The perfect storm: Disruptions to institutional delivery care arising from the COVID-19 pandemic in Nepal

Abstract

Background The COVID-19 pandemic has led to system-wide disruption of health services globally. We assessed the effect of the pandemic on the disruption of institutional delivery care in Nepal. Methods We conducted a prospective cohort study among 52 356 women in nine hospitals to assess the disruption of institutional delivery care during the pandemic (comparing March to August in 2019 with the same months in 2020). We also conducted a nested follow up cohort study with 2022 women during the pandemic to assess their provision and experience of respectful care. We used linear regression models to assess the association between provision and experience of care with volume of hospital births and women’s residence in a COVID-19 hotspot area. Results The mean institutional births during the pandemic across the nine hospitals was 24 563, an average decrease of 11.6% ( P < 0.0001) in comparison to the same time-period in 2019. The institutional birth in high-medium volume hospitals declined on average by 20.8% ( P < 0.0001) during the pandemic, whereas in low-volume hospital institutional birth increased on average by 7.9% ( P = 0.001). Maternity services halted for a mean of 4.3 days during the pandemic and there was a redeployment staff to COVID-19 dedicated care. Respectful provision of care was better in hospitals with low-volume birth (β = 0.446, P < 0.0001) in comparison to high-medium-volume hospitals. There was a positive association between women’s residence in a COVID-19 hotspot area and respectful experience of care (β = 0.076, P = 0.001). Conclusions The COVID-19 pandemic has had differential effects on maternity services with changes varying by the volume of births per hospital with smaller volume facilities doing better. More research is needed to investigate the effects of the pandemic on where women give birth and their provision and experience of respectful maternity care to inform a “building-back-better” approach in post-pandemic period.

Decline in Uptake of Childhood Vaccinations in a Tertiary Hospital in Northern Ghana during the COVID-19 Pandemic

“…The BCG vaccine given at birth was the most significantly affected vaccine. This may be due to a decline in the number of institutional deliveries or a decline in the number of births, with the former been more likely than the latter, as buttressed by previous studies [ 6 , 26 ]. Also, we recorded lower declines with progress in the vaccine schedule.…”

A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the COVID-19 pandemic

“…9 There have been a number of published studies that assessed effect of the COVID-19 pandemic on maternal health service utilisation in LMICs, all of which reported disruption in services during different periods of the pandemic. [12][13][14][15][16][17] Among the published studies, only one has been conducted across multiple facilities and country settings, finding that there was variation in patterns of service disruptions in maternal health service utilisation in eight sub-Saharan African countries. 13 Such comparative evidence is essential considering that levels of preparedness and response as well as the factors that led to disruption in maternal care service utilisation differ markedly between facilities and countries.…”

“…There have been a number of published studies that assessed effect of the COVID-19 pandemic on maternal health service utilisation in LMICs, all of which reported disruption in services during different periods of the pandemic 12–17. Among the published studies, only one has been conducted across multiple facilities and country settings, finding that there was variation in patterns of service disruptions in maternal health service utilisation in eight sub-Saharan African countries 13.…”

‘We are not going to shut down, because we cannot postpone pregnancy’: a mixed-methods study of the provision of maternal healthcare in six referral maternity wards in four sub-Saharan African countries during the COVID-19 pandemic

“…Townsend et al document a gap in the literature on maternity care provision during the COVID-19 pandemic in low-and middle-income countries, particularly in sub-Saharan Africa, 16 as the majority of the papers published from these contexts quantitatively describe changes in service utilisation. [33][34][35][36][37] A comprehensive, in-depth, quantitative and qualitative assessment of situation from the perspective of maternal SHP is lacking from the region. This paper is part of a larger study that presents an in-depth description of maternity care in six large maternity referrals in four sub-Saharan African countries (Guinea, Nigeria, Tanzania and Uganda) throughout the first year of the COVID-19 pandemic.…”

“…Townsend et al document a gap in the literature on maternity care provision during the COVID-19 pandemic in low- and middle-income countries, particularly in sub-Saharan Africa,16 as the majority of the papers published from these contexts quantitatively describe changes in service utilisation 33–37. A comprehensive, in-depth, quantitative and qualitative assessment of situation from the perspective of maternal SHP is lacking from the region.…”