Restoring and maintaining robust maternity services in the COVID-19 era: a public health dilemma in Zimbabwe

Murewanhema, Grant; Nyakanda, Munyaradzi Innocent; Madziyire, Mugove Gerald

doi:10.11604/pamj.supp.2020.37.1.26798

Cited by 13 publications

(19 citation statements)

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“…Similar to our findings, facilities in rural Uganda saw a drop in antenatal attendances, 29 as have hospitals in Kenya, Ethiopia, Zimbabwe and Rwanda in the first months of the pandemic [30][31][32][33][34][35][36][37] . The aim of preventative services is to reduce maternal and newborn morbidity and mortality and any reduction in their availability can give an indication of the potential longer-term impacts -including increased rates of maternal anaemia, puerperal sepsis, stillbirth, low birth weight, preterm birth, malaria infection, preeclampsia/eclampsia, mother to child transmission of HIV and neonatal tetanus 38 .…”

Section: Discussionsupporting

confidence: 84%

Indirect Effects of COVID-19 on Maternal, Neonatal, Child, Sexual and Reproductive Health Services in Kampala, Uganda

Burt

Ouma

Lubyayi

et al. 2021

Preprint

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Background: COVID-19 has impacted global maternal, neonatal and child health outcomes. We hypothesised that the early, strict lockdown which severely limited the movements of individuals in Uganda will have impacted access to services. Methods: An observational study, using routinely collected health data from Electronic Medical Records was carried out, utilising data from July 2019 to December 2020 in Kawempe district, Kampala. The mean and 95% confidence intervals were calculated pre-COVID (July 2019-February 2020) and post-COVID (March-December 2020). The means were compared using t-tests, and the monthly totals analysed as to whether they lay within or outside the normal range, compared to the previous 9 months. Results: Antenatal attendances decreased 96% in April 2020 and remain below pre-COVID levels. We found a rise in adverse pregnancy outcomes for Caesarean sections (5%), haemorrhages related to pregnancy (51%), stillbirths (31%) and low-birth-weight (162%) and premature infant births (400%). We noted a drop in neonatal unit admissions, immunisation clinic attendance and delivery of all vaccinations except measles. There was an immediate drop in clinic attendance for prevention of mother to child transmission of HIV (now stabilised) and an increase of 348% in childhood malnutrition clinic attendance. Maternal and neonatal deaths, immediate post-natal care and contraceptive provision remained within normal limits. Conclusion: The response to COVID-19 in Uganda has negatively impacted maternal, child and neonatal health, with the biggest and longest lasting impact seen in complications of pregnancy, stillbirths and low-birthweight infants likely due to delayed care-seeking behaviour. The decline in vaccination clinic attendance has implications for all vaccine-preventable diseases, with a cohort of infants currently unprotected. Further consideration of the impacts of restricting movement and limiting access to preventative services must be undertaken in responding to future pandemics if key maternal and child health services are to be maintained.

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Section: Discussionsupporting

confidence: 84%

Indirect Effects of COVID-19 on Maternal, Neonatal, Child, Sexual and Reproductive Health Services in Kampala, Uganda

Burt

Ouma

Lubyayi

et al. 2021

Preprint

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“…Similar to our findings, facilities in rural Uganda saw a drop in antenatal attendances, 31 as have hospitals in Kenya, Ethiopia, Zimbabwe and Rwanda in the first months of the pandemic. [32][33][34][35][36][37][38][39] The aim of preventative services is to reduce maternal and newborn morbidity and mortality and any reduction in their availability can give an indication of the potential longer term impactsincluding increased rates of maternal anaemia, puerperal sepsis, stillbirth, low birth weight, preterm birth, malaria infection, pre-eclampsia/eclampsia, mother to child transmission of HIV and neonatal tetanus. 40 Our study did not see an increase in maternal mortality despite fewer ANC attendances.…”

