Area-specific covid-19 effects on health services utilization in the Democratic Republic of the Congo using routine health information system data.

BACKGROUND: Since March 2020, the COVID-19 pandemic has shocked health systems worldwide. This analysis investigated the effects of the pandemic on basic health services utilization in the Democratic Republic of the Congo (DRC) and examined the variability of COVID effects in the capital city Kinshasa, in other urban areas, and in rural areas. METHODS: We estimated time trends models using national health information system data to replicate pre-COVID-19 (i.e., January 2017-February 2020) trajectories of health service utilization, and then used those models to estimate what the levels would have been in the absence of COVID-19 during the pandemic period, starting in March 2020 through March 2021. We classified the difference between the observed and predicted levels as the effect of COVID-19 on health services. We estimated 95% confidence intervals and p-values to examine if the effect of the pandemic, nationally and within specific geographies, was statistically significant. RESULTS: Our results indicate that COVID-19 negatively impacted health services and subsequent recovery varied by service type and by geographical area. COVID-19 had a lasting impact on overall service utilization as well as on malaria and pneumonia-related visits among young children in the DRC. We also found that the effects of COVID-19 were even more immediate and stronger in the capital city of Kinshasa compared with the national effect. Both nationally and in Kinshasa, most affected services had slow and incomplete recovery to expected levels. Therefore, our analysis indicates that COVID-19 continued to affect health services in the DRC throughout the first year of the pandemic. CONCLUSIONS: The methodology used in this article allows for examining the variability in magnitude, timing, and duration of the COVID effects within geographical areas of the DRC and nationally. This analytical procedure based on national health information system data could be applied to surveil health service disruptions and better inform rapid responses from health service managers and policymakers.

Health and economic implications of the ongoing coronavirus disease (COVID-19) pandemic on women and children in Africa.

The coronavirus disease (COVID-19) pandemic continues to pose major health and economic challenges for many countries worldwide. Particularly for countries in the African region, the existing precarious health status resulting from weak health systems have made the impact of the pandemic direr. Although the number of the COVID-19 infections in Africa cannot be compared to that of Europe and other parts of the world, the economic and health ramifications cannot be overstated. Significant impacts of the lockdowns during the onset of the pandemic caused disruptions in the food supply chain, and significant declines in income which decreased the affordability and consumption of healthy diets among the poor and most vulnerable. Access and utilization of essential healthcare services by women and children were also limited because of diversion of resources at the onset of the pandemic, limited healthcare capacity, fear of infection and financial constraint. The rate of domestic violence against children and women also increased, which further deepened the inequalities among these groups. While all African countries are out of lockdown, the pandemic and its consequent impacts on the health and socio-economic well-being of women and children persist. This commentary discusses the health and economic impact of the ongoing pandemic on women and children in Africa, to understand the intersectional gendered implications within socio-economic and health systems and to highlight the need for a more gender-based approach in response to the consequences of the pandemic in the Africa region.

MCH Leadership Training Program: An Innovative Application of an Implementation Science Framework.

INTRODUCTION: MCH training programs in schools of public health provide specialized training to develop culturally competent and skilled MCH leaders who will play key roles in public health infrastructure. Previous literature has reported on the effectiveness of MCH training programs (e.g., number of trainees, improvement in knowledge/skills); less attention has been devoted to understanding factors influencing program implementation during times of rapid change, while considering internal and external contexts (e.g., global pandemic, social unrest, uncertainty of funding, mental health issues, and other crises). PURPOSE: This article describes a graduate-level MCH leadership training program and illustrates how an implementation science framework can inform the identification of determinants and lessons learned during one year of implementation of a multi-year program. ASSESSMENT: Findings reveal how CFIR can be applicable to a MCH training program and highlight how constructs across domains can interact and represent determinants that serve as both a barrier and facilitator. Key lessons learned included the value of accountability, flexibility, learner-centeredness, and partnerships. CONCLUSION: Findings may apply to other programs and settings and could advance innovative training efforts that necessitate attention to the multi-level stakeholder needs (e.g., student, program, institution, community, and local/regional/national levels). Applying CFIR could be useful when interpreting process and outcome evaluation data and transferring findings and lessons learned to other organizations and settings. Integrating implementation science specifically into MCH training programs could contribute to the rigor, adaptability, and dissemination efforts that are critical when learning and sharing best practices to expand leadership capacity efforts that aim to eliminate MCH disparities across systems.

