Essential Healthcare Services in the Face of COVID-19 Prevention: Experiences from a Referral Hospital in Ethiopia

Abdela, Seid Getahun; Berhanu, Abel Balcha; Ferede, Leul Mesfin; Griensven, Johan van

doi:10.4269/ajtmh.20-0464

Cited by 64 publications

(116 citation statements)

References 6 publications

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“…Although health facilities in Rwanda remained open for both emergency and routine services throughout the duration of the lockdown, 22.7% of patients still reported being unable to access emergency care and 16.8% reported being unable to attend regular clinical appointments. These results indicate a reduced access to emergency care and attendance of scheduled medical appointments due to the COVID-19 lockdown that is consistent with evidence from other settings [ 24 – 29 ]. Perceived reasons for a dramatic decline in the utilization of emergency care services and low attendance of medical visits during the COVID-19 pandemic varied by setting, and included absence of public transport or increased costs of transport [ 24 ], shortage of care providers due to reallocation of staff to the COVID-19 response [ 25 ], and fear of COVID-19 infection [ 26 – 28 ].…”

Section: Discussionsupporting

confidence: 87%

Barriers and coping mechanisms to accessing healthcare during the COVID-19 lockdown: a cross-sectional survey among patients with chronic diseases in rural Rwanda

Nshimyiryo¹,

Barnhart

Cubaka³

et al. 2021

BMC Public Health

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Background Large scale physical distancing measures and movement restrictions imposed to contain COVID-19, often referred to as ‘lockdowns’, abruptly and ubiquitously restricted access to routine healthcare services. This study describes reported barriers and coping mechanisms to accessing healthcare among chronic care patients during the nationwide COVID-19 lockdown in Rwanda. Methods This cross-sectional study was conducted among chronic care patients enrolled in pediatric development, HIV/AIDS, non-communicable diseases, mental health, and oncology programs at 3 rural Rwandan districts. Active patients with an appointment scheduled between March–June 2020 and a phone number recorded in the electronic medical record system were eligible. Data were collected by telephone interviews between 23rd April and 11th May 2020, with proxy reporting by caregivers for children and critically ill-patients. Fisher’s exact tests were used to measure associations. Logistic regression analysis was also used to assess factors associated with reporting at least one barrier to accessing healthcare during the lockdown. Results Of 220 patient respondents, 44% reported at least one barrier to accessing healthcare. Barriers included lack of access to emergency care (n = 50; 22.7%), lack of access to medication (n = 44; 20.0%) and skipping clinical appointments (n = 37; 16.8%). Experiencing barriers was associated with the clinical program (p < 0.001), with oncology patients being highly affected (64.5%), and with increasing distance from home to the health facility (p = 0.031). In the adjusted logistic regression model, reporting at least one barrier to accessing healthcare was associated with the patient's clinical program and district of residence. Forty (18.2%) patients identified positive coping mechanisms to ensure continuation of care, such as walking long distances during suspension of public transport (n = 21; 9.6%), contacting clinicians via telephone for guidance or rescheduling appointments (n = 15; 6.8%), and delegating someone else for medication pick-up (n = 6; 2.7%). Of 124 patients who reported no barriers to accessing healthcare, 9% used positive coping mechanisms. Conclusion A large proportion of chronic care patients experienced barriers to accessing healthcare during the COVID-19 lockdown. However, many patients also independently identified positive coping mechanisms to ensure continuation of care - strategies that could be formally adopted by healthcare systems in Rwanda and similar settings to mitigate effects of future lockdowns on patients.

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Section: Discussionsupporting

confidence: 87%

Barriers and coping mechanisms to accessing healthcare during the COVID-19 lockdown: a cross-sectional survey among patients with chronic diseases in rural Rwanda

Nshimyiryo¹,

Barnhart

Cubaka³

et al. 2021

BMC Public Health

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“…One proposed explanation for the increase in adverse pregnancy outcomes is that such outcomes could be linked to reduced access to care. Although maternal anxiety was consistently shown to be increased during the pandemic, health-care providers around the world have reported reduced attendance for routine 6 , 13 , 15 , 52 , 53 , 54 , 55 and unscheduled pregnancy care. 6 , 12 , 13 , 15 , 19 , 56 This reduction could be driven by concern about the risk of acquiring COVID-19 in health-care settings, governmental advice to stay at home, or reduced public transport and childcare access during lockdowns.…”

Section: Discussionmentioning

confidence: 99%

“… 57 , 58 In LMICs, where remote consultations are less feasible, people might simply miss out on preventive antenatal care entirely. 13 , 53 In all settings, the impact is greatest on the most vulnerable individuals in the population: in Nepal, hospital deliveries decreased, most markedly among disadvantaged groups; 21 and in the UK, 88% of pregnant women who died during the first wave of the pandemic were from black and minority ethnic groups. 51…”

