Impact of the COVID-19 pandemic on utilisation of facility-based essential maternal and child health services from March to August 2020 compared with pre-pandemic March–August 2019: a mixed-methods study in North Shewa Zone, Ethiopia

Abstract

IntroductionHealth systems are often weakened by public health emergencies that make it harder to access health services. We aimed to assess maternal, newborn and child health (MNCH) service utilisation during the first 6 months of the COVID-19 pandemic compared with prior to the pandemic.MethodsWe conducted a mixed study design in eight health facilities that are part of the Birhan field site in Amhara, Ethiopia and compared the trend of service utilisation in the first 6 months of COVID-19 with the corresponding time and data points of the preceding year.ResultNew family planning visits (43.2 to 28.5/month, p=0.014) and sick under 5 child visits (225.0 to 139.8/month, p=0.007) declined over the first 6 months of the pandemic compared with the same period in the preceding year. Antenatal (208.9 to 181.7/month, p=0.433) and postnatal care (26.6 to 19.8/month, p=0.155) visits, facility delivery rates (90.7 to 84.2/month, p=0.776), and family planning visits (313.3 to 273.4/month, p=0.415) declined, although this did not reach statistical significance. Routine immunisation visits (37.0 to 36.8/month, p=0.982) for children were maintained. Interviews with healthcare providers and clients highlighted several barriers to service utilisation during COVID-19, including fear of disease transmission, economic hardship, and transport service disruptions and restrictions. Enablers of service utilisation included communities’ decreased fear of COVID-19 and awareness-raising activities.ConclusionWe observed a decline in essential MNCH services particularly in sick children and new family planning visits. To improve the resiliency of fragile health systems, resources are needed to continuously monitor service utilisation and clients’ evolving concerns during public health emergencies.

An integrative literature review on the impact of COVID-19 on maternal and child health in Africa

“… Bekele C., Bekele D., Hunegnaw B.M., et al, 2022. Ethiopia [ 8 ] Assess MNCH utilization during the first six months of the COVID-19 pandemic, as well as potential barriers and enablers of service utilization from health care providers and clients. Mixed study design.…”

“…Movement restrictions and transport challenges were also identified as barriers to maternal health service uptake in Ethiopia [ 8 , 14 ]. Similarly, the findings of cross-sectional survey of 1241 Nigerian women by Balogun et al, [ 25 ] and a mixed method study in Ethiopia [ 8 ] showed that lockdowns and lack of transportation were barriers to accessing MHC services.…”

“…COVID-19 caused distortion in health care services leading to non-regular attendance during ANC in rural and urban areas [ 26 ]. A mixed method study in eight health facilities in Ethiopia comparing the service utilisation trends in the first 6 months of COVID-19 with the corresponding time and data points of the preceding year showed reduced ANC visits (208.9 to 181.7/month, p = 0.433) and under 5 visits (225.0 to 139.8/month, p = 0.007) [ 8 ]. An assessment of effect of the pandemic on the uptake of MHC in Somali region of Ethiopia, through a retrospective chart review revealed that the mean number of ANC pre-pandemic was 4088 and intra-pandemic was 3498., reflecting a 14% decline in ANC attendance [ 37 ] .…”

“…However, facility birth decline was not universal. Bekele and colleagues reported reduced facility delivery rates in Ethiopia which was not statistically significant (90.7 to 84.2/month, p = 0.776) [ 8 ] and Enbiale and colleagues [ 29 ] also in Ethiopia did not find a significant decline. A cross-sectional study at Mpilo - Zimbabwe Central Hospital compared routine monthly maternal and perinatal statistics three months before and after COVID-19 emergency measures were implemented.…”

“…This resulted to a rise in facility stillbirth (14% vs 21.8%) and neonatal death (33.1% vs 46.2%) [ 11 ]. The facility delivery disparity rate seen here from the narrative of Ethiopia could be attributed to cultural practices such encouraging home delivery, fear and anxiety associated with the pandemic, misinformation by media, lockdowns, health system resilience, and no support from healthcare workers [ 8 , 13 , 29 ].…”