Indirect effects of COVID-19 on maternal, neonatal, child, sexual and reproductive health services in Kampala, Uganda

  1. Jessica Florence Burt
  2. Joseph Ouma
  3. Lawrence Lubyayi
  4. Alexander Amone
  5. Lorna Aol
  6. Musa Sekikubo
  7. Annettee Nakimuli
  8. Eve Nakabembe
  9. Robert Mboizi
  10. Philippa Musoke
  11. Mary Kyohere
  12. Emily Namara Lugolobi
  13. Asma Khalil
  14. Kirsty Le Doare

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Abstract

COVID-19 impacted global maternal, neonatal and child health outcomes. We hypothesised that the early, strict lockdown that restricted individuals’ movements in Uganda limited access to services.

Methods

An observational study, using routinely collected data from Electronic Medical Records, was carried out, in Kawempe district, Kampala. An interrupted time series analysis assessed the impact on maternal, neonatal, child, sexual and reproductive health services from July 2019 to December 2020. Descriptive statistics summarised the main outcomes before (July 2019–March 2020), during (April 2020–June 2020) and after the national lockdown (July 2020–December 2020).

Results

Between 1 July 2019 and 31 December 2020, there were 14 401 antenatal clinic, 33 499 deliveries, 111 658 childhood service and 57 174 sexual health attendances. All antenatal and vaccination services ceased in lockdown for 4 weeks.

During the 3-month lockdown, the number of antenatal attendances significantly decreased and remain below pre-COVID levels (370 fewer/month). Attendances for prevention of mother-to-child transmission of HIV dropped then stabilised. Increases during lockdown and immediately postlockdown included the number of women treated for high blood pressure, eclampsia and pre-eclampsia (218 more/month), adverse pregnancy outcomes (stillbirths, low-birth-weight and premature infant births), the rate of neonatal unit admissions, neonatal deaths and abortions. Maternal mortality remained stable. Immunisation clinic attendance declined while neonatal death rate rose (from 39 to 49/1000 livebirths). The number of children treated for pneumonia, diarrhoea and malaria decreased during lockdown.

Conclusion

The Ugandan response to COVID-19 negatively impacted maternal, child and neonatal health, with an increase seen in pregnancy complications and fetal and infant outcomes, likely due to delayed care-seeking behaviour. Decreased vaccination clinic attendance leaves a cohort of infants unprotected, affecting all vaccine-preventable diseases. Future pandemic responses must consider impacts of movement restrictions and access to preventative services to protect maternal and child health.

Article activity feed

  1. Version published to 10.1136/bmjgh-2021-006102
  2. Version published to 10.1101/2021.04.23.21255940v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.04.23.21255940: (What is this?)

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

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variableAfter the initial lockdown period (4 weeks without outpatient services), measures to reduce the number of women attending ANC included reducing the number of appointments per day from 150 to 90 for ANC and all women <26 weeks gestation being sent away to return after 30 weeks.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical Analysis: Data were input into Microsoft Excel and SPSS Statistics version 26 (IBM, UK) for collection and analysis purposes.
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and Limitations: Whilst the limitations of this study lie in the use of data from a single site, collected retrospectively, this has allowed the inclusion of over 33,000 births, 14,401 antenatal attendances and 111,658 childhood immunisations, highlighting the massive impact on this population. Furthermore, the use of data from EMR rather than direct patient records mean this data is likely an under-representation of the true values of each indicator. Statistical comparison using data from the full year of 2019 would have enabled a better understanding of how 2020 compared to the time before COVID-19. Even with these documented limitations, our findings reinforce the importance of considering maternal and child health in future pandemic responses.

    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.

    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.

  4. Version published to 10.1101/2021.04.23.21255940v1 on medRxiv