The impact of the COVID-19 pandemic on the provision & utilisation of primary health care services in Goma, Democratic Republic of the Congo, Kambia district, Sierra Leone & Masaka district, Uganda

Abstract

Introduction

This study aimed to determine whether the COVID-19 pandemic had an impact on the number of people seen at public facilities in Uganda, the Democratic Republic of the Congo (DRC) and Sierra Leone for essential primary healthcare services.

Methods

The number of weekly consultations for antenatal care (ANC), outpatient (OPD), expanded programme on immunisations (EPI), family planning (FP) services and HIV, for the period of January 2018-December 2020, were collected from 25 primary healthcare facilities in Masaka district, Uganda, 21 health centres in Goma, DRC, and 29 facilities in Kambia district, Sierra Leone. Negative binomial regression models accounting for facility level clustering and season were used to analyse changes in activity levels between 2018, 2019 and 2020.

Results

We found no evidence that the COVID-19 pandemic affected the number of OPD, EPI or ANC consultations in Goma. Family planning consultations were 17% lower in March-July 2020 compared to 2019, but this recovered by December 2020. New diagnoses of HIV were 34% lower throughout 2020 compared to 2019. Compared to the same periods in 2019, facilities in Sierra Leone had 18-29% fewer OPD consultations throughout 2020, and 27% fewer DTP3 doses in March-July 2020, but this had recovered by Jul-Dec. There was no evidence of differences in other services. In Uganda there were 20-35% fewer under-5 OPD consultations, 21-66% fewer MCV1 doses, and 48-51% fewer new diagnoses of HIV, throughout 2020, compared to 2019. There was no difference in the number of HPV doses delivered in 2020 compared to 2019.

Conclusions

The level of disruption appeared to correlate with the strength of lockdown measures in the different settings and community attitudes towards the risk posed by COVID-19. Mitigation strategies such as health communications campaigns and outreach services proved important to limit the impact of lockdowns on primary healthcare services.

Key messages

What is already known on this topic

The COVID-19 pandemic and the response measures put in place caused disruption to the provision and utilisation of primary healthcare services worldwide.

What this study adds

We document that the COVID-19 pandemic had a varied impact on different services in three distinct settings on the African continent. The extent that the pandemic impacted services correlated with the stringency of the lockdowns, community perceptions of the level of danger posed by the pandemic and communities’ prior exposure to Ebola epidemics and concomitant response measures.

How this study might affect research, practice, or policy

strategies such as communication campaigns and outreach services limited the impact of lockdowns on essential services and would be valuable strategies to implement in future epidemics.

SciScore for 10.1101/2022.04.28.22274416: (What is this?)

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

Table 1: Rigor

Ethics	IACUC: This study was approved by the Comite National d’Ethique de la Sante (CNES) of the DRC, the Sierra Leone Ethics and Scientific Review committee, the Uganda Virus Research Institute Research Ethics Committee, the Uganda National Council for Science and Technology, the London School of Hygiene and Tropical Medicine Ethics Committee and local health authorities in each area. IRB: This study was approved by the Comite National d’Ethique de la Sante (CNES) of the DRC, the Sierra Leone Ethics and Scientific Review committee, the Uganda Virus Research Institute Research Ethics Committee, the Uganda National Council for Science and Technology, the London School of Hygiene and Tropical Medicine Ethics Committee and local health authorities in each area. Consent: No informed consent was required for this study as individual level data were not collected.
Sex as a biological variable	not detected.
Randomization	A selection of health centres was made to include all 25 available government health centres in Masaka, all 21 accessible health centres in urban Goma; and a random number generator was used to select a representative selection of 29 health facilities in Kambia, proportional to the total number of health posts and health centres in the district.
Blinding	not detected.
Power Analysis	Assuming an average of 157 OPD visits per week, with a standard deviation of 73, a sample of at least 20 facilities per period would enable the study to detect a relative change of 30% with 80% power at the 5% significance level.

Table 2: Resources

Software and Algorithms
Sentences	Resources
Data were entered directly onto an electronic REDcap database on computer tablets(13, 14).	REDcap suggested: (REDCap, RRID:SCR_003445)

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:

There are several limitations of this analysis, the before-after design meant that we could not account for secular trends and there is evidence to suggest increasing catchment populations and increasing service activity across the three years in Goma. The lack of difference we observed between the pandemic periods compared to pre-pandemic periods may have been a reduction compared to what would be expected if 2020 had been ‘a normal year’. However, we did not have evidence of increased catchment populations or increasing activity levels over time for Masaka or Kambia. We assessed the comparability of the years of analysis with respect to climate factors and found no evidence of a difference in average maximum or minimum temperatures or atmospheric pressure between the years, by period. However, data were only available from international airport weather stations so do not account for local climate variations. We focused this analysis on government facilities so that recommendations were relevant to Ministry of Health officials; however, this means we do not have any evidence of whether the reductions in utilisation of government facilities coincided with an increase in the use of private or traditional health providers. Qualitative data in the DRC suggest the population may have opted to go to pharmacies, traditional practitioners, or private health structures in the belief that the state COVID testing and subsequent quarantine requirements, would be less strictly enforced. ...

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.

Results from scite Reference Check: We found no unreliable references.

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