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Journal Article Epublish 87 citations

PubMed: 36040910 DOI: 10.1371/journal.pmed.1004070

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 Med 19(8):e1004070

Authors: Tashrik Ahmed, Timothy Roberton, Petra Vergeer, Peter M Hansen, Michael A Peters, Anthony Adofo Ofosu, Charles Mwansambo, Charles Nzelu, Chea Sanford Wesseh, Francis Smart, Jean Patrick Alfred, Mamoutou Diabate, Martina Baye, Mohamed Lamine Yansane, Naod Wendrad, Nur Ali Mohamud, Paul Mbaka, Sylvain Yuma, Youssoupha Ndiaye, Husnia Sadat, Helal Uddin, Helen Kiarie, Raharison Tsihory, George Mwinnyaa, Jean de Dieu Rusatira, Pablo Amor Fernandez, Pierre Muhoza, Prativa Baral, Salomé Drouard, Tawab Hashemi, Jed Friedman, Gil Shapira

Affiliations

  • The Global Financing Facility for Women, Children, and Adolescents, Washington, DC, United States of America.
  • Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America.
  • Development Research, The World Bank, Washington, United States of America.
  • Ghana Health Service, Accra, Ghana.
  • Ministry of Health, Lilongwe, Malawi.
  • Federal Ministry of Health, Abuja, Nigeria.
  • Ministry of Health, Monrovia, Liberia.
  • Ministry of Health and Sanitation, Freetown, Sierra Leone.
  • Ministère de la Sante publique et de la population, Port-au-Prince, Haiti.
  • Ministère de la Santé et de l'Hygiène Publique, Bamako, Mali.
  • Ministére de la Sante Publiqué, Yaoundé, Cameroon.
  • Ministère de la Sante, Conakry, Guinea.
  • Ministry of Health, Addis-Ababa, Ethiopia.
  • Federal Ministry of Health & Human Services, Mogadishu, Somalia.
  • Ministry of Health, Kampala, Uganda.
  • Ministére de la Sante, Kinshasa, Republique Democratique du Congo.
  • Ministere de la santé et de l'action sociale, Dakar, Senegal.
  • Ministry of Health and Family Welfare, Dhaka, Bangladesh.
  • Ministry of Health, Nairobi, Kenya.
  • Ministère de la Sante publique, Antananarivo, Madagascar.

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.

MeSH

Maternal Mortality, Income, Health Services, Child Mortality, Pandemics, Interrupted Time Series Analysis, Covid-19

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