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. 2021 Oct;6(10):e005988.
doi: 10.1136/bmjgh-2021-005988.

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

Stephen Sevalie  1   2 , Daniel Youkee  3   4 , A J van Duinen  5   6 , Emma Bailey  7 , Thaimu Bangura  7 , Sowmya Mangipudi  7 , Esther Mansaray  7 , Maria Lisa Odland  8 , Divya Parmar  7 , Sorie Samura  7 , Diede van Delft  9 , Haja Wurie  10 , Justine I Davies  8   11 , H A Bolkan  5   6 , Andrew J M Leather  7
Affiliations

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

Stephen Sevalie et al. BMJ Glob Health. 2021 Oct.

Abstract

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.

Keywords: COVID-19; control strategies; health systems; public health; viral haemorrhagic fevers.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Daily COVID-19 cases in Sierra Leone, 2020.
Figure 2
Figure 2
Hospital inclusion flow chart. *Hospitals identified as providing surgery during 2017 mapping surgical activity in Sierra Leone.
Figure 3
Figure 3
(A) Nationwide mean weekly admissions, disaggregated by sex, overlaid COVID-19 cases, Q1–Q3 2020. (B) Nationwide mean weekly admissions by ward, overlaid COVID-19 cases, Q1–Q3 2020. (C) Nationwide mean weekly admissions by hospital service, overlaid COVID-19 cases, Q1–Q3 2020. (D) Nationwide mean weekly total operations, caesarean sections, hernia repairs and facility-based deliveries, overlaid COVID-19 cases, Q1–Q3 2020.
Figure 4
Figure 4
Weekly count of nationwide referrals 2019 and 2020. *The green dotted line represents the start-up phase of the referral coordinator system in 2019.
See this image and copyright information in PMC

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