Section: Discussionmentioning

confidence: 99%

Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis

Chmielewska

Barratt

Townsend

et al. 2021

The Lancet Global Health

844

820

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Background The COVID-19 pandemic has had a profound impact on health-care systems and potentially on pregnancy outcomes, but no systematic synthesis of evidence of this effect has been undertaken. We aimed to assess the collective evidence on the effects on maternal, fetal, and neonatal outcomes of the pandemic. Methods We did a systematic review and meta-analysis of studies on the effects of the pandemic on maternal, fetal, and neonatal outcomes. We searched MEDLINE and Embase in accordance with PRISMA guidelines, from Jan 1, 2020, to Jan 8, 2021, for case-control studies, cohort studies, and brief reports comparing maternal and perinatal mortality, maternal morbidity, pregnancy complications, and intrapartum and neonatal outcomes before and during the pandemic. We also planned to record any additional maternal and offspring outcomes identified. Studies of solely SARS-CoV-2-infected pregnant individuals, as well as case reports, studies without comparison groups, narrative or systematic literature reviews, preprints, and studies reporting on overlapping populations were excluded. Quantitative meta-analysis was done for an outcome when more than one study presented relevant data. Random-effects estimate of the pooled odds ratio (OR) of each outcome were generated with use of the Mantel-Haenszel method. This review was registered with PROSPERO (CRD42020211753). Findings The search identified 3592 citations, of which 40 studies were included. We identified significant increases in stillbirth (pooled OR 1·28 [95% CI 1·07–1·54]; I 2 =63%; 12 studies, 168 295 pregnancies during and 198 993 before the pandemic) and maternal death (1·37 [1·22–1·53; I 2 =0%, two studies [both from low-income and middle-income countries], 1 237 018 and 2 224 859 pregnancies) during versus before the pandemic. Preterm births before 37 weeks' gestation were not significantly changed overall (0·94 [0·87–1·02]; I 2 =75%; 15 studies, 170 640 and 656 423 pregnancies) but were decreased in high-income countries (0·91 [0·84–0·99]; I 2 =63%; 12 studies, 159 987 and 635 118 pregnancies), where spontaneous preterm birth was also decreased (0·81 [0·67–0·97]; two studies, 4204 and 6818 pregnancies). Mean Edinburgh Postnatal Depression Scale scores were higher, indicating poorer mental health, during versus before the pandemic (pooled mean difference 0·42 [95% CI 0·02–0·81; three studies, 2330 and 6517 pregnancies). Surgically managed ectopic pregnancies were increased during the pandemic (OR 5·81 [2·16–15·6]; I 2 =26%; three studies, 37 and 272 pregnancies). No overall significant effects were identified for other outcomes included in the quantitative analysis: maternal gestational diabetes; hypertensive disorders of pregnancy; preterm birth before 34 weeks', 32 weeks',...

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“…The aim is to protect both patients and workers from the risks of SARS-CoV-2 infection and ensure health care [ 26 , 27 ]. It will be important for everybody on the expedition to avoid quarantine, which means establishing work groups that are balanced with regard to the workers’ skills and functional units to which they belong (Table 1 ).…”

Section: Methodsmentioning

confidence: 99%

Humanitarian Surgical Missions in Times of COVID‐19: Recommendations to Safely Return to a Sub‐Saharan Africa Low‐Resource Setting

et al. 2021

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Background Since the declaration of the pandemic, humanitarian medicine has been discontinued. Until now, there have been no general recommendations on how humanitarian surgical missions should be organized. Methods Based on our experience in the field of humanitarian surgical missions to Sub-Saharan Africa, a panel of recommendations in times of COVID-19 was developed. The fields under study were as follows: (1) Planning of a multidisciplinary project; (2) Organization of the infrastructure; (3) Screening, management and treatment of SARS-COV-2; (4) Diagnostic tests for SARS-COV-2; (5) Surgical priorization and (6) Context of patients during health-care assistance. We applied a risk bias measurement to obtain a consensus among humanitarian health-care providers with experience in this field. Results A total of 94.36% of agreement were reached for the approval of the recommendations. Emergency surgery must be a priority, and elective surgery adapted. For emergency surgery, we established a priority level 1a (< 24 h) and 1b (< 72 h). For an elective procedure, according our American College of Surgeon adaptation score, process with more than 60 points should be reconsidered. Due to the low life expectancy in many African countries, we consider 45–50 years as age of risk. In case of SARS-COV-2 active infection or high clinical suspicion, the screening, management and treatment should be following the international guidelines adapted to duration of the stay, available infrastructure, size of the cooperation team and medical resources. Conclusions Humanitarian surgical mission in times of COVID-19 is a challenge that must extrapolate the established recommendations to the local cooperation environment. Supplementary Information The online version contains supplementary material available at (10.1007/s00268-021-06001-x).

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Essential Healthcare Services in the Face of COVID-19 Prevention: Experiences from a Referral Hospital in Ethiopia

Cited by 64 publications

References 6 publications

Barriers and coping mechanisms to accessing healthcare during the COVID-19 lockdown: a cross-sectional survey among patients with chronic diseases in rural Rwanda

Barriers and coping mechanisms to accessing healthcare during the COVID-19 lockdown: a cross-sectional survey among patients with chronic diseases in rural Rwanda

Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis

Humanitarian Surgical Missions in Times of COVID‐19: Recommendations to Safely Return to a Sub‐Saharan Africa Low‐Resource Setting

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