Assessment of maternal and child health care services performance in the context of COVID-19 pandemic in Addis Ababa, Ethiopia: evidence from routine service data

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Abstract

Background

In many settings, health care service provision has been modified to managing COVID-19 cases, and this has been affecting the provision of maternal and child health services. The aim of this study was to assess trends in selected maternal and child health services performance in the context of COVID-19 pandemic.

Methods

A cross-sectional data review was conducted in Addis Ababa, Ethiopia from April to May 2021. Routine health management information system database was reviewed from Addis Ababa Health Bureau for the period from July 2019 to March 2021 across all quarters. Proportion and mean with standard deviation were computed. T-test was used to assess statistically significant differences in services mean performance.

Results

Postnatal care visit, new contraceptives accepters, safe abortion care and number of under-5 years old children treated for pneumonia significantly decreased by 9.3% (p-value 0.04), 20.3% (p-value 0.004), 23.7% (p-value 0.01) and 77.2% (p-value < 0.001), respectively during the first 8 months of the COVID-19 pandemic compared to the previous 8 months’ average performance. The trends in Antenatal care first visit, new contraceptive accepters, pentavalent-3 vaccination and under-five children treated for pneumonia began to decline in January to March 2020, a quarter when the COVID-19 pandemic began; with accelerated declines in April to June 2020 following national lockdown. The trends for the stated services began to increase during July–September 2020, the last quarter of national lockdown. Contraceptive accepters and pentavalent-1 vaccination continued to decline and showed no recovery until January–March 2021 when this study was completed.

Conclusions

Most of the maternal and child health services performance declined following the onset of COVID-19 pandemic and national lockdown, and most of the services began recovering during July–September 2020, the last quarter of national lockdown. However, new and repeat contraceptive accepters and pentavalent-1 recipients continue to decline and show no recovery during end of the study period. Implementing COVID-19 prevention measures and assuring the community about the safety of service delivery is imperative to ensure continuity of the maternal and child health services. Regular monitoring and evaluation of services performance is required to identify slowly recovering services and respond to potentially volatile changes during the COVID-19 pandemic.

Plain English summary

The coronavirus disease 2019 (COVID-19) is the worst global health crisis of a century. In many settings, health care service provision has been modified to focus on managing COVID-19 cases, and this has been affecting the provision of health services including maternal and child health services. The aim of this study was to assess the trends in maternal and child health services performance in the era of COVID-19 pandemic in Addis Ababa, Ethiopia. The results of the studies showed post-delivery care, new family planning attendees, safe abortion care and number of under-5 years old children treated for pneumonia decreased during the first 8 months of the COVID-19 pandemic compared to the previous 8 months’ average performance. The trends in antenatal care (care during pregnancy), new family planning attendees, pentavalent-3 vaccination and under-five children treated for pneumonia began to decline between January-March 2020, a quarter when the COVID-19 pandemic began; with accelerated declines in April to June 2020 following national lockdown. The trends for the stated services began to increase during July–September 2020, the last quarter of national lockdown. Family planning attendees and pentavalent-1 vaccination continued to decline and showed no recovery until January–March 2021when this study was completed. Implementing COVID-19 prevention measures and assuring the community about the safety of service delivery is imperative to ensure continuity of the maternal and child health services. Regular monitoring and evaluation of services performance is required to identify slowly recovering services and respond to potentially volatile changes during the COVID-19 pandemic.

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Most cited references 24

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Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study

Ashish KC, Rejina Gurung, Mary V. Kinney … (2020)

