Use of controversial ACC/AHA guidelines for statin therapy is supported by US studies:
Authors: Michael McCarthy
Journal: BMJ (2015)

<h3>ABSTRACT</h3> <h3>Background</h3> COVID-19 has impacted global maternal, neonatal and child health outcomes. We hypothesised that the early, strict lockdown which severely limited the movements of individuals in Uganda will have impacted access to services. <h3>Methods</h3> An observational study, using routinely collected health data from Electronic Medical Records was carried out, utilising data from July 2019 to December 2020 in Kawempe district, Kampala. The mean and 95% confidence intervals were calculated pre-COVID (July 2019 – February 2020) and post-COVID (March-December 2020). The means were compared using t-tests, and the monthly totals analysed as to whether they lay within or outside the normal range, compared to the previous 9 months. <h3>Results</h3> Antenatal attendances decreased 96% in April 2020 and remain below pre-COVID levels. We found a rise in adverse pregnancy outcomes for Caesarean sections (5%), haemorrhages related to pregnancy (51%), stillbirths (31%) and low-birth-weight (162%) and premature infant births (400%). We noted a drop in neonatal unit admissions, immunisation clinic attendance and delivery of all vaccinations except measles. There was an immediate drop in clinic attendance for prevention of mother to child transmission of HIV (now stabilised) and an increase of 348% in childhood malnutrition clinic attendance. Maternal and neonatal deaths, immediate post-natal care and contraceptive provision remained within normal limits. <h3>Conclusion</h3> The response to COVID-19 in Uganda has negatively impacted maternal, child and neonatal health, with the biggest and longest lasting impact seen in complications of pregnancy, stillbirths and low-birthweight infants likely due to delayed care-seeking behaviour. The decline in vaccination clinic attendance has implications for all vaccine-preventable diseases, with a cohort of infants currently unprotected. Further consideration of the impacts of restricting movement and limiting access to preventative services must be undertaken in responding to future pandemics if key maternal and child health services are to be maintained. <h3>KEY QUESTIONS</h3><h3>What is already known?</h3> The response to COVID-19 has been shown to have indirectly impacted on maternal, child, neonatal, sexual, and reproductive health. This is largely related to access to services and fear of contracting COVID-19 in outpatient departments. There has been very little data published on the health impacts of the COVID-19 response in Uganda. <h3>What are the new findings?</h3> Antenatal attendances decreased dramatically in April, followed by increased numbers of c-sections, haemorrhage related to pregnancy, stillbirths and low-birthweight, premature and malnourished infants. Newborn immunisations against polio, tetanus, diphtheria, hepatitis B, haemophilus influenzae, rotavirus and pneumococcus decreased significantly Postnatal, sexual, and reproductive health services remained stable. <h3>What do the new findings imply?</h3> Uganda has been less affected directly by COVID-19 infections, the indirect impacts are far-reaching and will have future influences on population health. There is a degree of resilience within the healthcare service, but many services were adversely affected by the lockdown leading to poorer pregnancy and neonatal outcomes Antenatal and vaccination services are of particular importance in ensuring the safety of mother and child and must be prioritised in the responses to future pandemics.