Peer-reviewed article
Impact of the COVID-19 pandemic on maternal, neonatal and child health service utilisation, delivery and health outcomes in Gauteng province, South Africa: an interrupted time series (ITS) analysis.
Fonka CB, Khamisa N, Worku E, Blaauw D ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how COVID-19 and lockdown measures affected maternal, newborn and child health services in Gauteng province, South Africa between March 2019 and February 2021. Using health system data, researchers found that the March 2020 lockdown caused significant drops in primary healthcare visits for children under five and postnatal care visits within six days. Antenatal care attendance in early pregnancy also declined during the pandemic. Some immunisation and mortality measures were less severely affected, and services partially recovered after the initial lockdown.
Key points
- Primary healthcare headcount for children under 5 years dropped by 60,107 visits immediately after lockdown (p=0.039)
- Postnatal care visits within 6 days declined by 8.2 per unit rate after lockdown (p=0.001)
- Antenatal care first visits before 20 weeks showed declining trend during COVID-19 period (p=0.013)
- Immunisation coverage and facility mortality rates were not significantly affected by COVID-19
- Service disruption was driven by both supply-side and demand-side factors
Limitations
The study only covers one province (Gauteng) in South Africa, so findings may not generalise to other regions. The analysis uses secondary data from health information systems, which may have data quality issues or missing records during the pandemic period.
Abstract
Background Gauteng was one of the provinces in South Africa most hit by COVID-19. However, there has been no assessment of the pandemic's impact on essential maternal, neonatal and child health (MNCH) services in Gauteng, for planning against future emergencies. This study sought to assess the impact of the COVID-19 pandemic on essential MNCH service utilisation, delivery and health outcomes in Gauteng province. Methods We employed a quasi-experimental interrupted time series (ITS) study design, using the District Health Information System (DHIS) data set to evaluate the impact of COVID-19 on eight key MNCH indicators between March 2019 to February 2021. Using Stata V.17.0 and 5% alpha, a segmented linear regression (ITS) model quantified the trends of the indicators before COVID-19 (March 2019 to February 2020) (β1), the immediate change in level due to the March 2020 lockdown (β2), the post-lockdown (March 2020 to February 2021) trend (β4) and the change in gradient from before to after the lockdown (β3). Results COVID-19 lockdown exerted a significant decline in primary healthcare headcount<5 years (n) (β2= -60 106.9 (95% CI, -116 710.4; -3503.3), p=0.039); and postnatal care visits within 6 days (rate) (β2=-8.2 (95% CI, -12.4; -4.1), p=0.001). Antenatal care first visits before 20 weeks (rate) declined during COVID-19 (β3=-0.4 (95% CI, -0.7; -0.1), p=0.013) compared with the pre-COVID-19 period. COVID-19 adverse effects on service delivery (measles second dose coverage and fully immunised<1 year) and health outcomes (facility deaths 0-6 days, maternal mortality ratio and pneumonia case fatality<1 year) were insignificant. While some indicators post-lockdown attempted to recover, others deteriorated. Conclusion In Gauteng province, the COVID-19 pandemic significantly disrupted essential MNCH service utilisation, particularly during the March 2020 lockdown. The mechanism of MNCH service disruption by COVID-19 was induced by both supply and demand services. It is imperative to strike a balance between maintaining routine healthcare services and managing an outbreak.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- COVID-19 lockdown measures implemented in March 2020
- Population
- Maternal, neonatal and child health service users in Gauteng province, South Africa
Key finding
Primary healthcare visits for children under 5 declined by 60,106.9 immediately post-lockdown (p=0.039)
CB et al. · Europe PMC · 1 Nov 2024