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Shahwar DE, Naz S, Naseem M, Saleem S, Sheikh L, Malik A. Impact of the Early COVID-19 Pandemic on the Quality of Obstetric Care in a Tertiary Care Center in Karachi, Pakistan. Cureus 2024; 16:e65401. [PMID: 39184736 PMCID: PMC11344876 DOI: 10.7759/cureus.65401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2024] [Indexed: 08/27/2024] Open
Abstract
Objective This study aimed to assess the indirect impact of the COVID-19 pandemic on obstetric quality measures. Materials and methods This cross-sectional study was conducted at a private-sector tertiary care hospital in Karachi, Pakistan. Data were collected for specific antenatal, intrapartum, and postpartum care indicators during the initial six months of the COVID-19 phase (March to August 2020) and compared with baseline measures from the preceding six months before the COVID-19 phase (September 2019 to February 2020) using frequencies and percentages. Results During COVID-19, there was a 10% reduction (pre-COVID: 1041 and during COVID: 946) in outpatient obstetric volumes and a 65% increase (pre-COVID: 240 and during COVID: 396) in clinic cancellations, indicating a decreased influx of antenatal patients. Teleclinics served 8.3% (1429/18279) of the total obstetric patients during this period. Marginal decreases were observed in spontaneous vaginal deliveries 1358 (44%) vs 1049 (42.4%) and labor induction rates 818 (26.6%) vs 606 (24.2%). Additionally, there was a slight increase in instrumental deliveries, 121 (3.9%) vs 114 (4.6%) during the COVID phase. However, these changes were not statistically significant. Similarly, no substantial impact was observed on elective and emergency C-sections. Notably, there were more cases of primary postpartum hemorrhage (PPH) during the COVID-19 phase 36 (1.17%) vs 46 (1.86%), and these changes were statistically significant (p= 0.035). Similar trends were observed for eclampsia (p =0.05) and preeclampsia cases (p-value 0.074). However, other maternal morbidity indicators and intrauterine fetal deaths remained relatively unchanged. NICU admissions increased significantly (p=0.001), while early neonatal deaths remained unaffected. Patient satisfaction rates remained steady for inpatients and improved for outpatients during COVID-19. Conclusion The COVID-19 pandemic primarily affected antenatal volumes, neonatal admissions, and maternal morbidity indicators such as PPH, preeclampsia, and eclampsia. Despite the challenges, patient satisfaction and quality care standards were maintained during COVID-19 through new strategies and revised patient care processes.
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Affiliation(s)
- Dur-E- Shahwar
- Obstetrics and Gynaecology, Aga Khan University, Karachi, PAK
| | - Sumaira Naz
- Obstetrics and Gynaecology, Aga Khan University, Karachi, PAK
| | | | - Shamila Saleem
- Obstetrics and Gynaecology, Aga Khan University, Karachi, PAK
| | - Lumaan Sheikh
- Obstetrics and Gynaecology, Aga Khan University, Karachi, PAK
| | - Ayesha Malik
- Obstetrics and Gynaecology, Aga Khan University, Karachi, PAK
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Shafiq Y, Rubini E, Fazal ZZ, Bukhari MM, Zakaria M, Zeeshan NUH, Muhammad A, Ragazzoni L, Barone-Adesi F, Valente M. Impact of Ebola and COVID-19 on maternal, neonatal, and child health care among populations affected by conflicts: a scoping review exploring demand and supply-side barriers and solutions. Confl Health 2024; 18:12. [PMID: 38291492 PMCID: PMC10829480 DOI: 10.1186/s13031-024-00572-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION Armed conflicts have a severe impact on the health of women and children. Global health emergencies such as pandemics and disease outbreaks further exacerbate the challenges faced by vulnerable populations in accessing maternal, neonatal, and child healthcare (MNCH). There is a lack of evidence that summarizes the challenges faced by conflict-affected pregnant women, mothers, and children in accessing MNCH services during global health emergencies, mainly the Ebola and COVID-19 pandemics. This scoping review aimed to analyze studies evaluating and addressing barriers to accessing comprehensive MNCH services during Ebola and COVID-19 emergencies in populations affected by conflict. METHODS The search was conducted on PubMed, Scopus, and Web of Science databases using terms related to Ebola and COVID-19, conflicts, and MNCH. Original studies published between 1990 and 2022 were retrieved. Articles addressing the challenges in accessing MNCH-related services during pandemics in conflict-affected settings were included. Thematic analysis was performed to categorize the findings and identify barriers and solutions. RESULTS Twenty-nine studies met the inclusion criteria. Challenges were identified in various MNCH domains, including antenatal care, intrapartum care, postnatal care, vaccination, family planning, and the management of childhood illnesses. Ebola-related supply-side challenges mainly concerned accessibility issues, health workforce constraints, and the adoption of stringent protocols. COVID-19 has resulted in barriers related to access to care, challenges pertaining to the health workforce, and new service adoption. On the demand-side, Ebola- and COVID-19-related risks and apprehensions were the leading barriers in accessing MNCH care. Community constraints on utilizing services during Ebola were caused by a lack of trust and awareness. Demand-side challenges of COVID-19 included fear of disease, language barriers, and communication difficulties. Strategies such as partnerships, strengthening of health systems, service innovation, and community-based initiatives have been employed to overcome these barriers. CONCLUSION Global health emergencies amplify the barriers to accessing MNCH services faced by conflict-affected populations. Cultural, linguistic, and supply-side factors are key challenges affecting various MNCH domains. Community-sensitive initiatives enhancing primary health care (PHC), mobile clinics, or outreach programs, and the integration of MNCH into PHC delivery should be implemented. Efforts should prioritize the well-being and empowerment of vulnerable populations. Addressing these barriers is crucial for achieving universal health coverage and the Sustainable Development Goals.
