Use of healthcare services during the COVID-19 pandemic in urban Ethiopia: evidence from retrospective health facility survey data

  1. Zemzem Shuka
  2. Anagaw Mebratie
  3. Getnet Alemu
  4. Matthias Rieger
  5. Arjun S Bedi

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Abstract

In recent years, Ethiopia has made enormous strides in enhancing access to healthcare, especially, maternal and child healthcare. With the onset and spread of COVID-19, the attention of the healthcare system has pivoted to handling the disease, potentially at the cost of other healthcare needs. This paper explores whether this shift has come at the cost of non-Covid related healthcare, especially the use of maternal and child health (MCH) services.

Setting

Data covering a 24-month period are drawn from 59 health centres and 29 public hospitals located in urban Ethiopia.

Primary and secondary outcomes measures

The primary outcome measures are the use of MCH services including family planning, antenatal and postnatal care, abortion care, delivery and immunisation. The secondary outcome measures are the use of health services by adults including antiretroviral therapy (ART), tuberculosis (TB) and leprosy and dental services

Results

There is a sharp reduction in the use of both inpatient (20%–27%, p<0.001) and outpatient (27%–34%, p<0.001) care, particularly in Addis Ababa, which has been most acutely affected by the virus. This decline does not come at the cost of MCH services. The use of several MCH components (skilled birth attendant deliveries, immunisation, postnatal care) remains unaffected throughout the period while others (family planning services, antenatal care) experience a decline (8%–17%) in the immediate aftermath but recover soon after.

Conclusion

Concerns about the crowding out of MCH services due to the focus on COVID-19 are unfounded. Proactive measures taken by the government and healthcare facilities to ring-fence the use of essential healthcare services have mitigated service disruptions. The results underline the resilience and agility displayed by one of the world’s most resource-constrained healthcare systems. Further research on the approaches used to mitigate disruptions is needed.

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  1. Version published to 10.1136/bmjopen-2021-056745
  2. ScreenIT

    SciScore for 10.1101/2021.08.09.21261754: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: Ethics clearance: Ethics approval (Ethics 2020-24) was provided by the Research Ethics Committee of the International Institute of Social Studies, Erasmus University Rotterdam.
    Sex as a biological variablenot detected.
    RandomizationThere are 91 health centers in Addis Ababa and 44 were randomly chosen for the survey.
    Blindingnot detected.
    Power Analysisnot detected.

    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: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    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.
    • Thank you for including a protocol registration statement.

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

    About SciScore

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  3. Version published to 10.1101/2021.08.09.21261754v1 on medRxiv