Effects of the COVID-19 pandemic on essential health and nutrition service utilisations in Ghana: interrupted time-series analyses from 2016 to 2020

Kawakatsu, Yoshito; Osei, Ivy; Debpuur, Cornelius; Ayi, Atsu; Osei-Sarpong, Felix; Shetye, Mrunal; Aiga, Hirotsugu; Augusto, Orvalho; Wagenaar, Bradley H.

doi:10.1136/bmjopen-2022-061608

Cited by 5 publications

(2 citation statements)

References 20 publications

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“…However, in South Africa full immunisation dropped in the first months of the pandemic, especially in April where it dropped by 30% [19,20]. Ghana [21,22,23],…”

Section: Routine Immunisationmentioning

confidence: 99%

COVID-19-related disruption and resiliency in immunisation activities in LMICs: a rapid review

Hartner,

Li,

Gaythorpe

2023

Preprint

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Objectives Rapid review to determine the extent that immunisation services in LMICs were disrupted by the COVID-19 pandemic and what factors can be considered to build resilience in future. Setting We searched PubMed on 28th Feb 2023 for studies published after 1st December 2019 in English that focused on LMICs. Participants Screening and data extraction were conducted by two experienced reviewers with one reviewer vote minimum per study per stage. Of 3801 identified studies, 66 met the eligibility criteria. Outcomes Routine vaccine coverage achieved; Supplementary immunisation activity timing; Vaccine doses given; Timing of vaccination; Supply chain changes; factors contributing to disruption or resilience. Results Included studies showed evidence of notable declines in immunisation activities across LMICs related to the COVID-19 pandemic. These have included reductions in achieved routine coverage, cancellation or postponement of campaigns, and underimmunised cohorts. Immunisation was most disrupted in the early months of the pandemic, particularly March to May 2020; however, the amount of recovery seen varied by country, age-group, and vaccine. Though many countries observed partial recovery beginning after lockdown policies were lifted in 2020, disruption in many countries has also continued into 2021. It has also been noted that clinician staff shortages and vaccine stock outs caused by supply chain disruptions contributed to immunisation delays but that concern over COVID transmission was a leading factor. Key resiliency factors included community outreach and healthcare worker support. Finally, whilst our search took place in February 2023, the latest dataset used across all studies was from November 2022 and many focused on 2020; as a result some of the study conclusions do not take recovery into account. Conclusions There is limited information on whether reductions in vaccination coverage or delays have persisted beyond 2021. Further research is needed to assess ongoing disruptions and identify missed vaccine cohorts.

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“…However, in South Africa full immunisation dropped in the first months of the pandemic, especially in April where it dropped by 30% [19,20]. Ghana [21,22,23],…”

Section: Routine Immunisationmentioning

confidence: 99%

COVID-19-related disruption and resiliency in immunisation activities in LMICs: a rapid review

Hartner,

Li,

Gaythorpe

2023

Preprint

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“…19,20 Aberese-Ako et al 21 from their study on the socioeconomic and health effects of COVID-19 among rural and urban slum dwellers found a signi cant change in healthseeking behaviours during the pandemic with over 65% of participants from their study reporting anxiety and fear to seek healthcare even when they were unwell. Kawakatsu et al 22 also examined the effect of COVID-19 on essential health service utilisation (comprising maternal care, child health and general outpatient care) across the country and reported a loss of 3,480,292 (95% CI: −3,510,820 to − 3,449,676) outpatient visits by November 2020. Limited research has, however, focused on the impact of COVID-19 on NCDs such as hypertension in Ghana.…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on the Management of Hypertension: A Perspective on Disease Severity, Service Use Patterns and Expenditures from Ghana’s Health Insurance Claims Data

Fenny,

Otieku,

Achiaw

et al. 2024

Preprint

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Hypertension is a leading cause of death and morbidity in Ghana and other sub-Saharan African countries, but management has historically suffered from the fragility of health systems in these countries. This has been exacerbated by the COVID-19 pandemic and its associated measures. Our study examines and quantifies the effect of the pandemic on the management of hypertension in Ghana by determining changes in disease severity and presentation, as well as changes in service use patterns and expenditures. We used cross-sectional data to perform an impact evaluation of COVID-19 on hypertension management before and during the pandemic. We employed statistical tests to analyse medical claims data from Ghana’s National Health Insurance Authority database. The study duration includes a 12-month reference/pre-pandemic period (March 2019- February 2020) relative to the target/pandemic period (March 2020 - February 2021). We observed significant changes in health services use for hypertension during the pandemic. While there was a 20% reduction in the number of hypertension claimants in the pandemic year, there was an increase in hypertension severity as measured by the number of hypertension episodes per claimant (a 17.6% increase (95% CI. 15.0% – 20.3%; p = 0.031)). There was also an 18.64% or $22.88 (95% CI:$12 – $25, p = 0.01042) increase in the average cost per hypertension claimant in the pandemic year. The increase in episodes per claimant had the largest financial impact on the average cost per claimant. The findings from our studies are relevant for future policymaking and strategy implementation for hypertension control in Ghana.

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COVID-19 related disruption and resilience in immunisation activities in LMICs: a rapid review

Hartner,

Li,

Gaythorpe

2024

BMJ Open

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ObjectivesWe conducted a rapid review to determine the extent that immunisation services in low-income and middle-income countries (LMICs) were disrupted by the COVID-19 pandemic and synthesised the factors that can be used to build resilience in future.DesignRapid review reported in accordance with the Preferred reporting for Systematic reviews and Meta-Analyses (PRISMA) guidelines.Data sourcesPubMed and Web of Science were searched through 6 October 2023.Eligibility criteria for selecting studiesWe included studies that focused on disruption to immunisation activities due to the COVID-19 pandemic in LMICs. Outcomes included routine vaccine coverage, supplementary immunisation activities, vaccine doses, timing of vaccination, supply chain changes, and factors contributing to disruption or resilience.Data extraction and synthesisTwo independent reviewers used standardised methods to search, screen and code studies. Quality assessment was performed using a modified version of the Critical Appraisal Skills Programme for qualitative research. Findings were summarised qualitatively.ResultsOf 4978 identified studies, 85 met the eligibility criteria. Included studies showed declines in immunisation activities across LMICs related to the COVID-19 pandemic. These included reductions in achieved routine coverage, cancellation or postponement of campaigns and underimmunised cohorts. Immunisation was most disrupted in the early months of the pandemic; however, recovery varied by country, age-group and vaccine. Though many countries observed partial recovery in 2020, disruption in many countries continued into 2021. It has also been noted that clinician staff shortages and vaccine stock-outs caused by supply chain disruptions contributed to immunisation delays, but that concern over COVID-19 transmission was a leading factor. Key resiliency factors included community outreach and healthcare worker support.ConclusionsThere is limited information on whether reductions in vaccination coverage or delays have persisted beyond 2021. Further research is needed to assess ongoing disruptions and identify missed vaccine cohorts.

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Effects of the COVID-19 pandemic on essential health and nutrition service utilisations in Ghana: interrupted time-series analyses from 2016 to 2020

Cited by 5 publications

References 20 publications

COVID-19-related disruption and resiliency in immunisation activities in LMICs: a rapid review

COVID-19-related disruption and resiliency in immunisation activities in LMICs: a rapid review

Impact of COVID-19 on the Management of Hypertension: A Perspective on Disease Severity, Service Use Patterns and Expenditures from Ghana’s Health Insurance Claims Data

COVID-19 related disruption and resilience in immunisation activities in LMICs: a rapid review

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