Antenatal Care Service Utilization of Pregnant Women Attending Antenatal Care in Public Hospitals During the COVID-19 Pandemic Period

Adequacy of Antenatal Care during the COVID-19 Pandemic: Observational Study with Postpartum Women

OBJECTIVE

 The present study aimed to evaluate the antenatal care adequacy for women who gave birth at the University Hospital of Santa Catarina in Florianopolis (Brazil) during the COVID-19 pandemic, and to evaluate the association of adequacy with sociodemographic, clinical, and access characteristics.

METHODS

 Data were collected between October and December 2020, including 254 patients who delivered in the University Hospital from Federal University of Santa Catarina and answered our questionnaires. Additional data were obtained from patients' antenatal booklets. Antenatal care was classified as adequate, intermediate, or inadequate according to the number of appointments, gestational age at the beginning of follow-up, and tests results. We carried out a descriptive statistical analysis and a bivariate/with odds ratio analysis on maternal sociodemographic, clinical and health access variables that were compared with antenatal adequacy.

RESULTS

 Antenatal care was considered adequate in 35.8% of cases, intermediate in 46.8%, and inadequate in 17.4%. The following maternal variables were associated with inadequate prenatal care (intermediate or inadequate prenatal care): having black or brown skin colour, having two or more children, being of foreign nationality, not being fluent in Portuguese, and using illicit drugs during pregnancy; the clinical variables were more than 6 weeks between appointments, and not attending high-risk antenatal care; as for access, the variables were difficulties in attending or scheduling appointments, and attending virtual appointments only.

CONCLUSION

 In a sample of pregnant women from a teaching hospital in Florianópolis during the COVID-19 pandemic, antenatal care was considered adequate in 35.8%, intermediate in 46.8%, and inadequate in 17.4% of cases.

Assessment of maternal and child health care services performance in the context of COVID-19 pandemic in Addis Ababa, Ethiopia: evidence from routine service data

Background

In many settings, health care service provision has been modified to managing COVID-19 cases, and this has been affecting the provision of maternal and child health services. The aim of this study was to assess trends in selected maternal and child health services performance in the context of COVID-19 pandemic.

Methods

A cross-sectional data review was conducted in Addis Ababa, Ethiopia from April to May 2021. Routine health management information system database was reviewed from Addis Ababa Health Bureau for the period from July 2019 to March 2021 across all quarters. Proportion and mean with standard deviation were computed. T-test was used to assess statistically significant differences in services mean performance.

Results

Postnatal care  visit, new contraceptives accepters, safe abortion care and number of under-5 years old children treated for pneumonia significantly decreased by 9.3% (p-value 0.04), 20.3% (p-value 0.004), 23.7% (p-value 0.01) and 77.2% (p-value < 0.001), respectively during the first 8 months of the COVID-19 pandemic compared to the previous 8 months’ average performance. The trends in Antenatal care first visit, new contraceptive accepters, pentavalent-3 vaccination and under-five children treated for pneumonia began to decline in January to  March 2020, a quarter when the COVID-19 pandemic began; with accelerated declines in April to June 2020 following national lockdown. The trends for the stated services began to increase during July–September 2020, the last quarter of national lockdown. Contraceptive accepters and pentavalent-1 vaccination continued to decline and showed no recovery until January–March 2021 when this study was completed.

Conclusions

Most of the maternal and child health services performance declined following the onset of COVID-19 pandemic and national lockdown, and most of the services began recovering during July–September 2020, the last quarter of national lockdown. However, new and repeat contraceptive accepters and pentavalent-1 recipients continue to decline and show no recovery during end of the study period. Implementing COVID-19 prevention measures and assuring the community about the safety of service delivery is imperative to ensure continuity of the maternal and child health services. Regular monitoring and evaluation of services performance is required to identify slowly recovering services and respond to potentially volatile changes during the COVID-19 pandemic.

Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries

The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-based deliveries in all countries except Malawi from March to December 2020. Different strategies were adopted to maintain continuity of maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure compliance with international and national guidelines for front-line health workers, adapting spaces for safe distancing and ensuring the availability of personal protective equipment. We employ a local lens, providing prepandemic context and reporting results and strategies by country, to highlight the importance of developing context-specific interventions to design effective mitigation strategies.

Antenatal care services utilization during COVID-19 second wave attack in Pasuruan, Indonesia

Indonesia is currently experiencing the second wave of the COVID-19 pandemic, impacting maternal health services and maternal mortality. This research aims to investigate the use of antenatal care (ANC) during the COVID-19 second wave and the factors that play a role in this situation. A cross-sectional study was conducted during July 2021 on 344 pregnant women in primary, secondary, and tertiary maternal health care facilities in Pasuruan Regency, Indonesia. The data collection technique was simple random sampling, with face-to-face interviews assisted by questionnaires. Logistic regression and adjusted odds ratio with 95% CI and p<0.05 were performed to identify a significant relationship. 136 (39.5%) pregnant women did not use ANC services during the second wave of the COVID-19 outbreak. Husband’s support (AOR=13.814, 95% CI: 8.090–23.588), believing that pregnant women are not afraid of contracting COVID-19 (AOR=6.501, 95% CI: 3.904–10.825), easy access to transportation (AOR=12.145, 95% CI: 6.186–23.846), ease of ANC fees (AOR=4.105, 95% CI: 2.424–6.950), no lockdown policy (AOR=3.130, 95% CI: 1.983–4.940), knowledge regarding COVID-19 (AOR=2.975, 95% CI: 1.793–4.938), COVID-19 information on social media (AOR=3.035, 95% CI: 1.179–7.815), COVID-19 prevention protocols in health facilities (AOR=8.478, 95% CI: 3.611–19.903) were predictors of ANC utilization. This encourages the importance of prioritizing health services for pregnant women during the pandemic, overcoming the fear of contracting COVID-19 through maternal education, husband support, easy access to ANC, and improving the quality of ANC service facilities.

Designing a Logic Model for Mobile Maternal Health e-Voucher Programs in Low- and Middle-Income Countries: An Interpretive Review

Despite the increasing transition from paper vouchers to mobile e-vouchers for maternal health in low- and middle-income countries, few studies have reviewed key elements for program planning, implementation, and evaluation. To bridge this gap, this study conducted an interpretive review and developed a logic model for mobile maternal health e-voucher programs. Pubmed, EMBASE, and Cochrane databases were searched to retrieve relevant studies; 27 maternal health voucher programs from 84 studies were identified, and key elements for the logic model were retrieved and organized systematically. Some of the elements identified have the potential to be improved greatly by shifting to mobile e-vouchers, such as payment via mobile money or electronic claims processing and data entry for registration. The advantages of transitioning to mobile e-voucher identified from the logic model can be summarized as scalability, transparency, and flexibility. The present study contributes to the literature by providing insights into program planning, implementation, and evaluation for mobile maternal health e-voucher programs.

Impact of COVID-19 on maternal healthcare in Africa and the way forward

Background

The impact of COVID-19 is weighing heavily on many African countries. As of November 14th 2021, 6,109,722 cases had been recorded with 151,173 deaths and 2.5% case fatality rate. Studies reveal substantial morbidity and socioeconomic impacts when accessing quality maternal healthcare including fear of infection and the containment measures in place, including social distancing and community containment. The pandemic has put additional strain on healthcare systems that are overburdened and under-resourced even in normal times and has exposed the vulnerabilities of high-risk population groups in addressing critical healthcare concerns. This study presents a mini review of how COVID-19 has disrupted maternal healthcare in Africa, and it further proposes ways to improve the situation.