Summary Background The COVID-19 pandemic response is affecting maternal and neonatal health services all over the world. We aimed to assess the number of institutional births, their outcomes (institutional stillbirth and neonatal mortality rate), and quality of intrapartum care before and during the national COVID-19 lockdown in Nepal. Methods In this prospective observational study, we collected participant-level data for pregnant women enrolled in the SUSTAIN and REFINE studies between Jan 1 and May 30, 2020, from nine hospitals in Nepal. This period included 12·5 weeks before the national lockdown and 9·5 weeks during the lockdown. Women were eligible for inclusion if they had a gestational age of 22 weeks or more, a fetal heart sound at time of admission, and consented to inclusion. Women who had multiple births and their babies were excluded. We collected information on demographic and obstetric characteristics via extraction from case notes and health worker performance via direct observation by independent clinical researchers. We used regression analyses to assess changes in the number of institutional births, quality of care, and mortality before lockdown versus during lockdown. Findings Of 22 907 eligible women, 21 763 women were enrolled and 20 354 gave birth, and health worker performance was recorded for 10 543 births. From the beginning to the end of the study period, the mean weekly number of births decreased from 1261·1 births (SE 66·1) before lockdown to 651·4 births (49·9) during lockdown—a reduction of 52·4%. The institutional stillbirth rate increased from 14 per 1000 total births before lockdown to 21 per 1000 total births during lockdown (p=0·0002), and institutional neonatal mortality increased from 13 per 1000 livebirths to 40 per 1000 livebirths (p=0·0022). In terms of quality of care, intrapartum fetal heart rate monitoring decreased by 13·4% (−15·4 to −11·3; p<0·0001), and breastfeeding within 1 h of birth decreased by 3·5% (−4·6 to −2·6; p=0·0032). The immediate newborn care practice of placing the baby skin-to-skin with their mother increased by 13·2% (12·1 to 14·5; p<0·0001), and health workers' hand hygiene practices during childbirth increased by 12·9% (11·8 to 13·9) during lockdown (p<0·0001). Interpretation Institutional childbirth reduced by more than half during lockdown, with increases in institutional stillbirth rate and neonatal mortality, and decreases in quality of care. Some behaviours improved, notably hand hygiene and keeping the baby skin-to-skin with their mother. An urgent need exists to protect access to high quality intrapartum care and prevent excess deaths for the most vulnerable health system users during this pandemic period. Funding Grand Challenges Canada.

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Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit–risk analysis of health benefits versus excess risk of SARS-CoV-2 infection

Kaja M Abbas, Simon R. Procter, Kevin van Zandvoort … (2020)

Summary Background National immunisation programmes globally are at risk of suspension due to the severe health system constraints and physical distancing measures in place to mitigate the ongoing COVID-19 pandemic. We aimed to compare the health benefits of sustaining routine childhood immunisation in Africa with the risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection through visiting routine vaccination service delivery points. Methods We considered a high-impact scenario and a low-impact scenario to approximate the child deaths that could be caused by immunisation coverage reductions during COVID-19 outbreaks. In the high-impact scenario, we used previously reported country-specific child mortality impact estimates of childhood immunisation for diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b, Streptococcus pneumoniae, rotavirus, measles, meningitis A, rubella, and yellow fever to approximate the future deaths averted before 5 years of age by routine childhood vaccination during a 6-month COVID-19 risk period without catch-up campaigns. In the low-impact scenario, we approximated the health benefits of sustaining routine childhood immunisation on only the child deaths averted from measles outbreaks during the COVID-19 risk period. We assumed that contact-reducing interventions flattened the outbreak curve during the COVID-19 risk period, that 60% of the population will have been infected by the end of that period, that children can be infected by either vaccinators or during transport, and that upon child infection the whole household will be infected. Country-specific household age structure estimates and age-dependent infection-fatality rates were applied to calculate the number of deaths attributable to the vaccination clinic visits. We present benefit–risk ratios for routine childhood immunisation, with 95% uncertainty intervals (UIs) from a probabilistic sensitivity analysis. Findings In the high-impact scenario, for every one excess COVID-19 death attributable to SARS-CoV-2 infections acquired during routine vaccination clinic visits, 84 (95% UI 14–267) deaths in children could be prevented by sustaining routine childhood immunisation in Africa. The benefit–risk ratio for the vaccinated children is 85 000 (4900–546 000), for their siblings ( 60 years) is 96 (14–307). In the low-impact scenario that approximates the health benefits to only the child deaths averted from measles outbreaks, the benefit–risk ratio to the households of vaccinated children is 3 (0–10); if the risk to only the vaccinated children is considered, the benefit–risk ratio is 3000 (182–21 000). Interpretation The deaths prevented by sustaining routine childhood immunisation in Africa outweigh the excess risk of COVID-19 deaths associated with vaccination clinic visits, especially for the vaccinated children. Routine childhood immunisation should be sustained in Africa as much as possible, while considering other factors such as logistical constraints, staff shortages, and reallocation of resources during the COVID-19 pandemic. Funding Gavi, the Vaccine Alliance; Bill & Melinda Gates Foundation.

