TY - JOUR
T1 - Health service utilisation during the COVID-19 pandemic in sub-Saharan Africa in 2020
T2 - A multicountry empirical assessment with a focus on maternal, newborn and child health services
AU - Amouzou, Agbessi
AU - Maïga, Abdoulaye
AU - Faye, Cheikh Mbacke
AU - Chakwera, Samuel
AU - Melesse, Dessalegn Y.
AU - Mutua, Martin Kavao
AU - Thiam, Sokhna
AU - Abdoulaye, Idrissa Boukary
AU - Afagbedzi, Seth Kwaku
AU - Ag Iknane, Akory
AU - Ake-Tano, Odile Sassor
AU - Akinyemi, Joshua O.
AU - Alegana, Victor
AU - Alhassan, Yakubu
AU - Sam, Arinaitwe Emma
AU - Atweam, Dominic Kwabena
AU - Bajaria, Shraddha
AU - Bawo, Luke
AU - Berthé, Mamadou
AU - Blanchard, Andrea Katryn
AU - Bouhari, Hamissou Alaji
AU - Boulhassane, Ousmane Maimouna Ali
AU - Bulawayo, Maio
AU - Chooye, Ovost
AU - Coulibaly, Amed
AU - Diabate, Mamatou
AU - Diawara, Fatou
AU - Esleman, Ousman
AU - Gajaa, Mulugeta
AU - Garba, Kamil Halimatou Amadou
AU - Getachew, Theodros
AU - Jacobs, Choolwe
AU - Jacobs, George P.
AU - James, Femi
AU - Jegede, Ayodele S.
AU - Joachim, Catherine
AU - Kananura, Rornald Muhumuza
AU - Karimi, Janette
AU - Kiarie, Helen
AU - Kpebo, Denise
AU - Lankoandé, Bruno
AU - Lawanson, Akanni Olayinka
AU - Mahamadou, Yahaha
AU - Mahundi, Masoud
AU - Manaye, Tewabe
AU - Masanja, Honorati
AU - Millogo, Modeste Roch
AU - Mohamed, Abdoul Karim
AU - Musukuma, Mwiche
AU - Muthee, Rose
AU - Nabié, Douba
AU - Nyamhagata, Mukome
AU - Ogwal, Jimmy
AU - Orimadegun, Adebola
AU - Ovuoraye, Ajiwohwodoma
AU - Pongathie, Adama Sanogo
AU - Sable, Stéphane Parfait
AU - Saydee, Geetor S.
AU - Shabini, Josephine
AU - Sikapande, Brivine Mukombwe
AU - Simba, Daudi
AU - Tadele, Ashenif
AU - Tadlle, Tefera
AU - Tarway-Twalla, Alfred K.
AU - Tassembedo, Mahamadi
AU - Tehoungue, Bentoe Zoogley
AU - Terera, Ibrahim
AU - Traoré, Soumaïla
AU - Twalla, Musu P.
AU - Waiswa, Peter
AU - Wondirad, Naod
AU - Boerma, Ties
N1 - Funding Information:
Contributors TB conceptualised the study with substantial contribution from AA, AM, and CMF. AA led the descriptive and modeling analyses. AM led the data quality analysis. All facilitators (AA, AM, CMF, SC, MD, MM, STh and BZT) worked with country teams to run specific country analyses. TB prepared the initial draft, complemented by AA and AM. All authors reviewed critically the manuscript, provided comments and approved the final manuscript. TB is the guarantor. Funding This work was supported by a grant of the Bill & Melinda Gates Foundation to the Countdown to 2030 for Women’s, Children’s and Adolescents’ Health, through US Fund for UNICEF (grant number INV-001299). Additional funding was provided by UNICEF. Competing interests None declared. Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Patient consent for publication Not applicable.
Publisher Copyright:
©
PY - 2022/5/2
Y1 - 2022/5/2
N2 - Introduction There are concerns about the impact of the COVID-19 pandemic on the continuation of essential health services in sub-Saharan Africa. Through the Countdown to 2030 for Women's, Children's and Adolescents' Health country collaborations, analysts from country and global public health institutions and ministries of health assessed the trends in selected services for maternal, newborn and child health, general service utilisation. Methods Monthly routine health facility data by district for the period 2017-2020 were compiled by 12 country teams and adjusted after extensive quality assessments. Mixed effects linear regressions were used to estimate the size of any change in service utilisation for each month from March to December 2020 and for the whole COVID-19 period in 2020. Results The completeness of reporting of health facilities was high in 2020 (median of 12 countries, 96% national and 91% of districts ≥90%), higher than in the preceding years and extreme outliers were few. The country median reduction in utilisation of nine health services for the whole period March-December 2020 was 3.9% (range: -8.2 to 2.4). The greatest reductions were observed for inpatient admissions (median=-17.0%) and outpatient admissions (median=-7.1%), while antenatal, delivery care and immunisation services generally had smaller reductions (median from -2% to -6%). Eastern African countries had greater reductions than those in West Africa, and rural districts were slightly more affected than urban districts. The greatest drop in services was observed for March-June 2020 for general services, when the response was strongest as measured by a stringency index. Conclusion The district health facility reports provide a solid basis for trend assessment after extensive data quality assessment and adjustment. Even the modest negative impact on service utilisation observed in most countries will require major efforts, supported by the international partners, to maintain progress towards the SDG health targets by 2030.
AB - Introduction There are concerns about the impact of the COVID-19 pandemic on the continuation of essential health services in sub-Saharan Africa. Through the Countdown to 2030 for Women's, Children's and Adolescents' Health country collaborations, analysts from country and global public health institutions and ministries of health assessed the trends in selected services for maternal, newborn and child health, general service utilisation. Methods Monthly routine health facility data by district for the period 2017-2020 were compiled by 12 country teams and adjusted after extensive quality assessments. Mixed effects linear regressions were used to estimate the size of any change in service utilisation for each month from March to December 2020 and for the whole COVID-19 period in 2020. Results The completeness of reporting of health facilities was high in 2020 (median of 12 countries, 96% national and 91% of districts ≥90%), higher than in the preceding years and extreme outliers were few. The country median reduction in utilisation of nine health services for the whole period March-December 2020 was 3.9% (range: -8.2 to 2.4). The greatest reductions were observed for inpatient admissions (median=-17.0%) and outpatient admissions (median=-7.1%), while antenatal, delivery care and immunisation services generally had smaller reductions (median from -2% to -6%). Eastern African countries had greater reductions than those in West Africa, and rural districts were slightly more affected than urban districts. The greatest drop in services was observed for March-June 2020 for general services, when the response was strongest as measured by a stringency index. Conclusion The district health facility reports provide a solid basis for trend assessment after extensive data quality assessment and adjustment. Even the modest negative impact on service utilisation observed in most countries will require major efforts, supported by the international partners, to maintain progress towards the SDG health targets by 2030.
KW - COVID-19
KW - Child health
KW - Health systems
KW - Immunisation
KW - Maternal health
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U2 - 10.1136/bmjgh-2021-008069
DO - 10.1136/bmjgh-2021-008069
M3 - Article
C2 - 35501068
AN - SCOPUS:85130892327
SN - 2059-7908
VL - 7
JO - BMJ Global Health
JF - BMJ Global Health
IS - 5
M1 - e008069
ER -