School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
BMJ Open. 2024 Nov 1;14(10):e090645. doi: 10.1136/bmjopen-2024-090645.
Gauteng was one of the provinces in South Africa most hit by COVID-19. However, there has been no assessment of the pandemic's impact on essential maternal, neonatal and child health (MNCH) services in Gauteng, for planning against future emergencies. This study sought to assess the impact of the COVID-19 pandemic on essential MNCH service utilisation, delivery and health outcomes in Gauteng province.
We employed a quasi-experimental interrupted time series (ITS) study design, using the District Health Information System (DHIS) data set to evaluate the impact of COVID-19 on eight key MNCH indicators between March 2019 to February 2021. Using Stata V.17.0 and 5% alpha, a segmented linear regression (ITS) model quantified the trends of the indicators before COVID-19 (March 2019 to February 2020) (β1), the immediate change in level due to the March 2020 lockdown (β2), the post-lockdown (March 2020 to February 2021) trend (β4) and the change in gradient from before to after the lockdown (β3).
COVID-19 lockdown exerted a significant decline in primary healthcare headcount<5 years (n) (β2= -60 106.9 (95% CI, -116 710.4; -3503.3), p=0.039); and postnatal care visits within 6 days (rate) (β2=-8.2 (95% CI, -12.4; -4.1), p=0.001). Antenatal care first visits before 20 weeks (rate) declined during COVID-19 (β3=-0.4 (95% CI, -0.7; -0.1), p=0.013) compared with the pre-COVID-19 period. COVID-19 adverse effects on service delivery (measles second dose coverage and fully immunised<1 year) and health outcomes (facility deaths 0-6 days, maternal mortality ratio and pneumonia case fatality<1 year) were insignificant. While some indicators post-lockdown attempted to recover, others deteriorated.
In Gauteng province, the COVID-19 pandemic significantly disrupted essential MNCH service utilisation, particularly during the March 2020 lockdown. The mechanism of MNCH service disruption by COVID-19 was induced by both supply and demand services. It is imperative to strike a balance between maintaining routine healthcare services and managing an outbreak.
豪登省是南非受 COVID-19 影响最严重的省份之一。然而，尚未评估大流行对豪登省基本孕产妇、新生儿和儿童健康 (MNCH) 服务的影响，以便为未来的紧急情况做好规划。本研究旨在评估 COVID-19 对豪登省基本 MNCH 服务利用、分娩和健康结果的影响。
我们采用准实验性中断时间序列 (ITS) 研究设计，使用地区卫生信息系统 (DHIS) 数据集来评估 COVID-19 对 2019 年 3 月至 2021 年 2 月期间 8 项关键 MNCH 指标的影响。使用 Stata V.17.0 和 5%alpha，分段线性回归 (ITS) 模型量化了 COVID-19 之前（2019 年 3 月至 2020 年 2 月）（β1）、2020 年 3 月封锁导致的水平立即变化（β2）、封锁后（2020 年 3 月至 2021 年 2 月）趋势（β4）和封锁前后梯度变化（β3）的趋势。
COVID-19 封锁对初级保健 5 岁以下儿童人数（n）（β2=-60106.9（95%CI，-116710.4；-3503.3），p=0.039）和产后 6 天内访视（率）（β2=-8.2（95%CI，-12.4；-4.1），p=0.001）产生了显著影响。COVID-19 期间，产前检查首次在 20 周前（率）下降（β3=-0.4（95%CI，-0.7；-0.1），p=0.013）与 COVID-19 前时期相比。COVID-19 对服务提供（麻疹第二剂覆盖率和 1 岁以下完全免疫）和健康结果（0-6 天院内死亡、孕产妇死亡率和 1 岁以下肺炎病死率）的不良影响并不显著。尽管一些指标在封锁后试图恢复，但其他指标恶化了。
在豪登省，COVID-19 大流行严重扰乱了基本 MNCH 服务的利用，特别是在 2020 年 3 月封锁期间。COVID-19 对 MNCH 服务中断的机制是由供需两方面引起的。在维持常规医疗服务和管理疫情爆发之间取得平衡至关重要。
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