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Affiliation(s)
- Yasir Shafiq
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy.
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
- Centre of Excellence for Trauma and Emergencies (CETE) & Community Health Science, The Aga Khan University, Karachi, Pakistan.
- Harvard Humanitarian Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Bostan, USA.
- Department of Pediatrics, Brigham and Women's Hospital, Global Advancement of Infants and Mothers, Boston, USA.
| | - Elena Rubini
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | | | | | | | | | | | - Luca Ragazzoni
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Francesco Barone-Adesi
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Martina Valente
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
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Marzouk M, Lam ST, Durrance-Bagale A, Nagashima-Hayashi M, Neo P, Ung M, Zaseela A, Aribou ZM, Agarwal S, Howard N. Effects of COVID-19 on sexual and reproductive health services access in the Asia-Pacific region: a qualitative study of expert and policymaker perspectives. Sex Reprod Health Matters 2023; 31:2247237. [PMID: 37682084 PMCID: PMC10494729 DOI: 10.1080/26410397.2023.2247237] [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] [Indexed: 09/09/2023] Open
Abstract
The COVID-19 pandemic has strained health systems globally, with governments imposing strict distancing and movement restrictions. Little is known about the effects of the COVID-19 pandemic on sexual and reproductive health (SRH). This study examined perceived effects of COVID-19 on SRH service provision and use in the Asia-Pacific region. We conducted a qualitative study using semi-structured interviews with 28 purposively sampled SRH experts in 12 Asia-Pacific countries (e.g. United Nations, international and national non-governmental organisations, ministries of health, academia) between November 2020 and January 2021. We analysed data using the six-stage thematic analysis approach proposed by Braun and Clarke (2019). Interviewees reported that COVID-19 mitigation measures, such as transport restrictions and those that decreased the availability of personal protective equipment (PPE), reduced SRH service provision and use in most countries. SRH needs related to service barriers and gender-based violence increased. Systemic challenges included fragmented COVID-19 response plans and insufficient communication and collaboration, particularly between public and private sectors. SRH service-delivery challenges included COVID-19 response prioritisation, e.g. SRH staff task-shifting to COVID-19 screening and contact tracing, and lack of necessary supplies and equipment. Innovative SRH delivery responses included door-to-door antenatal care and family planning provision in the Philippines, online platforms for SRH education and outreach in Viet Nam, and increasing SRH service engagement through social media in Myanmar and Indonesia. To ensure continuation of SRH services during health emergencies, governments should earmark human and financial resources and prioritise frontline health-worker safety; work with communities and the private sector; and develop effective risk communications.
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Affiliation(s)
- Manar Marzouk
- Research Fellow, London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK; Overseas Research Associate], Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Sze Tung Lam
- Visiting Scholar Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Alumnus, London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK
| | - Anna Durrance-Bagale
- Research Fellow, London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK
| | - Michiko Nagashima-Hayashi
- Research Associate, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Pearlyn Neo
- Research Associate, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Mengieng Ung
- Research Fellow, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Ayshath Zaseela
- Intern, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Zeenathnisa Mougammadou Aribou
- Senior Resident, Preventive Medicine, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Sunanda Agarwal
- Partner, Stanford University, Stanford Distinguished Careers Institute, Stanford, USA
| | - Natasha Howard
- Associate Professor, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Associate Professor, London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK
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Dhillon P, Unisa S, Gupta A, Saraswat A, Km S, Pedgaonkar S. Utilisation of ANC services before and after the COVID-19 pandemic in selected resource-poor blocks of India: role of community health workers in Swabhimaan programme area. BMC Health Serv Res 2023; 23:864. [PMID: 37580689 PMCID: PMC10426095 DOI: 10.1186/s12913-023-09781-1] [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: 11/25/2022] [Accepted: 07/03/2023] [Indexed: 08/16/2023] Open
Abstract
INTRODUCTION COVID-19 has disrupted maternal and child health services. Community Health Workers (CHWs) supported the women by visiting pregnant women's homes and providing the MCH services as required. This study attempts to understand the role of CHW and its impact on the Ante-Natal Care (ANC) services pre-pandemic and post-Pandemic in the poor resource setting. METHODS The Swabhimaan programme interventions were carried out in the selected blocks in the Indian States of Bihar, Odisha and Chhattisgarh with the objective to improve the nutritional status of mothers, pregnant women and adolescents living in resource-poor blocks of three selected states during 2016-2022. Cross-sectional surveys, namely pre-pandemic (2018-19) and post-pandemic (2021-22) of pregnant and mothers of under two children, utilised to fulfil the objectives of this study. These surveys are part of Swabhimaan evaluation, a community-based non-randomised controlled study. RESULTS The ANC services received by women have increased over time from 2015 to 2022. Our findings confirm that the ground-level community and health systems were active during the pandemic, and the results show significant improvement. Additionally, the women supported by the CHW have substantially improved pregnancy registration, first ANC, Tetanus injection, consumption of Iron Folic Acid, Calcium and deworming tablets than those who did not. Propesnsity Score Matching analysis shows that the average treatment effect on the various ANC services of having the support of CHW is significant. CONCLUSION This study shows the vital role of CHWs in utilising various Maternal and Child Health services. Better linkage and networking of the CHWs with the community will ensure health service delivery regularly and in an emergency like a pandemic and develop resilience.
