The impact of the COVID-19 pandemic on hospital utilisation in Sierra Leone.

Autor:	Sevalie S; 34th Military Hospital, Wilberforce, Freetown, Sierra Leone.; Case Management Pillar, National COVID-19 Emergency Response Centre, Freetown, Sierra Leone., Youkee D; Case Management Pillar, National COVID-19 Emergency Response Centre, Freetown, Sierra Leone daniel.youkee@kcl.ac.uk.; School of Population Health and Environmental Sciences, King's College London, London, UK., van Duinen AJ; Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.; Department of Surgery, St Olavs Hospital University Hospital in Trondheim, Trondheim, Norway., Bailey E; King's Centre for Global Health and Health Partnerships, King's College London School of Population Health and Environmental Sciences, London, UK., Bangura T; King's Centre for Global Health and Health Partnerships, King's College London School of Population Health and Environmental Sciences, London, UK., Mangipudi S; King's Centre for Global Health and Health Partnerships, King's College London School of Population Health and Environmental Sciences, London, UK., Mansaray E; King's Centre for Global Health and Health Partnerships, King's College London School of Population Health and Environmental Sciences, London, UK., Odland ML; Institute of Applied Health Research, University of Birmingham, Birmingham, Birmingham, UK., Parmar D; King's Centre for Global Health and Health Partnerships, King's College London School of Population Health and Environmental Sciences, London, UK., Samura S; King's Centre for Global Health and Health Partnerships, King's College London School of Population Health and Environmental Sciences, London, UK., van Delft D; Capacare, Freetown, Sierra Leone., Wurie H; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Western Area, Sierra Leone., Davies JI; Institute of Applied Health Research, University of Birmingham, Birmingham, Birmingham, UK.; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, Western Cape, South Africa., Bolkan HA; Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.; Department of Surgery, St Olavs Hospital University Hospital in Trondheim, Trondheim, Norway., Leather AJM; King's Centre for Global Health and Health Partnerships, King's College London School of Population Health and Environmental Sciences, London, UK.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2021 Oct; Vol. 6 (10).
DOI:	10.1136/bmjgh-2021-005988
Abstrakt:	Introduction: The COVID-19 pandemic has adversely affected health systems in many countries, but little is known about effects on health systems in sub-Saharan Africa. This study examines the effects of COVID-19 on hospital utilisation in a sub-Saharan country, Sierra Leone. Methods: Mixed-methods study using longitudinal nationwide hospital data (admissions, operations, deliveries and referrals) and qualitative interviews with healthcare workers and patients. Hospital data were compared across quarters (Q) in 2020, with day 1 of Q2 representing the start of the pandemic in Sierra Leone. Admissions are reported in total and disaggregated by sex, service (surgical, medical, maternity and paediatric) and hospital type (government or private non-profit). Referrals in 2020 were compared with 2019 to assess whether any changes were the result of seasonality. Comparisons were performed using Student's t-test. Qualitative data were analysed using thematic analysis. Results: From Q1 to Q2, weekly mean hospital admissions decreased by 14.7% (p=0.005). Larger decreases were seen in male 18.8% than female 12.5% admissions. The largest decreases were in surgical admissions, a 49.8% decrease (p<0.001) and medical admissions, a 28.7% decrease (p=0.002). Paediatric and maternity admissions did not significantly change. Total operations decreased by 13.9% (p<0.001), while caesarean sections and facility-based deliveries showed significant increases: 12.7% (p=0.014) and 7.5% (p=0.03), respectively. In Q3, total admissions remained 13.2% lower (p<0.001) than Q1. Mean weekly referrals were lower in Q2 and Q3 of 2020 compared with 2019, suggesting findings were unlikely to be seasonal. Qualitative analysis identified both supply-side factors, prioritisation of essential services, introduction of COVID-19 services and pausing elective care, and demand-side factors, fear of nosocomial infection and financial hardship. Conclusion: The study demonstrated a decrease in hospital utilisation during COVID-19, the decrease is less than reported in other countries during COVID-19 and less than reported during the Ebola epidemic. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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