Indirect health effects of the COVID-19 pandemic in Kenya: a mixed methods assessment

Abstract

Background The COVID-19 pandemic and country measures to control it can lead to negative indirect health effects. Understanding these indirect health effects is important in informing strategies to mitigate against them. This paper presents an analysis of the indirect health effects of the pandemic in Kenya. Methods We employed a mixed-methods approach, combining the analysis of secondary quantitative data obtained from the Kenya Health Information System database (from January 2019 to November 2020) and a qualitative inquiry involving key informant interviews (n = 12) and document reviews. Quantitative data were analysed using an interrupted time series analysis (using March 2020 as the intervention period). Thematic analysis approach was employed to analyse qualitative data. Results Quantitative findings show mixed findings, with statistically significant reduction in inpatient utilization, and increase in the number of sexual violence cases per OPD visit that could be attributed to COVID-19 and its mitigation measures. Key informants reported that while financing of essential health services and domestic supply chains were not affected, international supply chains, health workforce, health infrastructure, service provision, and patient access were disrupted. However, the negative effects were thought to be transient, with mitigation measures leading to a bounce back. Conclusion Finding from this study provide some insights into the effects of the pandemic and its mitigation measures in Kenya. The analysis emphasizes the value of strategies to minimize these undesired effects, and the critical role that routine health system data can play in monitoring continuity of service delivery.

Accessibility to Non-COVID Health Services in the World During the COVID-19 Pandemic: Review

“…For oncology patients in the questionnaire-based study, the majority of the respondents experienced incidents of reduced access to medical services during the COVID-19 pandemic ( 35 ), and for patients with orthopedic injuries in Hong Kong, a decrease in the number of emergency visits was observed ( 36 ). Due to the transition of some facilities that were used to provide essential services to COVID-19 isolation units caused that patients with chronic illness in Kenya had difficulty getting the help they needed ( 37 ).…”

“…Similar outcomes were observed in Nepal, where the supply of medicines was the worst affected area of healthcare delivery next to immunization and maternity services ( 50 ). Furthermore, in Kenya, HPV vaccination was disrupted, and BCG, pentavalent, rotavirus, and pneumococcal vaccination were declined in Mexico ( 37 , 44 ). Significant declines in receipt of IFA supplements for pregnant women were observed in Bangladesh ( 42 ).…”

“…An increase in access to telemedicine services was also observed in patients with rheumatic disease in Poland ( 35 ). Authors of a retrospective study from Kenya found an increase in health facility baby deliveries and measles vaccination ( 37 ). In France, the percentage of consultations for psychotic disorders increased ( 46 ), and in Denmark mortality rate ratios remained higher for infectious diseases overall (with and without COVID-19), cancer, and respiratory diseases in periods between national lockdowns ( 28 ).…”

“…Technological advances and the acquisition of experience by healthcare professionals can minimize the risk of these drawbacks ( 57 ). The challenge is the use of telemedicine in developing countries, where despite encouragement for consultations and the use of virtual platforms to engage with patients, caregivers, and healthcare workers, most not economically well-off patients had challenges using these platforms ( 37 ). Telemedicine requires funding and appropriate guidelines ( 58 ), especially for the elderly and those living in rural areas ( 59 ).…”

Assessing equity and the determinants of socio-economic impacts of COVID-19: Results from a cross-sectional survey in three counties in Kenya

“…These measures notwithstanding, an increasing body of evidence points to significant socioeconomic impacts of the COVID-19 mitigation measures. For instance, implementation of the mitigation measures has been associated with an increase in the number of domestic or gender-based violence cases, food insecurity, loss of income or employment, learning disruption, healthcare access disruption, increased levels of stress, among other forms of disruption in people's livelihoods 7,[17][18][19][20][21] . Specifically, the implementation of various mitigation policies in Kenya has been shown to have disproportionate negative impacts on women dwelling in informal settlements in Nairobi as they were more at risk of facing income loss, food insecurity and foregoing needed healthcare 21 .…”