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Affiliation(s)
- Preeti Dhillon
- Department of Survey Research & Data Analystics, International Institute for Population Sciences, Mumbai, India
| | - Sayeed Unisa
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences, Mumbai, India.
| | - Ajay Gupta
- Swabhimaan Project, International Institute for Population Sciences, Mumbai, India
| | - Abhishek Saraswat
- Swabhimaan Project, International Institute for Population Sciences, Mumbai, India
| | - Sulaiman Km
- Swabhimaan Project, International Institute for Population Sciences, Mumbai, India
| | - Sarang Pedgaonkar
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, India
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Yadollahi P, Zangene N, Heiran A, Sharafi M, Heiran KN, Hesami E, Saffari M, Azima S, Mirahmadizadeh A. Effect of the COVID-19 pandemic on maternal healthcare indices in Southern Iran: an interrupted time series analysis. BMJ Open 2022; 12:e059983. [PMID: 36288832 PMCID: PMC9615178 DOI: 10.1136/bmjopen-2021-059983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Epidemics are anticipated to influence the coverage of health services. We assessed the impact of the COVID-19 pandemic on maternal healthcare indices and care providers' performance. SETTING 1801 maternal healthcare centres under the auspices of Shiraz University of Medical Sciences, Shiraz, Southern Iran. PARTICIPANTS Approximately 63 000 pregnant women. PRIMARY AND SECONDARY OUTCOME MEASURES In this prospective ecological study, interrupted time series analysis was used to model and compare the trend of maternal healthcare indices before and after the COVID-19 pandemic announcement. RESULTS The results showed a significant drop in count of preconception healthcare visits, first routine laboratory tests, first trimester prenatal care, first trimester sonography, prenatal screening for birth defects at weeks 11-13, prenatal care visits at weeks 16-20, second routine laboratory tests, second trimester sonography, prenatal care visits at weeks 24-30, prenatal care visits at weeks 31-34, postpartum care visits at days 10-15 and postpartum care visits at days 30-42 with the start of the COVID-19 pandemic (-50% (95% CI -48.68% to -51.36%), -19.67% (95% CI -22.12% to -17.15%), -25.88% (95% CI -28.46% to -23.21%), -23.84% (95% CI -26.26% to -21.34%), -20.16% (95% CI -23.01% to -17.20%), -18.53% (95% CI -21.25% to -15.71%), -28.63% (95% CI -31.03% to -26.14%), -27.48% (95% CI -30.07% to -24.79%), -31.08% (95% CI -33.43% to -28.61%), -31.84% (95% CI -34.35% to -29.23%), 32.55% (95% CI -35.12% to -29.89%) and -39.28% (95% CI -41.59% to -36.88%), respectively). Nevertheless, the trend in coverage of these services showed recovery in the subsequent months (8.36%, 10.55%, 5.74%, 8.01%, 4.40%, 5.06%, 11.20%, 7.58%, 7.38%, 7.80%, 9.59% and 9.61% per month, respectively). CONCLUSIONS Using ecological data during the COVID-19 pandemic era, we observed a 'level change and slope change' as the major pattern of interruption of maternal healthcare coverage, indicating a possible indirect effect rather than a causative relationship. Such relative predictability might assist with future pandemic planning.
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Affiliation(s)
- Parvin Yadollahi
- Maternal-Fetal Medicine Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Negar Zangene
- Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Alireza Heiran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Mehdi Sharafi
- Students Research Committee, School of Health, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Khadije Neda Heiran
- Department of Midwifery, School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Sistan and Baluchestan, Iran
| | - Elham Hesami
- Midwifery Counseling, Family Health Unit, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Masoumeh Saffari
- Department of Community Medicine, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Sara Azima
- Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Alireza Mirahmadizadeh
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Child mortality after the Ebola virus disease outbreak across Guinea, Liberia, and Sierra Leone. Int J Infect Dis 2022; 122:944-952. [PMID: 35781098 DOI: 10.1016/j.ijid.2022.06.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/30/2022] [Accepted: 06/27/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The Ebola virus disease outbreak in 2014-2016 had a substantial impact on population health in Guinea, Liberia, and Sierra Leone. This study aimed to assess whether the impact continued after the outbreak ended in regards to child mortality. METHODS Cross-sectional logistic regressions were run using data from the Demographic and Health Surveys in the three countries. RESULTS The average child mortality rate was significantly lower for children born after the outbreak ended than those born before. However, the association of the child mortality rate with an increase in the number of cases per 100,000 was significantly stronger for children born after the outbreak ended. Also, the change in the utilization of maternal health services after the outbreak varied across health services. CONCLUSIONS Restoring disrupted child health services to pre-Ebola levels may be more difficult in areas that suffered a higher number of cases. The recovery of maternal health services after the outbreak might be affected by factors such as the resilience of health systems at the subnational level. This study suggests that strengthening health system is crucial to fully recover from the Ebola outbreak and to cope with future epidemics.
