Effect of the COVID-19 pandemic on maternal and neonatal health services in three referral hospitals in Guinea: an interrupted time-series analysis

Abstract

Introduction In sub-Saharan Africa, there is limited evidence on the COVID-19 health-related effect from front-line health provision settings. Therefore, this study aimed to analyse the effect of the COVID-19 pandemic on routine maternal and neonatal health services in three referral hospitals. Materials and methods We conducted an observational study using aggregate monthly maternal and neonatal health services routine data for two years (March 2019–February 2021) in three referral hospitals including two maternities: Hôpital National Ignace Deen (HNID) in Conakry and Hôpital Regional de Mamou (HRM) in Mamou and one neonatology ward: Institut de Nutrition et de Santé de l’Enfant (INSE) in Conakry. We compared indicators of health service utilisation, provision and health outcomes before and during the COVID-19 pandemic periods. An interrupted time-series analysis (ITSA) was performed to assess the relationship between changes in maternal and neonatal health indicators and COVID-19 through cross-correlation. Results During COVID-19, the mean monthly number (MMN) of deliveries decreased significantly in HNID (p = 0.039) and slightly increased in HRM. In the two maternities, the change in the MMN of deliveries were significantly associated with COVID-19. The ITSA confirmed the association between the increase in the MMN of deliveries and COVID-19 in HRM (bootstrapped F-value = 1.46, 95%CI [0.036–8.047], p < 0.01). We observed an increasing trend in obstetric complications in HNID, while the trend declined in HRM. The MMN of maternal deaths increased significantly (p = 0.011) in HNID, while it slightly increased in HRM. In INSE, the MMN of neonatal admissions significantly declined (p < 0.001) and this decline was associated with COVID-19. The MMN of neonatal deaths significantly decreased (p = 0.009) in INSE and this decrease was related to COVID-19. Conclusion The pandemic negatively affected the maternal and neonatal care provision, health service utilisation and health outcomes in two referral hospitals located in Conakry, the COVID-19 most-affected region.

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 .…”

“…Even though eight studies highlighted a reduction in the number/proportion of institutional deliveries ( 36 , 49–51 , 56 , 61 , 62 , 67 , 71 ), six reports ( 38 , 43 , 63 , 73–75 ) observed growth and two studies ( 34 , 42 ) did not find any changes with respect to this indicator. The results varied depending on the setting in three multi-centred studies ( 64 , 77 , 78 ), making it difficult to provide a generalised conclusion. Home delivery rate rose based on the results of two studies originated from Mozambique and India ( 36 , 62 ) and reduced in Ghana ( 48 ).…”

“…A growth in stillbirth levels was observed in two studies ( 38 , 63 ), and a decline was reported in one instance ( 51 ). Diverse results were obtained concerning the risk of adverse birth outcomes and obstetric complications ( 43 , 64 , 72 ).…”

“…Despite the fact that the rate of neonatal admissions increased in Uganda ( 37 ), its overall number declined in Ethiopia, Ghana and Guinea ( 34 , 48 , 64 ) as compared to the pre-pandemic period. Furthermore, a decrease in the number of consultations for sick children and emergency visits was observed in four different countries – Cameroon ( 57 ), Mexico ( 71 ), Ethiopia ( 34 , 35 ) and South Africa ( 69 ).…”

“…Furthermore, a decrease in the number of consultations for sick children and emergency visits was observed in four different countries – Cameroon ( 57 ), Mexico ( 71 ), Ethiopia ( 34 , 35 ) and South Africa ( 69 ). In the context of the COVID-19 pandemic, the level of early neonatal deaths increased in Uganda, Zimbabwe, Guinea and South Africa ( 37 , 51 , 64 , 73 ). The majority of studies reported a fall in child immunisation levels ( 37 , 38 , 49 , 71 , 73 , 75 , 77–79 ).…”