Natural disasters and perinatal mental health: what are the impacts on perinatal women and the service system?

Aim: The perinatal period is characterised by radical change across multiple domains. When it coincides with natural disasters, women and families need targeted support to mitigate the impacts on their birthing and early parenting experiences. Disaster planning in Australia has paid scant attention to the needs of this group. This study aimed to explore rural maternal and child health nurses' perceptions of how women receiving postnatal care during times of disaster manage mental health and wellbeing issues. Subject and methods: Eight female maternal and child health nurses (MCHNs) were recruited through purposive sampling across two rural regions of Victoria, Australia. A qualitative design using an online survey followed by in-depth interviews, was underpinned by intersectional feminist theory. Thematic analysis was applied to qualitative data. Results: Three overarching themes: context of practice, impact of disasters on mothers, and impact of disasters on services were identified. Isolation for mothers was highlighted, necessitating increased provision of emotional support, at a time when service providers themselves were under strain. Conclusion: Natural disasters exacerbate stressors on perinatal rural women and can impede their access to formal and informal supports, jeopardizing mental health outcomes. Targeted investment in rural perinatal services to enable proactive planning and implementation of disaster strategies is urgently needed to reduce the impact of natural disasters on rural perinatal women and their families. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-023-01855-y.

The role of doulas in providing breastfeeding support during the COVID-19 pandemic.

BACKGROUND: Doulas have been instrumental in providing breastfeeding support to nursing mothers before and during the COVID-19 pandemic, as they can significantly impact a mother's ability to initiate and maintain breastfeeding. However, the COVID-19 pandemic, subsequent lockdowns, and social isolation created challenges for nursing mothers to access doulas' services, usually provided in person. In this study, we examined the role of doulas in providing breastfeeding support during the COVID-19 pandemic, exploring adaptation to COVID-19 guidelines and the challenges doulas face in providing breastfeeding support during the pandemic. METHODS: A systematic review was conducted following the PRISMA guidelines. Thirteen scientific databases and twenty peer-reviewed journals were searched for journal articles published in English between January 2020 and March 2022 using key search terms (e.g., Doula, Breastfeeding, COVID-19). Studies evaluating the role of doulas in providing breastfeeding support during COVID-19, and the impact of COVID-19 Guidelines on doula services, were included. Two reviewers independently performed the risk of bias assessment and data extraction. Summative content analysis was used to analyze the data. RESULTS: The majority of studies were conducted in developed nations. This systematic review includes eight articles, four qualitative, one survey, two mixed-methods studies, and one prospective research study. Seven of the eight studies were conducted in the United States, and the eighth was conducted in multiple countries. These studies have three main themes: (1) virtual breastfeeding support provided by doulas during the pandemic; (2) remote social support provided by doulas to breastfeeding mothers during the pandemic; and (3) barriers to doula service delivery due to COVID-19 restrictions, primarily the exclusion of doulas as essential workers. The eight studies showed that doulas found innovative ways to serve the needs of birthing and nursing mothers during the difficulties brought on by the pandemic. CONCLUSION: Doulas provided breastfeeding support during the COVID-19 pandemic by utilizing innovative service delivery methods while navigating changes in COVID-19 guidance. However, system-level integration of doulas' work and the acknowledgment of doulas as essential healthcare providers are needed to enhance doula service delivery capacity, especially during a pandemic, to help improve maternal health outcomes.

Adapting and Scaling a Digital Health Intervention to Improve Maternal and Child Health Among Ethnic Minority Women in Vietnam Amid the COVID-19 Context: Protocol for the dMOM Project.