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Palo SK, Dubey S, Negi S, Sahay MR, Patel K, Swain S, Mishra BK, Bhuyan D, Kanungo S, Som M, Merta BR, Bhattacharya D, Kshatri JS, Pati S. Effective interventions to ensure MCH (Maternal and Child Health) services during pandemic related health emergencies (Zika, Ebola, and COVID-19): A systematic review. PLoS One 2022; 17:e0268106. [PMID: 35536838 PMCID: PMC9089853 DOI: 10.1371/journal.pone.0268106] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 04/22/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Ensuring accessible and quality health care for women and children is an existing challenge, which is further exacerbated during pandemics. There is a knowledge gap about the effect of pandemics on maternal, newborn, and child well-being. This systematic review was conducted to study maternal and child health (MCH) services utilization during pandemics (Zika, Ebola, and COVID-19) and the effectiveness of various interventions undertaken for ensuring utilization of MCH services. METHODOLOGY A systematic and comprehensive search was conducted in MEDLINE/PubMed, Cochrane CENTRAL, Embase, Epistemonikos, ScienceDirect, and Google Scholar. Of 5643 citations, 60 potential studies were finally included for analysis. The included studies were appraised using JBI Critical appraisal tools. Study selection and data extraction were done independently and in duplicate. Findings are presented narratively based on the RMNCHA framework by World Health Organization (WHO). RESULTS Maternal and child health services such as antenatal care (ANC) visits, institutional deliveries, immunization uptake, were greatly affected during a pandemic situation. Innovative approaches in form of health care services through virtual consultation, patient triaging, developing dedicated COVID maternity centers and maternity schools were implemented in different places for ensuring continuity of MCH care during pandemics. None of the studies reported the effectiveness of these interventions during pandemic-related health emergencies. CONCLUSION The findings suggest that during pandemics, MCH care utilization often gets affected. Many innovative interventions were adopted to ensure MCH services. However, they lack evidence about their effectiveness. It is critically important to implement evidence-based appropriate interventions for better MCH care utilization.
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Affiliation(s)
| | - Shubhankar Dubey
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sapna Negi
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | - Kripalini Patel
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Swagatika Swain
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | - Dinesh Bhuyan
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Srikanta Kanungo
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Meena Som
- United Nations Children’s Fund (UNICEF), Odisha, India
| | | | | | | | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
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Kassa ZY, Scarf V, Fox D. The effect of Ebola virus disease on maternal health service utilisation and perinatal outcomes in West Africa: a systematic review. Reprod Health 2022; 19:35. [PMID: 35120540 PMCID: PMC8815720 DOI: 10.1186/s12978-022-01343-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Ebola outbreaks pose a major threat to global public health, especially in Sub-Saharan Africa. These outbreaks disrupt the already fragile maternal health services in West Africa. The aims of this study is to assess the effect of Ebola virus disease (EVD) on maternal health service utilisation and perinatal outcomes. Methods This systematic review was conducted in West Africa, and the databases used were Medline, PubMed, CINAHL, Scopus, EMBASE and African journals online. Studies that reported the effect of the Ebola outbreak on maternal health services in West Africa were eligible for this systematic review. The search was limited to articles written in the English language only and published between 2013 and 2020. Three authors independently appraised the articles, and the data were extracted using a standardised data extraction format. The findings were synthesised using a narrative summary, tables, and figures. Results Twelve studies met the inclusion criteria and were used for this systematic review synthesis. The results showed that antenatal care significantly decreased during Ebola virus disease and strove to recover post-Ebola virus disease. Women were less likely to have institutional childbirth during Ebola virus disease and struggled to recover post-Ebola virus disease. In addition, this review revealed a substantially higher rate of maternal mortality post EVD than those observed before or during the outbreak. Conclusion Based on our findings, antenatal care, institutional childbirth, and postnatal care are attempting to recover post-Ebola virus disease. We recommended that responsible bodies and stakeholders need to prepare locally tailored interventions to increase the number of women attending ANC, institutional childbirth, and PNC services post-EVD and future outbreaks including COVID-19. In order to build trust, creating community networks between health care providers and trusted community leaders may increase the number of women attending antenatal care (ANC), institutional childbirth and postnatal care (PNC) post-EVD and during future outbreaks. Further studies are needed to examine health centre and hospital availability and accessibility, and capacity to deliver maternal health services post-Ebola virus disease and future outbreaks. Ebola virus disease (EVD) is a serious public health concern affecting the health of humans and other primates. These outbreaks disrupt the already fragile maternal health services in West Africa. There is limited data on the effect of EVD on maternal health service utilisation and perinatal outcomes in West Africa. This systematic review aims to synthesise evidence on maternal health service utilisation and perinatal outcomes before EVD, during EVD and post EVD. This systematic review was conducted in West Africa, and the databases used were Medline, PubMed, CINAHL, Scopus, EMBASE and African journals online. Twelve studies met the inclusion criteria and were used for this systematic review synthesis. The results showed that antenatal care significantly decreased during the Ebola virus outbreak and strove to recover post-Ebola virus disease. This finding indicated that women were less likely to have an institutional birth during EVD and struggled to recover post-Ebola virus disease. Based on this finding, responsible bodies and stakeholders need to prepare locally tailored interventions to increase the number of women attending ANC, institutional childbirth, and PNC services post-EVD and future outbreaks.
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Affiliation(s)
- Zemenu Yohannes Kassa
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia. .,Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - Vanessa Scarf
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Deborah Fox
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Ulaganeethi R, Dorairajan G, Ramaswamy G, Thekkur P, Olickal JJ, Rajkumari N, Kumar Saya G. 'I was scared I will end up in another abortion': a mixed-methods study assessing the impact of COVID-19 pandemic and lockdown on the antenatal care of pregnant women in Puducherry, South India. Fam Pract 2021; 38:i23-i29. [PMID: 34169960 PMCID: PMC8344696 DOI: 10.1093/fampra/cmab042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND As a mitigation measure for COVID-19 pandemic, lockdown was implemented in India for a period of 2 months (24 March-31 May 2020). Disruption in antenatal care (ANC) provisions during lockdown is expected due to diversion of public health facilities on pandemic. OBJECTIVE To assess the proportion of pregnant women who had not completed the ideal number of antenatal visits, availability of iron-folic acid (IFA) supplements and challenges in availing health services during the period of lockdown. METHODS A concurrent mixed-methods study was conducted among pregnant women in Puducherry, India. Information on obstetric characteristics and details regarding antenatal visits were collected through telephonic interviews. In-depth interviews were conducted to understand the perceived challenges in availing health services during the lockdown period. RESULTS Out of 150 pregnant women, 62 [41.3%; 95% confidence interval (CI) 33.6-49.3] did not complete the ideal number of visits and 61 (40.7%, 95% CI 32.7-49.0) developed health problems. Out of 44 women who received medical care for health problems, 11 (25%) used teleconsultation. Of all the women, 13 (8.7%, 95% CI 4.9-14.0) had not taken the IFA supplements as prescribed by the health provider. Economic hardship, restricted mobility, lack of information about the health system changes and psychological stress due to the fear of COVID were the challenges in accessing care. CONCLUSIONS Two out of five pregnant women did not complete the ideal number of visits and developed health problems during the lockdown period.
