EHS-COVID (443) Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-Saharan African countries

22 September, 2021

This paper in Health Policy and Planning finds that 'Outpatient consultations and child vaccinations were the most commonly affected services and fell by the largest margins'. Citation, abstract and a comment/question from me below.

CITATION: Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-Saharan African countries. Health Policy Plan. 2021 Aug 12;36(7):1140-1151. doi: 10.1093/heapol/

ABSTRACT:

The coronavirus-19 pandemic and its secondary effects threaten the continuity of essential health services delivery, which may lead to worsened population health and a protracted public health crisis. We quantify such disruptions, focusing on maternal and child health, in eight sub-Saharan countries. Service volumes are extracted from administrative systems for 63 954 facilities in eight countries: Cameroon, Democratic Republic of Congo, Liberia, Malawi, Mali, Nigeria, Sierra Leone and Somalia. Using an interrupted time series design and an ordinary least squares regression model with facility-level fixed effects, we analyze data from January 2018 to February 2020 to predict what service utilization levels would have been in March-July 2020 in the absence of the pandemic, accounting for both secular trends and seasonality. Estimates of disruption are derived by comparing the predicted and observed service utilization levels during the pandemic period. All countries experienced service disruptions for at least 1 month, but the magnitude and duration of the disruptions vary. Outpatient consultations and child vaccinations were the most commonly affected services and fell by the largest margins. We estimate a cumulative shortfall of 5 149 491 outpatient consultations and 328 961 third-dose pentavalent vaccinations during the 5 months in these eight countries. Decreases in maternal health service utilization are less generalized, although significant declines in institutional deliveries, antenatal care and postnatal care were detected in some countries. There is a need to better understand the factors determining the magnitude and duration of such disruptions in order to design interventions that would respond to the shortfall in care. Service delivery modifications need to be both highly contextualized and integrated as a core component of future epidemic response and planning.

COMMENT (Neil): The authors suggest that 'Dedicated catch-up campaigns may minimize the adverse consequences of missed care, especially for children' and here presumably they refer to immunisation campaigns. The authors do not comment on the likely impact of these service disruptions on child morbidity and mortality. I invite CHIFA members on the front line to share any evidence, whether statistical or anecdotal, on how service diruptions have impacted on child health. Please email your observations to: chifa@dgroups.org

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Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org