Indirect effects of COVID-19 pandemic on reproductive, maternal, newborn and child health services in Pakistan

Abstract

Background: COVID-19 is having many impacts on health, economy and social life; some due to the indirect effects of closure of health facilities to curb the spread. Closures were implemented in Pakistan from March 2020, affecting provision of reproductive, maternal, newborn and child health (RMNCH) services. Aims: To appraise the effects of containment and lockdown policies on RMNCH service utilization in order to develop an early response to avoid the catastrophic impact of COVID-19 on RMNCH in Pakistan. Methods: Routine monitoring data were analysed for indicators utilization of RMNCH care. The analysis was based on Period 1 (January–May 2020, first wave of COVID-19); Period 2 (June–September 2020, declining number of cases of COVID-19); and Period 3 (October–December 2020, second wave of COVID-19). We also compared data from May and December 2020 with corresponding months in 2019, to ascertain whether changes were due to COVID-19. Results: Reduced utilization was noted for all RMNCH indicators during Periods 1 and 3. There was a greater decline in service utilization during the first wave, and the highest reduction (~82%) was among children aged < 5 years, who were treated for pneumonia. The number of caesarean sections dropped by 57%, followed by institutional deliveries and first postnatal visit (37% each). Service utilization increased from June to September, but the second wave of COVID-19 led to another decrease. Conclusion: To reinstate routine services, priority actions and key areas include continued provision of family planning services along with uninterrupted immunization campaigns and routine maternal and child services.

Assessing System Performance of Maternal and Child Health Care During Covid-19 Pandemic in Community Health Center- Comoro Dili Timor-Leste

“…So far, most of the studies that evaluates MCH Care performance during COVID-19 Pandemic were focusing mostly on the service delivery component of the health care system. [12] [11] [3] [10] [13] [14]…”

“…This is very important information to help develop better system preparedness and better response to pregnant women and newborns in the future pandemic. [9] [8] [10] Relying on information from service delivery (one component) only, may mislead the policy makers to prepare appropriate plans for MCH care in at Primary Health Care Institution (PHCI). A health system-based approach at PHCI must be comprehensive both in terms of treating COVID-19 and non-COVID-19 patients.…”

“…The number of caesarean sections dropped by 57%, followed by institutional deliveries and first postnatal visit (37% each). [10] Studies from Ethiopia reveal services disruption of MCH services and declining in health facilities visits for Family Planning, sick under 5 child visits (225.0 to 139.8/ month, p=0.007), Antenatal and postnatal care visits, facility delivery rates [11] [12] Similarly, study from Guyana, revealed significant decreases in utilizing all essential health services across the 41 health centres of Region 4. [13] A rapid review carried out on 20 March 2022 on postnatal care (PNC) services availability and utilization during the COVID-19 era in sub-Saharan Africa revealed that there were significant declines in the availability and utilization of PNC services during and after the COVID-19 lockdown.…”

“…The number of caesarean sections dropped by 57%, followed by institutional deliveries and first postnatal visit (37% each). [10]…”

“…[8] [9] It was argue that while priorities were given to fight COVID-19, there are important to quickly reinstate routine services with key areas include continued provision of family planning services along with uninterrupted immunization campaigns and routine maternal and child services. [10] For most developing countries those routine services could only be effectively implemented through the primary health facilities located closed to the community. Experiences from Indonesian suggest that during the COVID-19 pandemic, Community Health centers (CHCs) a primary health care facility is required to play a role in preventing, detection, and handling COVID-19 with optimal, while continued delivering MCH essential Services.…”