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Affiliation(s)
- Revathi Ulaganeethi
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Gowri Dorairajan
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Gomathi Ramaswamy
- Department of Preventive and Social Medicine, All India Institute of medical Sciences, Bibinagar, Hyderabad, India
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Jeby Jose Olickal
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nonika Rajkumari
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ganesh Kumar Saya
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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10
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Gray KL, Walker NF, Martineau F, Bhadelia N, Harmon-Gray WM, Skrip LA, DeMarco J, Konwloh P, Dunbar N. Interruption of tuberculosis detection and care during the Ebola virus disease epidemic (2014-2015) in Liberia: time-series analyses for 2013-2017. Int J Infect Dis 2021; 112:13-20. [PMID: 34433096 DOI: 10.1016/j.ijid.2021.08.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Interrupted time-series analyses, using 5 years of routinely collected health information system data, were conducted to estimate the magnitude of impact of the 2014-2015 Ebola virus disease (EVD) epidemic and determine trends in tuberculosis (TB) care services in Liberia. METHODS A segmented linear regression model was used to generate estimates and predictions for trends for three TB service indicators before, during, and after EVD, from January 2013 to December 2017. RESULTS It was found that the number of presumptive TB cases declined significantly at the start of the EVD outbreak, with an estimated loss of 3222 cases (95% confidence interval (CI) -5691 to -752; P = 0.014). There was also an estimated loss of 709 cases per quarter post-EVD (95% CI -1346 to -71; P = 0.032). However, over the post-EVD period, quarterly increases were observed in the proportion of smear-positive to presumptive cases (1.45%, 95% CI 0.38% to 2.5%; P = 0.011) and the proportion of treatment success to TB cases evaluated (3.3%, 95% CI 0.82% to 5.79%; P = 0.013). CONCLUSIONS These findings suggest that the EVD outbreak (2014-2015) negatively affected TB care services. Rigorous quantitative analyses can be used to assess the magnitude of interruption and advocate for preparedness in settings with limited healthcare capacity.
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Affiliation(s)
| | | | | | | | | | | | - Jean DeMarco
- University of North Carolina, Chapel Hill, North Carolina, USA
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11
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Yerger P, Jalloh M, Coltart CEM, King C. Barriers to maternal health services during the Ebola outbreak in three West African countries: a literature review. BMJ Glob Health 2021; 5:bmjgh-2020-002974. [PMID: 32895217 PMCID: PMC7476472 DOI: 10.1136/bmjgh-2020-002974] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 02/01/2023] Open
Abstract
Introduction The Ebola virus disease (EVD) outbreak in West Africa, affecting Guinea, Liberia and Sierra Leone from 2014 to 2016, was a substantial public health crisis with health impacts extending past EVD itself. Access to maternal health services (MHS) was disrupted during the epidemic, with reductions in antenatal care, facility-based deliveries and postnatal care. We aimed to identify and describe barriers related to the uptake and provision of MHS during the 2014–2016 EVD outbreak in West Africa. Methods In June 2020, we conducted a scoping review of peer-reviewed publications and grey literature from relevant stakeholder organisations. Search terms were generated to identify literature that explained underlying access barriers to MHS. Published literature in scientific journals was first searched and extracted from PubMed and Web of Science databases for the period between 1 January 2014 and 27 June 2020. We hand-searched relevant stakeholder websites. A ‘snowball’ approach was used to identify relevant sources uncaptured in the systematic search. The identified literature was examined to synthesise themes using an existing framework. Results Nineteen papers were included, with 26 barriers to MHS uptake and provision identified. Three themes emerged: (1) fear and mistrust, (2) health system and service constraints, and (3) poor communication. Our analysis of the literature indicates that fear, experienced by both service users and providers, was the most recurring barrier to MHS. Constrained health systems negatively impacted MHS on the supply side. Poor communication and inadequately coordinated training efforts disallowed competent provision of MHS. Conclusions Barriers to accessing MHS during the EVD outbreak in West Africa were influenced by complex but inter-related factors at the individual, interpersonal, health system and international level. Future responses to EVD outbreaks need to address underlying reasons for fear and mistrust between patients and providers, and ensure MHS are adequately equipped both routinely and during crises.
