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

  1. Celestin Hategeka
  2. Simone E Carter
  3. Faustin Mukalenge Chenge
  4. Eric Nyambu Katanga
  5. Grégoire Lurton
  6. Serge Ma-Nitu Mayaka
  7. Dieudonné Kazadi Mwamba
  8. Esther van Kleef
  9. Veerle Vanlerberghe
  10. Karen Ann Grépin

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Abstract

Health service use among the public can decline during outbreaks and had been predicted among low and middle-income countries during the COVID-19 pandemic. In March 2020, the government of the Democratic Republic of the Congo (DRC) started implementing public health measures across Kinshasa, including strict lockdown measures in the Gombe health zone.

Methods

Using monthly time series data from the DRC Health Management Information System (January 2018 to December 2020) and interrupted time series with mixed effects segmented Poisson regression models, we evaluated the impact of the pandemic on the use of essential health services (outpatient visits, maternal health, vaccinations, visits for common infectious diseases and non-communicable diseases) during the first wave of the pandemic in Kinshasa. Analyses were stratified by age, sex, health facility and lockdown policy (ie, Gombe vs other health zones).

Results

Health service use dropped rapidly following the start of the pandemic and ranged from 16% for visits for hypertension to 39% for visits for diabetes. However, reductions were highly concentrated in Gombe (81% decline in outpatient visits) relative to other health zones. When the lockdown was lifted, total visits and visits for infectious diseases and non-communicable diseases increased approximately twofold. Hospitals were more affected than health centres. Overall, the use of maternal health services and vaccinations was not significantly affected.

Conclusion

The COVID-19 pandemic resulted in important reductions in health service utilisation in Kinshasa, particularly Gombe. Lifting of lockdown led to a rebound in the level of health service use but it remained lower than prepandemic levels.

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  1. Version published to 10.1136/bmjgh-2021-005955
  2. ScreenIT

    SciScore for 10.1101/2021.04.08.21255096: (What is this?)

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

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    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 several limitations. First, while we had a relatively long period of data before COVID-19, the periods during the lockdown included only three data points. While three data points are the minimum recommended for ITS studies, this rather short period may have affected the power of our study. Second, our analyses did not include all health facilities in Kinshasa. Specifically, we excluded health posts and other health facilities due to low reporting rates, as well as private health facilities. Similarly, several health centres and hospitals in Kinshasa were not included in our analyses because of inconsistent reporting of data. Finally, the Provincial Hospital of Kinshasa, the largest hospital in the city and that provides services to the whole city, is located Gombe. Hence, the lockdown of the Gombe area also affected the use of health services outside of Gombe, which we could not isolate from the effect of the lockdown. However, ITS does not require a comparison area thus the results are still consistent for each geographical region. Although we found important reductions in the use of health services, we did not observe decreases as large as those predicted by modelling studies at the outset of the pandemic, with the exception of in Gombe. However, we also found that health service utilization did not return to pre-pandemic levels in the post-lockdown pandemic period, suggesting that short-run policies can also have longer-run effects. While our study has shed ...

    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.

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  3. Version published to 10.1101/2021.04.08.21255096v1 on medRxiv