Quaglio G, Cavallin F, Nsubuga J B, Lochoro P, Maziku D, Tsegaye A, Azzimonti G, Kamunga A M, Manenti F, Putoto G
European Parliamentary Research Services, European Parliament, Brussels, Belgium.
Department of International Health, Care and Public Health Research Institute (CAPHRI), University of Maastricht, Maastricht, The Netherlands.
Public Health Action. 2022 Mar 21;12(1):34-39. doi: 10.5588/pha.21.0073.
Six hospitals in four sub-Saharan African countries.
To examine the indirect effects of COVID-19 on health service utilisation and to explore the risk of bias in studies on prediction models.
Monthly data were analysed using interrupted time-series modelling. We used linear mixed-effect models for the analysis of antenatal care visits, institutional deliveries, vaccinations, outpatient visits and hospital admissions, and generalised linear mixed-effect models for hospital mortality.
During 2018-2020, the six hospitals recorded a total of 57,075 antenatal care visits, 38,706 institutional deliveries, 312,961 vaccinations, 605,925 out-patient visits and 143,915 hospital admissions. The COVID-19 period was associated with decreases in vacci-nations (- 575 vaccinations, < 0.0001), outpatient visits (- 700 visits, < 0.0001) and hospital admission (- 102 admission, = 0.001); however, no statistically significant effects were found for antenatal care visits ( = 0.71) or institutional deliveries ( = 0.14). Mortality rate increased by 2% per month in the pre-COVID-19 period; however, a decreasing trend (by 2% per month) was observed during the COVID-19 period ( = 0.004). Subgroup and sensitivity analyses broadly confirmed the main findings with only minor inconsistencies. A reduction in outpatient visits was also observed in hospitals from countries with a higher Stringency Index and in urban hospitals.
The pandemic resulted in a reduction in health service utilisation. The decreases were less than anticipated from modelling studies.
撒哈拉以南非洲四个国家的六家医院。
探讨新冠疫情对医疗服务利用的间接影响，并探究预测模型研究中的偏倚风险。
采用中断时间序列模型分析月度数据。我们使用线性混合效应模型分析产前检查、机构分娩、疫苗接种、门诊就诊和住院情况，使用广义线性混合效应模型分析医院死亡率。
2018年至2020年期间，这六家医院共记录了57,075次产前检查、38,706次机构分娩、312,961次疫苗接种、605,925次门诊就诊和143,915次住院。新冠疫情期间，疫苗接种量减少（-575次接种，<0.0001）、门诊就诊量减少（-700次就诊，<0.0001）、住院量减少（-102例住院，=0.001）；然而，产前检查（=0.71）和机构分娩（=0.14）未发现统计学显著影响。新冠疫情前死亡率每月上升2%；然而，在新冠疫情期间观察到下降趋势（每月下降2%，=0.004）。亚组分析和敏感性分析大致证实了主要结果，仅有细微不一致。在疫情防控指数较高国家的医院和城市医院中，门诊就诊量也有所减少。
疫情导致医疗服务利用减少。减少幅度小于模型研究预期。
