Impact of the COVID-19 pandemic on utilisation of facility-based essential maternal and child health services from March to August 2020 compared with pre-pandemic March–August 2019: a mixed-methods study in North Shewa Zone, Ethiopia
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Abstract
Health systems are often weakened by public health emergencies that make it harder to access health services. We aimed to assess maternal, newborn and child health (MNCH) service utilisation during the first 6 months of the COVID-19 pandemic compared with prior to the pandemic.
Methods
We conducted a mixed study design in eight health facilities that are part of the Birhan field site in Amhara, Ethiopia and compared the trend of service utilisation in the first 6 months of COVID-19 with the corresponding time and data points of the preceding year.
Result
New family planning visits (43.2 to 28.5/month, p=0.014) and sick under 5 child visits (225.0 to 139.8/month, p=0.007) declined over the first 6 months of the pandemic compared with the same period in the preceding year. Antenatal (208.9 to 181.7/month, p=0.433) and postnatal care (26.6 to 19.8/month, p=0.155) visits, facility delivery rates (90.7 to 84.2/month, p=0.776), and family planning visits (313.3 to 273.4/month, p=0.415) declined, although this did not reach statistical significance. Routine immunisation visits (37.0 to 36.8/month, p=0.982) for children were maintained. Interviews with healthcare providers and clients highlighted several barriers to service utilisation during COVID-19, including fear of disease transmission, economic hardship, and transport service disruptions and restrictions. Enablers of service utilisation included communities’ decreased fear of COVID-19 and awareness-raising activities.
Conclusion
We observed a decline in essential MNCH services particularly in sick children and new family planning visits. To improve the resiliency of fragile health systems, resources are needed to continuously monitor service utilisation and clients’ evolving concerns during public health emergencies.
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SciScore for 10.1101/2022.01.10.22268794: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethic Statement: This study involves human participants and was approved by Ethics Review Board (IRB) of Saint Paul’s Hospital Millennium Medical college (SPHMMC) and Harvard T.H.
Consent: To extract MNCH service statistics, permission was obtained from individual health facilities and individual verbal consent was obtained from respondents.Sex as a biological variable Birhan HDSS catchment health facilities’ medical records and monthly facility reports, interviews with health care providers working in the MNCH department, and interviews with women who delivered at home and facility, had ANC follow up, and who missed follow up were the data sources. Randomization not detected. Blinding not … SciScore for 10.1101/2022.01.10.22268794: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethic Statement: This study involves human participants and was approved by Ethics Review Board (IRB) of Saint Paul’s Hospital Millennium Medical college (SPHMMC) and Harvard T.H.
Consent: To extract MNCH service statistics, permission was obtained from individual health facilities and individual verbal consent was obtained from respondents.Sex as a biological variable Birhan HDSS catchment health facilities’ medical records and monthly facility reports, interviews with health care providers working in the MNCH department, and interviews with women who delivered at home and facility, had ANC follow up, and who missed follow up were the data sources. Randomization not detected. Blinding not detected. Power Analysis not 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: We detected the following sentences addressing limitations in the study:Limitation of the study: Our study focused on service utilization and may not have been powered to detect significant differences. Furthermore, we focused on coverage of service utilization as the primary outcome rather than mortality or morbidity. We do not have detailed data on service provision (e.g., which services were restricted and for how long, in what manner). There is the potential of recall bias were possible limitation since qualitative data was collected three months later than the initial six months of the pandemic (March to August 2020).
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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