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. 2021 Nov 17;1(11):e0000029.
doi: 10.1371/journal.pgph.0000029. eCollection 2021.

The indirect impact of COVID-19 pandemic on inpatient admissions in 204 Kenyan hospitals: An interrupted time series analysis

Steven Wambua  1 , Lucas Malla  2 , George Mbevi  2 , Amen-Patrick Nwosu  3 , Timothy Tuti  2 , Chris Paton  3 , Samuel Cheburet  4 , Ayub Manya  4 , Mike English  2   3 , Emelda A Okiro  1   3
Affiliations

The indirect impact of COVID-19 pandemic on inpatient admissions in 204 Kenyan hospitals: An interrupted time series analysis

Steven Wambua et al. PLOS Glob Public Health. .

Abstract

The first case of severe acute respiratory coronavirus 2 (SARS-CoV-2) was identified in March 2020 in Kenya resulting in the implementation of public health measures (PHM) to prevent large-scale epidemics. We aimed to quantify the impact of COVID-19 confinement measures on access to inpatient services using data from 204 Kenyan hospitals. Data on monthly admissions and deliveries from the District Health Information Software version 2 (DHIS 2) were extracted for the period January 2018 to March 2021 stratified by hospital ownership (public or private) and adjusting for missing data using multiple imputation (MI). We used the COVID-19 event as a natural experiment to examine the impact of COVID-19 and associated PHM on use of health services by hospital ownership. We estimated the impact of COVID-19 using two approaches; Statistical process control (SPC) charts to visualize and detect changes and Interrupted time series (ITS) analysis using negative-binomial segmented regression models to quantify the changes after March 2020. Sensitivity analysis was undertaken to test robustness of estimates using Generalised Estimating Equations (GEE) and impact of national health workers strike on observed trends. SPC charts showed reductions in most inpatient services starting April 2020. ITS modelling showed significant drops in April 2020 in monthly volumes of live-births (11%), over-fives admissions for medical (29%) and surgical care (25%) with the greatest declines in the under-five's admissions (59%) in public hospitals. Similar declines were apparent in private hospitals. Health worker strikes had a significant impact on post-COVID-19 trends for total deliveries, live-births and caesarean section rate in private hospitals. COVID-19 has disrupted utilization of inpatient services in Kenyan hospitals. This might have increased avoidable morbidity and mortality due to non-COVID-19-related illnesses. The declines have been sustained. Recent data suggests a reversal in trends with services appearing to be going back to pre- COVID levels.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig 1
Fig 1. COVID-19 control measures timeline during the period of study.
Fig 2
Fig 2. Statistical Process Control chart for both public and private hospitals.
Horizontal dashed lines represent the 3-standard deviation mark.
Fig 3
Fig 3. Fitted lines of segmented regression models for all indicators and by hospital ownership.
Vertical lines represent the month (March 2020) COVID-19 was announced in Kenya and as a pandemic by the WHO.
See this image and copyright information in PMC

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