Mount Kenya University, Directorate of Research and Innovation, Thika, Kenya.
Technical University of Kenya, Department of Computer Science and Technology, Nairobi, Kenya.
J Glob Health. 2021 Jul 10;11:05016. doi: 10.7189/jogh.11.05016. eCollection 2021.
The COVID-19 pandemic has resulted in both direct and indirect impacts on patients and population health. To better understand the impact of the measures put in place by the Kenyan government on health care provision, this project sought to document and quantify the impact of the restriction measures on patients' attendance in Machakos County.
Hospital attendance at 10 public hospitals were obtained including Machakos Level 5 Hospital (the county referral facility) and one health facility from each of the 9 Sub-counties of Machakos County. Data on outpatient and inpatient attendance from November 2019 to May 2020 were obtained and compared with a similar calendar period from the previous year. Key informant interviews (KIIs), focused group discussions (FGDs) and in-depth interviews were conducted with the hospital management personnel (n = 46), as well as with the patients (n = 453) who missed scheduled clinic appointments at Machakos Level 5 Hospital to understand the reasons behind the drop in attendance numbers.
Overall, there was a decline in the number of patient attendances compared to the prior calendar period. Outpatient attendance reduced by 24.7% in April 2020 (n = 39 704) compared with April 2019 (n = 52 731). Inpatient attendance reduced by 13.7% in April 2020 (n = 3298) compared with April 2019 (n = 2845). Declines in patient attendance were observed in all hospitals that had inpatient services. A great decline in attendance was noted among larger hospitals that run specialty clinics, which were suspended mid-March 2020 when the first case of COVID-19 was announced. Some increase in attendance was noted in May when most clinics resumed operations. Most hospital management staff highlighted the closure of clinics as the main reason for reduced attendance while patients added that they also feared contracting COVID-19 at the hospital and the stigma they would face should they be quarantined.
The findings from this study provide evidence that the COVID-19 pandemic outbreak and measures put in place by the government to curb its spread disrupted the provision of health services in Machakos County. Efforts to minimize adverse impacts of indirect impacts on access to health care and preventative services to counter increased morbidity and mortality require attention throughout the pandemic.
COVID-19 大流行对患者和人群健康造成了直接和间接的影响。为了更好地了解肯尼亚政府实施的措施对医疗保健服务的影响，本项目旨在记录和量化限制措施对 Machakos 县患者就诊的影响。
我们获得了 10 家公立医院的就诊情况，包括 Machakos 五级医院（县级转诊医院）和 Machakos 县 9 个分区中的每个分区的一家卫生机构。我们获取了 2019 年 11 月至 2020 年 5 月的门诊和住院就诊数据，并与前一年同期的类似日历数据进行了比较。我们对医院管理人员（n=46）和错过 Machakos 五级医院预约门诊的患者（n=453）进行了关键知情人访谈（KII）、焦点小组讨论（FGD）和深入访谈，以了解就诊人数下降的原因。
总体而言，与前一个日历期相比，就诊人数有所下降。2020 年 4 月门诊就诊人数减少了 24.7%（n=39704），而 2019 年 4 月为 52731 人。2020 年 4 月住院就诊人数减少了 13.7%（n=3298），而 2019 年 4 月为 2845 人。所有有住院服务的医院都出现了就诊人数下降的情况。在 2020 年 3 月中旬宣布首例 COVID-19 病例后暂停运营的大型医院，其就诊人数出现了大幅下降，这些医院运行专科诊所。2020 年 5 月，大多数诊所恢复运营后，就诊人数有所增加。大多数医院管理人员强调，关闭诊所是就诊人数减少的主要原因，而患者则补充说，他们也担心在医院感染 COVID-19，以及如果被隔离将面临的耻辱。
本研究结果表明，COVID-19 大流行的爆发和政府为遏制其传播而采取的措施扰乱了 Machakos 县的卫生服务提供。在整个大流行期间，需要关注努力将间接影响对获得医疗保健和预防服务的不良影响降至最低，以应对发病率和死亡率的增加。
