TY - JOUR T1 - COVID-19-related healthcare impacts: an uncontrolled, segmented time-series analysis of tuberculosis diagnosis services in Mozambique, 2017–2020 JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2021-007878 VL - 7 IS - 4 SP - e007878 AU - Ivan Manhiça AU - Orvalho Augusto AU - Kenneth Sherr AU - James Cowan AU - Rosa Marlene Cuco AU - Sãozinha Agostinho AU - Bachir C. Macuacua AU - Isaías Ramiro AU - Naziat Carimo AU - Maria Benigna Matsinhe AU - Stephen Gloyd AU - Sergio Chicumbe AU - Raimundo Machava AU - Stélio Tembe AU - Quinhas Fernandes Y1 - 2022/04/01 UR - http://gh.bmj.com/content/7/4/e007878.abstract N2 - Introduction Currently, COVID-19 dominates the public health agenda and poses a permanent threat, leading to health systems’ exhaustion and unprecedented service disruption. Primary healthcare services, including tuberculosis services, are at increased risk of facing severe disruptions, particularly in low-income and middle-income countries. Indeed, corroborating model-based forecasts, there is increasing evidence of the COVID-19 pandemic’s negative impact on tuberculosis case detection.Methods Applying a segmented time-series analysis, we assessed the effects of COVID-19-related measures on tuberculosis diagnosis service across districts in Mozambique. Ministry health information system data were used from the first quarter of 2017 to the end of 2020. The model, performed under the Bayesian premises, was estimated as a negative binomial with random effects for districts and provinces.Results A total of 154 districts were followed for 16 consecutive quarters. Together, these districts reported 96 182 cases of all forms of tuberculosis in 2020. At baseline (first quarter of 2017), Mozambique had an estimated incidence rate of 283 (95% CI 200 to 406) tuberculosis cases per 100 000 people and this increased at a 5% annual rate through the end of 2019. We estimated that 17 147 new tuberculosis cases were potentially missed 9 months after COVID-19 onset, resulting in a 15.1% (95% CI 5.9 to 24.0) relative loss in 2020. The greatest impact was observed in the southern region at 40.0% (95% CI 30.1 to 49.0) and among men at 15% (95% CI 4.0 to 25.0). The incidence of pulmonary tuberculosis increased at an average rate of 6.6% annually; however, an abrupt drop (15%) was also observed immediately after COVID-19 onset in March 2020.Conclusion The most significant impact of the state of emergency was observed between April and June 2020, the quarter after COVID-19 onset. Encouragingly, by the end of 2020, clear signs of health system recovery were visible despite the initial shock.Data are available upon reasonable request. ER -