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      COVID-19 Disrupted Provision and Utilization of Health and Nutrition Services in Uttar Pradesh, India: Insights from Service Providers, Household Phone Surveys, and Administrative Data

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          ABSTRACT

          Background

          The coronavirus (COVID-19) pandemic may substantially affect health systems, but little primary evidence is available on disruption of health and nutrition services.

          Objectives

          This study aimed to 1) determine the extent of disruption in provision and utilization of health and nutrition services induced by the pandemic in Uttar Pradesh, India; and 2) identify how adaptations were made to restore service provision in response to the pandemic.

          Methods

          We conducted longitudinal surveys with frontline workers (FLWs, n = 313) and mothers of children <2 y old ( n = 659) in December 2019 (in-person) and July 2020 (by phone). We also interviewed block-level managers and obtained administrative data. We examined changes in service provision and utilization using Wilcoxon matched-pairs signed-rank tests.

          Results

          Compared with prepandemic, service provision reduced substantially during lockdown (83–98 percentage points, pp), except for home visits and take-home rations (∼30%). Most FLWs (68%–90%) restored service provision in July 2020, except for immunization and hot cooked meals (<10%). Administrative data showed similar patterns of disruption and restoration. FLW fears, increased workload, inadequate personal protective equipment (PPE), and manpower shortages challenged service provision. Key adaptations made to provide services were delivering services to beneficiary homes (∼40%–90%), social distancing (80%), and using PPE (40%–50%) and telephones for communication (∼20%). On the demand side, service utilization reduced substantially (40–80 pp) during the lockdown, but about half of mothers received home visits and food supplementation. Utilization for most services did not improve after the lockdown, bearing the challenges of limited travel (30%), nonavailability of services (26%), and fear of catching the virus when leaving the house (22%) or meeting service providers (14%).

          Conclusions

          COVID-19 disrupted the provision and use of health and nutrition services in Uttar Pradesh, India, despite adaptations to restore services. Strengthening logistical support, capacity enhancement, performance management, and demand creation are needed to improve service provision and utilization during and post-COVID-19.

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          Most cited references35

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          Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study

          Summary Background While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food. Methods We modelled three scenarios in which the coverage of essential maternal and child health interventions is reduced by 9·8–51·9% and the prevalence of wasting is increased by 10–50%. Although our scenarios are hypothetical, we sought to reflect real-world possibilities, given emerging reports of the supply-side and demand-side effects of the pandemic. We used the Lives Saved Tool to estimate the additional maternal and under-5 child deaths under each scenario, in 118 low-income and middle-income countries. We estimated additional deaths for a single month and extrapolated for 3 months, 6 months, and 12 months. Findings Our least severe scenario (coverage reductions of 9·8–18·5% and wasting increase of 10%) over 6 months would result in 253 500 additional child deaths and 12 200 additional maternal deaths. Our most severe scenario (coverage reductions of 39·3–51·9% and wasting increase of 50%) over 6 months would result in 1 157 000 additional child deaths and 56 700 additional maternal deaths. These additional deaths would represent an increase of 9·8–44·7% in under-5 child deaths per month, and an 8·3–38·6% increase in maternal deaths per month, across the 118 countries. Across our three scenarios, the reduced coverage of four childbirth interventions (parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments) would account for approximately 60% of additional maternal deaths. The increase in wasting prevalence would account for 18–23% of additional child deaths and reduced coverage of antibiotics for pneumonia and neonatal sepsis and of oral rehydration solution for diarrhoea would together account for around 41% of additional child deaths. Interpretation Our estimates are based on tentative assumptions and represent a wide range of outcomes. Nonetheless, they show that, if routine health care is disrupted and access to food is decreased (as a result of unavoidable shocks, health system collapse, or intentional choices made in responding to the pandemic), the increase in child and maternal deaths will be devastating. We hope these numbers add context as policy makers establish guidelines and allocate resources in the days and months to come. Funding Bill & Melinda Gates Foundation, Global Affairs Canada.
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            Supporting the Health Care Workforce During the COVID-19 Global Epidemic

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              Estimates of the Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health In Low- and Middle-Income Countries

              Riley, Sully, Ahmed (2020)
              The novel coronavirus (SARS-CoV-2) that causes COVID-19 has spread rapidly since emerging in late 2019, leading the World Health Organization (WHO) to declare the disease a global pandemic on March 11, 2020. Governments around the world have had to quickly adapt and respond to curb transmission of the virus and to provide care for the many who have been infected. The strain that the outbreak imposes on health systems will undoubtedly impact the sexual and reproductive health of individuals living in low- and middle-income countries (LMICs); however, sexual and reproductive health will also be affected by societal responses to the pandemic, such as local or national lockdowns that force health services to shut down if they are not deemed essential, as well as the consequences of physical distancing, travel restrictions and economic slowdowns.
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                Author and article information

                Contributors
                Journal
                J Nutr
                J Nutr
                jn
                The Journal of Nutrition
                Oxford University Press
                0022-3166
                1541-6100
                03 June 2021
                : nxab135
                Affiliations
                Poverty, Health and Nutrition Division, International Food Policy Research Institute , Washington, DC, USA
                Poverty, Health and Nutrition Division, International Food Policy Research Institute , New Delhi, India
                Poverty, Health and Nutrition Division, International Food Policy Research Institute , New Delhi, India
                FHI Solutions , Hanoi, Vietnam
                Poverty, Health and Nutrition Division, International Food Policy Research Institute , New Delhi, India
                FHI Solutions , New Delhi, India
                FHI Solutions , New Delhi, India
                FHI Solutions , Washington, DC, USA
                Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina , Columbia, SC, USA
                Poverty, Health and Nutrition Division, International Food Policy Research Institute , New Delhi, India
                Poverty, Health and Nutrition Division, International Food Policy Research Institute , New Delhi, India
                Author notes
                Address correspondence to PHN (e-mail: p.h.nguyen@ 123456cgiar.org )
                Author information
                https://orcid.org/0000-0003-3418-1674
                https://orcid.org/0000-0001-5988-2894
                Article
                nxab135
                10.1093/jn/nxab135
                8195077
                34236434
                7eedc81b-c67c-4702-b1c4-1b28d38fd234
                © The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited

                History
                : 21 March 2021
                : 12 April 2021
                : 16 April 2021
                Page count
                Pages: 12
                Funding
                Funded by: Bill & Melinda Gates Foundation, DOI 10.13039/100000865;
                Funded by: International Food Policy Research Institute;
                Categories
                Community and International Nutrition
                AcademicSubjects/MED00060
                AcademicSubjects/SCI00960
                Custom metadata
                PAP

                Nutrition & Dietetics
                covid-19,service delivery,service utilization,nutrition,india
                Nutrition & Dietetics
                covid-19, service delivery, service utilization, nutrition, india

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