The direct and indirect impact of COVID-19 pandemic on maternal and child health services in Africa: a scoping review

Abstract

Introduction The novel coronavirus disease 2019 (COVID-19) continues to disrupt the availability and utilization of routine and emergency health care services, with differing impacts in jurisdictions across the world. In this scoping review, we set out to synthesize documentation of the direct and indirect effect of the pandemic, and national responses to it, on maternal, newborn and child health (MNCH) in Africa. Methods A scoping review was conducted to provide an overview of the most significant impacts identified up to March 15, 2022. We searched MEDLINE, Embase, HealthSTAR, Web of Science, PubMed, and Scopus electronic databases. We included peer reviewed literature that discussed maternal and child health in Africa during the COVID-19 pandemic, published from January 2020 to March 2022, and written in English. Papers that did not focus on the African region or an African country were excluded. A data-charting form was developed by the two reviewers to determine which themes to extract, and narrative descriptions were written about the extracted thematic areas. Results Four-hundred and seventy-eight articles were identified through our literature search and 27 were deemed appropriate for analysis. We identified three overarching themes: delayed or decreased care, disruption in service provision and utilization and mitigation strategies or recommendations. Our results show that minor consideration was given to preserving and promoting health service access and utilization for mothers and children, especially in historically underserved areas in Africa. Conclusions Reviewed literature illuminates the need for continued prioritization of maternity services, immunization, and reproductive health services. This prioritization was not given the much-needed attention during the COVID-19 pandemic yet is necessary to shield the continent’s most vulnerable population segments from the shocks of current and future global health emergencies.

Trends in fertility intentions and contraceptive practices in the context of COVID-19 in sub-Saharan Africa: insights from four national and regional population-based cohorts

“…While these initial studies were pivotal in reporting early pandemic trends, the longer term societal impacts of COVID-19, including rising poverty3 16 and interruptions to schooling and employment,17 were likely to affect relationships and childbearing decisions 18 19. At the same time, growing economic disparities were projected to affect people’s financial access and use of health services,4 20 potentially reducing their ability to achieve their reproductive goals. Furthermore, early impact estimates were drawn from phone-based surveys amid COVID-19 lockdowns, which may have affected the interpretation of early study findings due to selection bias and data collection mode 14 15 21.…”

Impacts of COVID-19 on reproductive health service provision, access, and utilization in Ethiopia: Results from a qualitative study with service users, providers, and stakeholders

“…Service provision shifted dramatically to accommodate the need for COVID-19 treatment and prevention efforts, at times at the expense of essential SRH services. This finding is reflected in other research as well; a scoping review of studies from across Africa found disruptions in maternal and child health service provision were a common theme in countries including South Africa and Kenya as well [ 9 ]. Declines in utilization of sexual and reproductive health services in the early months of the pandemic have been documented in numerous countries, such as Nigeria, South Africa, and Pakistan [ 32 , 33 ], as well as prior research in Ethiopia [ 12 , 24 ].…”

“…At the same time, efforts to mitigate the spread of COVID-19, such as travel restrictions and changes to health service delivery, have impacted the availability of SRH services, and subsequently SRH outcomes [ 8 ]. In a scoping review of research from across Africa, 78% of studies reported delayed or decreased access to maternal and child health services due to the pandemic [ 9 ]. Subsequently, preference for home birth increased, health facility visits and inpatient care decreased, and health system capacity was reduced, with added challenges faced by already vulnerable populations such as adolescents and displaced people [ 9 , 10 ].…”

“…In a scoping review of research from across Africa, 78% of studies reported delayed or decreased access to maternal and child health services due to the pandemic [ 9 ]. Subsequently, preference for home birth increased, health facility visits and inpatient care decreased, and health system capacity was reduced, with added challenges faced by already vulnerable populations such as adolescents and displaced people [ 9 , 10 ]. Marie Stopes International projected 1.3 million additional unintended pregnancies and 5,000 additional pregnancy-related deaths due to the pandemic in the 37 countries where they operate, including Ethiopia [ 11 ].…”

Effects of the COVID-19 pandemic on the outcomes of HIV-exposed neonates: a Zimbabwean tertiary hospital experience

“…Although we found no evidence of this, there was an increase in the number who were not risk-strati ed. This could be due to several reasons, for example reduced senior clinical oversight due to the increased work demands and reduced sta ng associated with the pandemic waves [19], the junior HCPs may have lacked the con dence to accurately stratify each neonate. Alongside this the time pressure to admit and discharge neonates may have meant the information to accurately stratify the HIV-exposed neonates may not have been available or accurately recorded.…”