Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low- and middle-income countries: An interrupted time-series analysis with mathematical modeling of administrative data

Ahmed, Tashrik and Roberton, Timothy and Vergeer, Petra and Hansen, Peter M. and Peters, Michael A. and Ofosu, Anthony Adofo and Mwansambo, Charles and Nzelu, Charles and Wesseh, Chea Sanford and Smart, Francis and Alfred, Jean Patrick and Diabate, Mamoutou and Baye, Martina and Yansane, Mohamed Lamine and Wendrad, Naod and Mohamud, Nur Ali and Mbaka, Paul and Yuma, Sylvain and Ndiaye, Youssoupha and Sadat, Husnia and Uddin, Helal and Kiarie, Helen and Tsihory, Raharison and Mwinnyaa, George and de Dieu Rusatira, Jean and Amor Fernandez, Pablo and Muhoza, Pierre and Baral, Prativa and Drouard, Salomé and Hashemi, Tawab and Friedman, Jed and Shapira, Gil and Persson, Lars Åke (2022) Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low- and middle-income countries: An interrupted time-series analysis with mathematical modeling of administrative data. PLOS Medicine, 19 (8). e1004070. ISSN 1549-1676

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Abstract

Background
The Coronavirus Disease 2019 (COVID-19) pandemic has had wide-reaching direct and indirect impacts on population health. In low- and middle-income countries, these impacts can halt progress toward reducing maternal and child mortality. This study estimates changes in health services utilization during the pandemic and the associated consequences for maternal, neonatal, and child mortality.

Methods and findings
Data on service utilization from January 2018 to June 2021 were extracted from health management information systems of 18 low- and lower-middle-income countries (Afghanistan, Bangladesh, Cameroon, Democratic Republic of the Congo (DRC), Ethiopia, Ghana, Guinea, Haiti, Kenya, Liberia, Madagascar, Malawi, Mali, Nigeria, Senegal, Sierra Leone, Somalia, and Uganda). An interrupted time-series design was used to estimate the percent change in the volumes of outpatient consultations and maternal and child health services delivered during the pandemic compared to projected volumes based on prepandemic trends. The Lives Saved Tool mathematical model was used to project the impact of the service utilization disruptions on child and maternal mortality. In addition, the estimated monthly disruptions were also correlated to the monthly number of COVID-19 deaths officially reported, time since the start of the pandemic, and relative severity of mobility restrictions. Across the 18 countries, we estimate an average decline in OPD volume of 13.1% and average declines of 2.6% to 4.6% for maternal and child services. We projected that decreases in essential health service utilization between March 2020 and June 2021 were associated with 113,962 excess deaths (110,686 children under 5, and 3,276 mothers), representing 3.6% and 1.5% increases in child and maternal mortality, respectively. This excess mortality is associated with the decline in utilization of the essential health services included in the analysis, but the utilization shortfalls vary substantially between countries, health services, and over time. The largest disruptions, associated with 27.5% of the excess deaths, occurred during the second quarter of 2020, regardless of whether countries reported the highest rate of COVID-19-related mortality during the same months. There is a significant relationship between the magnitude of service disruptions and the stringency of mobility restrictions. The study is limited by the extent to which administrative data, which varies in quality across countries, can accurately capture the changes in service coverage in the population.

Conclusions
Declines in healthcare utilization during the COVID-19 pandemic amplified the pandemic’s harmful impacts on health outcomes and threaten to reverse gains in reducing maternal and child mortality. As efforts and resource allocation toward prevention and treatment of COVID-19 continue, essential health services must be maintained, particularly in low- and middle-income countries.

Item Type: Article
Subjects: Institute Archives > Medical Science
Depositing User: Managing Editor
Date Deposited: 03 Dec 2022 04:26
Last Modified: 18 Jun 2024 06:35
URI: http://eprint.subtopublish.com/id/eprint/770

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