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

Impact of Covid-19 on antenatal care: evidence from Madagascar Demographic and Health Survey

Despite the growing literature on the impact of Covid-19 on antenatal care (ANC) and maternal/neonatal and child health outcomes globally, substantial knowledge gaps remain about the population-level impact in sub-Saharan Africa (SSA). Existing evidence on the ANC impact of Covid-19 in SSA is largely based on health facility or small-scale qualitative research, which are limited in providing population-level understanding. This paper examines the extent to which Covid-19 impacted ANC service utilisation and identifies what population sub-groups were most adversely impacted. It is based on a secondary analysis of the Madagascar Demographic and Health Survey (DHS), the first DHS in SSA released following the Covid-19 pandemic. Multilevel logistic regression analysis was used to estimate the net effect of Covid-19 on ANC and identify the most at-risk population sub-groups. The findings show that all ANC measures considered (no ANC, early ANC, adequate ANC visits) were significantly affected by Covid-19 (p<0.05). On average, Covid-19 was associated with a 42% increase in the odds of having no ANC, a 22% reduction in the odds of starting early ANC during the first trimester, and a 22% reduction in the odds of receiving adequate ANC (at least four visits, starting during the first trimester). Births to older mothers and to mothers with no education were disproportionately affected during Covid-19. Although youth aged 15-24 had poorer ANC compared to older women before the pandemic, the pattern was reversed during the pandemic. Also, the protective effect of education was stronger during than before the pandemic. These findings underscore the importance of Covid-19 impact mitigation strategies targeting the most at-risk groups (e.g. older mothers). Furthermore, essential information/education during pandemics should be in formats accessible to non-literate women. This paper advances understanding of the population-level impact of Covid-19 on ANC and emphasises the need for further research to better understand the population-level impact of Covid-19 across countries of SSA.

Adequate antenatal care service utilizations after the onset of COVID-19 pandemic in Ethiopia: a systematic review and meta-analysis

Background

The world faces great difficulty in continuing to provide essential maternity health care after the onset of COVID-19 pandemic Many women have trouble accessing maternity healthcare due to fear of infection. A decline in the utilization of maternity health services is suggested to worsen adequate antenatal care service utilization. Thus, this study aimed to determine the pooled estimate of adequate antenatal care service utilization after the onset of COVID-19 in Ethiopia.

Methods

The searching of articles was carried out on Web of Science, Scopus, PubMed, CINHAL, Google Scholar, African journals online, and the institutional repository of Ethiopian universities. Using a Microsoft Excel standardized spreadsheet, the data were extracted. A random effect model was used to determine a pooled estimate of adequate antenatal care utilization. I 2 statistics were used to quantify the amount of heterogeneity. The evidence of publication bias was examined using Egger's regression test and a visual inspection of the funnel plot. Subgroup and sensitivity analyses were also carried out.

Results

Finally, this systematic review and meta-analysis included 11 eligible articles. The overall pooled estimate of adequate antenatal care service utilization after the onset of COVID-19 pandemic in Ethiopia was 46.28% (95% CI: 35.32%-57.26%). There is a substantial amount of heterogeneity between studies (I 2 = 99.07%, p < 0.001). Pregnant women who visited antenatal care early were 10.9 times more likely to have adequate antenatal care utilization than those without early visits (AOR = 10.93, 95% CI: 7.2-14.66).

Conclusion

In this review, the percentage of women who utilized adequate antenatal care after the onset of COVID-19 pandemic in Ethiopia was less than half. Early antenatal care visit is an important factor to achieve adequate antenatal care service utilizations.

Systematic review registration

: CRD42023495279.

COVID-19 pandemic, pregnancy care, perinatal outcomes in Eastern Myanmar and North-Western Thailand: a retrospective marginalised population cohort

BACKGROUND

The COVID-19 pandemic disrupted routine health care and antenatal and birth services globally. The Shoklo Malaria Research Unit (SMRU) based at the Thailand-Myanmar border provides cross border antenatal care (ANC) and birth services to marginalised pregnant women. The border between the countries entered lockdown in March 2020 preventing cross-border access for women from Myanmar to Thailand. SMRU adapted by opening a new clinic during the COVID-19 pandemic in Myanmar. This study explored the impact of the COVID-19 pandemic and response on access to ANC and pregnancy outcomes for marginalised pregnant women in the border regions between Thailand and Myanmar.