BACKGROUND: Due to interconnected structural determinants including low maternal health knowledge, economic marginalization, and remoteness from low-capacity health centers, ethnic minority women in remote areas of Vietnam face severe maternal, newborn, and child health (MNCH) inequities. As ethnic minorities represent 15% of the Vietnamese population, these disparities are significant. mMOM-a pilot mobile health (mHealth) intervention using SMS text messaging to improve MNCH outcomes among ethnic minority women in northern Vietnam-was implemented from 2013-2016 with promising results. Despite mMOM's findings, exacerbated MNCH inequities, and digital health becoming more salient amid COVID-19, mHealth has not yet been scaled to address MNCH among ethnic minority women in Vietnam. OBJECTIVE: We describe the protocol for adapting, expanding, and exponentially scaling the mMOM intervention qualitatively through adding COVID-19-related MNCH guidance and novel technological components (mobile app and artificial intelligence chatbots) and quantitatively through broadening the geographical area to reach exponentially more participants, within the evolving COVID-19 context. METHODS: dMOM will be conducted in 4 phases. (1) Drawing on a review of international literature and government guidelines on MNCH amid COVID-19, mMOM project components will be updated to respond to COVID-19 and expanded to include a mobile app and artificial intelligence chatbots to more deeply engage participants. (2) Using an intersectionality lens and participatory action research approach, a scoping study and rapid ethnographic fieldwork will explore ethnic minority women's unmet MNCH needs; acceptability and accessibility of digital health; technical capacity of commune health centers; gendered power dynamics and cultural, geographical, and social determinants impacting health outcomes; and multilevel impacts of COVID-19. Findings will be applied to further refine the intervention. (3) dMOM will be implemented and incrementally scaled across 71 project communes. (4) dMOM will be evaluated to assess whether SMS text messaging or mobile app delivery engenders better MNCH outcomes among ethnic minority women. The documentation of lessons learned and dMOM models will be shared with Vietnam's Ministry of Health for adoption and further scaling up. RESULTS: The dMOM study was funded by the International Development Research Centre (IDRC) in November 2021, cofacilitated by the Ministry of Health, and is being coimplemented by provincial health departments in 2 mountainous provinces. Phase 1 was initiated in May 2022, and phase 2 is planned to begin in December 2022. The study is expected to be complete in June 2025. CONCLUSIONS: dMOM research outcomes will generate important empirical evidence on the effectiveness of leveraging digital health to address intractable MNCH inequities among ethnic minority women in low-resource settings in Vietnam and provide critical information on the processes of adapting mHealth interventions to respond to COVID-19 and future pandemics. Finally, dMOM activities, models, and findings will inform a national intervention led by the Ministry of Health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/44720.

The post-discharge coping difficulty of puerperal women in a middle and low-income tourist city during the COVID-19 pandemic.

BACKGROUND: Since the coronavirus disease 2019 (COVID-19) pandemic outbreak, the incidence of mental health problems in perinatal women has been high, and particularly prominent in China which was the first country affected by COVID-19. This paper aims to investigate the current situation and the related factors of maternal coping difficulties after discharge during COVID-19. METHODS: General information questionnaires (the Perinatal Maternal Health Literacy Scale, Postpartum Social Support Scale and Post-Discharge Coping Difficulty Scale-New Mother Form) were used to investigate 226 puerperal women in the third week of puerperium. The influencing factors were analyzed by single factor analysis, correlation and multiple linear regression. RESULTS: The total score of coping difficulties after discharge was 48.92 ± 12.05. At the third week after delivery, the scores of health literacy and social support were 21.34 ± 5.18 and 47.96 ± 12.71. There were negative correlations among health literacy, social support and coping difficulties after discharge (r = -0.34, r = -0.38, P < 0.001). Primipara, family income, health literacy and social support were the main factors influencing maternal coping difficulties after discharge. CONCLUSION: During the COVID-19 pandemic, puerperal women in a low- and middle-income city had moderate coping difficulties after discharge and were affected by many factors. To meet the different needs of parturients and improve their psychological coping ability, medical staff should perform adequate assessment of social resources relevant to parturients and their families when they are discharged, so they can smoothly adapt to the role of mothers.