Main body

COVID-19 has disrupted antenatal, skilled birth, and postnatal family planning services. Women and girls are vulnerable to the impact of COVID-19 on several fronts and represent a group whose needs including antenatal, skilled birth, and postnatal family planning services have been disrupted, leading to unmet needs for contraception and an increase in unintended pregnancies. Restricted travel due to the fear and anxiety associated with contracting COVID-19 has resulted in delays in accessing prompt skilled care and essential healthcare services such as pregnancy care, immunisation, and nutritional supplementation. Misconceptions relating to COVID-19 have prompted concerns and created distrust in the safety of the healthcare system. Innovative measures are required to address these obstacles and ensure women are not denied access to available, accessible, acceptable, and quality maternal healthcare services in spite of COVID-19.

Conclusions

In the immediate term while physical distancing measures remain in force, deliberate effort must be made to provide evidence-based guidelines, good practice and expert advice that addresses the unique sexual and reproductive health context of African countries. Efforts to train and motivate healthcare providers to adopt online, remote approaches such as use of telemedicine, and expand the involvement of frontline maternal healthcare providers to deliver information on the availability of services through phone-based referral networks, culturally appropriate social media, community radio and folklore messaging strategies are critical to mobilise and secure community confidence in the safety of sexual and reproductive health and maternal care services.

Obstetric challenges during COVID-19 pandemic: A narrative review

The severe acute respiratory coronavirus 2 (COVID-19) pandemic impacts the health of women at reproductive age in different ways, starting from pregnancy planning to post-delivery. This narrative review summarises the challenges to obstetric practice posed by the severe acute respiratory coronavirus 2 (COVID-19) pandemic. In this paper, we highlight the impacts of COVID-19 to obstetric practice globally and the efforts taken to address these challenges. Further study is critical to investigate the effects of COVID-19 on pregnancy, the outcome of COVID-19 positive pregnant women, and the safety of vaccination during pregnancy and breastfeeding.

Antenatal care dropout and associated factors among mothers delivering in public health facilities of Dire Dawa Town, Eastern Ethiopia

Introduction

More than two-thirds of the pregnant women in Africa have at least one antenatal care contact with a health care provider. However, to achieve the full life-saving potential that antenatal care promises for women and babies, four visits providing essential evidence-based interventions – a package often called focused antenatal care are required. Hence, identifying the factors associated with dropout of maternal health care utilization would have meaningful implications. The study aimed to assess antenatal care dropout and associated factors among mothers delivering in the public health facilities of Dire Dawa town, Ethiopia.

Methods

Facility-based cross-sectional study was conducted from January 1 to 30, 2020. Proportionate sampling and simple random sampling techniques were used to select 230 women. Data were collected using a structured and pretested interview administered questionnaire during delivery. The data were entered into Epidata version 3.1 and analyzed using SPSS version 20. A binary logistic regression model with a 95 % confidence interval was used to analyze the results. Bivariable analysis (COR [crude odds ratio]) and multivariable analysis (AOR [adjusted odds ratio]) was used to analyze the results. From the bivariable analysis, variables with a p-value < 0.25 were entered into the multivariable logistic regression analysis. From the multivariable logistic regression analysis, variables with a significance level of p-value < 0.05 were taken as factors independently associated with ANC dropout.

Result

The proportion of antenatal care dropouts was 86 (37.4 %) (95 % CI: 31.3–43.9). In logistic regression analyses, those who had no past antenatal care follow up were more likely to have ANC dropout (AOR = 7.89; 95 % CI: 2.109–29.498) and those who had no professional advice were more likely to have antenatal care dropout (AOR = 4.64 95 % CI: 1.246–17.254).

Conclusions

This study indicates that a high number of women had antenatal care dropout. Having no past ANC follow-up and professional advice were the major factors of ANC service utilization dropout. Hence, giving more information during the ANC visit is important to reduce the dropout rate from the maternity continuum of care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04107-7.

Effect of COVID-19 pandemic on provision of sexual and reproductive health services in primary health facilities in Nigeria: a cross-sectional study

Background

Nigeria, like many other countries, has been severely affected by the COVID-19 pandemic. While efforts have been devoted to curtailing the disease, a major concern has been its potential effects on the delivery and utilization of reproductive health care services in the country. The objective of the study was to investigate the extent to which the COVID-19 pandemic and related lockdowns had affected the provision of essential reproductive, maternal, child, and adolescent health (RMCAH) services in primary health care facilities across the Nigerian States.

