Maternal and newborn care during the COVID-19 pandemic in Kenya: re-contextualising the community midwifery model

Kimani, Rachel Wangari; Maina, Rose; Shumba, Constance; Shaibu, Sheila

doi:10.1186/s12960-020-00518-3

Cited by 45 publications

(63 citation statements)

References 36 publications

(46 reference statements)

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“…Focusing on PHC is particularly important in the context of Nigeria, being closer-to-the community. Also, PHC and use of lower-cadre health workers has been argued to be the golden goose needed to address care provision during the pandemic [ 36 , 37 ]. Incorporating tailored respectful maternity care [ 38 ] as part of on-going COVID-19 trainings will make a significant difference at all levels, more so for PHC workers.…”

Section: Discussionmentioning

confidence: 99%

Challenges in access and satisfaction with reproductive, maternal, newborn and child health services in Nigeria during the COVID-19 pandemic: A cross-sectional survey

et al. 2021

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Background The presence of COVID-19 has led to the disruption of health systems globally, including essential reproductive, maternal, newborn and child health (RMNCH) services. This study aimed to assess the challenges faced by women who used RMNCH services in Nigeria’s epicentre, their satisfaction with care received during the COVID-19 pandemic and the factors associated with their satisfaction. Methods This cross-sectional survey was conducted in Lagos, southwest Nigeria among 1,241 women of reproductive age who had just received RMNCH services at one of twenty-two health facilities across the primary, secondary and tertiary tiers of health care. The respondents were selected via multi-stage sampling and face to face exit interviews were conducted by trained interviewers. Client satisfaction was assessed across four sub-scales: health care delivery, health facility, interpersonal aspects of care and access to services. Bivariate and multivariate analyses were used to assess the relationship between personal characteristics and client satisfaction. Results About 43.51% of respondents had at least one challenge in accessing RMNCH services since the COVID-19 outbreak. Close to a third (31.91%) could not access service because they could not leave their houses during the lockdown and 18.13% could not access service because there was no transportation. The mean clients’ satisfaction score among the respondents was 43.25 (SD: 6.28) out of a possible score of 57. Satisfaction scores for the interpersonal aspects of care were statistically significantly lower in the PHCs and general hospitals compared to teaching hospitals. Being over 30 years of age was significantly associated with an increased clients’ satisfaction score (ß = 1.80, 95%CI: 1.10–2.50). Conclusion The COVID-19 lockdown posed challenges to accessing RMNCH services for a significant proportion of women surveyed. Although overall satisfaction with care was fairly high, there is a need to provide tailored COVID-19 sensitive inter-personal care to clients at all levels of care.

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Section: Discussionmentioning

confidence: 99%

Challenges in access and satisfaction with reproductive, maternal, newborn and child health services in Nigeria during the COVID-19 pandemic: A cross-sectional survey

et al. 2021

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“…Although this was the case, it is important to highlight that poor mental health during pregnancy has numerous detrimental effects for both expectant women and the unborn babies [ 17 , 18 ], and it is likely that the pandemic exacerbates the risk for mental illness and sub-optimal perinatal health care [ 15 ]. For instance, there have been reports within the Kenyan context of decreased and delayed antenatal attendance arising from the fear of COVID-19 infection and restricted access to care due to lockdowns and imposed curfew hours that limit access to services within designated hours [ 44 , 45 ]. The implications of these are that some pregnant women who opt to delay seeking care may miss out on the opportunity of early screening for mental health symptoms during routine care [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

“…For instance, there have been reports within the Kenyan context of decreased and delayed antenatal attendance arising from the fear of COVID-19 infection and restricted access to care due to lockdowns and imposed curfew hours that limit access to services within designated hours [ 44 , 45 ]. The implications of these are that some pregnant women who opt to delay seeking care may miss out on the opportunity of early screening for mental health symptoms during routine care [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

“…Other suggestions put forward for mental health response during COVID-19 within the Kenyan context include: the need for preparation and allocation of adequate funding to a formal mental health response plan specific to the COVID-19 pandemic; training of community health workers/volunteers on provision of psychological first-aid support at household and community level, in order to enhance improved access to mental healthcare and support for those in need during the pandemic; and the need for assessments/surveys on the mental health impact in order to inform decision-making during the COVID-19 pandemic [ 44 , 46 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

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Mental Health during COVID-19 Pandemic among Caregivers of Young Children in Kenya’s Urban Informal Settlements. A Cross-Sectional Telephone Survey

