Abstract
The first case of severe acute respiratory coronavirus 2 (SARS-CoV-2) was identified in March 2020 in Kenya resulting in the implementation of public health measures (PHM) to prevent large-scale epidemics. We aimed to quantify the impact of COVID-19 confinement measures on access to inpatient services using data from 204 Kenyan hospitals. Data on monthly admissions and deliveries from the District Health Information Software version 2 (DHIS 2) were extracted for the period January 2018 to March 2021 stratified by hospital ownership (public or private) and adjusting for missing data using multiple imputation (MI). We used the COVID-19 event as a natural experiment to examine the impact of COVID-19 and associated PHM on use of health services by hospital ownership. We estimated the impact of COVID-19 using two approaches; Statistical process control (SPC) charts to visualize and detect changes and Interrupted time series (ITS) analysis using negative-binomial segmented regression models to quantify the changes after March 2020. Sensitivity analysis was undertaken to test robustness of estimates using Generalised Estimating Equations (GEE) and impact of national health workers strike on observed trends. SPC charts showed reductions in most inpatient services starting April 2020. ITS modelling showed significant drops in April 2020 in monthly volumes of live-births (11%), over-fives admissions for medical (29%) and surgical care (25%) with the greatest declines in the under-five's admissions (59%) in public hospitals. Similar declines were apparent in private hospitals. Health worker strikes had a significant impact on post-COVID-19 trends for total deliveries, live-births and caesarean section rate in private hospitals. COVID-19 has disrupted utilization of inpatient services in Kenyan hospitals. This might have increased avoidable morbidity and mortality due to non-COVID-19-related illnesses. The declines have been sustained. Recent data suggests a reversal in trends with services appearing to be going back to pre- COVID levels.
Highlights
The global impact of the severe acute respiratory coronavirus 2 (SARS-CoV-2) virus has been extensive with over 137.5 million confirmed cases and 2.9 million official deaths globally as of April 13, 2021 [1]
Statistical process control (SPC) charts illustrate that for both public and private hospitals, no reported values fell outside the 3SD mark in the first three months of 2020 (Fig 2)
Monthly admissions fell below the 3SD mark in the paediatrics, adult medical and surgical wards starting in April 2020 through June 2020
Summary
The global impact of the severe acute respiratory coronavirus 2 (SARS-CoV-2) virus has been extensive with over 137.5 million confirmed cases and 2.9 million official deaths globally as of April 13, 2021 [1]. 147147 cases have been reported with 2394 official deaths confirmed by April 13, 2021 [1] even though the real extent of spread is estimated to be greater [2]. The initial stage of the outbreak following the first case triggered implementation of a partial lockdown on April 6,2020, when 158 cases and 6 deaths had been reported nationally. This wave peaked in July/August 2020, and cases started to drop gradually [2]. The third wave was experienced in March 2021, during which the second partial lockdown was instituted on 27 March 2021
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