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Affiliation(s)
- Piper Yerger
- Institute for Global Health, University College London, London, UK.,Care Ring, Children and Family Services Center, Charlotte, North Carolina, USA
| | - Mohamed Jalloh
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Carina King
- Institute for Global Health, University College London, London, UK .,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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12
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Reported health and social consequences of the COVID-19 pandemic on vulnerable populations and implemented solutions in six West African countries: A media content analysis. PLoS One 2021; 16:e0252890. [PMID: 34133438 PMCID: PMC8208543 DOI: 10.1371/journal.pone.0252890] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022] Open
Abstract
Coronavirus has spread worldwide with over 140 million cases and resulting in more than 3 million deaths between November 2019 to April 2021, threatening the socio-economic and psychosocial stability of many families and communities. There has been limited research to understand the consequences of COVID-19 on vulnerable populations in West Africa, and whether such consequences differ by countries’ previous experience with Ebola. Using a media analysis of leading online news sources, this study identified the populations particularly vulnerable to the threats of the COVID-19 pandemic, described the consequences of COVID-19 experienced by these populations, and reported on the solutions to address them. All articles from the selected news sources published between January 1 and June 30, 2020 on 6 West African countries were imported into Dedoose. A total of 4,388 news articles were coded for excerpts on vulnerable populations, only 285 excerpts of which mentioned the existing effects of COVID-19 on vulnerable populations or implemented solutions. News articles from countries with past experience with Ebola were more likely to mention the pandemic’s effects on vulnerable populations, especially on incarcerated people. Vulnerable groups were reported to have experienced a range of effects including economic disruptions, heightened domestic and sexual abuse, arbitrary arrests, health care inaccessibility, and educational challenges throughout the pandemic. With implications for the achievement of the Sustainable Development Goals (SDG) for 2030 in West Africa, these countries should consider and focus more strategic efforts on vulnerable populations to overcome their fight against the COVID-19 pandemic and to achieve the SDG for 2030.
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13
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Wanyana D, Wong R, Hakizimana D. Rapid assessment on the utilization of maternal and child health services during COVID-19 in Rwanda. Public Health Action 2021; 11:12-21. [PMID: 33777716 DOI: 10.5588/pha.20.0057] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
SETTING All public health facilities in Rwanda, East Africa. OBJECTIVE To assess the change in the utilization of maternal and child health (MCH) services during the COVID-19 outbreak. DESIGN This was a cross-sectional quantitative study. RESULTS During the COVID-19 outbreak in Rwanda, the utilization of 15 MCH services in all four categories-antenatal care (ANC), deliveries, postnatal care (PNC) and vaccinations-significantly declined. The Northern and Western Provinces were affected the most, with significant decrease in respectively nine and 12 services. The Eastern Province showed no statistically significant utilization changes. Kigali was the only province with significant increase in the fourth PNC visits for babies and mothers, while the Southern Province showed significant increase in utilization of measles + rubella (MR) 1 vaccination. CONCLUSION Access and utilization of basic MCH services were considerably affected during the COVID-19 outbreak in Rwanda. This study highlighted the need for pre-emptive measures to avoid disruptions in MCH service delivery and routine health services during outbreaks. In order for the reductions in MCH service utilization to be reversed, targeted resources and active promotion of ANC, institutional deliveries and vaccinations need to be prioritized. Further studies on long-term impact and geographical variations are needed.
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Affiliation(s)
- D Wanyana
- Institute of Global Health, University of Global Health Equity, Kigali, Rwanda
| | - R Wong
- Institute of Global Health, University of Global Health Equity, Kigali, Rwanda.,School of Public Health, Yale University, New Haven, CT, USA
| | - D Hakizimana
- Institute of Global Health, University of Global Health Equity, Kigali, Rwanda
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14
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Pilato TC, Taki FA, Kaur G. Safeguarding pregnant asylum-seekers and refugees during the era of COVID-19. J Glob Health 2021; 11:03026. [PMID: 33692881 PMCID: PMC7914379 DOI: 10.7189/jogh.11.03026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Tara C Pilato
- Weill Cornell Medical College, New York, New York, USA
| | - Faten A Taki
- Department of Anesthesia, Weill Cornell Medicine, New York, New York, USA
| | - Gunisha Kaur
- Department of Anesthesia, Weill Cornell Medicine, New York, New York, USA
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15
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Brown LB, Spinelli MA, Gandhi M. The interplay between HIV and COVID-19: summary of the data and responses to date. Curr Opin HIV AIDS 2021; 16:63-73. [PMID: 33186229 PMCID: PMC7735216 DOI: 10.1097/coh.0000000000000659] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW We examine the interplay between the HIV and COVID-19 epidemics, including the impact of HIV on COVID-19 susceptibility and severe disease, the effect of the COVID-19 epidemic on HIV prevention and treatment, and the influence of the HIV epidemic on responses to COVID-19. RECENT FINDINGS Evidence to date does not suggest that people living with HIV (PLWH) have a markedly higher susceptibility to SARS-CoV-2 infection, with disparities in the social determinants of health and comorbidities likely having a greater influence. The majority of literature has not supported a higher risk for severe disease among PLWH in Europe and the United States, although a large, population-based study in South Africa reported a higher rate of death due to COVID-19. Higher rates of comorbidities associated with COVID-19 disease severity among PLWH is an urgent concern. COVID-19 is leading to decreased access to HIV prevention services and HIV testing, and worsening HIV treatment access and virologic suppression, which could lead to worsening HIV epidemic control. CONCLUSION COVID-19 is threatening gains against the HIV epidemic, including the U.S. Ending the HIV Epidemic goals. The ongoing collision of these two global pandemics will continue to need both study and interventions to mitigate the effects of COVID-19 on HIV efforts worldwide.
