Resilience and vulnerability of maternity services in Zimbabwe: a comparative analysis of the effect of Covid-19 and lockdown control measures on maternal and perinatal outcomes, a single-centre cross-sectional study at Mpilo Central Hospital

Abstract

Background On the 27th of March 2020 the Zimbabwean government declared the Covid-19 pandemic a ‘national disaster’. Travel restrictions and emergency regulations have had significant impacts on maternity services, including resource stock-outs, and closure of antenatal clinics during the lockdown period. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality was expected it to be considerable, but little data was yet available. This study aimed to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before, and after the lockdown was implemented. Methods This was a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures were implemented at Mpilo Central Hospital. Results Between January-March and April-June 2020, the mean monthly deliveries reduced from 747.3 (SD ± 61.3) in the first quarter of 2020 to 681.0 (SD ± 17.6) during lockdown, but this was not statistically significant, p = 0.20. The Caesarean section rates fell from a mean of 29.8% (SD ± 1.7) versus 28.0% (SD ± 1.7), which was also not statistically significant, p = 0.18. During lockdown, the percentage of women delivering at Mpilo Central Hospital who were booked at the hospital fell from a mean of 41.6% (SD ± 1.1) to 35.8% (SD ± 4.3) which was statistically significant, p = 0.03. There was no significant change, however, in maternal mortality or severe maternal morbidity (such as post-partum haemorrhage (PPH), uterine rupture, and severe preeclampsia/eclampsia), stillbirth rate or special care baby unit admission. There was an increase in the mean total number of early neonatal deaths (ENND) (mean 18.7 (SD ± 2.9) versus 24.0 (SD ± 4.6), but this was not statistically significant, p = 0.32. Conclusions Overall, maternity services at Mpilo showed resilience during the lockdown period, with no significant change in maternal and perinatal adverse outcomes, with the same number of man-hours worked before and during the lockdown Maternal and perinatal outcomes should continue to be monitored to assess the impact of Covid-19 and the lockdown measures as the pandemic in Zimbabwe unfolds. Further studies would be beneficial to explore women’s experiences and understand how bookings and deliveries at local clinics changed during this time.

Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review

“…In terms of geographical area, 19 studies were conducted in European countries [47,51,53,55,57,62,64,[67][68][69][70]75,79,83,84,88,90,92,95], 9 in North American countries [49,58,59,77,78,80,82,85,86], 9 in Sub-Saharan Africa [46,48,71,72,76,87,93,94,98], 3 in Latin America [60,91,96], 5 in the East Asia-Pacific region [50,56,61,66,81], 3 in South Asia [63,65,74], 2 in the North Africa-Middle East region [52], and, lastly, 3 studies covered various regions…”

“…With regard to the period of analysis, 38 of the selected studies were conducted over the first months of the pandemic (February to June 2020) [46][47][48][49][50][51][52][53][54][55][57][58][59][60]62,[65][66][67][68][69][70][72][73][74][75][76][77][78][79][80]82,84,86,88,90,92,93,98]; 4 during the second stage of the pandemic (June to September 2020) [85,89,91,96]; 1 at a later stage (September to November 2020) [94]; finally, 8 analyzed the whole period (February to December 2020) [56,61,63,64,71,…”

Impact of COVID-19 on maternal and perinatal outcomes in Harare, Zimbabwe: a comparative maternal audit

“…3 During the lockdown, pregnant women were unable to access adequate antenatal care, failed to reach healthcare facilities on time, and faced delays in receiving care once at the hospital. [2][3][4][5][6][7][8] While emergency procedures continued to take place, all elective surg-…”

“…The COVID-19 pandemic also impacted the utilisation of health services, as evidenced by declines in outpatient attendances. 1,7,11 A retrospective study at a tertiary hospital in Zimbabwe comparing routine maternal and perinatal statistics three months before and after the nationwide lockdown commenced found that the number of monthly hospital deliveries and caesarean section rates fell. In contrast, the number of women presenting in labour with unbooked pregnancies almost doubled.…”

“…In contrast, the number of women presenting in labour with unbooked pregnancies almost doubled. 7 However, there was no significant change in maternal mortality, stillbirth rate, severe maternal morbidity such as post-partum haemorrhage (PPH), uterine ruptures, severe preeclampsia/eclampsia, and special care baby unit (SCBU) admissions.…”