The impacts of COVID-19 and its policy response on access and utilization of maternal and child health services in Tanzania: A mixed methods study

Tuberculosis service delivery challenges and their mitigations during the COVID-19 pandemic in Tanzania: a qualitative study

OBJECTIVE

To describe challenges posed by COVID-19 on tuberculosis (TB) commodity supply, care cascade, active case finding and responses taken by healthcare workers (HCWs) and community health workers (CHWs) during the first year of the pandemic (March 2020 to February 2021).

DESIGN

A qualitative descriptive study involving 25 in-depth interviews and 10 focus group discussions conducted in July 2022.

SETTING

37 TB treatment facilities were purposively selected from seven regions due to high TB case notifications in 2019 and their provision of TB and COVID-19 services during the first year of the pandemic (March 2020 to February 2021).

PARTICIPANTS

Purposive selection of 58 HCWs and 55 CHWs who provided TB services in the first year of the COVID-19 pandemic.

RESULTS

HCWs reported unusual stockouts and delayed receipt of GeneXpert cartridges and sputum containers. TB services faced a decline in client attendance, as clients were hesitant to undergo TB screening, sputum sample collection and contact tracing due to fear of contracting or being diagnosed with COVID-19 and subsequently being quarantined. To mitigate these challenges, HCWs used alternative containers for sputum sample collection, optimised GeneXpert cartridge use by prioritising GeneXpert testing for TB risk groups and diagnosed TB by microscopy, chest X-ray and sputum pooling method. Moreover, they extended drug refill schedules to minimise the risk of contracting COVID-19 in clinics. CHWs used mobile communication for client tracing and focused household visits on TB risk groups.

CONCLUSION

COVID-19 disrupted TB commodity availability and TB treatment-seeking behaviour. Adaptations like multi-month drug refills and optimised GeneXpert use supported the TB healthcare system's resilience. While these adaptations offer valuable insights for strengthening TB service delivery, their effectiveness and sustainability require further evaluation. Thus, prospective studies could clarify their long-term impact. National Tuberculosis Program could consider adapting these practices postpandemic, with appropriate modifications to suit different contexts.

Understanding the impact of the COVID-19 pandemic on HIV/AIDS care and management in Tanzania: challenges, adaptations and lessons learnt-a review

This review examines the impact of the COVID-19 pandemic on HIV/AIDS care and management in Tanzania, highlighting challenges, adaptations and lessons learnt. The pandemic has led to disruptions in service delivery, reduced access to testing and treatment, and increased stigma and discrimination. Adaptations and innovations, such as telemedicine (telehealth and virtual care), multimonth dispensing of antiretroviral therapy, decentralised drug distribution initiatives, have been implemented to mitigate the challenges faced in HIV/AIDS care and management. Integration of HIV/AIDS and COVID-19 services is crucial to ensure the continuity of care and management in the postpandemic by strengthening healthcare systems, improving supply chain management and enhancing community engagement.

Impact of COVID-19 lockdown measures on mother and child health - the case of Ghana

BACKGROUND

The lockdown measures in response to the coronavirus disease (COVID-19) have led to a wide range of unintended consequences for women and children. Until the outbreak of COVID-19, attention was on reducing maternal and infant mortality due to pregnancy and delivery complications. The aim of this study was to interrogate the impact of lockdown measures on women and children in two contrasting districts in Ghana - Krobo Odumase and Ayawaso West Wuogon.

METHODS

This study adopted the mixed-method approach using both qualitative and quantitative data. The qualitative study relied on two data collection methods to explore the impacts of COVID-19 control measures on women and children in Ghana. These were: Focus Group Discussions (FGDs; n = 12) and Key Informant Interviews (KIIs; n = 18). The study complemented the qualitative data with survey data - household surveys (n = 78) which were used to support the nutrition and school closure data; and policy data gathered from government websites consisting of government responses to COVID-19. The qualitative data was analysed using the thematic approach with codes generated apriori with the NVIVO software. The quantitative data used percentages and frequencies.