Kabue

Chongwo

Mabrouk

et al. 2021

IJERPH

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The emergence of COVID-19 has profoundly affected mental health, especially among highly vulnerable populations. This study describes mental health issues among caregivers of young children and pregnant women in three urban informal settlements in Kenya during the first pandemic year, and factors associated with poor mental health. A cross-sectional telephone survey was administered to 845 participants. Survey instruments included the Patient Health Questionnaire-9, General Anxiety Disorder-7 scale, COVID-19 Anxiety Scale, and questions on the perceived COVID-19 effects on caregiver wellbeing and livelihood. Data were analyzed using descriptive statistics, and univariate and multivariate analysis. Caregivers perceived COVID-19 as a threatening condition (94.54%), affecting employment and income activities (>80%). Caregivers experienced discrimination (15.27%) and violence (12.6%) during the pandemic. Levels of depression (34%), general anxiety (20%), and COVID-19 related anxiety (14%) were highly prevalent. There were significant associations between mental health outcomes and economic and socio-demographic factors, violence and discrimination experiences, residency, and perceptions of COVID-19 as a threatening condition. Caregivers high burden of mental health problems highlights the urgent need to provide accessible mental health support. Innovative and multi-sectoral approaches will be required to maximize reach to underserved communities in informal settlements and tackle the root causes of mental health problems in this population.

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“…14,[16][17][18][19] For examples, studies in Ethiopia, Kenya, Malawi, and Uganda have reported significant increases in stillbirth rates, neonatal mortality, maternal mortality and decreases in institutional deliveries and quality of care provided. 17,[20][21][22][23] Therefore, objectives of this study were to: (1) determine the impact of the lockdown on maternal and perinatal outcomes at two tertiary hospitals in Harare, Zimbabwe, using a maternal audit, and (2) estimate the potential effect of COVID-19 related decreases in coverage of maternal and newborn health interventions on maternal, neonatal and stillbirth mortality at the national level using the Lives Saved Tool (LiST).…”

mentioning

confidence: 99%

Impact of COVID-19 on maternal and perinatal outcomes in Harare, Zimbabwe: a comparative maternal audit

Bikwa

Murewanhema

Kanyangarara

et al. 2021

Journal of Global Health Reports

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Background The COVID-19 pandemic lockdown resulted in the disruption of health services in Zimbabwe. The objectives of this study were two-fold. First, the study sought to determine the impact of the lockdown on maternal and perinatal outcomes at two tertiary hospitals in Harare, Zimbabwe, using a maternal audit. Second, the study sought to estimate the potential effect of COVID-19 related decreases in coverage of maternal and newborn health interventions on maternal, and neonatal mortality in Zimbabwe using the Lives Saved Tool (LiST). Methods A retrospective review of labour ward delivery registers, postnatal records and patients’ maternity booklets was conducted. Data on total hospital deliveries, mode of delivery, and maternal and neonatal outcomes for March-August 2020 were abstracted and compared to data from March-August 2019. Logistic regression was performed to assess the association between maternal and perinatal outcomes and year as a proxy for the COVID-19 pandemic impact. Based on changes in coverage of interventions, LiST was used to estimate the impact of COVID-19 related disruptions on maternal and neonatal mortality at the national level. Results A total of 19,835 hospital deliveries that occurred at Sally Mugabe and Mbuya Nehanda Maternity Hospitals (11,346 for 2019 and 8,489 for 2020) were reviewed. Compared to 2019, there was a significant increased likelihood of breech deliveries (odds ratio, OR=1.2; 95% confidenxce interval, CI=1.1-1.5), uterine ruptures (OR=2.3; 95% CI=1.1-5.1), stillbirths (OR=1.8; 95% CI=1.5-2.2) and neonatal deaths (OR=1.4; 95% CI=1.03-1.86) in 2020. However, there was a decrease in the odds of caesarean deliveries (OR=0.7; 95% CI=0.7-0.8). From the LiST analysis, if similar disruptions to maternity services were observed across the country for a 12 month period, there would be an excess of 343 maternal deaths, 2,658 neonatal deaths and 450 stillbirths nationally. Conclusions These findings indicate a reduction in the utilisation of maternal health services and an increased risk of adverse maternal and neonatal outcomes during the nationwide lockdown. The provision of maternal and neonatal health services amid the pandemic remains crucial to reducing the negative indirect impacts of the pandemic.

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Maternal and newborn care during the COVID-19 pandemic in Kenya: re-contextualising the community midwifery model

Cited by 45 publications

References 36 publications

Challenges in access and satisfaction with reproductive, maternal, newborn and child health services in Nigeria during the COVID-19 pandemic: A cross-sectional survey

Challenges in access and satisfaction with reproductive, maternal, newborn and child health services in Nigeria during the COVID-19 pandemic: A cross-sectional survey

Mental Health during COVID-19 Pandemic among Caregivers of Young Children in Kenya’s Urban Informal Settlements. A Cross-Sectional Telephone Survey

Impact of COVID-19 on maternal and perinatal outcomes in Harare, Zimbabwe: a comparative maternal audit

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