EHS-COVID (443) Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-Saharan African countries

23 September, 2021

Citation, abstract and a comment from me below.

CITATION: Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-Saharan African countries

Gil Shapira et al. Health Policy Plan 2021 Aug 12;36(7):1140-1151. doi: 10.1093/heapol/czab064.


The coronavirus-19 pandemic and its secondary effects threaten the continuity of essential health services delivery, which may lead to worsened population health and a protracted public health crisis. We quantify such disruptions, focusing on maternal and child health, in eight sub-Saharan countries. Service volumes are extracted from administrative systems for 63 954 facilities in eight countries: Cameroon, Democratic Republic of Congo, Liberia, Malawi, Mali, Nigeria, Sierra Leone and Somalia. Using an interrupted time series design and an ordinary least squares regression model with facility-level fixed effects, we analyze data from January 2018 to February 2020 to predict what service utilization levels would have been in March-July 2020 in the absence of the pandemic, accounting for both secular trends and seasonality. Estimates of disruption are derived by comparing the predicted and observed service utilization levels during the pandemic period. All countries experienced service disruptions for at least 1 month, but the magnitude and duration of the disruptions vary. Outpatient consultations and child vaccinations were the most commonly affected services and fell by the largest margins. We estimate a cumulative shortfall of 5 149 491 outpatient consultations and 328 961 third-dose pentavalent vaccinations during the 5 months in these eight countries. Decreases in maternal health service utilization are less generalized, although significant declines in institutional deliveries, antenatal care and postnatal care were detected in some countries. There is a need to better understand the factors determining the magnitude and duration of such disruptions in order to design interventions that would respond to the shortfall in care. Service delivery modifications need to be both highly contextualized and integrated as a core component of future epidemic response and planning.

COMMENT (Neil): Unusually, the paper does not have a formal conclusion, but the last paragraph says: 'The COVID pandemic’s scope presents added difficulties by long-lasting lockdown policies that restrict movement and magnify financial pressures, which reduce the ability to pay for medical services. The analysis presented in this study should be seen as a first step in characterizing service disruptions. Disentangling the potential casual pathways behind observed disruptions requires further contextual knowledge and additional data collection of supply and demand-side factors. Targeted facility or household surveys can indicate the primary causes of disruptions to inform public health interventions and investments and uncover pockets of disruption possibly masked by reporting aggregation. Potential instances of service disruptions should also be disaggregated to explore effect heterogeneity by specific populations, regions or types of health facilities and thus better inform a public health response.'

The impact of disruptions on mortality and morbidity is not explored.

Neil Pakenham-Walsh, HIFA Coordinator,