RESULTS

Engagements with participants in the study revealed that the lockdown measures implemented in Ghana had consequences on child and maternal health, and the health care system as a whole. Our study revealed, for example, that there was a decrease in antenatal and postnatal attendance in hospitals. Childhood vaccinations also came to a halt. Obesity and malnutrition were found to be common among children depending on the location of our study participants (urban and rural areas respectively). Our study also revealed that TB, Malaria and HIV treatment seeking reduced due to the fear of going to health facilities since those ailments manifest similar symptoms as COVID 19.

CONCLUSION

Government responded to COVID-19 using different strategies however the policy response resulted in both intended and unintended consequences especially for women and children in Ghana. It is recommended that national policy directions should ensure the continuous provision of child and maternal healthcare services which are essential health services during lockdowns.

Maternal and Child Health Services Utilization During COVID-19 in Eastern Ethiopia

Objectives: This study aimed to describe the impact of COVID-19 on maternal and child health service utilization in the Eastern part of Ethiopia. Methods: Comparative analysis was used to examine 2 years of maternal and child health service utilization. Data were extracted from client registers. A traditional Expert Modeler and one-way Analysis of Variance were used to compare service utilization before and during the COVID-19 pandemic. Results: A total of 34,576 client records were reviewed, of which 17,100 (49.5%) and 17,476 (50.5%) had visited the MCH service before and during the COVID-19 pandemic, respectively. The total client visit has shown a 2% percentage point increase. However, postnatal care and child immunization services showed a decrease. Moreover, there was a significant difference between service visits before and during COVID-19 (f = 4.6, p < 0.04). Conclusion: Mothers and children have missed or unattended facility appointments due to protective impositions or fear of getting infected with COVID-19, which might suggest a higher proportion of MCH issues were not addressed during the pandemic. The health system should therefore improve its resilience and strengthen its access at the lowest health care inlets.

Root causes of COVID-19 data backlogs: a mixed methods analysis in four African countries

With the unprecedented scale and scope of the COVID-19 vaccination response, many countries used digital systems to capture vaccine administration data. Data backlogs, a build-up of information captured via paper forms not yet entered into digital systems, were common across countries. This study aimed to identify the root causes of COVID-19 vaccination data backlogs in the Democratic Republic of the Congo, Kenya, Senegal and Tanzania based on primary (interviews and observations at vaccine delivery sites) and secondary data. Root causes of data backlogs were related to technology (system slowdowns, insufficient devices and limited system functionality), infrastructure (lack of reliable internet and data bundles), processes (incongruence between paper and digital tools, separate data collection and entry, lack of integration with routine immunization and lack of standard operating procedures) and people (staff shortages, large workloads and non-payment of staff). Recommendations to inform digital and data systems include: (i) use a country-led, coordinated, iterative approach for system design and introduction, (ii) start with a minimum viable product and (iii) proactively address the needs of the health workforce. As the COVID-19 global emergency ends, these findings can help inform broader health system strengthening efforts to improve effectiveness, resilience and pandemic preparedness.

Abrégé

Face à l’ampleur et à la portée sans précédent de la campagne vaccinale contre la COVID-19, de nombreux pays ont utilisé des systèmes numériques pour recueillir des données sur l’administration du vaccin. Tous les pays ont connu des retards de données, soit une accumulation d’informations recueillies au moyen de formulaires papier qui n’avaient pas encore été saisies dans les systèmes numériques. Cette étude vise à cerner les causes premières de ces retards de données sur la vaccination contre la COVID-19 en République démocratique du Congo, au Kenya, au Sénégal et en Tanzanie sur la base de données primaires (entretiens et observations sur les sites d’administration du vaccin) et secondaires. Les causes premières des retards de données étaient liées à la technologie (ralentissements des systèmes, insuffisance des appareils et fonctionnalité limitée des systèmes), à l’infrastructure (absence de forfaits de données et de liaison Internet fiables), aux processus (incompatibilité entre les outils papier et numériques, collecte et saisie séparées des données, manque d’intégration avec les vaccinations de routine et absence de procédures opérationnelles normalisées) et au personnel (manque d’effectifs, charges de travail importantes et non-paiement du personnel). Les recommandations pour informer les systèmes numériques et de données comprennent: (i) utiliser une approche itérative, coordonnée et dirigée par les pays pour la conception et la mise en place des systèmes, (ii) commencer par un produit minimum viable et (iii) répondre aux besoins du personnel de santé en amont des problèmes. La crise mondiale liée à la COVID-19 touchant à sa fin, ces résultats sont susceptibles d’éclairer les efforts de renforcement des systèmes de santé dans leur ensemble visant à améliorer l’efficacité, la résilience et la préparation aux pandémies.