Methods

This was a cross-sectional study of 307 primary health centres (PHCs) in 30 Local Government Areas in 10 States, representing the six geopolitical regions of the country. A semi-structured interviewer-administered questionnaire was used to obtain data on issues relating to access and provision of RMCAH services before, during and after COVID-19 lockdowns from the head nurses/midwives in the facilities. The questionnaire was entered into Open Data Kit mounted on smartphones. Data were analysed using frequency and percentage, summary statistics, and Kruskal–Wallis test.

Results

Between 76 and 97% of the PHCS offered RMCAH services before the lockdown. Except in antenatal, delivery and adolescent care, there was a decline of between 2 and 6% in all the services during the lockdown and up to 10% decline after the lockdown with variation across and within States. During the lockdown. Full-service delivery was reported by 75.2% whereas 24.8% delivered partial services. There was a significant reduction in clients’ utilization of the services during the lockdown, and the difference between States before the pandemic, during, and after the lockdown. Reported difficulties during the lockdown included stock-out of drugs (25.7%), stock-out of contraceptives (25.1%), harassment by the law enforcement agents (76.9%), and transportation difficulties (55.8%). Only 2% of the PHCs reported the availability of gowns, 18% had gloves, 90.1% had hand sanitizers, and a temperature checker was available in 94.1%. Slightly above 10% identified clients with symptoms of COVID-19.

Conclusions

The large proportion of PHCs who provided RMCAH services despite the lockdown demonstrates resilience. Considering the several difficulties reported, and the limited provision of primary protective equipment more effort by the government and non-governmental agencies is recommended to strengthen delivery of sexual and reproductive health in primary health centres in Nigeria during the pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01217-5.

The onset of COVID-19 has raised concerns that it may compromise women’s access to sexual and reproductive health and rights. Although data are still emerging, some reports indicate reduced access to sexual and reproductive health services, largely due to disruptions in the demand and supply of contraceptive commodities, the diversion of staff and resources to other clinical services, and clinic closures. While these concerns have similarly been broached for Nigeria, there has been no systematic documentation of the extent of the disruptions of reproductive health services caused by COVID-19 and its effects on the provision and utilization of related services in the country This study was a cross-sectional facility-based survey conducted in 10 states, 30 Local Government Areas and 302 primary health centres in Nigeria. The objective of the study was to explore through key informant interviews with service providers in the health centres, the effects of the COVID-19 pandemic on demand and supply of sexual and reproductive health services. Field assistants administered a semi-structured interview guide to the heads of the health centres that elicited information on availability and use of the health centres before, during and after the lock-downs associated with the pandemic. The results indicate that a large proportion of the health centres opened for the provision of essential sexual and reproductive health services during the COVID-19 pandemic lockdown. However, fewer clients used the services due to difficulties in travel because of the lockdowns, stock-outs in the health centres, and the fear that they may contract the virus if they leave their houses to the health centres. Although the health centres reported some cases of COVID-19, there was limited provision for personal protective equipment to motivate the health workers to optimize services for clients. From this study, we conclude that efforts should be made to identify innovations for addressing these challenges to enable the continued provision of sexual and reproductive health services by health centres despite the COVID-19 pandemic in Nigeria’s health centres.

Indirect effects of COVID-19 on maternal, neonatal, child, sexual and reproductive health services in Kampala, Uganda

BACKGROUND

COVID-19 impacted global maternal, neonatal and child health outcomes. We hypothesised that the early, strict lockdown that restricted individuals' movements in Uganda limited access to services.

METHODS

An observational study, using routinely collected data from Electronic Medical Records, was carried out, in Kawempe district, Kampala. An interrupted time series analysis assessed the impact on maternal, neonatal, child, sexual and reproductive health services from July 2019 to December 2020. Descriptive statistics summarised the main outcomes before (July 2019-March 2020), during (April 2020-June 2020) and after the national lockdown (July 2020-December 2020).

