Impact of the COVID-19 pandemic on utilisation of facility-based essential maternal and child health services from March to August 2020 compared with pre-pandemic March–August 2019: a mixed-methods study in North Shewa Zone, Ethiopia
Introduction Health systems are often weakened by public health emergencies that make it harder to access health services. We aimed to assess maternal, newborn and child health (MNCH) service utilisation during the first 6 months of the COVID-19 pandemic compared with prior to the pandemic.Methods W...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-06-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e059408.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832584193304952832 |
|---|---|
| author | Grace J Chan Delayehu Bekele Bezawit Mesfin Hunegnaw Kimiko Van Wickle Chalachew Bekele Fanos Ashenafi Gebremeskel Michelle Korte Christine Tedijanto Lisanu Taddesse |
| author_facet | Grace J Chan Delayehu Bekele Bezawit Mesfin Hunegnaw Kimiko Van Wickle Chalachew Bekele Fanos Ashenafi Gebremeskel Michelle Korte Christine Tedijanto Lisanu Taddesse |
| author_sort | Grace J Chan |
| collection | DOAJ |
| description | Introduction Health systems are often weakened by public health emergencies that make it harder to access health services. We aimed to assess maternal, newborn and child health (MNCH) service utilisation during the first 6 months of the COVID-19 pandemic compared with prior to the pandemic.Methods We conducted a mixed study design in eight health facilities that are part of the Birhan field site in Amhara, Ethiopia and compared the trend of service utilisation in the first 6 months of COVID-19 with the corresponding time and data points of the preceding year.Result New family planning visits (43.2 to 28.5/month, p=0.014) and sick under 5 child visits (225.0 to 139.8/month, p=0.007) declined over the first 6 months of the pandemic compared with the same period in the preceding year. Antenatal (208.9 to 181.7/month, p=0.433) and postnatal care (26.6 to 19.8/month, p=0.155) visits, facility delivery rates (90.7 to 84.2/month, p=0.776), and family planning visits (313.3 to 273.4/month, p=0.415) declined, although this did not reach statistical significance. Routine immunisation visits (37.0 to 36.8/month, p=0.982) for children were maintained. Interviews with healthcare providers and clients highlighted several barriers to service utilisation during COVID-19, including fear of disease transmission, economic hardship, and transport service disruptions and restrictions. Enablers of service utilisation included communities’ decreased fear of COVID-19 and awareness-raising activities.Conclusion We observed a decline in essential MNCH services particularly in sick children and new family planning visits. To improve the resiliency of fragile health systems, resources are needed to continuously monitor service utilisation and clients’ evolving concerns during public health emergencies. |
| format | Article |
| id | doaj-art-9fe9fd612dd54842b7d3222c3f46d20a |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-9fe9fd612dd54842b7d3222c3f46d20a2025-01-27T15:00:09ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2021-059408Impact of the COVID-19 pandemic on utilisation of facility-based essential maternal and child health services from March to August 2020 compared with pre-pandemic March–August 2019: a mixed-methods study in North Shewa Zone, EthiopiaGrace J Chan0Delayehu Bekele1Bezawit Mesfin Hunegnaw2Kimiko Van Wickle3Chalachew Bekele4Fanos Ashenafi Gebremeskel5Michelle Korte6Christine Tedijanto7Lisanu Taddesse8Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USADepartment of Obstetrics and Gynecology, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, EthiopiaHaSET Maternal and Child Health Research Program, Addis Ababa, EthiopiaDepartment of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USAHaSET, St Paul’s Hospital Millennium Medical College, Addis Ababa, EthiopiaBirhan HDSS, St Paul`s Hospital Millennium Medical College, Addis Ababa, EthiopiaDepartment of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USAFrancis I Proctor Foundation, University of San Francisco, San Francisco, California, USAHaSET Maternal and Child Health Research Program, Addis Ababa, EthiopiaIntroduction Health systems are often weakened by public health emergencies that make it harder to access health services. We aimed to assess maternal, newborn and child health (MNCH) service utilisation during the first 6 months of the COVID-19 pandemic compared with prior to the pandemic.Methods We conducted a mixed study design in eight health facilities that are part of the Birhan field site in Amhara, Ethiopia and compared the trend of service utilisation in the first 6 months of COVID-19 with the corresponding time and data points of the preceding year.Result New family planning visits (43.2 to 28.5/month, p=0.014) and sick under 5 child visits (225.0 to 139.8/month, p=0.007) declined over the first 6 months of the pandemic compared with the