Maternal and child health service disruptions due to COVID-19: A WHO health-care worker exposure response and outcomes survey in western Kenya

Abstract

Background: COVID-19 has disrupted health-care services delivery globally. Limited data exists about personal protective equipment (PPE) availability for health-care workers (HCW) and perceptions of COVID-19 service disruption in low-resource settings. Methods: We used the Healthcare Worker Exposure Response and Outcomes (HERO) Registry Protective Equipment Survey to assess PPE availability and reuse. HCW reported perceptions of client volume changes and time spent on various activities using a 5-point Likert scale ranging from large decreases to large increases. Results: Of the 99 HCW enrolled who completed the HERO survey, 32% were nurses, 21% clinical officers, 16% facility in-charges, among others. Forty percent worked in both maternal and child health and family planning clinics and HCW had an average of 5.3 years (interquartile range: 3.5–10.4) providing care to peripartum women. HCW reported problems procuring multiple forms of PPE, including respiratory masks (71%), face shield/googles (60%), gowns (58%), surgical masks (54%), hand sanitizer (45%), disinfecting products (43%), gloves (40%), and soap (31%). Re-use of N95/KN95 masks was common with 56% of HCW reporting reusing a single mask when attending to all patients and 2% reporting having sufficient masks to use one per patient. HCW reported reduced volume of women seeking services due to COVID-19; nearly two-thirds reported decreases in antenatal (62%) and postnatal clients (66%), as well as decreases in the number of pregnant and postpartum women initiating or continuing pre-exposure prophylaxis for HIV prevention (60% and 57%, respectively). HCW reported changes in how their time was spent; 79% spent more time disinfecting spaces between clients and 49% reported increases in responsibilities related to providing psychosocial care. Conclusions: HCW reported a dual burden of PPE shortages and client psychosocial needs, limiting their own protection and adding to workload during the pandemic.