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. 2022 Mar 10;12(3):e055815.
doi: 10.1136/bmjopen-2021-055815.

Quantifying the indirect impact of COVID-19 pandemic on utilisation of outpatient and immunisation services in Kenya: a longitudinal study using interrupted time series analysis

Steven Wambua  1 , Lucas Malla  2 , George Mbevi  2 , Joel Kandiah  3 , Amen-Patrick Nwosu  4 , Timothy Tuti  2 , Chris Paton  4 , Bernard Wambu  5 , Mike English  2   4 , Emelda A Okiro  6   4
Affiliations

Quantifying the indirect impact of COVID-19 pandemic on utilisation of outpatient and immunisation services in Kenya: a longitudinal study using interrupted time series analysis

Steven Wambua et al. BMJ Open. .

Abstract

Objective: In this study, we assess the indirect impact of COVID-19 on utilisation of immunisation and outpatient services in Kenya.

Design: Longitudinal study.

Setting: Data were analysed from all healthcare facilities reporting to Kenya's health information system from January 2018 to March 2021. Multiple imputation was used to address missing data, interrupted time series analysis was used to quantify the changes in utilisation of services and sensitivity analysis was carried out to assess robustness of estimates.

Exposure of interest: COVID-19 outbreak and associated interventions.

Outcome measures: Monthly attendance to health facilities. We assessed changes in immunisation and various outpatient services nationally.

Results: Before the first case of COVID-19 and pursuant intervention measures in March 2020, uptake of health services was consistent with historical levels. There was significant drops in attendance (level changes) in April 2020 for overall outpatient visits for under-fives (rate ratio, RR 0.50, 95% CI 0.44 to 0.57), under-fives with pneumonia (RR 0.43, 95% CI 0.38 to 0.47), overall over-five visits (RR 0.65, 95% CI 0.57 to 0.75), over-fives with pneumonia (RR 0.62, 95% CI 0.55 to 0.70), fourth antenatal care visit (RR 0.86, 95% CI 0.80 to 0.93), total hypertension (RR 0.89, 95% CI 0.82 to 0.96), diabetes cases (RR 0.95 95% CI, 0.93 to 0.97) and HIV testing (RR 0.97, 95% CI 0.94 to 0.99). Immunisation services, first antenatal care visits, new cases of hypertension and diabetes were not affected. The post-COVID-19 trend was increasing, with more recent data suggesting reversal of effects and health services reverting to expected levels as of March 2021.

Conclusion: COVID-19 pandemic has had varied indirect effects on utilisation of health services in Kenya. There is need for proactive and targeted interventions to reverse these effects as part of the pandemic's response to avert non-COVID-19 indirect mortality.

Keywords: COVID-19; DHIS2; SARS-CoV-2; immunization; outpatient services.

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Conflict of interest statement

Competing interests: The authors declare that they have no competing interests

Figures

Figure 1
Figure 1
Daily seven moving average trend of COVID-19 cases in Kenya showing various public health interventions initiated by the government to control the spread of the pandemic.
Figure 2
Figure 2
Temporal trends in monthly immunisation and outpatient attendance nationally and by year. ANC, antenatal care; OPD, outpatient department;BCG, Bacillus Calmette–Guérin vaccine; OPV, Oral polio vaccine;DPT, Diphtheria, Tetanus, Pertussis vaccine; IPV, Inactivated Polio Vaccine
Figure 3
Figure 3
Statistical process control chart of immunisation, antenatal care (ANC) and outpatient services. Horizontal dashed lines represent the 3 SD mark. OPD, outpatient department;BCG, Bacillus Calmette–Guérin vaccine; OPV, Oral polio vaccine;DPT, Diphtheria, Tetanus, Pertussis vaccine; IPV, Inactivated Polio Vaccine
Figure 4
Figure 4
Fitted lines of interrupted time series models for outpatient and antenatal care attendance. vertical lines represent the month (March 2020) COVID-19 was announced in Kenya and as a pandemic by the WHO. ANC, antenatal care; OPD, outpatient department.
See this image and copyright information in PMC

References

    1. John Hopkins University . COVID-19 Dashboard. Available: https://coronavirus.jhu.edu/
    1. Sam DSO, Pokhariyal GP, Rogo K. Otoi-NARIMA model for forecast seasonality of COVID-19 waves: case of Kenya. Int. J. Stat. Appl. Math. 2021;6:48–58. 10.22271/maths.2021.v6.i2a.675 - DOI
    1. Uyoga S, Adetifa IMO, Karanja HK, et al. . Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Kenyan blood donors. Science 2021;371:79–82. 10.1126/science.abe1916 - DOI - PMC - PubMed
    1. WHO . Kenya receives COVID-19 vaccines and launches landmark national campaign 2021. Available: https://www.afro.who.int/news/kenya-receives-covid-19-vaccines-and-launc... [Accessed 01/07/2021].
    1. Bai HM, Zaid A, Catrin S. The socio-economic implications of the coronavirus pandemic (COVID-19): a review. Int J Surg 2020;8:8–17. - PMC - PubMed

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