The impact of COVID-19 on health service utilization in sub-Saharan Africa – a scoping review

Abstract

Introduction The Coronavirus Disease 2019(COVID-19) pandemic has undoubtedly exposed weaknesses in health systems, especially in sub-Saharan Africa (SSA). Despite comparatively low rates of COVID-19 admissions and recorded deaths in SSA, the pandemic still had a significant impact on health service utilization (HSU). The aim of this scoping review is to synthesize the available evidence on HSU in SSA during the COVID-19 pandemic focusing on changes in HSU generally and amongst particular patient groups studied. Methods The Scoping review was guided by the methodological framework for conducting scoping reviews developed by Arskey and O’Malley. We identified relevant studies through a search of PubMed(MEDLINE), Embase, Scopus and Web of Science. We then provided a general descriptive overview of the extracted data focusing on the types of studies, patient groups and change in HSU. Results We identified 262 studies reporting on HSU in 39 countries in SSA. The median study duration was 364.5[IQR:89 - 730] days. Studies were mainly quantitative 192(73.3%) and retrospective 117(44.7%). The majority were multiple centre studies 163(62.2%), hospital-based 205 (78.2%) and in urban settings 121(46.2%). Median number of participants was 8329[IQR:103-5848] involving 62.7% females. Communicable diseases were the most studied disease category in 92(35.1%) and mainly among out-patients 92(34.2%). Change in HSU was reported in 249(95.0%) of studies with 221(84.4%) of studies reporting a decrease in HSU. The median decrease in HSU was 35.6% [IQR: 19.0-55.8] and median increase was 16.2% [IQR: 9.1-31.9]. HSU was mostly reported among maternal and child health patients 58(22.1%) and people living with Human immunodeficiency virus 32(12.2%). The patient groups with the highest percentage decrease and increase in HSU were cardiovascular diseases 68.0%[IQR:16.7-71.1] and surgical cases 38.3%[IQR 24.0-52.5] respectively. Conclusion HSU was generally reduced during the COVID-19 pandemic among different patient groups in SSA.