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Impact of COVID-19 pandemic response on uptake of routine immunizations in Sindh, Pakistan: an analysis of provincial electronic immunization registry

Subhash Chandir, Danya Arif Siddiqi, Mariam Mehmood … (2020)

Highlights • Three out of five children in Sindh province have missed their routine vaccinations during COVID-19 lockdown. • Around 9,469 children/day were missing immunization during the lockdown. • Enrollment into immunziation declined furthest in rural districts, and urban sub-districts with large slums, and polio-endemic super high-risk sub-districts. • The pool of un-immunized children is expanding during lockdown, leaving them susceptible to vaccine-preventable diseases. • Higher maternal education, facility-based births, and early enrollment into the immunization program continue to show a positive association with immunization uptake, even during a challenging lockdown.

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Author and article information

Contributors

Senedu Bekele Gebreegziabher: senedu.bekele@ahri.gov.et

Solomon Sisay Marrye: solomon.sisay@gmail.com

Tsegaye Hailu Kumssa: tsegaye.hailu@ahri.gov.et

Kassa Haile Merga: kassa.haile@ahri.gov.et

Alemu Kibret Feleke: alemkibr@gmail.com

Degu Jerene Dare: degujerene@gmail.com

Inger Kristensson Hallström: inger.kristensson_hallstrom@med.lu.se

Solomon Abebe Yimer: s.a.yimer@medisin.uio.no

Mulatu Biru Shargie: mulatu.biru@ahri.gov.et

Journal

Journal ID (nlm-ta): Reprod Health

Journal ID (iso-abbrev): Reprod Health

Title: Reproductive Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1742-4755

Publication date (Electronic): 14 February 2022

Publication date PMC-release: 14 February 2022

Publication date Collection: 2022

Volume: 19

Electronic Location Identifier: 42

Affiliations

[1 ]GRID grid.418720.8, ISNI 0000 0000 4319 4715, Armauer Hansen Research Institute (AHRI), ; Addis Ababa, Ethiopia

[2 ]KNCV, Addis Ababa, Ethiopia

[3 ]Yekatit-12 Hospital Medical Collage Public Health Department, Addis Ababa, Ethiopia

[4 ]GRID grid.418950.1, ISNI 0000 0001 2188 3883, KNCV Tuberculosis Foundation, ; Hague, The Netherlands

[5 ]GRID grid.4514.4, ISNI 0000 0001 0930 2361, Department of Health Sciences, Child and Family Health, , Lund University, ; Stockholm, Sweden

[6 ]GRID grid.507196.c, ISNI 0000 0004 9225 0356, Vaccine Research and Development Department, , Coalition for Epidemic Preparedness Innovations (CEPI), ; Oslo, Norway

[7 ]GRID grid.5510.1, ISNI 0000 0004 1936 8921, Faculty of Medicine, Unit for Genome Dynamics, , University of Oslo, ; Oslo, Norway

Article

Publisher ID: 1353

DOI: 10.1186/s12978-022-01353-6

PMC ID: 8842853

PubMed ID: 35164776

SO-VID: f14e0799-eaf3-4a39-9d4a-6027bb25076f

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 25 October 2021

Date accepted : 29 January 2022

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: covid-19,pandemic,maternal,child,health services,routine service data,addis ababa,ethiopia

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: covid-19, pandemic, maternal, child, health services, routine service data, addis ababa, ethiopia

Assessment of maternal and child health care services performance in the context of COVID-19 pandemic in Addis Ababa, Ethiopia: evidence from routine service data

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Most cited references 24

Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study

Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit–risk analysis of health benefits versus excess risk of SARS-CoV-2 infection

Impact of COVID-19 pandemic response on uptake of routine immunizations in Sindh, Pakistan: an analysis of provincial electronic immunization registry

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