METHODS

A retrospective review of medical records of all pregnancies delivered or followed at antenatal clinics of the SMRU from 2017 to the end of 2022. Logistic regression was done to compare the odds of maternal and neonatal outcomes between women who delivered pre-COVID (2017-2019) and women who delivered in the COVID-19 pandemic (2020-2022), grouped by reported country of residence: Thailand or Myanmar.

RESULTS

Between 2017 and the end of 2022, there were 13,865 (5,576 resident in Thailand and 8,276 in Myanmar) marginalised pregnant women who followed ANC or gave birth at SMRU clinics. Outcomes of pregnancy were known for 9,748 women with an EGA ≥ 28 weeks. Unknown outcome of pregnancy among women living in Thailand did not increase during the pandemic. However, there was a high (60%) but transient increase in unknown outcome of pregnancy for women with Myanmar residence in March 2020 following border closure and decreasing back to the baseline of 20-30% after establishment of a new clinic. Non-literate women were more likely to have an unknown outcome during the pandemic. There was no statistically significant increase in known stillbirths or maternal deaths during the COVID pandemic in this population but homebirth was over represented in maternal and perinatal mortality.

CONCLUSION

Decreasing barriers to healthcare for marginalised pregnant women on the Thailand-Myanmar border by establishment of a new clinic was possible in response to sudden border closure during the COVID-19 pandemic and most likely preventing an increase in maternal and perinatal mortality.

Access to and Utilization of Maternal and Child Healthcare Services During COVID-19 Pandemic in Rural Bangladesh

Background and Objective

Geographically remote areas in lower-middle-income countries like Bangladesh experienced significant Maternal and Child Health (MCH) care shortages during the COVID-19 pandemic. These shortages were exacerbated by preexisting inadequate public health infrastructure and using existing health resources for pandemic management. The objective of this study was to assess the status of access to and utilization of maternal and child healthcare services among rural people during the outbreak of COVID-19.

Methods

A community-based descriptive, exploratory, cross-sectional study was carried out from May to August 2020 among the rural people of the four districts of northern Bangladesh. A total of 639 women were included in the study with a sample random sampling technique, and multistage random sampling techniques were applied to select the study area. A pretested semi-structured questionnaire was used for data collection. SPSS Version 22 was used for the statistical analysis.

Results

The mean age of the respondents was 34.3 years with an SD ± 10 years. 37.7% of respondents belonged to the 21-30 year age group followed by the 31-40 years age group (34.9 %). Of the total 639 respondents, 59.5% were female. There were significant associations and moderate positive correlations between educational qualification, occupational status, and age group of the respondents (p=0.001). Most of the respondents (67.6%) indicated that they experienced health problems during COVID-19 with 70.6% of them specifically mentioning MCH-related problems. Out of them, only 33.1% mentioned they could access and utilize MCH services, whereas 66.9% of them could not access MCH Services. Major barriers to utilizing MCH services were the COVID-19 lockdown, lack of transport facilities, fear of being infected, shutdown of healthcare facilities, and unavailability of healthcare professionals. The differences in health facility usage before and during COVID-19 are statistically significant with p = < 0.001.

Conclusion and Global Health Implications

During the COVID-19 pandemic, access to and utilization of MCH services was significantly hampered, particularly in Bangladesh's remote and rural regions during the strict lockdown times. The identified barriers were the COVID-19 lockdown, lack of transport facilities, fear of being infected, shutdown of healthcare facilities, and unavailability of healthcare professionals. Building strengthened health systems, capacity building of informal healthcare providers, backup plans, and alternate service delivery models are necessary to ensure access to maternity and child health.

Recommendations

For future pandemics and natural disaster situations, the 'concerned officials should strategically have backup plans and alternative service delivery models to strengthen the health system. And, there should be collaborative efforts among the countries to support each other to address the crisis situations.