Resumen

Ante la escala y el alcance sin precedentes de la vacunación como respuesta a la COVID-19, muchos países utilizaron sistemas digitales para registrar datos sobre la administración de las vacunas. En todos los países era común que la información recabada a través de formularios en papel se acumulara sin ingresarse en los sistemas digitales. El objetivo de este estudio consistió en identificar las causas fundamentales de la acumulación de datos sin procesar sobre la vacunación contra la COVID-19 en la República Democrática del Congo, Kenia, Senegal y Tanzania a partir de datos primarios (entrevistas y observaciones en los sitios de vacunación) y secundarios. Las causas fundamentales de esa acumulación estaban relacionadas con la tecnología (desaceleraciones del sistema, dispositivos insuficientes y funcionalidad limitada del sistema), la infraestructura (falta de conexión confiable a Internet y paquetes de datos), los procesos (incongruencia entre las herramientas en papel y las digitales, recopilación e ingreso de datos por separado, falta de integración con la inmunización de rutina y falta de procedimientos operativos estándar) y las personas (escasez de personal, grandes cargas de trabajo y falta de pago del personal). Las siguientes son algunas recomendaciones para los sistemas digitales y de datos: (i) utilizar un enfoque iterativo, coordinado y dirigido por el país para el diseño y la introducción del sistema, (ii) comenzar con un producto mínimo viable y (iii) atender de manera proactiva las necesidades del personal de la salud. Ahora que está terminando la emergencia mundial de COVID-19, estos hallazgos pueden servir de base a esfuerzos más amplios de fortalecimiento del sistema de salud dirigidos a mejorar la efectividad, la resiliencia y la preparación para pandemias.

Knowledge of non-communicable diseases and access to healthcare services among adults before and during COVID-19 pandemic in rural Tanzania

Background

The COVID-19 pandemic significantly affected access to healthcare services, particularly among individuals living with Non-Communicable Diseases (NCDs) who require regular healthcare visits. Studies suggest that knowledge about a specific disease is closely linked to the ability to access services for that condition. In preparation for the future, we conducted the study to assess knowledge of NCDs and access to healthcare services among adults residing in rural areas before and during the COVID-19 pandemic.

Methods

We conducted a community-based cross-sectional study in rural Tanzania in October 2022, a few months after the end of the third wave of the COVID-19 pandemic. A total of 689 community residents participated in the study. The level of knowledge of NCDs was assessed using an 11-item Likert questionnaire, which was later dichotomized into adequate and inadequate levels of knowledge. In addition, access to healthcare was assessed before and during the pandemic. We summarized the results using descriptive statistics and logistic regression was applied to determine factors associated with adequate levels of knowledge of NCDs. All statistical tests were two-sided; a p-value <0.05 was considered statistically significant. All data analyses were performed using SPSS.

Results

Among 689 participants, more than half 369 (55%) had adequate knowledge of whether a disease is NCD or not; specifically, 495 (73.8%), 465 (69.3%), and 349 (52%) knew that hypertension, diabetes mellitus, and stroke are NCDs while 424 (63.2%) know that UTI is not NCD. Of the interviewed participants, 75 (11.2%) had at least one NCD. During the COVID-19 pandemic the majority 57 (72.2%) accessed healthcare services from nearby health facilities followed by traditional healers 10 (12.7%) and community drug outlets 8 (10.1%). Residence and education level were found to be significantly associated with knowledge of NCDs among participants.

Conclusion

The study revealed that the community has a moderate level of knowledge of NCDs, and during the COVID-19 pandemic outbreaks, people living with NCD (s) relied on nearby health facilities to obtain healthcare services. Health system preparedness and response to pandemics should take into account empowering the community members to understand that NCD care is continuously needed even during pandemic times. We further advocate for a qualitative study to explore contextual factors influencing the knowledge of NCDs and access to healthcare services beyond the big domains of education and residence.

