The impact of the COVID-19 pandemic on health service utilisation in Sierra Leone

Abstract

Introduction: The COVID-19 pandemic has adversely affected health systems in many countries, but little is known about effects on health systems in sub-Saharan Africa. This study examines the effects of COVID-19 on health service utilisation in a sub-Saharan country, Sierra Leone. Methods: Mixed-methods study using longitudinal nationwide hospital data (admissions, operations, deliveries and referrals), and qualitative interviews with healthcare workers and patients. Hospital data were compared across Quarters (Q) in 2020, with day 1 of Q2 representing the start of the pandemic in Sierra Leone. Admissions are reported in total and disaggregated by sex, service (surgical, medical, maternity, paediatric), and hospital type (government or private not for profit). Referrals in 2020 were compared with 2019, to assess whether any changes were the result of seasonality. Comparisons were performed using students t test. Qualitative data were analysed using thematic analysis. Results: From Q1-Q2, weekly mean hospital admissions decreased by 14.7% (p=0.005). Larger decreases were seen in male 18.8%, than female 12.5% admissions. The largest decreases were in surgical admissions, a 49.8 % decrease (p<0.001) and medical admissions, a 28.7% decrease (p=0.002). Paediatric and maternity admissions did not significantly change. Total operations decreased by 13.9% (p<0.001), whilst caesarean sections and facility-based deliveries showed significant increases, 12.7 % (p=0.014) and 7.5% (p=0.03) respectively. In Q3 total admissions remained 13.2% lower (p<0.001) than Q1. Mean weekly referrals were lower in Q2 and Q3 of 2020 compared to 2019, suggesting findings were unlikely to be seasonal. Qualitative analysis identified both supply-side factors, prioritisation of essential services, introduction of COVID-19 services and pausing elective care, and demand-side factors, fear of nosocomial infection and financial hardship. Conclusion: The study demonstrated a decrease in health service utilisation during Covid-19, the decrease is less than in other countries during COVID-19 and less than reported during the Ebola epidemic.

The impact of COVID-19 pandemic on hospital admissions for nine diseases in Iran: insight from an interrupted time series analysis

“…Our study indicates that hospital admissions fell dramatically with the onset of the COVID-19 pandemic for all of nine non-COVID-19 diseases investigated, including infectious and parasitic diseases, neoplasms, mental and behavioral disorders, diseases of the nervous system, diseases of the circulatory system, diseases of the respiratory system, diseases of the digestive system, diseases of the genitourinary system, and pregnancy, childbirth and the puerperium. Our results demonstrate a sharp and significant decrease in hospitalizations in the first month after the COVID-19 outbreak, which is consistent with previous studies in other countries [ 6 – 8 , 16 , 17 ]. A recent WHO survey looked at the extent of the disruption of services for the prevention and treatment of non-communicable diseases [ 23 ].…”

“…Healthcare utilization has repeatedly been observed to decrease during the COVID-19 pandemic [ 16 , 17 ]. Iran, as one of the countries with a high incidence of COVID-19, was found to be similarly affected, with steep reductions in the rate of hospitalizations, particularly early in the pandemic.…”

“…In addition, decreases in recruitment of patients into cancer clinical trials were observed, despite positive steps taken [ 14 ]. Other studies suggest that even among hospitals experiencing relatively low numbers of COVID-19 admissions, admissions for other diseases have still fallen [ 15 , 16 ]. These findings support the argument that people were avoiding going to hospitals because they feared contracting the COVID-19 virus [ 12 ].…”

“…Although healthcare utilization has decreased during the pandemic in all countries [ 9 , 16 , 17 ], this reduction has varied across different health systems and different diseases. To our knowledge, no study has comprehensively explored the effect of the COVID-19 pandemic on national healthcare service utilization and hospital admissions in Iran.…”

Impact of the COVID-19 pandemic and response on the utilisation of health services in public facilities during the first wave in Kinshasa, the Democratic Republic of the Congo

“…In this study, we document important declines in the use of health services during the first wave of the pandemic in Kinshasa, mostly notably in the parts of the city that were subject to lockdown. A number of recent preprinted studies have also begun to document similar effects observed in other SSA countries, including in Sierra Leone, 37 where hospital services were observed to have declined, and in Kenya. 38 More attention needs to be paid to ensuring the continuity of essential health services during outbreaks, especially during lockdown policies like the ones implemented in Gombe during the early phase of the pandemic.…”