ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has resulted in a substantial decline in routine immunisation coverage in children globally, especially in low- and middle-income countries (LMICs). This study summarises the reasons for disruptions to routine child immunisations in LMICs. A systematic review (PROSPERO CRD42021286386) was conducted following PRISMA 2020 guidelines. Six databases were searched: MEDLINE, Embase, Global Health, CINAHL, Scopus and MedRxiv, on 11/02/2022. Observational and qualitative studies published from January 2020 onwards were included if exploring reasons for missed immunisations during the COVID-19 pandemic in LMICs. Study appraisal used National Heart, Lung, and Blood Institute and Critical Appraisal Skills Programme tools. Reasons for disruption were defined with descriptive codes;cross-sectional (quantitative) data were summarised as mean percentages of responses weighted by study population, and qualitative data were summarised narratively. A total of thirteen studies were included describing reasons behind disruptions;7 cross-sectional (quantitative), 5 qualitative and 1 mixed methods. Seventeen reasons for disruptions were identified. In quantitative studies (total respondents = 2,853), the most common reasons identified were fear of COVID-19 and consequential avoidance of health centres (41.2%, SD ±13.3%), followed by transport challenges preventing both families and healthcare professionals from reaching vaccination services (11.1% SD ±16.6%). Most reasons stemmed from reduced healthcare-seeking (83.4%), as opposed to healthcare-delivery issues (15.2%). Qualitative studies showed a more even balance of healthcare-seeking (49.5%) and healthcare-delivery issues (50.5%), with fear of COVID-19 remaining a major identified issue (total respondents = 92). The most common reasons for disruption were parental fear of COVID-19 and avoidance of health services. Health systems must therefore prioritise public health messaging to encourage vaccine uptake and recovery of missed immunisations.
ABSTRACT
Maternity service providers have struggled to provide high-quality services to women and newborns during the ongoing COVID-19 pandemic which has substantially impacted health systems and disrupted maternity services globally. Nepal is a resources-limited country that reported a significant impact of the pandemic on maternal health services. It is therefore important to understand better the perspective of health care professionals in this context. This study intends to explore the experiences of nurses providing maternity care in the public sector during the COVID-19 pandemic in Nepal. A qualitative study using a phenomenological design was conducted. Altogether ten nurses working in maternity services were selected using purposive sampling technique. Data were collected by face-to-face in-depth interviews using a semi-structured interview guide. Thematic analysis was conducted using Clarke and Braun 2006 technique. The findings of the study were organized into codes, sub-themes and themes. The six themes identified were fear of COVID-19 at work, challenges at work, changes at work and services, motivations to work, stigma due to COVID-19, and impact on services. Participants described how maternity services could not be stopped during the pandemic. They had experienced decreased utilization of antenatal services as a consequence of ‘lockdown' thereby leading to an increase in maternal and neonatal mortality. Respondents reported ineffective human resource management compromising the quality of care. The professional responsibility to cope with adverse circumstances and serve society is a major source of motivation that health workers relied upon to get them through the pandemic period. A wide range of challenges were faced by service providers during the pandemic which requires action and support of all levels of government, institutions and society-at-large to assure the continued provision of safe maternity care during such a protracted period of challenging work.
ABSTRACT
Maternity service providers have struggled to provide high-quality services to women and newborns during the ongoing COVID-19 pandemic which has substantially impacted health systems and disrupted maternity services globally. Nepal is a resources-limited country that reported a significant impact of the pandemic on maternal health services. It is therefore important to understand better the perspective of health care professionals in this context. This study intends to explore the experiences of nurses providing maternity care in the public sector during the COVID-19 pandemic in Nepal. A qualitative study using a phenomenological design was conducted. Altogether ten nurses working in maternity services were selected using purposive sampling technique. Data were collected by face-to-face in-depth interviews using a semi-structured interview guide. Thematic analysis was conducted using Clarke and Braun 2006 technique. The findings of the study were organized into codes, sub-themes and themes. The six themes identified were fear of COVID-19 at work, challenges at work, changes at work and services, motivations to work, stigma due to COVID-19, and impact on services. Participants described how maternity services could not be stopped during the pandemic. They had experienced decreased utilization of antenatal services as a consequence of 'lockdown' thereby leading to an increase in maternal and neonatal mortality. Respondents reported ineffective human resource management compromising the quality of care. The professional responsibility to cope with adverse circumstances and serve society is a major source of motivation that health workers relied upon to get them through the pandemic period. A wide range of challenges were faced by service providers during the pandemic which requires action and support of all levels of government, institutions and society-at-large to assure the continued provision of safe maternity care during such a protracted period of challenging work.