Impact of COVID-19 on utilization of maternal and child health services in India: Health management information system data analysis.

Background/Objectives: Studies globally have documented the impact of COVID 19 on maternal and newborn health services. This study assesses the impact of COVID-19 on essential maternal and child health (MCH) services in India based on the national Health Management Information System (HMIS). Methods: Present retrospective study used secondary data analysis upon the routinely collected data accessed from Health Management Information System. Microdata on maternal and newborn indicators was extracted for all states between April and June during 2019, 2020 and 2021. Relative change for each indicator were taken into consideration for the year 2020 and 2021; with respect to the outcomes in 2019. Results: Compared to 2019, antenatal care registrations saw a decline in all states for both periods in 2020 and 2021 except for Sikkim, Telangana, Maharashtra and Andhra Pradesh. Similarly, the relative changes in 2019 pertaining to the proportion of pregnant women provided with emergency obstetric care for pregnancy complications registered a decline in all states except for Himachal Pradesh, Telangana and Arunachal Pradesh. There was a decreasing trend noted in institutional deliveries in 2020 and 2021 among all major states. However, an increasing trend was seen in the number of immunization sessions held among all major states. Conclusion: The study demonstrates a disruption in service delivery during the lockdown period in the first wave and the peak of the second wave. Further qualitative studies need to be undertaken to generate evidence for maintaining continuum of care during a pandemic situation.

Impact of COVID-19 pandemic on the availability of maternal and child health products and childhood vaccines.

BACKGROUND: In many low- and middle-income countries, the 2019 novel coronavirus (COVID-19) has challenged efforts to ensure access to and availability of quality maternal, newborn, and child health (MCH) services and essential MCH commodities. OBJECTIVES: This study evaluated the impact of COVID-19 pandemic on the availability of maternal and child health products and childhood vaccines at selected health facilities in Ethiopia. METHODS: We have prospectively assessed 28 maternal-child health products and 14 childhood vaccines and accessories, which are listed in the Ethiopian national essential medicines list. Data were collected from 5 hospitals located in the Jimma zone of Oromia regional state in the southwestern part of Ethiopia. We extracted data on drug availability, and order fill rates for these pharmaceutical products between May 2019 and August 2020. RESULTS: The overall mean availability of selected maternal and child health products was 43.2%. It was 52.9% (range 21.0-63.6%) prior COVID-19 and 42.6% (range 19-56.4) during COVID-19 time. The average monthly orders fill rates of hospitals for the selected products ranged from 39 to 79%. Before COVID-19 the average order fill rate was near 70% of total orders placed by the hospitals. However, immediately after the COVID-19 case notification in Ethiopia, the percentage of order filled correctly in items and quantities began decreasing. CONCLUSION: This study illustrates that the availability of key essential medicines for maternal and child health in the study area was low. The overall stock-out situation of MCH products has worsened during COVID-19 compared to pre-COVID-19 pandemic. None of the surveyed MCH products met the ideal availability benchmark of 80% in the public hospitals. To allow governments to guarantee these products are constantly available and affordable, a variety of policy frameworks and choices addressing inevitable epidemics should exist.

Impact of COVID-19 on maternal and child health services

Coronavirus disease (COVID-19) outbreaks caused a significant mortality and morbidity at a global level. Maternal and child health (MCH) services are one of the most affected services during the pandemic. Maternal health is an essential component of high-quality maternal care, according to the WHO framework for the quality care for pregnant women and newborns. The aim of this study was to provide a review of COVID-19 impact on MCH services. The Web of Science, Scopus, Google Scholar, and PubMed databases were systematically searched. Articles reporting MCH services, COVID-19, and coronavirus were included for assessment. The initial search resulted in 106 records. After the primary screening of titles, s, and full texts and removing duplicates, 11 articles were selected and included in this review study. The findings revealed that the range of projected maternal mortality and child mortality was 1.3%-38.6% and 9.8%-44.7%, respectively. Additionally, the review highlighted that there is a huge impact of COVID-19 on the utilization of reproductive, maternal, and newborn health services. Moreover, the study also reported huge increases in maternal mental health issues, such as clinically relevant anxiety and depression. There is a need to identify the factors and the prompt management of maternal health services during COVID-19. Hence, clinicians should maintain reproductive and maternal care and MCH during any pandemic. © 2022 Medical Journal of Babylon ;Published by Wolters Kluwer - Medknow.