Health care utilisation in Cox's Bazar district, Bangladesh, during the first year of the COVID-19 pandemic: A mixed-methods study among host communities

To respond to the COVID-19 pandemic, countries introduced public health and social measures that had indirect societal, economic consequences. Concerns during epidemics include continuity of routine health services. We investigate how healthcare utilisation and healthcare seeking behaviour changed during the first year of the COVID-19 pandemic among host communities in Cox's Bazar, Bangladesh. This mixed-methods study combines quantitative analyses of routine health data and population-based findings about healthcare seeking behaviours. Trends in consultations changed according to facility level (higher-level facilities included Upazila Health Complexes and District Hospitals; lower-level facilities included Community Clinics and Union Health and Family Welfare Centers). At the pandemic's beginning, drops were seen at higher-level health facilities for outpatient department (OPD) consultations, respiratory infections, and antenatal care. Minor reductions or increases were seen at lower-level facilities for the same services. Half of the subdistricts reported a cumulative increase in OPD and respiratory tract infection consultations. Most subdistricts reported a cumulative decrease in antenatal care. Child vaccinations dropped in all subdistricts, half of which did not catch-up, resulting in a cumulative decrease of delivered doses. Fear of contracting COVID-19 and financial constraints were the main reasons for decreased access. Drivers of healthcare seeking behaviours should be better understood to guide preparedness and service delivery modalities at primary and secondary levels.

Barriers and facilitators to the provision of maternal health services at community health centers during the COVID-19 pandemic: Experiences of midwives in Indonesia

OBJECTIVE

To explore the experiences of midwives in Indonesia on the provision of maternal health services during the COVID-19 pandemic.

DESIGN AND METHODS

A qualitative descriptive study using focus group discussions was undertaken. A conventional content analysis was used to analyze the data. Coding categories were generated from the transcripts.

SETTING AND PARTICIPANTS

Twenty-two midwives from five community health centers of three regions in the Province of Jambi, Indonesia were included.

FINDINGS

The interviewees shared similar barriers and facilitators in delivering the services, including the unavailability of adequate protective equipment, the limitation of the number of services, and dealing with the new public health measures related to the COVID-19. Overall, midwives demonstrated a continued commitment to provide maternal health services during the pandemic.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Significant changes in service delivery have been made to comply with pandemic related restrictions. Despite the unprecedentedly difficult working environment, the midwives continue to provide adequate services to the community by implementing a strict health protocol. Findings from this study contribute to a better understanding of how the quality of the services changed, as well as how new challenges can be addressed and positive changes can be reinforced.

Factors Influencing the Antenatal Care Attendance of Pregnant Women During the First COVID-19 Wave Lockdown in Thailand

Background

The coronavirus disease 2019 (COVID-19) outbreak impacted healthcare service management worldwide. Thailand had limited healthcare resources. During the pandemic, several medical supplies were in high demand and expensive. The Thai government needed to declare a lockdown to reduce the unnecessary use of medical supplies. Antenatal care (ANC) services have adapted to the outbreak situation. However, information about the potential impact of COVID-19 lockdown on pregnant women and the reduction of disease exposure risk in this population remains unclear. Thus, this study aimed to assess the percentage of ANC attendance and factors affecting the scheduled ANC attendance of pregnant women during the first COVID-19 wave lockdown in Thailand.

Methods

This retrospective cross-sectional study included Thai women who were pregnant between 1 March and 31 May 2020. An online survey was conducted among pregnant women who had first ever ANC attendance before 1 March 2020. A total of 266 completed responses were returned and analysed. Statistically, the sample size was representative of the population. The predictors of scheduled ANC attendance during the lockdown were identified through logistic regression analysis.

Results

Overall, 223 (83.8%) pregnant women had scheduled ANC attendance during the lockdown. The predictive factors of ANC attendance were non-relocation (adjusted odds ratio [AOR] = 2.91, 95% confidence interval [CI]: 1.009-8.381) and access to health services (AOR = 2.234, 95% CI: 1.125-4.436).

Conclusion

During the lockdown, ANC attendance slightly declined, and the extended duration of each ANC or reduced face-to-face interactions with healthcare professionals. For pregnant women with non-relocation, healthcare providers must provide opportunities to contact them directly if they had doubts. The limited number of pregnant women who access health services allowed the clinic to be less crowded and therefore easy to ANC attendance.

'We delivered at home out of fear': Maternity Care in Rural Nigeria During the COVID-19 Pandemic

Background and Objective

The COVID-19 pandemic response overwhelmed health systems, disrupting other services, including maternal health services. The disruptive effects on the utilization of maternal health services in low-resource settings, including Nigeria have not been well documented. We assessed maternal health service utilization, predictors, and childbirth experiences amidst COVID-19 restrictions in a rural community of Kumbotso, Kano State, in northern Nigeria.