Treatment seeking and antibiotic use for urinary tract infection symptoms in the time of COVID-19 in Tanzania and Uganda

Background

There is still little empirical evidence on how the outbreak of coronavirus disease 2019 (COVID-19) and associated regulations may have disrupted care-seeking for non-COVID-19 conditions or affected antibiotic behaviours in low- and middle-income countries (LMICs). We aimed to investigate the differences in treatment-seeking behaviours and antibiotic use for urinary tract infection (UTI)-like symptoms before and during the pandemic at recruitment sites in two East African countries with different COVID-19 control policies: Mbarara, Uganda and Mwanza, Tanzania.

Methods

In this repeated cross-sectional study, we used data from outpatients (pregnant adolescents aged >14 and adults aged >18) with UTI-like symptoms who visited health facilities in Mwanza, Tanzania and Mbarara, Uganda. We assessed the prevalence of self-reported behaviours (delays in care-seeking, providers visited, antibiotics taken) at three different time points, labelled as 'pre-COVID-19 phase' (February 2019 to February 2020), 'COVID-19 phase 1' (March 2020 to April 2020), and 'COVID-19 phase 2' (July 2021 to February 2022).

Results

In both study sites, delays in care-seeking were less common during the pandemic than they were in the pre-COVID phase. Patients in Mwanza, Tanzania had shorter care-seeking pathways during the pandemic compared to before it, but this difference was not observed in Mbarara, Uganda. Health centres were the dominant sources of antibiotics in both settings. Over time, reported antibiotic use for UTI-like symptoms became more common in both settings. During the COVID-19 phases, there was a significant increase in self-reported use of antibiotics like metronidazole (<30% in the pre-COVID-19 phase to 40% in COVID phase 2) and doxycycline (30% in the pre-COVID-19 phase to 55% in COVID phase 2) that were not recommended for treating UTI-like symptoms in the National Treatment Guidelines in Mbarara, Uganda.

Conclusions

There was no clear evidence that patients with UTI-like symptoms attending health care facilities had longer or more complex treatment pathways despite strict government-led interventions related to COVID-19. However, antibiotic use increased over time, including some antibiotics not recommended for treating UTI, which has implications for future antimicrobial resistance.

The role of trust in the implementation and uptake of COVID-19 response measures: a qualitative study of health professionals' experiences in Tanzania

BACKGROUND

Even though trust is placed at the central point in ensuring proper functioning of the health systems, studies remain scant on how it affects both the implementation and uptake of COVID-19 response measures in low- and middle-income countries such as Tanzania. This study, therefore, explored the role of trust in the implementation and uptake of recommended COVID-19 response measures including vaccines from the perspective of health professionals in Tanzania.

METHODS

This cross-sectional qualitative study was implemented in four of Tanzania's thirty-one regions. Qualitative data was collected through 26 in-depth interviews held with regional and district disease outbreak response teams, district cold chain co-ordinators and health facility in-charges. In addition, five focus group discussions and seven group interviews were conducted with healthcare workers from the lower-level health facilities. Thematic analysis was conducted and applied the trust constructs.

RESULTS

Interpersonal trust and health system trust emerged as two major themes in the study. Interpersonal trust was reported to stem from lack of transparency that instigated fear, worries, and confusion regarding the implementation and uptake of the recommended response measures. The distrust was mainly between health professionals in health facilities and those assigned to isolation centres as well as between patients and community members. On the other hand, the health system trust was shaped by mixed feelings regarding COVID-19 vaccine national decisions, and conflicting messages from national officials, politicians and religious leaders on COVID-19 responses, safety, and effectiveness of the vaccines. Questions surrounding the short duration of clinical trials, indeterminate post-vaccination protection duration, impotence-linked beliefs, freemasonry notion and unclear vaccinated cards information are other reported contributory factors to mistrust in the health system. However, after a comprehensive health education and experience in COVID-19 vaccination administration most professionals affirmed the effectiveness of the vaccines in limiting infections and its severe consequences.

CONCLUSION

Participants indicated limited trust at both interpersonal and health system levels aggravated by lack of transparency, unclear and conflicting messages on COVID-19 infections and response measures. Enforced transparency on pandemics alongside standardised messages from the reliable sources is crucial in enhancing trust in implementation and uptake of the recommended response measures.