Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-Saharan African countries
Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-Saharan African countries
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DOI：
10.1093/heapol/czab064
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发表时间：
2021-06-19
影响因子：
3.2
通讯作者：
Friedman, Jed
中科院分区：
文献类型：
--
作者：
Shapira, Gil;Ahmed, Tashrik;Friedman, Jed
新型冠状病毒19大流行及其继发影响威胁到基本卫生服务提供的连续性，这可能导致人口健康状况恶化和长期公共卫生危机。我们量化了撒哈拉以南八个国家的这种破坏，重点是孕产妇和儿童健康。服务量取自八个国家63 954个设施的行政系统：喀麦隆、刚果民主共和国、利比里亚、马拉维、马里、尼日利亚、塞拉利昂和索马里。我们使用中断时间序列设计和具有设施级固定效应的普通最小二乘回归模型，分析了2018年1月至2020年2月的数据，以预测在没有大流行的情况下，2020年3月至7月的服务利用水平，同时考虑了长期趋势和季节性。中断的估计是通过比较大流行期间的预测和观察到的服务使用水平得出的。所有国家都经历了至少1个月的服务中断，但中断的程度和持续时间各不相同。门诊咨询和儿童疫苗接种是受影响最普遍的服务，下降幅度最大。我们估计，在这8个国家的5个月内，累计短缺5 149 491次门诊咨询和328 961次第三剂五价疫苗接种。产妇保健服务利用率下降的情况不那么普遍，但在一些国家发现，住院分娩、产前护理和产后护理显著下降。有必要更好地了解决定这种中断的程度和持续时间的因素，以便设计应对护理不足的干预措施。服务提供的修改需要高度结合具体情况，并作为未来流行病应对和规划的核心组成部分加以整合。
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.