Experiences of postnatal mothers with quality of care including water, sanitation and hygiene amenities during the outbreak of COVID - 19 in Ghana: An institutional cross-sectional study.

Objective: To investigate the experiences and perceptions of postnatal mothers with quality of healthcare including WASH amenities among postnatal mothers in Ghana during the COVID-19 outbreak. Study design: The study was an institutional cross-sectional. Methods: The survey was conducted in six (6) regions across the northern, middle, and coastal belts of Ghana among postnatal mothers (n = 424). Eligible respondents accessed antenatal care (ANC) in 12 healthcare facilities (primary level and secondary level) during the outbreak of COVID-19 pandemic. Univariate ordered logistic regression analysis was conducted to predict determinants of overall perceived quality of healthcare and experiences with WASH amenities in healthcare facilities visited. Findings: Privacy and confidentiality (mean score = 3.07) were the most highly rated quality indicator while the least rated indicator was dignity and respect of clients (mean score = 2.13). Approximately 50% of postnatal mothers reported paying out-of-pocket for essential ANC medications. Perceived quality of healthcare was positive among those who accessed care at a district/municipal hospital (Coef. = 1.29; 95%CI 0.45, 2.13, p = 0.003); co-habiting with a partner (Coef. = 1.64; 95%CI 0.64, 2.65, p = 0.001), and resident in an urban location (Coef. = 2.30; 95%CI 0.30, 3.30, p = 0.001). Mothers who accessed care at a district or municipal hospital (Coef. = 1.81; 95%CI 0.83, 2.78, p = 0.001); were co-habiting with a partner (Coef. = 1.92; 95%CI 0.76, 3.07, p = 0.001), and had a private health insurance cover (Coef. = 3.18; 95%CI 0.69, 5.67, p = 0.012) were more likely to rank WASH amenities better than their comparators. Conclusion: Overall perception of postnatal mothers of healthcare quality including WASH amenities after outbreak of COVID-19 was good, but with significant concerns about dignity and respect accorded them during care and having to pay out-of-pocket for some ANC medications. Relevant managers, service providers and regulatory institutions are encouraged to initiate and sustain policy dialogues and stakeholder consultations on the healthcare quality care gaps established in this study. There is the need for more investments in WASH amenities in the health sector as a quality assurance strategy, especially for maternal and child health services.

An integrative literature review on the impact of COVID-19 on maternal and child health in Africa.

Africa has the highest rates of maternal deaths globally which have been linked to poorly functioning health care systems. The pandemic revealed already known weaknesses in the health systems in Africa, such as workforce shortages, lack of equipment and resources. The aim of this paper is to review the published literature on the impact of the COVID-19 pandemic on maternal and child health in Africa. The integrative review process delineated by Whittemore and Knafl (2005) was used to meet the study aims. The literature search of Ovid Medline, CINAHL, PubMed, WHO, Google and Google scholar, Africa journals online, MIDIRS was limited to publications between March 2020 and May 2022. All the studies went through the PRISMA stages, and 179 full text papers screened for eligibility, 36 papers met inclusion criteria. Of the studies, 6 were qualitative, 25 quantitative studies, and 5 mixed methods. Thematic analysis according to the methods of Braun and Clark (2006) were used to synthesize the data. From the search the six themes that emerged include: effects of lockdown measures, COVID concerns and psychological stress, reduced attendance at antenatal care, childhood vaccination, reduced facility-based births, and increase maternal and child mortality. A review of the literature revealed the following policy issues: The need for government to develop robust response mechanism to public health emergencies that negatively affect maternal and child health issues and devise health policies to mitigate negative effects of lockdown. In times of pandemic there is need to maintain special access for both antenatal care and child delivery services and limit a shift to use of untrained birth attendants to reduce maternal and neonatal deaths. These could be achieved by soliciting investments from various sectors to provide high-quality care that ensures sustainability to all layers of the population.

