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Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic
  1. Aline Semaan1,2,
  2. Constance Audet1,
  3. Elise Huysmans1,
  4. Bosede Afolabi3,
  5. Bouchra Assarag4,
  6. Aduragbemi Banke-Thomas5,
  7. Hannah Blencowe6,
  8. Séverine Caluwaerts1,
  9. Oona Maeve Renee Campbell6,
  10. Francesca L Cavallaro7,
  11. Leonardo Chavane8,
  12. Louise Tina Day6,
  13. Alexandre Delamou9,
  14. Therese Delvaux1,
  15. Wendy Jane Graham6,
  16. Giorgia Gon6,
  17. Peter Kascak10,
  18. Mitsuaki Matsui11,
  19. Sarah Moxon6,
  20. Annettee Nakimuli12,13,
  21. Andrea Pembe14,
  22. Emma Radovich6,
  23. Thomas van den Akker15,16,
  24. Lenka Benova1
  1. 1Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
  2. 2Center for Research on Population and Health, American University of Beirut Faculty of Health Sciences, Beirut, Lebanon
  3. 3Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
  4. 4National School of Public Health, Ministry of Health, Rabat, Morocco
  5. 5LSE Health, London School of Economics and Political Science, London, UK
  6. 6Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
  7. 7Institute of Child Health, University College London, London, UK
  8. 8Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
  9. 9Africa Centre of Excellence for Prevention and Control of Transmissible Diseases (CEA-PCMT), Universite Gamal Abdel Nasser de Conakry, Conakry, Guinea
  10. 10Department of Obstetrics and Gynaecology, General Hospital Trencin, Trencin, Slovakia
  11. 11Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
  12. 12Department of Obstetrics & Gynaecology, Makerere University, Kampala, Uganda
  13. 13Department of Obstetrics and Gynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
  14. 14Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
  15. 15Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Vrije Universiteit Amsterdam, The Netherlands
  16. 16Department of Obstetrics and Gynaecology, VU Amsterdam Athena Institute, Vrije Universiteit Amsterdam, The Netherlands
  1. Correspondence to Aline Semaan; aline.t.semaan{at}


Introduction The COVID-19 pandemic has substantially impacted maternity care provision worldwide. Studies based on modelling estimated large indirect effects of the pandemic on services and health outcomes. The objective of this study was to prospectively document experiences of frontline maternal and newborn healthcare providers.

Methods We conducted a global, cross-sectional study of maternal and newborn health professionals via an online survey disseminated through professional networks and social media in 12 languages. Information was collected between 24 March and 10 April 2020 on respondents’ background, preparedness for and response to COVID-19 and their experience during the pandemic. An optional module sought information on adaptations to 17 care processes. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregating by low-income and middle-income countries (LMICs) and high-income countries (HICs).

Results We analysed responses from 714 maternal and newborn health professionals. Only one-third received training on COVID-19 from their health facility and nearly all searched for information themselves. Half of respondents in LMICs received updated guidelines for care provision compared with 82% in HICs. Overall, 47% of participants in LMICs and 69% in HICs felt mostly or completely knowledgeable in how to care for COVID-19 maternity patients. Facility-level responses to COVID-19 (signage, screening, testing and isolation rooms) were more common in HICs than LMICs. Globally, 90% of respondents reported somewhat or substantially higher levels of stress. There was a widespread perception of reduced use of routine maternity care services, and of modification in care processes, some of which were not evidence-based practices.

Conclusions Substantial knowledge gaps exist in guidance on management of maternity cases with or without COVID-19. Formal information-sharing channels for providers must be established and mental health support provided. Surveys of maternity care providers can help track the situation, capture innovations and support rapid development of effective responses.

  • maternal health
  • child health
  • health systems
  • health services research
  • cross-sectional survey

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  • Handling editor Seye Abimbola

  • Twitter @abankethomas, @profwendygraham, @lenkabenova

  • Contributors LB conceptualised the study and obtained funding. All authors contributed to the design of the study and development of the survey tool. AS analysed the data. CA, LB, EH and AS wrote the original draft of the manuscript. All authors contributed to the development of the manuscript and read and approved the final version. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. AS is the guarantor.

  • Funding This study was funded by the Institute of Tropical Medicine’s COVID-19 Pump Priming fund supported by the Flemish Government, Science & Innovation. LB is funded in part by the Research Foundation – Flanders (FWO) as part of her Senior Postdoctoral Fellowship.

  • Disclaimer The funder had no role in the study design, data collection, analysis and interpretation of data or in writing the manuscript. Researchers are independent from funders, and all authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data, and the accuracy of the data analysis is also required.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Institutional Review Committee at the Institute of Tropical Medicine (Antwerp, Belgium) on 20 March 2020 (approval reference 1372/20).

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

  • Data availability statement Anonymised data analysed in the current study will be made available from the corresponding author on reasonable request.

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