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A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the COVID-19 pandemic
  1. Aduragbemi Banke-Thomas1,2,
  2. Aline Semaan3,
  3. Dinah Amongin4,5,
  4. Ochuwa Babah6,
  5. Nafissatou Dioubate7,
  6. Amani Kikula8,
  7. Sarah Nakubulwa4,9,
  8. Olubunmi Ogein6,
  9. Moses Adroma4,
  10. William Anzo Adiga10,
  11. Abdourahmane Diallo11,
  12. Lamine Diallo12,
  13. Mamadou Cellou Diallo11,
  14. Cécé Maomou12,
  15. Nathanael Mtinangi13,
  16. Telly Sy11,
  17. Therese Delvaux3,
  18. Bosede Bukola Afolabi6,
  19. Alexandre Delamou7,14,
  20. Annettee Nakimuli4,
  21. Andrea Barnabas Pembe8,
  22. Lenka Benova3
  1. 1School of Human Sciences, University of Greenwich, London, UK
  2. 2LSE Health, London School of Economics and Political Science, London, UK
  3. 3Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
  4. 4Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
  5. 5Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
  6. 6Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
  7. 7Centre National de Formation et de Recherche en Santé Rurale de Maférinyah, Forécariah, Guinea
  8. 8Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
  9. 9Kawempe National Referral Hospital, Kampala, Uganda
  10. 10Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
  11. 11Maternité de l'Hôpital National Ignace Deen de Conakry, Conakry, Guinea
  12. 12Maternité de l’Hôpital Régional de Mamou, Mamou, Guinea
  13. 13Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Dar es Salaam, Tanzania, United Republic of
  14. 14Centre d’Excellence Africain pour la Prévention et le Contrôle des Maladies Transmissibles, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
  1. Correspondence to Dr Aduragbemi Banke-Thomas; a.bankethomas{at}gre.ac.uk

Abstract

Introduction In sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic.

Methods Mixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019–February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020–February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting.

Results Three periods including a first wave, slow period and second wave were identified. Maternal health service utilisation was lower during the pandemic compared with the prepandemic year in all but one selected referral hospital. During the pandemic, service utilisation was particularly lower during the waves and higher or stable during the slow period. Fear of being infected in hospitals, lack of transportation, and even when available, high cost of transportation and service closures were key reasons affecting utilisation during the waves. However, community perception that the pandemic was over or insinuation by Government of the same appeared to stabilise use of referral hospitals for childbirth.

Conclusion Utilisation of maternal health services across the continuum of care varied through the different periods and across countries. In crisis situations such as COVID-19, restrictions and service closures need to be implemented with consideration given to alternative options for women to access and use services. Information on measures put in place for safe hospital use should be communicated to women.

  • maternal health
  • COVID-19
  • health services research
  • obstetrics
  • descriptive study

Data availability statement

Data underlying this study can be made available upon reasonable request and data sharing agreements. These data include pseudonymised interview transcripts and aggregate monthly routine data indicators on caesarean section and labour induction. Data requests can be sent to the study PI Prof Lenka Benova at lbenova@itg.be and the ethics committee at the Institute of Tropical Medicine at irb@itg.be.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2021-008064

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    Data availability statement

    Data underlying this study can be made available upon reasonable request and data sharing agreements. These data include pseudonymised interview transcripts and aggregate monthly routine data indicators on caesarean section and labour induction. Data requests can be sent to the study PI Prof Lenka Benova at lbenova@itg.be and the ethics committee at the Institute of Tropical Medicine at irb@itg.be.

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    Footnotes

    • Handling editor Seye Abimbola

    • Twitter @abankethomas, @semaaline, @Coolgynae, @lenkabenova

    • Contributors Conceptualisation, investigation, data curation, formal analysis, visualisation, writing—original draft preparation, writing—review and editing: AB-T. Conceptualisation, data curation, formal analysis, visualisation writing—original draft preparation, writing—review and editing: AS. Investigation, data curation, validation, writing—review and editing: DA, OB, ND, AK, SN, OO, MA, WAA, ADiallo, LD, MCD, CM, NM, TS. Conceptualisation, funding acquisition, project administration, writing—review and editing: TD, ADelamou. Conceptualisation, project administration, validation, writing—review and editing: BBA, AN, AP. Conceptualisation, funding acquisition, project administration, methodology, investigation, data curation, formal analysis, writing—original draft preparation, writing—review and editing, and takes full responsibilty for the overall content, conduct of the study, had access to the data, and controlled the decision to publish, as guarantor: LB.

    • Funding This study was funded by the Institute of Tropical Medicine’s COVID-19 Pump Priming fund supported by the Flemish Government—Department of Economy, Science & Innovation and by the Embassy of the UK in Belgium. LB is funded in part by the Research Foundation—Flanders (FWO) as part of her Senior Postdoctoral Fellowship. Research in Guinea was funded by the 4th framework agreement between the Institute of Tropical Medicine and Maferenyiah Research Centre funded by the Belgian Development Cooperation. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.