Mothers' Impressions and Beliefs About Taking a Booster Dose for COVID-19 Vaccine During Pregnancy and Lactation.

OBJECTIVES: This study aimed to explore perceptions and willingness to get coronavirus disease 2019 (COVID-19) booster vaccination among pregnant and lactating women in Jordan. METHODS: A cross-sectional study using a 29-item web-based questionnaire was conducted. Sociodemographic characteristics, vaccine acceptance, confidence in the booster dose of COVID-19 vaccine, perception of risk for COVID-19, and acceptance to participate in COVID-19 booster vaccine clinical trials were prospectively evaluated. Logistic regression was used to identify factors that might affect the participants' acceptance of a COVID-19 vaccine and their willingness to enroll in clinical trials of a booster dose of COVID-19 vaccine. RESULTS: Among all participants (pregnant and lactating women, n = 584), 328 (56.2%) intended to receive the booster dose of the COVID-19 vaccine. Predictors of booster dose acceptance were a medical-related degree (OR 1.62, CI 1.06-2.5, p = 0.028), income (OR 0.677, CI 0.52-0.88, p = 0.004), living residency (OR 0.44, CI 0.32-0.60, p < 0.001), knowing pregnant/lactating women previously infected with infectious microbe (OR 1.539, CI 1.07-2.23, p = 0.022), commitment to immunization for children (OR 3.01, CI 1.03-8.82, p = 0.044), receiving an influenza vaccine (OR 1.46, CI 1.04-2.05, p = 0.031), and worried about infectious microbes (OR 1.32, CI 1.15-1.52, p < 0.001). Among participants, only 22.9% were willing to participate in clinical trials of the booster dose of COVID-19 vaccine. The biggest motivator for participation was the participants' desire to help find the best vaccine during pregnancy/lactation (57.5%) while the main barrier towards participation was not wanting to expose themselves and their babies to more side effects (88.0%). CONCLUSION: This study reported reasonable acceptance of vaccination in a sample of pregnant/lactating women. Vaccination hesitancy for the booster dose was in-line with similar studies on the primary series around the globe, but the willingness to participate in clinical trials was lower than non-pregnant/non-lactating women.

Effect of COVID-19 Pandemic on Maternal and Child Health Services and Strategies for Effective Service Implementation in Ethiopia.

Introduction: The COVID-19 pandemic is a global burden to the Health sector of developing countries. However, the effect of COVID-19 on maternal and child health services is scarce and no evidence was documented in the Ethiopian context. Hence, this particular study aimed to examine the effect of the pAndemic and to identify effective strategies in Ethiopia. Methods: Both quantitative and qualitative approaches were applied. For the qualitative, 74 study participants were considered. Study participants were selected purposively and interview guide was used to collect data. Finally audio records were transcribed verbatim, coded and analyzed thematically. For the quantitative, data were extracted from the DHIS2 reports to assess the trend over time. Results: The qualitative findings indicated that the pandemic affected the MNCH services to be inaccessible and low quality. The trend analysis also showed that the COVID-19 has disrupted MNCH services particularly in the first two months Of the pandemic. Health workers also faced a scarcity of personal protective equipment, work overload and shortage Of resources during the pandemic. As a cope up strategy, the Health system at all levels has established a COVID-19 task force supported by a working guideline. There is also a media prevention program, establishment of quarantine at home, resource mobilization, active surveillance, availing extra ambulances and strong follow-up. Conclusion: Multiple interventions applied to curb the pandemic have lowered MNCH service utilization. The low commitment of health workers, resources shortage and movement restrictions had a an impact on the uptake of MCH services. There should be a balance in resource utilization to COVID and other essential Health services and the government should avail the necessary supplies during the COVID era. Regionally tailored adaptive interventions are also required to improve MNCH service uptake. Extensive media advocacy and HEWs active involvement for community mobilization are also recommended.

