G Quaglio1,2, F Cavallin3, J B Nsubuga4, P Lochoro5, D Maziku6, A Tsegaye7, G Azzimonti8, A M Kamunga9, F Manenti10, G Putoto10. 1. European Parliamentary Research Services, European Parliament, Brussels, Belgium. 2. Department of International Health, Care and Public Health Research Institute (CAPHRI), University of Maastricht, Maastricht, The Netherlands. 3. Independent Statistician, Solagna, Italy. 4. St. Kizito Hospital, Matany, Uganda. 5. Doctors with Africa Cuamm, Aber Hospital, Jaber, Uganda. 6. Tosamaganga Hospital, Iringa, United Republic of Tanzania. 7. Doctors with Africa Cuamm, Addis Ababa, Ethiopia. 8. Songambele Hospital, Simiyu, Tanzania. 9. Doctors with Africa Cuamm, Pujehun Hospital, Sierra Leone. 10. Doctors with Africa Cuamm, Padua, Italy.
Abstract
SETTING: Six hospitals in four sub-Saharan African countries. OBJECTIVE: To examine the indirect effects of COVID-19 on health service utilisation and to explore the risk of bias in studies on prediction models. DESIGN: Monthly data were analysed using interrupted time-series modelling. We used linear mixed-effect models for the analysis of antenatal care visits, institutional deliveries, vaccinations, outpatient visits and hospital admissions, and generalised linear mixed-effect models for hospital mortality. RESULTS: During 2018-2020, the six hospitals recorded a total of 57,075 antenatal care visits, 38,706 institutional deliveries, 312,961 vaccinations, 605,925 out-patient visits and 143,915 hospital admissions. The COVID-19 period was associated with decreases in vacci-nations (- 575 vaccinations, P < 0.0001), outpatient visits (- 700 visits, P < 0.0001) and hospital admission (- 102 admission, P = 0.001); however, no statistically significant effects were found for antenatal care visits (P = 0.71) or institutional deliveries (P = 0.14). Mortality rate increased by 2% per month in the pre-COVID-19 period; however, a decreasing trend (by 2% per month) was observed during the COVID-19 period (P = 0.004). Subgroup and sensitivity analyses broadly confirmed the main findings with only minor inconsistencies. A reduction in outpatient visits was also observed in hospitals from countries with a higher Stringency Index and in urban hospitals. CONCLUSIONS: The pandemic resulted in a reduction in health service utilisation. The decreases were less than anticipated from modelling studies.
SETTING: Six hospitals in four sub-Saharan African countries. OBJECTIVE: To examine the indirect effects of COVID-19 on health service utilisation and to explore the risk of bias in studies on prediction models. DESIGN: Monthly data were analysed using interrupted time-series modelling. We used linear mixed-effect models for the analysis of antenatal care visits, institutional deliveries, vaccinations, outpatient visits and hospital admissions, and generalised linear mixed-effect models for hospital mortality. RESULTS: During 2018-2020, the six hospitals recorded a total of 57,075 antenatal care visits, 38,706 institutional deliveries, 312,961 vaccinations, 605,925 out-patient visits and 143,915 hospital admissions. The COVID-19 period was associated with decreases in vacci-nations (- 575 vaccinations, P < 0.0001), outpatient visits (- 700 visits, P < 0.0001) and hospital admission (- 102 admission, P = 0.001); however, no statistically significant effects were found for antenatal care visits (P = 0.71) or institutional deliveries (P = 0.14). Mortality rate increased by 2% per month in the pre-COVID-19 period; however, a decreasing trend (by 2% per month) was observed during the COVID-19 period (P = 0.004). Subgroup and sensitivity analyses broadly confirmed the main findings with only minor inconsistencies. A reduction in outpatient visits was also observed in hospitals from countries with a higher Stringency Index and in urban hospitals. CONCLUSIONS: The pandemic resulted in a reduction in health service utilisation. The decreases were less than anticipated from modelling studies.
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