The impact of the COVID-19 pandemic on health service use in sub-Saharan Africa

• Published in: Public health action Vol. 12; no. 1; pp. 34 - 39
• Main Authors: Quaglio, G., Cavallin, F., Nsubuga, J. B., Lochoro, P., Maziku, D., Tsegaye, A., Azzimonti, G., Kamunga, A. M., Manenti, F., Putoto, G.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 21.03.2022
• Subjects: Health Policy; Healthcare Utilisation; Impact; Original; health policy; impact; healthcare utilisation
• ISSN: 2220-8372; 2220-8372
• DOI: 10.5588/pha.21.0073

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.