The COVID-19 pandemic and disruptions to essential health services in Kenya: a retrospective time-series analysis

Abstract

Background: Public health emergencies can disrupt the provision of and access to essential health-care services, exacerbating health crises. We aimed to assess the effect of the COVID-19 pandemic on essential health-care services in Kenya.

Methods: Using county-level data routinely collected from the health information system from health facilities across the country, we used a robust mixed-effect model to examine changes in 17 indicators of essential health services across four periods: the pre-pandemic period (from January, 2018 to February, 2020), two pandemic periods (from March to November 2020, and February to October, 2021), and the period during the COVID-19-associated health-care workers' strike (from December, 2020 to January, 2021).

Findings: In the pre-pandemic period, we observed a positive trend for multiple indicators. The onset of the pandemic was associated with statistically significant decreases in multiple indicators, including outpatient visits (28·7%; 95% CI 16·0-43·5%), cervical cancer screening (49·8%; 20·6-57·9%), number of HIV tests conducted (45·3%; 23·9-63·0%), patients tested for malaria (31·9%; 16·7-46·7%), number of notified tuberculosis cases (26·6%; 14·7-45·1%), hypertension cases (10·4%; 6·0-39·4%), vitamin A supplements (8·7%; 7·9-10·5%), and three doses of the diphtheria, tetanus toxoid, and pertussis vaccine administered (0·9%; 0·5-1·3%). Pneumonia cases reduced by 50·6% (31·3-67·3%), diarrhoea by 39·7% (24·8-62·7%), and children attending welfare clinics by 39·6% (23·5-47·1%). Cases of sexual violence increased by 8·0% (4·3-25·0%). Skilled deliveries, antenatal care, people with HIV infection newly started on antiretroviral therapy, confirmed cases of malaria, and diabetes cases detected were not significantly affected negatively. Although most of the health indicators began to recover during the pandemic, the health-care workers' strike resulted in nearly all indicators falling to numbers lower than those observed at the onset or during the pre-strike pandemic period.

Interpretation: The COVID-19 pandemic and the associated health-care workers' strike in Kenya have been associated with a substantial disruption of essential health services, with the use of outpatient visits, screening and diagnostic services, and child immunisation adversely affected. Efforts to maintain the provision of these essential health services during a health-care crisis should target the susceptible services to prevent the exacerbation of associated disease burdens during such health crises.

Funding: Bill & Melinda Gates Foundation.

Figure 1

Model fit for primary health-care use Figure shows the period before the pandemic, during the pandemic, and during the health-care workers’ strike. The dashed line represents the period when the first confirmed case of SARS-CoV-2 was reported in Kenya.

Figure 2

Model fit for reproductive, maternal, and newborn and adolescent health indicators Figure shows the period before the pandemic, during the pandemic, and during the health-care workers’ strike. The dashed line represents the period when the first confirmed case of SARS-CoV-2 was reported in Kenya. The indicators shown are antenatal care visits (A), children presenting with pneumonia (B), vitamin A supplements (C), three doses of the diphtheria, tetanus toxoid, and pertussis vaccine administered (D), children attending a child welfare clinic who are underweight (E), and children treated for diarrhoea (F).

Figure 3

Model fit for skilled deliveries Figure shows the period before the pandemic, during the pandemic, and during the health-care workers’ strike. The dashed line represents the period when the first confirmed case of SARS-CoV-2 was reported in Kenya.

Figure 4

Model fit for indicators of communicable diseases Figure shows the period before the pandemic, during the pandemic, and during the health-care workers’ strike. The dashed line represents the period when the first confirmed case of SARS-CoV-2 was reported in Kenya. The indicators shown are HIV tests conducted (A), people with HIV infection newly started on antiretroviral therapy (B), patients tested for malaria (C), confirmed cases of malaria (D), and the number of notified cases of tuberculosis (E).

Figure 5

Model fit for indicators of non-communicable diseases Figure shows the period before the pandemic, during the pandemic, and during the health-care workers’ strike. The dashed line represents the period when the first confirmed case of SARS-CoV-2 was reported in Kenya. The indicators shown are cervical cancer screening tests (A), hypertension cases (B), and diabetes cases (C).