Impact of COVID-19 on antenatal care provision at public hospitals in the Sidama region, Ethiopia: A mixed methods study

Abstract

Background Coronavirus disease 2019 (COVID-19) continues to pose a global public health threat. The pandemic overstretched already weak health systems in low- and low-middle-income countries, including Ethiopia. There is a paucity of studies on the impact of COVID-19 on antenatal care access, uptake, and provision in Ethiopia. This study examines the impact of COVID-19 on antenatal care provision in the Sidama region, Ethiopia. Methods A concurrent mixed-methods study was conducted between 14 February and 10 May 2022 at 15 public hospitals in the Sidama region. An interrupted times series design was applied for a quantitative study, which included data from all pregnant women who attended antenatal care before COVID-19 (12 months, March 2019 to February 2020) and during COVID-19 (six months, March to August 2020) at 15 public hospitals in the region. The total numbers in the antenatal care 1 cohort (at least one antenatal care contact) and antenatal care 4 cohort (at least four antenatal care contacts) were 15,150 and 5,850, respectively, forming a combined final dataset of 21,000 women. Routinely collected monthly data were derived from the hospitals’ health management information system and imported into Stata version 17 for analysis. The mean monthly incidence rate ratio of antenatal care uptake was calculated using a Poisson regression model with a 95% confidence interval. Simultaneously, an exploratory study design was conducted for qualitative using in-depth interviews to explore maternity care providers’ perceptions of the impact of COVID-19 on antenatal care access, uptake, and provision. Qualitative data were thematically analysed. The quantitative and qualitative findings were then integrated using the joint display technique. Results Our findings indicate a significant monthly decrease of 0.7% in antenatal care 1 and 1.8% in antenatal care 4 during the first six months of the pandemic. A lack of medical supplies, fear of contracting COVID-19, inadequate personal protective equipment, discrimination against those attending the hospital, and the absence of antenatal care guidelines for care provision, COVID-19 vaccine hesitancy and long waiting times for ANC led to disrupted access, uptake, and provision of antenatal care during COVID-19. Conclusion and recommendations Our findings demonstrate that the COVID-19 pandemic affected antenatal care access, uptake, and provision in the study area from March to August 2020. To mitigate disrupted antenatal care access, uptake and provision, antenatal care clinics should be equipped with medical supplies. It is crucial to maintain rapport between the community and maternity care providers and provide training for maternity care providers regarding the adapted/adopted guidelines during COVID-19 at the hospital grassroots level for use in the current and future pandemics. Pregnant women should have timely access to maternity care providers in order to maintain at least a minimum standard of care in current and future pandemics.

Maternal and Child Health Services Utilization During COVID-19 in Eastern Ethiopia

“…The findings are in line with research conducted in Ethiopia, Nepal, and Kenya, where ANC services declined in the early stages of COVID-19 [ 15 , 24 , 28 ]. Nonetheless, other studies demonstrated that the presence of COVID-19 had a significant negative influence on ANC [ 14 , 16 , 19 – 21 ]. This impact may have been caused by several factors, such as the absence of guidelines for ANC during the pandemic, fear of contracting COVID-19, long waiting times for ANC, hesitancy to get vaccinated against COVID-19, staff reallocations, rescheduling of appointments, a lack of medical supplies and PPE for basic health services, and persistent hesitation to use the services [ 14 , 25 ].…”

“…Nonetheless, other studies demonstrated that the presence of COVID-19 had a significant negative influence on ANC [ 14 , 16 , 19 – 21 ]. This impact may have been caused by several factors, such as the absence of guidelines for ANC during the pandemic, fear of contracting COVID-19, long waiting times for ANC, hesitancy to get vaccinated against COVID-19, staff reallocations, rescheduling of appointments, a lack of medical supplies and PPE for basic health services, and persistent hesitation to use the services [ 14 , 25 ]. This could potentially challenge the 2016 WHO recommendation that ANC visits should be increased to eight during the time of each pregnancy [ 29 ], as there may be a greater chance of missing opportunities to detect high-risk pregnancies early on, which is essential to preventing maternal mortality.…”

“…COVID-19 crippled the healthcare system and created a serious crisis [ 5 , 6 ]. Evidence from the WHO study, Global Financing, and other studies confirmed that the existence of COVID-19 had severely disrupted most health services, including essential health services like MCH [ 7 – 14 ]. The adoption of a range of inconsistent policies and interventions during the COVID-19 pandemic may have contributed to the disruption of MCH service.…”

“…In a similar vein, compared to comparable times the previous year, there was a decline in the use of child vaccination services. The decrease in child immunization services since the COVID-19 announcement has also been documented by several studies, including one that was conducted globally in 63,000 health facilities [ 8 ], one that was conducted multi-nationwide in Bangladesh, Nigeria, and South Africa [ 10 ], India [ 13 ], Sub-Saharan Africa [ 14 ], Rwanda [ 16 ], Mozambique [ 18 ], and one in Ethiopia [ 15 , 26 ]. Low child immunization service utilization in Tanzania has been linked to a number of issues, such as disruptions in the procurement and distribution of medical supplies, shortages of vaccines and related supplies, and rescheduling of clinic services [ 25 ].…”

“…Although there was a decline in the use of maternal health services, not everyone experienced this. Nonetheless, in certain nations, there were noticeable reductions in hospital deliveries and both prenatal and postnatal services [ 14 ]. In the first 2 months of COVID-19, there was no difference in the number of people attending reproductive, maternal, newborn, child, and adolescent health (RMNCAH) service points, hospital births, family planning visits, post-abortion care, and pentavalent 1 immunization, according to a 4-month comparative study conducted in Kenya.…”