Impact of COVID-19 Pandemic on Utilization of Facility-Based Essential Maternal and Child Health Services in North Shewa Zone, Ethiopia
Authors: Bekele Chalachew , Bekele Delayehu , Hunegnaw Bezawit M. , Van Wickle Kimiko , Ashenafi Fanos , Korte Michelle , Tedijanto Christine , Tadesse Lisanu , Chan Grace J. 
Published: January 2022

AbstractIntroductionEthiopia registered its first case of COVID-19 on March 13, 2020. We aimed to assess maternal, newborn, and child health care (MNCH) utilization during the first six months of the COVID-19 pandemic, as well as potential barriers and enablers of service utilization from health care providers and clients.MethodsMixed study design was conducted as part of the Birhan Health and Demographic Surveillance System in Ethiopia. The trend of service utilization during the first six months of COVID-19 was compared to corresponding time and data points of the preceding year.ResultService utilization of new family planning visits (43.2 to 28.5/month, p = 0.014) and sick under five child visits (225.0 to 139.8/month, P = 007) declined during the initial six months of the pandemic compared to the same period in the preceding year. Antenatal and postnatal care visits, facility delivery rates, and child routine immunization visits also decreased although this did not reach statistical significance. Interviews with health care providers and clients highlighted several barriers to service utilization during COVID-19, including fear of disease transmission, economic hardship, and transport service disruptions and restrictions. Enablers of service utilization included communities’ decreased fear of COVID-19, and awareness-raising activities.ConclusionProvision of essential MNCH services is crucial to ascertain favorable maternal and child health outcomes. In low- and middle-income country settings like Ethiopia, health systems might be fragile to withstand the caseloads and priority setting due to the pandemic. Our study presents early findings on the utilization of MNCH services that were maintained except sick child and new family planning visits. Government leaders, policy makers, and clinicians who wish to improve the resilience of their health system will need to continuously monitor service utilization and clients’ evolving concerns during the pandemic to prevent increases in maternal and child morbidity and mortality.What is already known?Facility-based essential MNCH services utilization decreased during the initial phase of the pandemic and similarly facility-based healthcare utilizations were reduced in the 2014-2015 Ebola outbreak in west Africa.What are the new findings?Facility based essential MNCH services such as antenatal care, postnatal care, family planning, facility deliveries, routine immunization and repeat family planning utilization were maintained in the initial six month of the pandemic unlike other similar studies elsewhere.What do the new findings imply?In light of a pandemic, essential MNCH services such as antenatal and postnatal care, family planning, facility deliveries, repeat family planning and routine immunizations can be sustained in a health system. More attention may be given to better understand the reduction of sick under five visits. Further research can be conducted on the utilization of essential MNCH services on maternal and child health outcomes. Our results emphasize the importance of health systems and clinicians to sustain the resilience of their health system. Among those the Ministry of Health (MoH) directive to avail MNCH services in all facilities during the pandemic and the maturity level of some programs (Even though new family planning utilizers are limited, they know the benefit and would want to continue the repeat family planning utilization, benefits of facility delivery, routine immunization, antenatal care and postnatal care).Strengths and limitations of this studyStrengths of the study✓We present primary data on service utilization during the early months of the pandemic in an area of Ethiopia, one of the agrarian regions, which is generalizable to 80% of the country’s population.✓The mixed methods approach integrated both quantitative service utilization coverage data with sociocultural, contextual, and exploratory qualitative to better understand our findings and reasons for changes in service utilization.✓The study highlights success stories in community-based care and government leadership for key services like routine immunization that may benefit other settings.Limitation of the study✓Our study focused on service utilization and may not have been powered to detect significant differences. Furthermore, we focused on coverage of service utilization as the primary outcome rather than mortality or morbidity.✓We do not have detailed data on service provision (e.g., which services were restricted and for how long, in what manner).✓There is the potential of recall bias were possible limitation since qualitative data was collected three months later than the initial six months of the pandemic (March to August 2020).