COVID-19 大流行对几内亚三家转诊医院母婴保健服务的影响：一项中断时间序列分析。

Effect of the COVID-19 pandemic on maternal and neonatal health services in three referral hospitals in Guinea: an interrupted time-series analysis.

机构信息

Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.

Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Faculté des Sciences et Techniques de la Santé, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea.

出版信息

Reprod Health. 2023 Mar 25;20(1):50. doi: 10.1186/s12978-023-01599-8.

INTRODUCTION

In sub-Saharan Africa, there is limited evidence on the COVID-19 health-related effect from front-line health provision settings. Therefore, this study aimed to analyse the effect of the COVID-19 pandemic on routine maternal and neonatal health services in three referral hospitals.

MATERIALS AND METHODS

We conducted an observational study using aggregate monthly maternal and neonatal health services routine data for two years (March 2019-February 2021) in three referral hospitals including two maternities: Hôpital National Ignace Deen (HNID) in Conakry and Hôpital Regional de Mamou (HRM) in Mamou and one neonatology ward: Institut de Nutrition et de Santé de l'Enfant (INSE) in Conakry. We compared indicators of health service utilisation, provision and health outcomes before and during the COVID-19 pandemic periods. An interrupted time-series analysis (ITSA) was performed to assess the relationship between changes in maternal and neonatal health indicators and COVID-19 through cross-correlation.

RESULTS

During COVID-19, the mean monthly number (MMN) of deliveries decreased significantly in HNID (p = 0.039) and slightly increased in HRM. In the two maternities, the change in the MMN of deliveries were significantly associated with COVID-19. The ITSA confirmed the association between the increase in the MMN of deliveries and COVID-19 in HRM (bootstrapped F-value = 1.46, 95%CI [0.036-8.047], p < 0.01). We observed an increasing trend in obstetric complications in HNID, while the trend declined in HRM. The MMN of maternal deaths increased significantly (p = 0.011) in HNID, while it slightly increased in HRM. In INSE, the MMN of neonatal admissions significantly declined (p < 0.001) and this decline was associated with COVID-19. The MMN of neonatal deaths significantly decreased (p = 0.009) in INSE and this decrease was related to COVID-19.

CONCLUSION

The pandemic negatively affected the maternal and neonatal care provision, health service utilisation and health outcomes in two referral hospitals located in Conakry, the COVID-19 most-affected region.

引言

在撒哈拉以南非洲地区，关于新冠疫情对一线卫生服务机构的健康影响的证据有限。因此，本研究旨在分析新冠疫情对三家转诊医院常规孕产妇和新生儿保健服务的影响。

材料和方法

我们采用了观察性研究方法，使用了两年（2019 年 3 月至 2021 年 2 月）在三家转诊医院（包括两家妇产科：科纳克里的国家伊格内修斯·德恩医院（HNID）和马木的地区总医院（HRM）和一家新生儿科病房：科纳克里的儿童营养与健康研究所（INSE））的每月常规孕产妇和新生儿保健服务汇总数据。我们比较了疫情前后卫生服务利用、提供和健康结果的指标。采用中断时间序列分析（ITSA）通过交叉相关评估孕产妇和新生儿健康指标与新冠疫情之间的变化关系。

结果

在新冠疫情期间，HNID 的每月分娩例数（MMN）显著下降（p=0.039），HRM 略有增加。在这两家妇产科医院，分娩 MMN 的变化与新冠疫情显著相关。ITSA 证实了 HRM 中分娩 MMN 增加与新冠疫情之间的关联（bootstrap F 值=1.46，95%CI [0.036-8.047]，p<0.01）。我们观察到 HNID 中的产科并发症呈上升趋势，而 HRM 中的趋势则下降。HNID 的孕产妇死亡 MMN 显著增加（p=0.011），而 HRM 中的 MMN 略有增加。在 INSE，新生儿入院 MMN 显著下降（p<0.001），且这一下降与新冠疫情有关。INSE 的新生儿死亡 MMN 显著下降（p=0.009），这一下降与新冠疫情有关。