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

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 duri...

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Published in:	PLoS medicine Vol. 19; no. 8; p. e1004070
Main Authors:	Ahmed, Tashrik, Roberton, Timothy, Vergeer, Petra, Hansen, Peter M, Peters, Michael A, Ofosu, Anthony Adofo, Mwansambo, Charles, Nzelu, Charles, Wesseh, Chea Sanford, Smart, Francis, Alfred, Jean Patrick, Diabate, Mamoutou, Baye, Martina, Yansane, Mohamed Lamine, Wendrad, Naod, Mohamud, Nur Ali, Mbaka, Paul, Yuma, Sylvain, Ndiaye, Youssoupha, Sadat, Husnia, Uddin, Helal, Kiarie, Helen, Tsihory, Raharison, Mwinnyaa, George, de Dieu Rusatira, Jean, Amor Fernandez, Pablo, Muhoza, Pierre, Baral, Prativa, Drouard, Salomé, Hashemi, Tawab, Friedman, Jed, Shapira, Gil
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 30-08-2022 Public Library of Science (PLoS)
Subjects:	Biology and Life Sciences Child Child Health Services Child Mortality Coronaviruses COVID-19 COVID-19 - epidemiology COVID-19 vaccines Developing Countries Epidemics Family planning Health care Health facilities Health services Health services utilization Humans Immunization Infant, Newborn Infants Influence Information systems Low income groups Maternal mortality Mathematical models Medical care Medicine and Health Sciences Mobility Models, Theoretical Mortality Mothers Neonates Pandemics Patient Acceptance of Health Care Patient outcomes Population Population decline Prenatal care Public sector Resource allocation Time series Utilization United States Uganda Bangladesh Nigeria Kenya
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Summary:	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. 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. 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 The authors have declared that no competing interests exist.
ISSN:	1549-1676 1549-1277 1549-1676
DOI:	10.1371/journal.pmed.1004070