Early indirect impact of COVID-19 pandemic on utilization and outcomes of reproductive, maternal, newborn, child and adolescent health services in Kenya

  1. Duncan Shikuku
  2. Irene Nyaoke
  3. Sylvia Gichuru
  4. Onesmus Maina
  5. Martin Eyinda
  6. Pamela Godia
  7. Lucy Nyaga
  8. Charles Ameh

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Abstract

Background

The COVID-19 global pandemic is expected to result in 8.3–38.6% additional maternal deaths in many low-income countries. The objective of this paper was to determine the initial impact of COVID-19 pandemic on reproductive, maternal, newborn, child and adolescent health (RMNCAH) services in Kenya.

Methods

Data for the first four months (March-June) of the pandemic and the equivalent period in 2019 were extracted from Kenya Health Information System. Two-sample test of proportions for hospital attendance for select RMNCAH services between the two periods were computed.

Results

There were no differences in monthly mean (±SD) attendance between March-June 2019 vs 2020 for antenatal care (400,191.2±12,700.0 vs 384,697.3±20,838.6), hospital births (98,713.0±4,117.0 vs 99,634.5±3,215.5), family planning attendance (431,930.5±19,059.9 vs 448,168.3±31,559.8), post-abortion care (3,206.5±111.7 vs 448,168.3±31,559.8) and pentavalent 1 immunisation (114,701.0±3,701.1 vs 110,915.8±7,209.4), p>0.05. However, there were increasing trends for adolescent pregnancy rate, significant increases in FP utilization among young people (25.7% to 27.0%), injectable (short-term) FP method uptake (58.2% to 62.3%), caesarean section rate (14.6% to 15.8%), adolescent maternal deaths (6.2% to 10.9%) and fresh stillbirths (0.9% to 1.0%) with a reduction in implants (long-term) uptake (16.5% to 13.0%) (p< 0.05). No significant change in maternal mortality ratio between the two periods (96.6 vs 105.8/100,000 live births, p = 0.1023) although the trend was increasing.

Conclusion

COVID-19 may have contributed to increased adolescent pregnancy, adolescent maternal death and stillbirth rates in Kenya. If this trend persists, recent gains achieved in maternal and perinatal health in Kenya will be lost. With uncertainty around the duration of the pandemic, strategies to mitigate against catastrophic indirect maternal health outcomes are urgently needed.

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  1. ScreenIT

    SciScore for 10.1101/2020.09.09.20191247: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data analysis: Data on RMNCAH service utilization variables of interest were extracted from the KHIS to Microsoft Excel 2016 for processing and cleaning.
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)
    Cleaned data was exported to STATA v12 (StataCorp. 2011. Stata Statistical
    STATA
    suggested: (Stata, RRID:SCR_012763)
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has strengths and limitations. The use of a comparison period enabled testing the hypothesis on whether the COVID-19 pandemic had any impact on the utilization of RMNCAH services and maternal and perinatal outcomes. However, the use of DHIS2 data poses key data quality challenges including inaccurate and incomplete reporting that are prevalent in low and middle-income countries [47–50]. The short period reviewed during the peri-COVID-19 pandemic represents the period when the burden of the pandemic was not at the peak in the country compared to the transmission trends as experienced in other European and American countries at similar periods and therefore the results should be interpreted in context. Further evaluations at 6 and 12 months may be required to validate the outcomes. Based on the earlier models, the predictions in reduction of access and utilization of essential RMNCAH services and worsening maternal and perinatal mortality did not hold at four months. The concerted efforts by the government in managing the communication and messaging during the pandemic played a key difference although further evaluations may be required to clearly assess the impact of the pandemic on RMNCAH services and maternal and perinatal outcomes.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.09.09.20191247v1 on medRxiv