Sagastume Diana, Serra Aloma, Gerlach Nina, Portela Anayda, Beňová Lenka
Institute of Tropical Medicine, Department of Public Health, Antwerp, Belgium.
London School of Economics and Political Science, Department of International Development, London, UK.
J Glob Health. 2024 Jun 14;14:05024. doi: 10.7189/jogh.14.05024.
The coronavirus disease 2019 (COVID-19) pandemic had challenged health systems worldwide, including those in low- and middle-income countries (LMICs). Aside from measures to control the pandemic, efforts were made to continue the provision and use of essential services. At that time, information was not organised and readily available to guide country-level decision-making. This review aims to summarise evaluated interventions to maintain essential services for maternal, newborn, child, and adolescent health in response to COVID-19 in LMICs, in order to learn from the interventions and facilitate their use in the next disruption.
We conducted a scoping review by Embase, MEDLINE, and Global Health for literature published between 1 January 2020 and 26 December 2022, without restrictions for language. We extracted information about the setting, population targeted, service type, intervention, and evaluation from the included studies and summarised it both quantitatively and narratively.
We retrieved 11 395 unique references and included 30 studies describing 32 evaluated interventions. Most interventions (84%) were implemented in 2020, with a median duration of five months (interquartile range (IQR) = 3-8), and were conducted in Africa (34%) or Southeast Asia (31%). Interventions focussed on maintaining services for maternal and newborn health (56%) or children and adolescents (56%) were most common. Interventions aimed to address problems related to access (94%), fear (31%), health workers shortage (25%), and vulnerability (22%). Types of interventions included telehealth (69%), protocols/guidelines to adapt care provision (56%), and health education (40%); a few entailed health worker training (16%). The described interventions were mostly led by the public (56%) or non-profit (34%) sectors. Methodologies of their evaluations were heterogeneous; the majority used quantitative methods, had a prospective research design, and used output- and outcome-based indicators.
In this review, we identified an important and growing body of evidence of evaluated interventions to maintain essential services for maternal, newborn, child, and adolescent health during COVID-19 in LMICs. To improve preparedness and responsiveness for future disruptions, managers for decision-makers in LMICs could benefit from up-to-date inventories describing implemented interventions and evaluations to facilitate evidence-based implementation of strategies, as well as tools for conducting optimal quality operational and implementation research during disruptions (e.g. rapid ethical approvals, access to routine data).
2019年冠状病毒病（COVID-19）大流行给全球卫生系统带来了挑战，包括低收入和中等收入国家（LMICs）的卫生系统。除了控制疫情的措施外，各方还努力继续提供和使用基本服务。当时，信息没有得到整理，也无法随时获取以指导国家层面的决策。本综述旨在总结为应对COVID-19而在低收入和中等收入国家维持孕产妇、新生儿、儿童和青少年基本卫生服务的已评估干预措施，以便从这些干预措施中吸取经验教训，并促进其在下一次危机中得到应用。
我们通过Embase、MEDLINE和Global Health对2020年1月1日至2022年12月26日期间发表的文献进行了范围综述，对语言没有限制。我们从纳入的研究中提取了有关背景、目标人群、服务类型、干预措施和评估的信息，并进行了定量和叙述性总结。
我们检索到11395篇独特的参考文献，纳入了30项研究，描述了32项已评估的干预措施。大多数干预措施（84%）于2020年实施，中位持续时间为5个月（四分位间距（IQR）=3-8），在非洲（34%）或东南亚（31%）开展。最常见的干预措施集中在维持孕产妇和新生儿健康服务（56%）或儿童和青少年健康服务（56%）。干预措施旨在解决与服务可及性（94%）、恐惧（31%）、卫生工作者短缺（25%）和脆弱性（22%）相关的问题。干预措施类型包括远程医疗（69%）、调整护理提供的方案/指南（56%）和健康教育（40%）；少数涉及卫生工作者培训（16%）。所描述的干预措施大多由公共部门（56%）或非营利部门（34%）主导。其评估方法各不相同；大多数使用定量方法，采用前瞻性研究设计，并使用基于产出和结果的指标。
在本综述中，我们发现了越来越多的重要证据，证明在低收入和中等收入国家应对COVID-19期间维持孕产妇、新生儿、儿童和青少年基本卫生服务的已评估干预措施。为提高对未来危机的准备和应对能力，低收入和中等收入国家的决策者和管理者可以从最新的清单中受益，这些清单描述了已实施的干预措施和评估，以促进基于证据的战略实施，以及在危机期间进行高质量运营和实施研究的工具（例如快速伦理批准、获取常规数据）。
