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. 2023 Oct 31:4:1192473.
doi: 10.3389/fgwh.2023.1192473. eCollection 2023.

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

Aline Semaan #  1 , Kristi Sidney Annerstedt #  2 , Lenka Beňová  1 , Jean-Paul Dossou  3 , Christelle Boyi Hounsou  3 , Gottfried Agballa  3 , Gertrude Namazzi  4 , Bianca Kandeya  5 , Samuel Meja  5 , Dickson Ally Mkoka  6 , Anteneh Asefa  1 , Soha El-Halabi  2 , Claudia Hanson  2   7
Affiliations

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

Aline Semaan et al. Front Glob Womens Health. .

Abstract

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.

Keywords: COVID-19 pandemic; health facility survey; maternal health; referral hospital; routine data; sub-Saharan Africa.

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Conflict of interest statement

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.

Figures

Figure 1
Figure 1
Monthly number of antenatal care consultations in the four hospitals in 2019 and 2020 in (A) Benin, (B) Malawi, (C) Tanzania and (D) Uganda.
Figure 2
Figure 2
Monthly number of deliveries in the four hospitals in 2019 and 2020 in (A) Benin, (B) Malawi, (C) Tanzania and (D) Uganda.
Figure 3
Figure 3
Monthly numbers (bars—left axis) and percentages (lines—right axis) of caesarean section in the four hospitals in 2019 and 2020 in (A) Benin, (B) Malawi, (C) Tanzania and (D) Uganda.
Figure 4
Figure 4
Quarterly number (bars—left axis) and in-facility maternal mortality per 100,000 deliveries (lines—right axis) in the four hospitals in 2019 and 2020 in (A) Benin, (B) Malawi, (C) Tanzania and (D) Uganda.
Figure 5
Figure 5
Quarterly number (bars—left axis) and rate (lines—right axis) of stillbirths per 1,000 deliveries in the four hospitals in 2019 and 2020 in (A) Benin, (B) Malawi, (C) Tanzania and (D) Uganda.
Figure 6
Figure 6
Summary of the categories of management and organization of health services in the 16 hospitals and maternity wards during the COVID-19 pandemic.
See this image and copyright information in PMC

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