Kuloba MaryBennah N, Strupat Christoph, Aye Thit Thit, Wamalwa Phidelis N, Gichuki Judy, Tsofa Benjamin, De Allergi Manuela
Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Im Neuenheimer Feld 130.3, 69120, Germany.
German Institute of Development and Sustainability (IDOS), Tulpenfeld 6, Bonn, 53113, Germany.
BMC Health Serv Res. 2025 Aug 1;25(1):1014. doi: 10.1186/s12913-025-13070-4.
Amidst the COVID-19 pandemic, lockdown policies emerged as pivotal policies to contain viral transmission. Questions arise about whether their implementation challenged access to care, particularly in regions with fragile health systems, such as sub-Saharan Africa. Robust evidence on the effect of lockdown policies on access to healthcare services is sparse, also due to a lack of suitable data. We addressed this knowledge gap and assessed the effect of the COVID-19 lockdown policy on facility-based delivery during the first wave of the pandemic in Kenya.
We triangulated results from two parallel yet independent quantitative analyses, exploiting the fact that COVID-19 lockdown policies in Kenya were implemented only in some counties. First, we relied on nationally representative repeated cross-sectional population-based surveys conducted in 2018 and 2020, with data being analyzed using a pre-post study with control. Second, we used monthly data from the Kenya Health Information System (from January 2019 to November 2020) to construct an interrupted time series (ITS) with independent controls, setting April 2020 as the interruption month (i.e., the onset of the lockdowns).
The controlled pre-post-analysis detected no significant effect of the lockdown policy on facility-based delivery in lockdown counties compared with non-lockdown counties. The ITSA model showed that the lockdown counties experienced an immediate increase of 4.97% (CI: 0.51%, 9.43%) in facility-based delivery compared with the non-lockdown counties during the first wave of the pandemic. This was followed by a significant monthly decrease of 0.97% (CI: -1.60%, -0.34%) compared with non-lockdown counties.
We found no overall effect of the lockdown policy on facility-based deliveries. Our findings suggest that when managed effectively, lockdowns do not disrupt access to maternal health services. Our findings highlight the importance of implementing context-specific strategies to safeguard maternal healthcare during public health crises. Future research should explore localized and socioeconomic differences in how populations respond to public health interventions during pandemics.
在新冠疫情期间，封锁政策成为遏制病毒传播的关键政策。人们提出疑问，这些政策的实施是否对获得医疗服务产生了挑战，尤其是在撒哈拉以南非洲等卫生系统脆弱的地区。由于缺乏合适的数据，关于封锁政策对获得医疗服务的影响的有力证据也很稀少。我们填补了这一知识空白，并评估了新冠疫情封锁政策在肯尼亚第一波疫情期间对机构分娩的影响。
我们对两项平行但独立的定量分析结果进行了三角测量，利用了肯尼亚仅在部分县实施新冠疫情封锁政策这一事实。首先，我们依靠2018年和2020年进行的具有全国代表性的基于人群的重复横断面调查，使用带有对照的前后研究对数据进行分析。其次，我们使用肯尼亚卫生信息系统的月度数据（2019年1月至2020年11月）构建了一个带有独立对照的中断时间序列（ITS），将2020年4月设为中断月份（即封锁开始）。
对照前后分析发现，与非封锁县相比，封锁政策对封锁县的机构分娩没有显著影响。ITSA模型显示，在疫情第一波期间，与非封锁县相比，封锁县的机构分娩立即增加了4.97%（置信区间：0.51%，9.43%）。随后，与非封锁县相比，每月显著下降0.97%（置信区间：-1.60%，-0.34%）。
我们发现封锁政策对机构分娩没有总体影响。我们的研究结果表明，有效管理时，封锁不会扰乱孕产妇保健服务的获取。我们的研究结果凸显了在公共卫生危机期间实施因地制宜的战略以保障孕产妇医疗保健的重要性。未来的研究应探讨疫情期间人群对公共卫生干预措施反应的局部和社会经济差异。