Maternity in times of the Covid-19 pandemic: what mothers admitted in a reference hospital have to tell us

The Covid-19 pandemic has affected all aspects of our lives. Women in the perinatal period have unique needs, demanding health and safety guidelines regarding the risks associated to social isolation. The objective was to know the women's experience during pregnancy or puerperium in the pandemic while being cared at a hospital. Qualitative study referenced on concepts of integrality of care and daily life. Eighteen pregnant and postpartum participated. Three themes emerged: Repercussions on pregnancy and puerperium, repercussions on practical life, and coping strategies created by women. The reports reveal different repercussions of the pandemic in the lives of women and their families, also the strategies and precautions used to mitigate its adverse effects. We suggest directing preventive measures and public health policies to prioritize pregnant and postpartum women, recognizing and embracing subjective issues involved at this moment in women's lives. Copyright © 2022, Fundacao UNI Botucatu/UNESP. All rights reserved.

Factors affecting delayed and non-receipt of healthcare during the COVID-19 pandemic for women in rural Maharashtra, India: Evidence from a cross-sectional study.

Background: Pathways to low healthcare utilisation under the COVID-19 pandemic are not well understood. This study aims to understand women's concerns about the health system's priorities and their increased burden of domestic responsibilities during COVID-19 as predictors of delayed or non-receipt of needed care for themselves or their children. Methods: We surveyed married women in rural Maharashtra, India (N = 1021) on their health and economic concerns between Feb 1 and March 26, 2021. This study period was when India emerged from the first wave of the pandemic, which had severely impacted the health systems, and before the second-even more devastating wave had started. We captured if women were concerned about access to non-COVID health services due to healthcare being directed solely to COVID-19) (exposure 1) and whether their domestic responsibilities increased during the pandemic (exposure 2). Our outcomes included women's reports on whether they delayed healthcare seeking (secondary outcome and mediator) and whether they received healthcare for themselves or their children when needed (primary outcome). We conducted adjusted regression models on our predictor variables with each outcome and assessed the mediation effects of delayed healthcare seeking for each of the exposure variables. Findings: We found that women who were concerned that healthcare was directed solely towards COVID-19 were more likely not to receive healthcare when needed (Adjusted Risk Ratio [ARR] = 1.49, 95% CI = 1.14, 1.95). We also found that women whose domestic care burden increased under the pandemic were more likely to delay healthcare seeking (ARR = 1.84, 95% CI = 1.05, 3.21). Delayed healthcare seeking mediated the associations between each of our exposure variables with our outcome variable, non-receipt of needed healthcare. Interpretation: Our findings suggested that women's perceptions of healthcare systems and their domestic labour burdens affected healthcare seeking during the pandemic in India, even before the second wave of COVID-19 incapacitated the health system. Support for women and health systems is needed to ensure healthcare uptake during crises. Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, USA (grant numbers: R01HD084453- 01A1 and RO1HD61115); Department of Biotechnology, Government of India (grant #BT/IN/US/01/BD/2010); the EMERGE project (Bill and Melinda Gates Foundation Grants: OPP1163682 and INV018007; PI Anita Raj), and Bill and Melinda Gates Foundation Grant number INV-002967.

Predictors of happiness during the COVID-19 pandemic in mothers of infants and/or preschoolers: a pre-COVID-19 comparative study in Japan.