RESULTS

Between 1 July 2019 and 31 December 2020, there were 14 401 antenatal clinic, 33 499 deliveries, 111 658 childhood service and 57 174 sexual health attendances. All antenatal and vaccination services ceased in lockdown for 4 weeks.During the 3-month lockdown, the number of antenatal attendances significantly decreased and remain below pre-COVID levels (370 fewer/month). Attendances for prevention of mother-to-child transmission of HIV dropped then stabilised. Increases during lockdown and immediately postlockdown included the number of women treated for high blood pressure, eclampsia and pre-eclampsia (218 more/month), adverse pregnancy outcomes (stillbirths, low-birth-weight and premature infant births), the rate of neonatal unit admissions, neonatal deaths and abortions. Maternal mortality remained stable. Immunisation clinic attendance declined while neonatal death rate rose (from 39 to 49/1000 livebirths). The number of children treated for pneumonia, diarrhoea and malaria decreased during lockdown.

CONCLUSION

The Ugandan response to COVID-19 negatively impacted maternal, child and neonatal health, with an increase seen in pregnancy complications and fetal and infant outcomes, likely due to delayed care-seeking behaviour. Decreased vaccination clinic attendance leaves a cohort of infants unprotected, affecting all vaccine-preventable diseases. Future pandemic responses must consider impacts of movement restrictions and access to preventative services to protect maternal and child health.

Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis

Background

The COVID-19 pandemic has had a profound impact on healthcare systems globally, with a worrying increase in adverse maternal and foetal outcomes. We aimed to assess the changes in maternity healthcare provision and healthcare-seeking by pregnant women during the COVID-19 pandemic.

Methods

We performed a systematic review and meta-analysis of studies of the effects of the pandemic on provision of, access to and attendance at maternity services (CRD42020211753). We searched MEDLINE and Embase in accordance with PRISMA guidelines from January 1st, 2020 to April 17th 2021 for controlled observational studies and research letters reporting primary data comparing maternity healthcare-seeking and healthcare delivery during compared to before the COVID-19 pandemic. Case reports and series, systematic literature reviews, and pre-print studies were excluded. Meta-analysis was performed on comparable outcomes that were reported in two or more studies. Data were combined using random-effects meta-analysis, using risk ratios (RR) or incidence rate ratios (IRR) with 95% confidence intervals (CI).

Findings

Of 4743 citations identified, 56 were included in the systematic review, and 21 in the meta-analysis. We identified a significant decrease in the number of antenatal clinic visits (IRR 0614, 95% CI 0486-0776, P<00001, I2=54.6%) and unscheduled care visits (IRR 0741, 95% CI 0602-0911, P = 00046, I2=00%) per week, and an increase in virtual or remote antenatal care (IRR 4656 95% CI 7762-2794, P<00001, I2=90.6%) and hospitalisation of unscheduled attendees (RR 1214, 95% CI 1118-1319, P<00001, I2=00%). There was a decrease in the use of GA for category 1 Caesarean sections (CS) (RR 0529, 95% CI 0407-0690, P<00001, I2=00%). There was no significant change in intrapartum epidural use (P = 00896) or the use of GA for elective CS (P = 079).

Interpretation

Reduced maternity healthcare-seeking and healthcare provision during the COVID-19 pandemic has been global, and must be considered as potentially contributing to worsening of pregnancy outcomes observed during the pandemic.

Impact of Coronavirus Diseases-2019 (COVID-19) on Utilization and Outcome of Reproductive, Maternal, and Newborn Health Services at Governmental Health Facilities in South West Ethiopia, 2020: Comparative Cross-Sectional Study

Background

In low-and middle-income countries, it is challenging to provide basic health-care services even before the COVID-19 pandemic outbreak. The purpose of this study was to evaluate the early indirect impact of COVID-19 on the utilization of reproductive, maternal, and newborn health services at government health facilities in South West Ethiopia, and its consequences.