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Affiliation(s)
- Lillian B. Brown
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | - Matthew A. Spinelli
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | - Monica Gandhi
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
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16
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Women's Empowerment as a Mitigating Factor for Improved Antenatal Care Quality despite Impact of 2014 Ebola Outbreak in Guinea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218172. [PMID: 33167397 PMCID: PMC7663814 DOI: 10.3390/ijerph17218172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/31/2020] [Accepted: 11/04/2020] [Indexed: 01/16/2023]
Abstract
Improving maternal outcomes and reducing pregnancy morbidity and mortality are critical public health goals. The provision of quality antenatal care (ANC) is one method of doing so. Increasing women’s empowerment is associated with positive women’s health outcomes, including the adequate timing and amount of ANC use. However, little is known about the relationship between women’s empowerment and quality ANC care. Despite a history of political instability, low women’s equality and poor maternal health, the Republic of Guinea has committed to improving the status of women and access to health. However, the 2014 Ebola outbreak may have had a negative impact on achieving these goals. This study sought to examine factors in the relationship between women’s empowerment and the receipt of quality ANC (indicated by the number of health components) within the context of the Ebola outbreak. This study conducted multiple logistic regressions examining associations between covariates and the number of ANC components received using data from the 2012 and 2018 Guinea Demographic Health Surveys. Several aspects of women’s empowerment (healthcare decision-making, literacy/access to magazines, monogamous relationship status, contraceptive use, socio-economic status/employment) were significantly linked with the receipt of a greater number of ANC components, highlighting the importance of women’s empowerment in accessing quality maternity care.
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17
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McDonald CR, Weckman AM, Wright JK, Conroy AL, Kain KC. Pregnant Women in Low- and Middle-Income Countries Require a Special Focus During the COVID-19 Pandemic. Front Glob Womens Health 2020; 1:564560. [PMID: 34816152 PMCID: PMC8594030 DOI: 10.3389/fgwh.2020.564560] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/24/2020] [Indexed: 01/22/2023] Open
Affiliation(s)
- Chloe R McDonald
- University Health Network-Toronto General Hospital, Toronto, ON, Canada
| | - Andrea M Weckman
- SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Julie K Wright
- SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrea L Conroy
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Kevin C Kain
- SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
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18
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Bong CL, Brasher C, Chikumba E, McDougall R, Mellin-Olsen J, Enright A. The COVID-19 Pandemic: Effects on Low- and Middle-Income Countries. Anesth Analg 2020; 131:86-92. [PMID: 32243287 PMCID: PMC7173081 DOI: 10.1213/ane.0000000000004846] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, health care workers, health systems, and economies. As it reaches low- and middle-income countries, its effects could be even more dire, because it will be difficult for them to respond aggressively to the pandemic. There is a great shortage of all health care providers, who will be at risk due to a lack of personal protection equipment. Social distancing will be almost impossible. The necessary resources to treat patients will be in short supply. The end result could be a catastrophic loss of life. A global effort will be required to support faltering economies and health care systems.
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Affiliation(s)
- Choon-Looi Bong
- From the Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, Singapore.,Department of Paediatric Anaesthesia, KK Women's & Children's Hospital, Singapore
| | - Christopher Brasher
- University of Melbourne, Victoria, Australia.,Department of Anaesthesia & Pain Management, Royal Children's Hospital, Melbourne, Australia
| | - Edson Chikumba
- Department of Anaesthesia & Critical Care Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Robert McDougall
- University of Melbourne, Victoria, Australia.,Department of Anaesthesia & Pain Management, Royal Children's Hospital, Melbourne, Australia
| | - Jannicke Mellin-Olsen
- World Federation of Societies of Anaesthesiologists, London, United Kingdom.,From the Duke-NUS Medical School, Singapore.,From the Duke-NUS Medical School, Singapore
| | - Angela Enright
- Yong Loo Lin School of Medicine, Singapore.,Yong Loo Lin School of Medicine, Singapore
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19
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Mukunya D, Tumwine JK. Challenges of tackling non COVID-19 emergencies during the unprecedent pandemic. Afr Health Sci 2020; 20:V-VI. [PMID: 33402946 PMCID: PMC7750045 DOI: 10.4314/ahs.v20i1.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- David Mukunya
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - James K Tumwine
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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20
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Karmbor-Ballah EG, Fallah MP, Silverstein JB, Gilbert HN, Desai IK, Mukherjee JS, Farmer PE, Richardson ET. Maternal mortality and the metempsychosis of user fees in Liberia: A mixed-methods analysis. SCIENTIFIC AFRICAN 2019. [DOI: 10.1016/j.sciaf.2019.e00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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21
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Abstract
The 2014 to 2016 Ebola outbreak, primarily based in 3 West African countries, had far-reaching global effects. Importantly, the crisis highlighted large gaps in reproductive health services in affected countries and inadequate health care system preparedness for obstetrical patients in the setting of highly contagious infectious diseases. We aim to review Ebola virus effects with a focus on the obstetrical implications in the context of this recent Ebola outbreak, discuss the lessons learned following this outbreak and propose current measures specific to obstetrics that should be considered in preparation for the next concerning emergent infectious disease.
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22
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Tracking health seeking behavior during an Ebola outbreak via mobile phones and SMS. NPJ Digit Med 2018; 1:51. [PMID: 31304330 PMCID: PMC6550280 DOI: 10.1038/s41746-018-0055-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/21/2018] [Accepted: 06/27/2018] [Indexed: 11/21/2022] Open
Abstract
The recent Ebola outbreak in West Africa was an exemplar for the need to rapidly measure population-level health-seeking behaviors, in order to understand healthcare utilization during emergency situations. Taking advantage of the high prevalence of mobile phones, we deployed a national SMS-poll and collected data about individual-level health and health-seeking behavior throughout the outbreak from 6694 individuals from March to June 2015 in Liberia. Using propensity score matching to generate balanced subsamples, we compared outcomes in our survey to those from a recent household survey (the 2013 Liberian Demographic Health Survey). We found that the matched subgroups had similar patterns of delivery location in aggregate, and utilizing data on the date of birth, we were able to show that facility-based deliveries were significantly decreased during, compared to after the outbreak (p < 0.05) consistent with findings from retrospective studies using healthcare-based data. Directly assessing behaviors from individuals via SMS also enabled the measurement of public and private sector facility utilization separately, which has been a challenge in other studies in countries including Liberia which rely mainly on government sources of data. In doing so, our data suggest that public facility-based deliveries returned to baseline values after the outbreak. Thus, we demonstrate that with the appropriate methodological approach to account for different population denominators, data sourced via mobile tools such as SMS polling could serve as an important low-cost complement to existing data collection strategies especially in situations where higher-frequency data than can be feasibly obtained through surveys is useful.
