Health and Nutrition Unit, UNICEF, Accra, Ghana
Department of Global Health, University of Washington, Seattle, Washington, USA.
BMJ Open. 2023 Jan 23;13(1):e061608. doi: 10.1136/bmjopen-2022-061608.
This study aimed to assess the national-level and subnational-level effects of the COVID-19 pandemic on essential health and nutrition service utilisation in Ghana.
Interrupted time-series.
This study used facility-level data of 7950 governmental and non-governmental health facilities in Ghana between January 2016 and November 2020.
As the essential health and nutrition services, we selected antenatal care (ANC); institutional births, postnatal care (PNC); first and third pentavalent vaccination; measles vaccination; vitamin A supplementations (VAS); and general outpatient care. We performed segmented mixed effects linear models for each service with consideration for data clustering, seasonality and autocorrelation. Losses of patient visits for essential health and nutrition services due to the COVID-19 pandemic were estimated as outcome measures.
In April 2020, as an immediate effect of the COVID-19 pandemic, the number of patients for all the services decreased except first pentavalent vaccine. While some services (ie, institutional birth, PNC, third pentavalent and measles vaccination) recovered by November 2020, ANC, VAS and outpatient services had not recovered to prepandemic levels. The total number of lost outpatient visits in Ghana was estimated to be 3 480 292 (95% CI: -3 510 820 to -3 449 676), followed by VAS (-180 419, 95% CI: -182 658 to -177 956) and ANC (-87 481, 95% CI: -93 644 to -81 063). The Greater Accra region was the most affected region by COVID-19, where four out of eight essential services were significantly disrupted.
COVID-19 pandemic disrupted the majority of essential healthcare services in Ghana, three of which had not recovered to prepandemic levels by November 2020. Millions of outpatient visits and essential ANC visits were lost. Furthermore, the immediate and long-term impacts of the COVID-19 pandemic on service utilisation varied by service type and region.
本研究旨在评估 COVID-19 大流行对加纳基本卫生和营养服务利用的国家级和国家级以下层面的影响。
中断时间序列研究。
本研究使用了 2016 年 1 月至 2020 年 11 月期间加纳 7950 家政府和非政府卫生机构的机构级数据。
我们选择了产前护理 (ANC)；机构分娩、产后护理 (PNC)；第一和第三针五联疫苗；麻疹疫苗接种；维生素 A 补充剂 (VAS)；以及普通门诊护理作为基本卫生和营养服务。我们对每种服务都进行了分段混合效应线性模型分析，并考虑了数据聚类、季节性和自相关性。因 COVID-19 大流行而损失的基本卫生和营养服务患者就诊人数被估计为结果测量。
2020 年 4 月，作为 COVID-19 大流行的直接影响，除了第一针五联疫苗之外，所有服务的就诊人数都有所下降。虽然一些服务（即机构分娩、PNC、第三针五联和麻疹疫苗接种）在 2020 年 11 月之前已恢复，但 ANC、VAS 和门诊服务尚未恢复到大流行前的水平。加纳估计总共有 3480292 人次的门诊服务损失（95%CI：-3510820 至 -3449676），其次是 VAS（-180419，95%CI：-182658 至 -177956）和 ANC（-87481，95%CI：-93644 至 -81063）。大阿克拉地区是加纳受 COVID-19 影响最严重的地区，八个基本服务中有四个受到严重干扰。
COVID-19 大流行扰乱了加纳的大部分基本医疗服务，其中有三项服务到 2020 年 11 月尚未恢复到大流行前的水平。数百万次门诊就诊和基本 ANC 就诊机会流失。此外，COVID-19 对服务利用的直接和长期影响因服务类型和地区而异。