Methods

Using an explanatory mixed methods design, 389 mothers were surveyed in January 2022 using validated interviewer-administered questionnaires, followed by in-depth interviews with a sub-sample (n=20). Data were analyzed using logistic regression models and the framework approach.

Results

Less than one-half (n=165, 42.4%) of women utilized maternal health services during the period of COVID-19 restrictions compared with nearly two-thirds (n=237, 65.8%) prior to the period (p<0.05). Non-utilization was mainly due to fear of contracting COVID-19 (n=122, 54.5%), clinic overcrowding (n=43, 19.2%), transportation challenges (n=34, 15.2%), and harassment by security personnel (n=24, 10.7%). The utilization of maternal health services was associated with participant's post-secondary education (aOR=2.06, 95% CI:1.14- 11.40) (p=0.02), and employment type (civil service, aOR=4.60, 95% CI: 1.17-19.74) (p<0.001), business aOR=1.94, 95% CI:1.19- 4.12) (p=0.032) and trading aOR=1.62, 95% CI:1.19-2.94) (p=0.04)). Women with higher household monthly income (≥ N30,000, equivalent to 60 US Dollars) (aOR=1.53, 95% CI:1.13-2.65) (p=0.037), who adhered to COVID-19 preventive measures and utilized maternal health services before the COVID-19 pandemic were more likely to utilize those services during the COVID-19 restrictions. In contrast, mothers of higher parity (≥5 births) were less likely to use maternal health services during the lockdown (aOR=0.30, 95% CI:0.10-0.86) (p=0.03). Utilization of maternal services was also associated with partner education and employment type.

Conclusion and Global Health Implications

The utilization of maternal health services declined during the COVID-19 restrictions. Utilization was hindered by fear of contracting COVID-19, transport challenges, and harassment by security personnel. Maternal and partner characteristics, adherence to COVID-19 preventive measures, and pre-COVID maternity service utilization influenced attendance. There is a need to build resilient health systems and contingent alternative service delivery models for future pandemics.

Observational study on necrotizing enterocolitis in neonates born to SARS-CoV-2-positive mothers

Background

The impact of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic on expectant mother and their babies extends to many aspects of life. Necrotizing enterocolitis (NEC) has been recognized as a life-threatening gastrointestinal inflammatory process in neonates that has high rates of morbidity and mortality.

Objective

To investigate factors associated with NEC in hospitalized neonates whose mothers were SARS-CoV-2-positive and their relationship to mortality.

Method

This observational study was conducted from May 2020 to March 2021. All neonates who were hospitalized, after confirming that the mother was SARS-CoV-2-positive, were included in this study. The confirmation of positive SARS-CoV-2 was determined according to the reverse transcription-polymerase chain reaction (PCR) assay. The neonatal SARS-CoV-2 test was performed on the first day of birth. NEC was established based on a suggestive clinical presentation and abnormal abdominal radiographs.

Results

Of the 125 neonates enrolled in this study, there were 5 neonates who developed NEC and only one survived. Significant associated factors with NEC included lower birth weight (p < 0.001), lower gestational age (p < 0.001), positive SARS-CoV-2 PCR results (OR = 15.333; 95% CI = 2.074–113.381, p = 0.007), asphyxia (OR = 13.143; 95% CI = 1.411–122.443, p = 0.024), and mortality (OR = 156.000; 95% CI = 13.157–1849.623; p < 0.001). Mortality was significantly associated with lower gestational age (p = 0.025), cesarean section delivery (p = 0.025), and asphyxia (p = 0.025).

Conclusion

Significant associated factors with NEC in neonates born to SARS-CoV-2-positive mothers included positive SARS-CoV-2 PCR results, asphyxia, lower gestational age, and lower birth weight. In addition to caesarean section delivery, these factors were related to mortality in neonates in such conditions.

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There is an association between SARS-CoV-2 positive mothers and the incidence of NEC in their neonates.

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Significant associated factors with NEC in neonates born to SARS-CoV-2-positive mothers included positive SARS-CoV-2, asphyxia, lower gestational age, and lower birth weight.

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There is a link between NEC and mortality in neonates born to SARS-CoV-2-positive mothers.