Effect of the COVID-19 pandemic on health service utilization across regions of Ethiopia: An interrupted time series analysis of health information system data from 2019–2020

Abstract

The spread of COVID-19 and associated deaths have remained low in Ethiopia. However, the pandemic could pose a public health crisis indirectly through disruptions in essential health services. The aim of this study was to examine disruptions in health service utilization during the first nine months of the COVID-19 pandemic across 10 regions in Ethiopia. We analyzed utilization of 21 different health services across all of Ethiopia (except the Tigray region) for the period of January 2019 to December 2020. Data were extracted from the Ethiopian district health information system (DHIS2). Monthly visits in 2020 were graphed relative to the same months in 2019. Interrupted time series analysis was used to estimate the effect of the pandemic on service utilization in each region. We found that disruptions in health services were generally higher in urban regions which were most affected by COVID. Outpatient visits declined by 52%, 54%, and 58%, specifically in Dire Dawa, Addis Ababa and Harari, the three urban regions. Similarly, there was a 47% reduction in inpatient admissions in Addis Ababa. In agrarian regions, the pandemic caused an 11% to 17% reduction in outpatient visits and a 10% to 27% decline in inpatient admissions. Visits for children with diarrhea, pneumonia and malnutrition also declined substantially while maternal health services were less affected. Our study indicates that disruptions in health services were more pronounced in areas that were relatively harder hit by the pandemic. Our results show that the Ethiopian health system has a limited capacity to absorb shocks. During future waves of COVID or future pandemics, the Ethiopian health system must be better prepared to maintain essential services and mitigate the indirect impact of the pandemic on public health, particularly in urban areas.

Effect of and Interventions in Prevention and Management of Maternal Anemia in the Advent of COVID-19

“…Further, measuring the effects of COVID-19 disruptions on the delivery of essential health and nutrition interventions has proven challenging, as resilient, real-time information systems were not well established in many countries before the crisis [58]. A world Health Organization survey demonstrated an extent of disruptions across all healthcare services which solemnly may have led to disruption on the pregnancy anemia management and interventions [59].Adding on the same, an African based study found that, healthcare services utilization in the advent of COVID-19 were disrupted [60]. This could be expected to somehow affect and compromise the measures of mitigating the maternal.…”

“…A world Health Organization survey demonstrated an extent of disruptions across all healthcare services which solemnly may have led to disruption on the pregnancy anemia management and interventions[59]. Adding on the same, an African based study found that, healthcare services utilization in the advent of COVID-19 were disrupted [60]. This could be expected to somehow affect and compromise the measures of mitigating the maternal.…”

Poor adherence to antiretroviral therapy among adult people living with HIV initiated during the COVID-19 epidemic waves – observations at the University Teaching Hospital in Lusaka, Zambia

“…There could be many explanations for this but we are persuaded to think that the COVID-19 pandemic is one of them. This is because widespread health system disruptions due to COVID-19 in various settings were reported (32), resulting in reduced health service utilization in general and for various reasons, ranging from negative myths on how the infection spreads to a general fear of contracting the infection, including fear of being tested and fear of being vaccinated (33)(34)(35)(36). The emergence of the COVID-19 pandemic masked the effects of the U=U campaign because of the kind of COVID-19 control measures being implemented, which included quarantine, controlled local travel or mobility, social distancing, and limited access to health facilities for ART refills due to fear of exposure to the virus.…”

The Need to Establish and Sustain Public Health Emergency Operation Centers for Managing Infectious Disease Outbreaks: Lesson From Response to Louse-Borne Relapsing Fever Outbreak in Jimma, Ethiopia

“…In addition, service demand and uptake by the community fell sharply at all levels of the health system. 20,21 This indicated the lack of proactive emergency response strategies which can support containment of public health emergencies while maintaining essential and primary health care (PHC) services.…”