2 research outputs found
Assessing the impact of COVID-19 pandemic on maternal healthcare usage: evidence from routine health data in Kenya and Ethiopia
Objectives Lockdowns and fear of COVID-19 may have reduced access to antenatal care (ANC) and skilled birth attendance (SBA) in sub-Saharan Africa, which could undermine progress towards maternal and child survival and the sustainable development goals (SDGs). We analysed COVID-19’s impact on maternal healthcare usage, focusing on subnational levels, to identify healthcare disruption hotspots that require targeted interventions and help policymakers prioritise resources to accelerate progress.Methods and analysis Using monthly health management information system (HMIS) data, we tracked changes in healthcare access at subnational levels in Ethiopia and Kenya during the pandemic. We compared service usage before and during the pandemic, using interrupted time series and counterfactual analyses to evaluate the pandemic’s impact on healthcare usage trends. We also performed geospatial mapping of the affected regions to identify hotspots.Results Our results show significant changes at subnational levels. ANC declined in several Kenyan counties during the pandemic, with improvements observed in others. SBA disruptions were observed in two counties. In Ethiopia, ANC declined in the north but remained unchanged in the south, with some improvements observed in the two regions. Southern regions showed resilience in SBA, experiencing gains, while northern regions showed no change.Conclusion Future disease outbreaks may continue to cause further disruptions to health service delivery, affecting maternal and child health outcomes. Our analysis highlights the low resilience of subnational health systems to shocks, underscoring the need to strengthen healthcare systems and HMIS data capture for better data quality. Evidence-based research is essential in identifying hotspots and supporting targeted interventions to achieve the SDGs and improve maternal and child health outcomes
Interventions to enhance healthcare utilisation among pregnant women to reduce maternal mortality in low- and middle-income countries: a review of systematic reviews
Abstract Background Maternal mortality in low- and middle-income countries (LMIC) has reduced considerably over the past three decades, but it remains high. Effective interventions are available, but their uptake and coverage remain low. We reviewed and synthesised evidence from systematic reviews on interventions to increase healthcare services utilisation to reduce maternal mortality in LMICs. Methods We searched Medline PubMed and Cochrane Library databases for systematic reviews published between January 2014 and December 2021, investigating interventions to increase healthcare services uptake among pregnant women in LMICs. We used the AMSTAR tool (A Measurement Tool to Assess Systematic Reviews) to assess the methodological quality of the included reviews. We extracted data on the interventions and their effects and grouped them into broad groups based on the outcomes reported in each systematic review. Results We retrieved 4,022 articles. After removing duplicates and screening, we included 14 systematic reviews. Male-partner interventions were effective in increasing skilled birth attendance (SBA) postnatal visits and maternal antiretroviral (ART) uptake for HIV-positive pregnant women. However, there was no evidence of their effectiveness on increased early ANC initiation or adequate ANC visits. Mobile health interventions were effective in increasing adequate ANC visits, SBA, facility-based service utilisation, early ANC initiation, and adherence to nutritional supplements. Incentive-based interventions, particularly financial incentives, were effective in increasing the number of ANC visits but not postnatal visits. Facility-based interventions were effective in increasing postnatal visits, maternal ART initiation and uptake, immunisation uptake and follow-up ANC visits. None of the reviews assessed their impact on SBA or adequate ANC visits. Community-based interventions were effective in increasing SBA, ANC service utilisation, ART initiation and uptake, and nutritional supplements and immunisation uptake. Conclusion Our findings show that the different interventions effectively improved different outcomes on the maternal healthcare continuum. Implementing these interventions in combination has the potential to enhance healthcare service uptake further