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Tilahun BT, Tariku Z, Alemu MK, Dejene T, Natae LA, Mohammed H, Assegid DT, Tekle MH. Maternal and Child Health Services Utilization During COVID-19 in Eastern Ethiopia. Int J Public Health 2024; 69:1606626. [PMID: 38841538 PMCID: PMC11150649 DOI: 10.3389/ijph.2024.1606626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 04/29/2024] [Indexed: 06/07/2024] Open
Abstract
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.
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Affiliation(s)
- Bereket Tefera Tilahun
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Zerihun Tariku
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Mesfin Kebede Alemu
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Tafese Dejene
- School of Medicine, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Legesse Abera Natae
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Hussen Mohammed
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Daniel Tadesse Assegid
- Department of Midwifery, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Mickiale Hailu Tekle
- Department of Midwifery, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
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Sirili N, Kilonzi M, Kiwango G, Lengai E, Nandala R, Mwakawanga DL, Philipo EG, Thobias JM, Frumence G. Knowledge of non-communicable diseases and access to healthcare services among adults before and during COVID-19 pandemic in rural Tanzania. Front Public Health 2024; 12:1342885. [PMID: 38605870 PMCID: PMC11008714 DOI: 10.3389/fpubh.2024.1342885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
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.
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Affiliation(s)
- Nathanael Sirili
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Manase Kilonzi
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - George Kiwango
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | - Dorkasi L. Mwakawanga
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Erick G. Philipo
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joseph Matobo Thobias
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gasto Frumence
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Olamijuwon E, Keenan K, Mushi MF, Kansiime C, Konje ET, Kesby M, Neema S, Asiimwe B, Mshana SE, Fredricks KJ, Sunday B, Bazira J, Sandeman A, Sloan DJ, Mwanga JR, Sabiiti W, Holden MTG. Treatment seeking and antibiotic use for urinary tract infection symptoms in the time of COVID-19 in Tanzania and Uganda. J Glob Health 2024; 14:05007. [PMID: 38236690 PMCID: PMC10795859 DOI: 10.7189/jogh.14.05007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
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.
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Affiliation(s)
- Emmanuel Olamijuwon
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Katherine Keenan
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Martha F Mushi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Catherine Kansiime
- School of Public Health, College of Health Sciences, Makerere University Kampala, Uganda
| | - Eveline T Konje
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mike Kesby
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Stella Neema
- Department of Sociology and Anthropology, Makerere University, Kampala, Uganda
| | - Benon Asiimwe
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stephen E Mshana
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Kathryn J Fredricks
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Benjamin Sunday
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joel Bazira
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alison Sandeman
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Derek J Sloan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Joseph R Mwanga
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Wilber Sabiiti
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | - CARE Consortium
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- School of Public Health, College of Health Sciences, Makerere University Kampala, Uganda
- Department of Sociology and Anthropology, Makerere University, Kampala, Uganda
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
- School of Medicine, University of St Andrews, St Andrews, UK
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Metta E, Shayo EH, Ngalesoni F, Kalolo A, Nyamuryekung'e K, Mboya IB, Ndumwa HP, Njiro BJ, Amour MA. The role of trust in the implementation and uptake of COVID-19 response measures: a qualitative study of health professionals' experiences in Tanzania. BMC Health Serv Res 2023; 23:1077. [PMID: 37817175 PMCID: PMC10566036 DOI: 10.1186/s12913-023-10043-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/17/2023] [Indexed: 10/12/2023] Open
Abstract
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.
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Affiliation(s)
- Emmy Metta
- Department of Behavioral Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.
| | - Elizabeth H Shayo
- National Institute for Medical Research, P.O. Box 9653, Dar es Salaam, Tanzania
| | - Frida Ngalesoni
- AMREF Health Africa in Tanzania, P.O. Box 2773, Dar es Salaam, Tanzania
| | - Albino Kalolo
- Department of Public Health, St. Francis University College of Health, and Allied Sciences, P.O. Box 175, Morogoro, Tanzania
| | - Kasusu Nyamuryekung'e
- Department of Community Dentistry, School of Dentistry, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Innocent B Mboya
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Tanzania
- Department of Translational Medicine, Lund University, 202 13 Malmö, P.O. Box 50332, Malmö, Sweden
| | - Harrieth P Ndumwa
- Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Belinda J Njiro
- Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Maryam A Amour
- Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
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