The COVID-19 pandemic and disruptions to essential health services in Kenya:A retrospective time-series analysis

Background: Public health emergencies can disrupt the provision of and access to essential health-care services, exacerbating health crises. We aimed to assess the effect of the COVID-19 pandemic on essential health-care services in Kenya. Methods: Using county-level data routinely collected from the health information system from health facilities across the country, we used a robust mixed-effect model to examine changes in 17 indicators of essential health services across four periods: the pre-pandemic period (from January, 2018 to February, 2020), two pandemic periods (from March to November 2020, and February to October, 2021), and the period during the COVID-19-associated health-care workers' strike (from December, 2020 to January, 2021). Findings: In the pre-pandemic period, we observed a positive trend for multiple indicators. The onset of the pandemic was associated with statistically significant decreases in multiple indicators, including outpatient visits (28·7%; 95% CI 16·0-43·5%), cervical cancer screening (49·8%; 20·6-57·9%), number of HIV tests conducted (45·3%; 23·9-63·0%), patients tested for malaria (31·9%; 16·7-46·7%), number of notified tuberculosis cases (26·6%; 14·7-45·1%), hypertension cases (10·4%; 6·0-39·4%), vitamin A supplements (8·7%; 7·9-10·5%), and three doses of the diphtheria, tetanus toxoid, and pertussis vaccine administered (0·9%; 0·5-1·3%). Pneumonia cases reduced by 50·6% (31·3-67·3%), diarrhoea by 39·7% (24·8-62·7%), and children attending welfare clinics by 39·6% (23·5-47·1%). Cases of sexual violence increased by 8·0% (4·3-25·0%). Skilled deliveries, antenatal care, people with HIV infection newly started on antiretroviral therapy, confirmed cases of malaria, and diabetes cases detected were not significantly affected negatively. Although most of the health indicators began to recover during the pandemic, the health-care workers' strike resulted in nearly all indicators falling to numbers lower than those observed at the onset or during the pre-strike pandemic period. Interpretation: The COVID-19 pandemic and the associated health-care workers' strike in Kenya have been associated with a substantial disruption of essential health services, with the use of outpatient visits, screening and diagnostic services, and child immunisation adversely affected. Efforts to maintain the provision of these essential health services during a health-care crisis should target the susceptible services to prevent the exacerbation of associated disease burdens during such health crises. Funding: Bill & Melinda Gates Foundation

Decision to delivery interval of emergency caesarean section and associated maternal and neonatal outcomes in a county hospital in Kenya

Objective: The objective of the study was to determine the decision to delivery interval and the associated maternal and neonatal outcomes at Thika level five hospital.Design: Ambidirectional studySetting: Secondary Level Hospital in KenyaSubjects: Four hundred and nineteen mothers who underwent emergency caesarean section and their newbornsMain outcome measure: Decision to delivery interval, maternal and neonatal outcomes.Results: The median decision to delivery interval was 248 minutes. Only 1% attained the recommended decision to delivery interval of ≤30 minutes. Majority of the participants (40.1%) had a decision to delivery interval above 300 minutes. Six percent of the mothers developed complications among which postpartum haemorrhage accounted for 1.9% (n=8), wound sepsis 0.7% (n=3), ruptured uterus 0.5% (n=2) and maternal deaths recorded were 0.5% (n=2). There was no significant association between DDI and maternal complications. Of the newborn admissions, meconium aspiration syndrome accounted for 17.6%, respiratory distress syndrome 17.6% and birth asphyxia 12.0%. Perinatal deaths recorded were 1.4%, fresh and macerated still births were 2.6% and 1%, respectively. There was a significance association between prolonged DDI and neonatal outcome (p=0.024)Conclusions: Decision to delivery interval at Thika Level Five Hospital was longer than the recommended. There was no significant association between the decision to delivery interval and the maternal complications and prolonged duration of hospital stay. Prolonged decision to delivery interval significantly influenced the neonatal outcome

The COVID-19 pandemic and disruptions to essential health services in Kenya: a retrospective time-series analysis

Background: Public health emergencies can disrupt the provision of and access to essential health-care services, exacerbating health crises. We aimed to assess the effect of the COVID-19 pandemic on essential health-care services in Kenya. Methods: Using county-level data routinely collected from the health information system from health facilities across the country, we used a robust mixed-effect model to examine changes in 17 indicators of essential health services across four periods: the pre-pandemic period (from January, 2018 to February, 2020), two pandemic periods (from March to November 2020, and February to October, 2021), and the period during the COVID-19-associated health-care workers’ strike (from December, 2020 to January, 2021). Findings: In the pre-pandemic period, we observed a positive trend for multiple indicators. The onset of the pandemic was associated with statistically significant decreases in multiple indicators, including outpatient visits (28·7%; 95% CI 16·0–43·5%), cervical cancer screening (49·8%; 20·6–57·9%), number of HIV tests conducted (45·3%; 23·9–63·0%), patients tested for malaria (31·9%; 16·7–46·7%), number of notified tuberculosis cases (26·6%; 14·7–45·1%), hypertension cases (10·4%; 6·0–39·4%), vitamin A supplements (8·7%; 7·9–10·5%), and three doses of the diphtheria, tetanus toxoid, and pertussis vaccine administered (0·9%; 0·5–1·3%). Pneumonia cases reduced by 50·6% (31·3–67·3%), diarrhoea by 39·7% (24·8–62·7%), and children attending welfare clinics by 39·6% (23·5–47·1%). Cases of sexual violence increased by 8·0% (4·3–25·0%). Skilled deliveries, antenatal care, people with HIV infection newly started on antiretroviral therapy, confirmed cases of malaria, and diabetes cases detected were not significantly affected negatively. Although most of the health indicators began to recover during the pandemic, the health-care workers’ strike resulted in nearly all indicators falling to numbers lower than those observed at the onset or during the pre-strike pandemic period. Interpretation: The COVID-19 pandemic and the associated health-care workers’ strike in Kenya have been associated with a substantial disruption of essential health services, with the use of outpatient visits, screening and diagnostic services, and child immunisation adversely affected. Efforts to maintain the provision of these essential health services during a health-care crisis should target the susceptible services to prevent the exacerbation of associated disease burdens during such health crises