.01%, 4.40%, 5.06%, 11.20%, 7.58%, 7.38%, 7.80%, 9.59% and 9.61% per month, respectively).ConclusionsUsing ecological data during the COVID-19 pandemic era, we observed a ‘level change and slope change’ as the major pattern of interruption of maternal healthcare coverage, indicating a possible indirect effect rather than a causative relationship. Such relative predictability might assist with future pandemic planning.

Stillbirth and Preterm Birth During Lockdown Periods in 5 Waves of COVID-19 Pandemic in Northern Iran: A Region-Wide Cohort Study in Mazandaran Province

“…Previous studies showed that most maternal healthcare indices sharply declined with the announcement of the COVID-19 pandemic in Iran but soon started to recover after a gap of 1 to 2 months. 27 Two studies in India, like our study, reported an increase in stillbirths during the COVID-19 lockdown period. In this study, the lack of prenatal care and lack of access to the urgent transfer system to the hospitals were mentioned as one of the possible main risk factors for this increase.…”

“…Previous studies showed that most maternal healthcare indices sharply declined with the announcement of the COVID-19 pandemic in Iran but soon started to recover after a gap of 1 to 2 months. 27 …”

Impact of the COVID-19 pandemic on access to and delivery of maternal and child healthcare services in low-and middle-income countries: a systematic review of the literature

“…Overall, 14 studies reported data from four low-income countries ( 34–47 ), 21 studies were focused on 13 lower-middle income countries ( 48–68 ), seven studies were conducted in five upper-middle income countries ( 69–75 ) and three were multi-centred ( 76–78 ). Out of 45 included studies, 11 studies were cross-sectional ( 41 , 45 , 48 , 51 , 55–57 , 65 , 69 , 70 , 76 ), 14 were pre-post studies ( 34 , 38 , 49 , 50 , 52 , 53 , 56 , 62 , 64 , 72–75 , 77 ), nine were time-series ( 35 , 37 , 39 , 43 , 58 , 59 , 67 , 71 , 78 ), five were mixed methods ( 36 , 42 , 47 , 61 , 63 ) and six were qualitative ( 40 , 44 , 46 , 54 , 60 , 68 ). The included studies’ characteristics are summarised in Table 1 .…”

“…In nine studies ( 34 , 38 , 41 , 47 , 49 , 58 , 67 , 76 , 77 ), the analysis showed interruptions in family planning services ( 76 ), a decrease in attendance of family planning visits ( 77 ), in the overall number of such visits ( 34 , 41 , 47 , 49 , 58 , 67 ) and family planning acceptance rate ( 38 ) compared to the pre-COVID-19 levels. Although some authors observed a reduction in the number of new contraceptive acceptors ( 45 ) and difficulties accessing contraceptives ( 73 ), Tilahun and colleagues reported an increased contraceptive acceptance rate in Ethiopia ( 42 ).…”

The effect of COVID-19 pandemic on diabetes care indices in Southern Iran: an interrupted time series analysis

“…The segmented Poisson regression was selected since each dependent variable was constituted from the counts of care delivered in a season. The interrupted time series models require at least three independent variables [ 22 ]: …”