Effects of the COVID-19 pandemic on maternal and perinatal health service utilisation and outcomes in Mozambique: an interrupted time series analysis

Abstract

ObjectivesTo measure the effects of the COVID-19 pandemic on maternal and perinatal health services and outcomes in Mozambique.DesignThis is an observational study analysing routine service delivery data using interrupted time series analysis. We used 43 months of district-level panel data with April 2020 as the point of interruption, adjusting for seasonality and population growth to analyse service utilisation outcomes.SettingThe 222 public health facilities in Nampula Province, Mozambique, from January 2018 to July 2021.Outcome measuresThe change in the number of antenatal care (ANC) visits and facility deliveries, and the change in the rate of adverse birth outcomes at pandemic onset and over time compared with expected levels and trends, respectively.ResultsThere were no significant disruptions to ANC at pandemic onset. Following this, there was a significant monthly increase of 29.8 (18.2–41.4) first ANC visits and 11.3 (5.5–17.2) ANC visits within the first trimester per district above prepandemic trends. There was no significant change in the number of fourth ANC visits completed. At the onset of COVID-19, districts experienced a significant decrease of 71.1 (−110.5 to −31.7) facility deliveries, but the rate then increased significantly above prepandemic trends. There was no significant increase in any adverse birth outcomes during the pandemic. Conversely, districts observed a significant monthly decrease of 5.3 uterine rupture cases (−9.9 to −0.6) and 19.2 stillbirths (−33.83 to −4.58) per 100 000 facility deliveries below prepandemic trends. There was a significant drop of 23.5 cases of neonatal sepsis/100 000 facility deliveries per district at pandemic onset.ConclusionDespite pandemic interference, Nampula Province saw no disruptions to ANC, only temporary disruptions to facility deliveries and no increases in adverse birth outcomes. ANC visits surprisingly increased, and the rates of uterine rupture, stillbirth and neonatal sepsis decreased, suggesting that Nampula Province may offer insights about health system resilience.

Perinatal care and breastfeeding education during the COVID‐19 pandemic: Perspectives from Kenyan mothers and healthcare workers

“…A study in Nampula Province, Mozambique noted no disruptions and an actual increase in ANC visits, comparing data 2 years before COVID lockdowns to July 2021 (Lydon et al, 2022). Telehealth and mobilisation of community health workers were important interventions that improved education and outreach for COVID-19 across geographically diverse regions of Bangladesh, but they were not optimised to ensure the continuity of essential health and nutrition services (Gaitán-Rossi et al, 2022).…”

Impact of the COVID-19 pandemic on access to and delivery of maternal and child healthcare services in low-and middle-income countries: a systematic review of the literature

“…Included studies showed mixed results concerning institutional deliveries that comprise normal vaginal deliveries and caesarean sections. Even though eight studies highlighted a reduction in the number/proportion of institutional deliveries ( 36 , 49–51 , 56 , 61 , 62 , 67 , 71 ), six reports ( 38 , 43 , 63 , 73–75 ) observed growth and two studies ( 34 , 42 ) did not find any changes with respect to this indicator. The results varied depending on the setting in three multi-centred studies ( 64 , 77 , 78 ), making it difficult to provide a generalised conclusion.…”

“…Albeit no changes were made to the standard antenatal care protocol in the majority of settings, increased interruptions in antenatal care ( 76 ) and a decrease in antenatal care coverage ( 42 ), antenatal recruitment rate and prenatal visit completion rate ( 59 ), antenatal care registrations ( 62 ), number/proportion of antenatal care visits ( 34 , 36–38 , 47 , 49 , 56 , 58 , 61 , 65 , 67 , 71 , 72 , 74 , 75 ) and attendance ( 50 , 51 , 70 , 77 , 78 ) was noticed in most cases as compared to the pre-pandemic period. However, Pillay and colleagues ( 73 ) observed no difference in the number of first antenatal care visits in South Africa and Lydon and colleagues ( 43 ) detected an increased number of first antenatal visits and no difference in the number of fourth antenatal visits in Mozambique. No difficulties in accessing antenatal care were declared in one study originated from India ( 63 ).…”

“…Overall, 14 studies reported data from four low-income countries ( 34–47 ), 21 studies were focused on 13 lower-middle income countries ( 48–68 ), seven studies were conducted in five upper-middle income countries ( 69–75 ) and three were multi-centred ( 76–78 ). Out of 45 included studies, 11 studies were cross-sectional ( 41 , 45 , 48 , 51 , 55–57 , 65 , 69 , 70 , 76 ), 14 were pre-post studies ( 34 , 38 , 49 , 50 , 52 , 53 , 56 , 62 , 64 , 72–75 , 77 ), nine were time-series ( 35 , 37 , 39 , 43 , 58 , 59 , 67 , 71 , 78 ), five were mixed methods ( 36 , 42 , 47 , 61 , 63 ) and six were qualitative ( 40 , 44 , 46 , 54 , 60 , 68 ). The included studies’ characteristics are summarised in Table 1 .…”

“…Twenty-seven studies reported on antenatal care coverage during the pandemic using various metrics ( 34 , 36–38 , 42 , 43 , 47 , 49–51 , 56 , 58 , 59 , 61–63 , 65 , 67 , 70–78 ). Albeit no changes were made to the standard antenatal care protocol in the majority of settings, increased interruptions in antenatal care ( 76 ) and a decrease in antenatal care coverage ( 42 ), antenatal recruitment rate and prenatal visit completion rate ( 59 ), antenatal care registrations ( 62 ), number/proportion of antenatal care visits ( 34 , 36–38 , 47 , 49 , 56 , 58 , 61 , 65 , 67 , 71 , 72 , 74 , 75 ) and attendance ( 50 , 51 , 70 , 77 , 78 ) was noticed in most cases as compared to the pre-pandemic period.…”