Methods

A comparative cross-sectional study was employed. The collected data were entered into Microsoft excel 2010 and then exported to SPSS 25 and R3.5.0 software for analysis. Independent sample t-test and two-sample test of proportion were computed, and the results were presented in text, tables, and graphs. P-value <0.05 was considered statistically significant.

Results

This study showed that there was a significant reduction in mean utilization of antenatal care (943.25 visits vs 694.75 visits), health facility birth (808.75 births vs 619 births), family planning (4744.5 visits vs 3991.25 visits), and newborn immunization (739.5 given vs 528.5 given) between March–June 2019 and March–June 2020. However, there were significant increases in proportion of teenage pregnancy (7.5% vs 13.1%), teenage abortion care user (21.3% vs 28.5%), institutional stillbirth (14% vs 21.8%) and neonatal death (33.1% vs 46.2%) during the same period.

Conclusion and Recommendation

This study showed that utilization of reproductive, maternal, and newborn health-care services was affected by the pandemic with deterioration of maternal and perinatal outcomes. An increase in the proportion of teenage pregnancy who seeks abortion care and the rising cesarean section rate with no improvement in perinatal outcome is a great concern that needs further investigation. Further research is also needed to explore the main reason for an increase in teenage pregnancy, abortion care users, stillbirth, and neonatal death during COVID-19.

The Potential Impact of COVID-19 Pandemic on the Antenatal Care as Perceived by Non-COVID-19 Pregnant Women: Women's Experience Research Brief

We aimed to study the impact of Coronavirus disease 2019 (COVID-19) pandemic on the basic antenatal care received during the. A facility-based descriptive cross-sectional study was conducted and 62 pregnant women were interviewed. A total of 80.6% of mothers were satisfied with the quality of antenatal care they received, ≥ 7 of 10 on visual analogue scales (VAS). The majority of women were not confident to deliver their baby and 58.1% of women showed ≤ 5 of 10 on VAS. Midwife (90.3%) was the commonest source of information. Internet (1.6%) was a poor source. The impact of the COVID-19 pandemic on the quality of antenatal care was significant, and the findings are useful for the policymakers to plan necessary actions.

Effect of the COVID-19 pandemic on health facility delivery in Ethiopia; results from PMA Ethiopia's longitudinal panel

OBJECTIVES

To examine the effect of COVID-19 on health facility delivery in Ethiopia.

DESIGN

We used longitudinal data with a pre-post exposure to the pandemic to assess change in facility delivery patterns nationally and by urban and rural strata. We conducted design-based multivariable multinomial logistic regression comparing home, lower-level facility, and hospital delivery with date of birth as a spline term, with a knot indicating births before and on/after April 8, 2020.

SETTING

Six regions in Ethiopia, covering 91% of the population.

PARTICIPANTS

Women were eligible to participate if they were currently pregnant or less than six weeks postpartum and were recontacted at six weeks, six months, and one year postpartum. 2,889 women were eligible and 2,855 enrolled. Data used in this paper come from the six-week interview, with a follow-up rate of 88.9% (2,537 women).

RESULTS

In urban areas, women who delivered during the COVID-19 pandemic had a 77% reduced relative risk of delivering in a hospital relative to women who delivered prior to the pandemic (aRRR: 0.23, 95% CI: 0.07-0.71). There were no significant differences between the pre- and COVID-19 periods within rural strata where the majority of women deliver at home (55.6%). Overall, the effect was non-significant at a national level. Among women who delivered during the COVID-19 pandemic, 20.0% of urban women said COVID-19 affected where they delivered relative to 8.7% of rural women (p-value = 0.01).

CONCLUSION

We found that delivery patterns in urban areas changed during the early months of the COVID-19 pandemic, but there was no evidence of large-scale declines of hospital delivery at the national level. Concerns about COVID-19 transmission in health facilities and ensuring lower-level facilities are equipped to address obstetric emergencies are critical to address. COVID-19 will likely slow progress towards increasing rates of institutional delivery in urban areas in Ethiopia.