same period in the preceding year. Antenatal (208.9 to 181.7/month, p=0.433) and postnatal care (26.6 to 19.8/month, p=0.155) visits, facility delivery rates (90.7 to 84.2/month, p=0.776), and family planning visits (313.3 to 273.4/month, p=0.415) declined, although this did not reach statistical significance. Routine immunisation visits (37.0 to 36.8/month, p=0.982) for children were maintained. Interviews with healthcare providers and clients highlighted several barriers to service utilisation during COVID-19, including fear of disease transmission, economic hardship, and transport service disruptions and restrictions. Enablers of service utilisation included communities’ decreased fear of COVID-19 and awareness-raising activities.Conclusion We observed a decline in essential MNCH services particularly in sick children and new family planning visits. To improve the resiliency of fragile health systems, resources are needed to continuously monitor service utilisation and clients’ evolving concerns during public health emergencies.https://bmjopen.bmj.com/content/12/6/e059408.full |
| spellingShingle | Grace J Chan Delayehu Bekele Bezawit Mesfin Hunegnaw Kimiko Van Wickle Chalachew Bekele Fanos Ashenafi Gebremeskel Michelle Korte Christine Tedijanto Lisanu Taddesse Impact of the COVID-19 pandemic on utilisation of facility-based essential maternal and child health services from March to August 2020 compared with pre-pandemic March–August 2019: a mixed-methods study in North Shewa Zone, Ethiopia BMJ Open |
| title | Impact of the COVID-19 pandemic on utilisation of facility-based essential maternal and child health services from March to August 2020 compared with pre-pandemic March–August 2019: a mixed-methods study in North Shewa Zone, Ethiopia |
| title_full | Impact of the COVID-19 pandemic on utilisation of facility-based essential maternal and child health services from March to August 2020 compared with pre-pandemic March–August 2019: a mixed-methods study in North Shewa Zone, Ethiopia |
| title_fullStr | Impact of the COVID-19 pandemic on utilisation of facility-based essential maternal and child health services from March to August 2020 compared with pre-pandemic March–August 2019: a mixed-methods study in North Shewa Zone, Ethiopia |
| title_full_unstemmed | Impact of the COVID-19 pandemic on utilisation of facility-based essential maternal and child health services from March to August 2020 compared with pre-pandemic March–August 2019: a mixed-methods study in North Shewa Zone, Ethiopia |
| title_short | Impact of the COVID-19 pandemic on utilisation of facility-based essential maternal and child health services from March to August 2020 compared with pre-pandemic March–August 2019: a mixed-methods study in North Shewa Zone, Ethiopia |
| title_sort | impact of the covid 19 pandemic on utilisation of facility based essential maternal and child health services from march to august 2020 compared with pre pandemic march august 2019 a mixed methods study in north shewa zone ethiopia |
| url | https://bmjopen.bmj.com/content/12/6/e059408.full |
| work_keys_str_mv | AT gracejchan impactofthecovid19pandemiconutilisationoffacilitybasedessentialmaternalandchildhealthservicesfrommarchtoaugust2020comparedwithprepandemicmarchaugust2019amixedmethodsstudyinnorthshewazoneethiopia AT delayehubekele impactofthecovid19pandemiconutilisationoffacilitybasedessentialmaternalandchildhealthservicesfrommarchtoaugust2020comparedwithprepandemicmarchaugust2019amixedmethodsstudyinnorthshewazoneethiopia AT bezawitmesfinhunegnaw impactofthecovid19pandemiconutilisationoffacilitybasedessentialmaternalandchildhealthservicesfrommarchtoaugust2020comparedwithprepandemicmarchaugust2019amixedmethodsstudyinnorthshewazoneethiopia AT kimikovanwickle impactofthecovid19pandemiconutilisationoffacilitybasedessentialmaternalandchildhealthservicesfrommarchtoaugust2020comparedwithprepandemicmarchaugust2019amixedmethodsstudyinnorthshewazoneethiopia AT chalachewbekele impactofthecovid19pandemiconutilisationoffacilitybasedessentialmaternalandchildhealthservicesfrommarchtoaugust2020comparedwithprepandemicmarchaugust2019amixedmethodsstudyinnorthshewazoneethiopia AT fanosashenafigebremeskel impactofthecovid19pandemiconutilisationoffacilitybasedessentialmaternalandchildhealthservicesfrommarchtoaugust2020comparedwithprepandemicmarchaugust2019amixedmethodsstudyinnorthshewazoneethiopia AT michellekorte impactofthecovid19pandemiconutilisationoffacilitybasedessentialmaternalandchildhealthservicesfrommarchtoaugust2020comparedwithprepandemicmarchaugust2019amixedmethodsstudyinnorthshewazoneethiopia AT christinetedijanto impactofthecovid19pandemiconutilisationoffacilitybasedessentialmaternalandchildhealthservicesfrommarchtoaugust2020comparedwithprepandemicmarchaugust2019amixedmethodsstudyinnorthshewazoneethiopia AT lisanutaddesse impactofthecovid19pandemiconutilisationoffacilitybasedessentialmaternalandchildhealthservicesfrommarchtoaugust2020comparedwithprepandemicmarchaugust2019amixedmethodsstudyinnorthshewazoneethiopia |