Section: Discussionmentioning

confidence: 99%

Indirect effects of COVID-19 on maternal, neonatal, child, sexual and reproductive health services in Kampala, Uganda

et al. 2021

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BackgroundCOVID-19 impacted global maternal, neonatal and child health outcomes. We hypothesised that the early, strict lockdown that restricted individuals’ movements in Uganda limited access to services.MethodsAn observational study, using routinely collected data from Electronic Medical Records, was carried out, in Kawempe district, Kampala. An interrupted time series analysis assessed the impact on maternal, neonatal, child, sexual and reproductive health services from July 2019 to December 2020. Descriptive statistics summarised the main outcomes before (July 2019–March 2020), during (April 2020–June 2020) and after the national lockdown (July 2020–December 2020).ResultsBetween 1 July 2019 and 31 December 2020, there were 14 401 antenatal clinic, 33 499 deliveries, 111 658 childhood service and 57 174 sexual health attendances. All antenatal and vaccination services ceased in lockdown for 4 weeks.During the 3-month lockdown, the number of antenatal attendances significantly decreased and remain below pre-COVID levels (370 fewer/month). Attendances for prevention of mother-to-child transmission of HIV dropped then stabilised. Increases during lockdown and immediately postlockdown included the number of women treated for high blood pressure, eclampsia and pre-eclampsia (218 more/month), adverse pregnancy outcomes (stillbirths, low-birth-weight and premature infant births), the rate of neonatal unit admissions, neonatal deaths and abortions. Maternal mortality remained stable. Immunisation clinic attendance declined while neonatal death rate rose (from 39 to 49/1000 livebirths). The number of children treated for pneumonia, diarrhoea and malaria decreased during lockdown.ConclusionThe Ugandan response to COVID-19 negatively impacted maternal, child and neonatal health, with an increase seen in pregnancy complications and fetal and infant outcomes, likely due to delayed care-seeking behaviour. Decreased vaccination clinic attendance leaves a cohort of infants unprotected, affecting all vaccine-preventable diseases. Future pandemic responses must consider impacts of movement restrictions and access to preventative services to protect maternal and child health.

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“…In the current COVID-19 era, provision of essential health services in public health facilities, including HIV and TB care, maternity care and care for patients with other chronic diseases has gone down substantially by an estimated 90% [20,[22][23][24]. Additionally, public health services which are principally utilized by individuals with no health insurance have over the years suffered from neglect and under investment with a poorly motivated health force [25].…”

Section: Discussionmentioning

confidence: 99%

Access to Health Insurance in Zimbabwe and associated factors: Insights from data from the Zimbabwe Demographic Health survey, 2015

Musuka¹,

Dzinamarira²,

Cuadros³

et al. 2021

Preprint

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Objective: To determine factors associated with access to health insurance among adults in Zimbabwe. Methods: We used statistical analysis to determine the association between various variables and access to health insurance using the Zimbabwe Demographic and Health Survey, 2015-16 data.Results: Overall, only 11% of 7397 females and 12% of 7420 males included in the analysis had access to health insurance. Age, educational level, marital status, religion, area of residence and wealth quintile were associated with access to health insurance for both females and males. For females, HIV status was associated with access to health insurance. Although not statistically significant a smaller proportion of HIV positive males (10%) had access to any medical insurance compared to their HIV negative counterparts (12%), p=0.189. Conclusion: Our study showed that geospatial distribution of individuals with access to health insurance in Zimbabwe is concentrated around urban areas. Since the bulk of Zimbabweans do not have access to health insurance and mainly use the public health sector for services, there is need for the Ministry of Health to enhance its investment in these facilities so that the bulk of the population can also get quality healthcare.

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Restoring and maintaining robust maternity services in the COVID-19 era: a public health dilemma in Zimbabwe

Cited by 13 publications

References 0 publications

Indirect Effects of COVID-19 on Maternal, Neonatal, Child, Sexual and Reproductive Health Services in Kampala, Uganda

Indirect Effects of COVID-19 on Maternal, Neonatal, Child, Sexual and Reproductive Health Services in Kampala, Uganda

Indirect effects of COVID-19 on maternal, neonatal, child, sexual and reproductive health services in Kampala, Uganda

Access to Health Insurance in Zimbabwe and associated factors: Insights from data from the Zimbabwe Demographic Health survey, 2015

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