Provision and utilization of maternal health services during the COVID-19 pandemic in 16 hospitals in sub-Saharan Africa.

Autor:	Semaan A; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium., Annerstedt KS; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden., Beňová L; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium., Dossou JP; Department of Health Policy and Systems, Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin., Boyi Hounsou C; Department of Health Policy and Systems, Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin., Agballa G; Department of Health Policy and Systems, Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin., Namazzi G; Centre of Excellence for Maternal Newborn and Child Health, Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda., Kandeya B; College of Medicine, the Centre for Reproductive Health, University of Malawi, Blantyre, Malawi., Meja S; College of Medicine, the Centre for Reproductive Health, University of Malawi, Blantyre, Malawi., Ally Mkoka D; Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania., Asefa A; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium., El-Halabi S; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden., Hanson C; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.; Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	Frontiers in global women's health [Front Glob Womens Health] 2023 Oct 31; Vol. 4, pp. 1192473. Date of Electronic Publication: 2023 Oct 31 (Print Publication: 2023).
DOI:	10.3389/fgwh.2023.1192473
Abstrakt:	Objective: Maintaining provision and utilization of maternal healthcare services is susceptible to external influences. This study describes how maternity care was provided during the COVID-19 pandemic and assesses patterns of service utilization and perinatal health outcomes in 16 referral hospitals (four each) in Benin, Malawi, Tanzania and Uganda. Methods: We used an embedded case-study design and two data sources. Responses to open-ended questions in a health-facility assessment survey were analyzed with content analysis. We described categories of adaptations and care provision modalities during the pandemic at the hospital and maternity ward levels. Aggregate monthly service statistics on antenatal care, delivery, caesarean section, maternal deaths, and stillbirths covering 24 months (2019 and 2020; pre-COVID-19 and COVID-19) were examined. Results: Declines in the number of antenatal care consultations were documented in Tanzania, Malawi, and Uganda in 2020 compared to 2019. Deliveries declined in 2020 compared to 2019 in Tanzania and Uganda. Caesarean section rates decreased in Benin and increased in Tanzania in 2020 compared to 2019. Increases in maternal mortality ratio and stillbirth rate were noted in some months of 2020 in Benin and Uganda, with variability noted between hospitals. At the hospital level, teams were assigned to respond to the COVID-19 pandemic, routine meetings were cancelled, and maternal death reviews and quality improvement initiatives were interrupted. In maternity wards, staff shortages were reported during lockdowns in Uganda. Clinical guidelines and protocols were not updated formally; the number of allowed companions and visitors was reduced. Conclusion: Varying approaches within and between countries demonstrate the importance of a contextualized response to the COVID-19 pandemic. Maternal care utilization and the ability to provide quality care fluctuated with lockdowns and travel bans. Women's and maternal health workers' needs should be prioritized to avoid interruptions in the continuum of care and prevent the deterioration of perinatal health outcomes. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2023 Semaan, Annerstedt, Beňová, Dossou, Boyi Hounsou, Agballa, Namazzi, Kandeya, Meja, Ally Mkoka, Asefa, El-halabi and Hanson.)
Databáze:	MEDLINE
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