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23
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Wagenaar BH, Augusto O, Beste J, Toomay SJ, Wickett E, Dunbar N, Bawo L, Wesseh CS. The 2014-2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010-2016. PLoS Med 2018; 15:e1002508. [PMID: 29462138 PMCID: PMC5819774 DOI: 10.1371/journal.pmed.1002508] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/16/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of this study is to estimate the immediate and lasting effects of the 2014-2015 Ebola virus disease (EVD) outbreak on public-sector primary healthcare delivery in Liberia using 7 years of comprehensive routine health information system data. METHODS AND FINDINGS We analyzed 10 key primary healthcare indicators before, during, and after the EVD outbreak using 31,836 facility-month service outputs from 1 January 2010 to 31 December 2016 across a census of 379 public-sector health facilities in Liberia (excluding Montserrado County). All indicators had statistically significant decreases during the first 4 months of the EVD outbreak, with all indicators having their lowest raw mean outputs in August 2014. Decreases in outputs comparing the end of the initial EVD period (September 2014) to May 2014 (pre-EVD) ranged in magnitude from a 67.3% decrease in measles vaccinations (95% CI: -77.9%, -56.8%, p < 0.001) and a 61.4% decrease in artemisinin-based combination therapy (ACT) treatments for malaria (95% CI: -69.0%, -53.8%, p < 0.001) to a 35.2% decrease in first antenatal care (ANC) visits (95% CI: -45.8%, -24.7%, p < 0.001) and a 38.5% decrease in medroxyprogesterone acetate doses (95% CI: -47.6%, -29.5%, p < 0.001). Following the nadir of system outputs in August 2014, all indicators showed statistically significant increases from October 2014 to December 2014. All indicators had significant positive trends during the post-EVD period, with every system output exceeding pre-Ebola forecasted trends for 3 consecutive months by November 2016. Health system outputs lost during and after the EVD outbreak were large and sustained for most indicators. Prior to exceeding pre-EVD forecasted trends for 3 months, we estimate statistically significant cumulative losses of -776,110 clinic visits (95% CI: -1,480,896, -101,357, p = 0.030); -24,449 bacille Calmette-Guérin vaccinations (95% CI: -45,947, -2,020, p = 0.032); -9,129 measles vaccinations (95% CI: -12,312, -5,659, p < 0.001); -17,191 postnatal care (PNC) visits within 6 weeks of birth (95% CI: -28,344, -5,775, p = 0.002); and -101,857 ACT malaria treatments (95% CI: -205,839, -2,139, p = 0.044) due to the EVD outbreak. Other outputs showed statistically significant cumulative losses only through December 2014, including losses of -12,941 first pentavalent vaccinations (95% CI: -20,309, -5,527, p = 0.002); -5,122 institutional births (95% CI: -8,767, -1,234, p = 0.003); and -45,024 acute respiratory infections treated (95% CI: -66,185, -24,019, p < 0.001). Compared to pre-EVD forecasted trends, medroxyprogesterone acetate doses and first ANC visits did not show statistically significant net losses. ACT treatment for malaria was the only indicator with an estimated net increase in system outputs through December 2016, showing an excess of +78,583 outputs (95% CI: -309,417, +450,661, p = 0.634) compared to pre-EVD forecasted trends, although this increase was not statistically significant. However, comparing December 2013 to December 2017, ACT malaria cases have increased 49.2% (95% CI: 33.9%, 64.5%, p < 0.001). Compared to pre-EVD forecasted trends, there remains a statistically significant loss of -15,144 PNC visits within 6 weeks (95% CI: -29,453, -787, p = 0.040) through December 2016. CONCLUSIONS The Liberian public-sector primary healthcare system has made strides towards recovery from the 2014-2015 EVD outbreak. All primary healthcare indicators tracked have recovered to pre-EVD levels as of November 2016. Yet, for most indicators, it took more than 1 year to recover to pre-EVD levels. During this time, large losses of essential primary healthcare services occurred compared to what would have been expected had the EVD outbreak not occurred. The disruption of malaria case management during the EVD outbreak may have resulted in increased malaria cases. Large and sustained investments in public-sector primary care health system strengthening are urgently needed for EVD-affected countries.
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Affiliation(s)
- Bradley H. Wagenaar
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Partners in Health, Monrovia, Liberia
- Health Alliance International, Seattle, Washington, United States of America
- * E-mail:
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Health Alliance International, Seattle, Washington, United States of America
- Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Jason Beste
- Partners in Health, Monrovia, Liberia
- Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | | | - Luke Bawo
- Ministry of Health, Monrovia, Liberia
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Decroo T, Fitzpatrick G, Amone J. What was the effect of the West African Ebola outbreak on health programme performance, and did programmes recover? Public Health Action 2017; 7:S1-S2. [PMID: 28744431 DOI: 10.5588/pha.17.0029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Tom Decroo
- Unit HIV & Infectious Diseases, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Jackson Amone
- Department of Clinical Services, Ministry of Health, Kampala, Uganda
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