Impact of COVID-19 on essential healthcare services in Addis Ababa, Ethiopia: Implications for future pandemics

Abstract

Background: Responding to the COVID-19 pandemic has presented an unprecedented challenge to health systems, with countries needing to balance the demands of responding directly to the pandemic, while simultaneously continuing provision of essential health services. This study aimed to explore the impact of COVID-19 on essential healthcare services in Addis Ababa, Ethiopia.

Methods: A facility-based retrospective study was undertaken in 30 health centers in Addis Ababa which were selected using simple random sampling. Secondary data were extracted for 22 indicators on maternal and child health, communicable and non-communicable diseases, and outpatient services for the period spanning between July 2019 and October 2020. These indicators were selected based on the WHO operational guidance on maintaining essential health services during an outbreak guide, essential packages of health services in Ethiopia and expert consultation. The difference in the trends of services before and during COVID-19 was compared using linear-by-linear tests and the difference of magnitude across the indicators was compared using Autoregressive Integrated Moving Average (ARIMA) interrupted time series analysis at a 5% significance level.

Results: Overall, more than 1.7 million people visited the studied facilities for outpatient services, and 18,325 mothers attended skilled delivery in the study period. The present study found that the mean number of patients treated for TB declined by 35 patients (β: -34.62; 95%CI: -50.29, -18.95) compared to the pre-COVID-19 era while the number of new patients enrolled for ART decreased by 71 patients (β: -70.62; 95%CI: -107.19, -34.05). Regarding maternal health services, the number of women who received post-natal care decreased by about 215 mothers (β: -214.87; 95%CI: -331.57, -98.17). Similarly, the mean number of clients served at inpatient services declined by 34 (β: -33.72; 95%CI: -68.55, 1.05). On the other hand, the mean number of patients screened for diabetes and hypertension during the pandemic increased by more than 1014 (β: 1014.5; 95%CI: 103.07, 1925.92) and 610 patients (β: 611.21; 95%CI: 302.42, 919.99), respectively. However, changes with regard to antenatal care, skilled birth delivery, and children immunization services did not show a statistically significant change after COVID-19 was reported in Ethiopia.

Conclusion: Despite the notable efforts to sustain essential health services amidst the COVID-19 pandemic, our study revealed that there were disruptions in these services. This reinforces the need to adapt strategies to ensure sustainable provision of essential health services when pandemics of COVID19 magnitude cause disruptions of the health services.

Fig 1. Trends of diabetes mellitus and hypertension; July 2019 to October 2020 in Addis Ababa Ethiopia.

Fig 2. Trends of HIV related services in Addis Ababa Ethiopia from July 2019 to October 2020.

Fig 3. Trend of TB cases detected and TB loss-to-follow up in Addis Ababa Ethiopia from July 2019 to August 2020.

Fig 4. Trends of maternal health service utilization in Addis Ababa Ethiopia; July 2019 to October 2020.

Fig 5. Trends of expanded immunization program in Addis Ababa Ethiopia from July 2019 to October 2020.

Fig 6. Trends in outpatient services utilizations in Addis Ababa Ethiopia from July 2019 to October 2020.

Fig 7. In-patient services utilizations in selected health facilities in Addis Ababa from July 2019 to October 2020.