BACKGROUND: Happiness may help to prevent negative physiological outcomes in response to life events; however, factors contributing to happiness during the COVID-19 pandemic have not been longitudinally investigated. This study explored the predictors of happiness in mothers of young children in Japan using comparable data that were obtained before and during the COVID-19 pandemic. METHODS: We conducted the baseline survey in February 2020, and 4 months later, we also conducted the follow-up survey. Throughout all 47 prefectures in Japan, 4,700 (100 respondents/prefecture) mothers of infants and/or preschoolers (0-6 years) participated in the baseline online survey; 2,489 of these also participated in the follow-up survey. RESULTS: We performed hierarchical multiple regression analysis and our final model indicated that maternal happiness during COVID-19 pandemic was positively related to employment status (homemaker, ß = 0.052, p = 0.014), levels of available social support (average, ß = 0.052, p = 0.012, high, ß = 0.055, p = 0.010) and happiness score before the pandemic (ß = 0.467, p < 0.001), and satisfaction toward the measures against the COVID-19 at partners' workplace (average, ß = 0.129, p < 0.001; high, ß = 0.279, p < 0.001), preventive behavior against COVID-19 (average, ß = 0.055, p = 0.002; high, ß = 0.045, p = 0.015) and positive attitudes/thinking (ß = 0.087, p < 0.001) during the pandemic. In contrast, poor mental health (K6 ≥5, ß = -0.042, p = 0.011) before the pandemic and negative changes during the pandemic (≥3, ß = -0.085, p < 0.001) were negatively related to maternal happiness during the pandemic. Our final model explained 44.9% of the variance in mothers' happiness during the COVID-19 pandemic. CONCLUSIONS: Satisfaction toward the measures against the COVID-19 at partners' workplace, preventive behavior, and positive attitudes/thinking were especially important for maternal happiness during the COVID-19 pandemic. Future study is needed to consider measures against infectious diseases in the workplace that are desirable for the well-being of parents with young children, taking into account the gender perspective.

Results of work of the maternal child program. University Pediatric Hospital of Cienfuegos, 2021

Background: A fundamental strategy to achieve satisfactory results in maternal and child care was the implementation of the National Program for Maternal and Child Care (PAMI). The results of the PAMI in 2021 are not what is expected each year at the country level and it was not far from the reality of the Paquito Glez University Pediatric Hospital. Objective: Mention the results of the work of the Maternal and Child Program at the University Pediatric Hospital of Cienfuegos in the year 2021. Methods: descriptive, cross-sectional study, carried out at the Pediatric Hospital of Cienfuegos and which includes the comprehensive results of the Maternal and Child Program at said institution. All the indicators of the program are exposed. It also offers a contextualization of the scenario in the year 2021. Results: The scenario of confrontation with COVID-19 in Cienfuegos had an impact during the year 2021 on the results obtained by the institution, increasing care in the emergency room to 45,151 consultations, as the main reason for Acute Respiratory Diseases. Hospital mortality increases by six more deaths compared to 2020, responding to the main cause of emergency care followed by Sepsis. The municipal seat remains the main issuer of patients and is followed in frequency by Cumanayagua and Rodas, corresponding to the municipalities that contribute the greatest number of admissions. The average hospital stay was 4.3 and the general survival behaves in 96.8%. Conclusions: The group of the institution continues to develop clinical management to achieve the quality of optimal hospital services to influence, modify and make sustainable the indicators with unfavorable results.

Understanding changes made to reproductive, maternal, newborn and child health services in Pakistan during the COVID-19 pandemic: a qualitative study.

COVID-19 mitigation measures have disrupted the provision of essential health services. The goal of this study was to understand changes in reproductive, maternal, neonatal, and child health (RMNCH) services during the pandemic in Pakistan. We conducted a qualitative study in November and December 2020 consisting of telephone in-depth interviews with women, healthcare providers, and community stakeholders. Interviews were analysed using a thematic, iterative approach. All health facilities had changed their routine procedures, including adjustments in service delivery time and staff hours to reduce crowding, and maintain standard operating procedures (SOPs) such as social distancing. Women highlighted stockouts and lack of supplies as key barriers to care-seeking. Stockouts and crowding led to shifts in care-seeking away from public to private facilities. RMNCH service utilisation declined first due to restrictions during the lockdown, then due to fear of contracting COVID-19 at healthcare facilities. This study provides important insights into RMNCH services during the COVID-19 pandemic from care-seekers' and care-providers' perspectives. The findings of this study were used to develop interventions to address access to RMNCH care during the COVID-19 pandemic.