Abstract
Introduction: Very little is known and predictable on how long the COVID-19 pandemic will last, even though dramatic preventive measures to flatten the curve and stop its transmission have been taken worldwide periodically since its start. These preventive measures coupled with people’s fear of COVID-19, significantly altered people’s health-seeking behavior and healthcare accessibility. This study aims to measure the impact of the COVID-19 pandemic on the utilization of reproductive, maternal, newborn, and child health (RMNCH) care services at primary health care (PHC) facilities in Pakistan. Methods: A retrospective study was conducted in 22 districts using data from 1169 primary health care facilities. The District Health Information System (DHIS) was used to retrieve district-wise services utilization data from January to April 2020 i.e. January to February 2020 (pre-COVID-19) and March to April 2020 (during COVID-19). The monthly difference (in percentage change) for selected RMNCH services indicators was calculated using the expected number of clients (January to February average) versus the actual number of clients for March and April 2020.Results: We observed a decrease of 12.5% for March and 33% for April 2020 in the total number of clients who availed of primary health care services in Sindh as compared to the pre-COVID-19 monthly average. A decrease in first antenatal care visits (15.6% and 16.3%), delivery coverage (12.8% and 17.9%) and family planning client visits (31.6% and 36.3%) were observed for March and April 2020 respectively. The pentavalent vaccine results revealed a decrease of 19.3% and 63.1%, while a decrease of 17.3% and 54.3% were observed for children receiving the first dose of measles vaccine in March and April, respectively. Conclusions: Our findings show that the number of clients who avail of routine care or RMNCH services at the primary health care level considerably declined during the initial phase of the first wave of the COVID-19 outbreak in Sindh, Pakistan. These results highlight a rising threat to poor RMNCH and outcomes.
Highlights
Very little is known and predictable on how long the COVID-19 pandemic will last, even though dramatic preventive measures to flatten the curve and stop its transmission have been taken worldwide periodically since its start
An overall decrease in pregnant women seeking first-ever antenatal care visit after conception i.e., ANC-1 (15.6% and 16.3%), pregnant women receiving the second dose of tetanus toxoid (TT) vaccine during pregnancy i.e., TT-2 (6.5% and 28.3%), number of normal vaginal deliveries (NVDs) conducted at People's Primary Health Care Initiative (PPHI) health facilities (HF) (19.6% and 28.9%) and family planning (31.6% and 36.3%) services were observed for March and April respectively
Keeping in view the general fear of the public for going out of homes during this COVID-19 pandemic, to hospitals and clinics, which are categorized as high risk for transmission, we hypothesize that most of these deliveries that failed to access health facilities perhaps had been conducted at homes through untrained traditional midwives
Summary
Very little is known and predictable on how long the COVID-19 pandemic will last, even though dramatic preventive measures to flatten the curve and stop its transmission have been taken worldwide periodically since its start. In December 2019, the first outbreak of coronavirus diseases (COVID-19) originated in the city of Wuhan, Hubei province of China [1]. It quickly spread worldwide, becoming a pandemic in no time, resulting in nearly 200 million confirmed cases and 4.2 million deaths by the end of July 2021 [2]. The international and national public health agencies worldwide advised people to adopt preventive measures in the wake of this growing pandemic, such as wearing masks in public, maintaining social distancing, and performing frequent hand hygiene [4]
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