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The perfect storm: Disruptions to institutional delivery care arising from the COVID-19 pandemic in Nepal.
Ashish, K C; Peterson, Stefan Swartling; Gurung, Rejina; Skalkidou, Alkistis; Gautam, Jageshwar; Malla, Honey; Paudel, Punya; Bhattarai, Kumari; Joshi, Nisha; Tinkari, Bhim Singh; Adhikari, Shree; Shrestha, Durgalaxmi; Ghimire, Binda; Sharma, Seema; Khanal, Laxmi; Shrestha, Sunil; Graham, Wendy Jane; Kinney, Mary.
  • Ashish KC; Department of Women's and Children's Health, Uppsala University, Sweden.
  • Peterson SS; Department of Women's and Children's Health, Uppsala University, Sweden.
  • Gurung R; Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.
  • Skalkidou A; Department of Women's and Children's Health, Uppsala University, Sweden.
  • Gautam J; Research Division, Golden Community, Lalitpur, Nepal.
  • Malla H; Department of Women's and Children's Health, Uppsala University, Sweden.
  • Paudel P; Ministry of Health and Population, Kathmandu, Nepal.
  • Bhattarai K; Research Division, Golden Community, Lalitpur, Nepal.
  • Joshi N; Family Welfare Division, Department of Health Services, Nepal.
  • Tinkari BS; Family Welfare Division, Department of Health Services, Nepal.
  • Adhikari S; Family Welfare Division, Department of Health Services, Nepal.
  • Shrestha D; Family Welfare Division, Department of Health Services, Nepal.
  • Ghimire B; Paropakar Maternity and Women's Hospital, Nepal.
  • Sharma S; Bheri Hospital, Nepalgunj, Nepal.
  • Khanal L; Nepal Nursing Council, Kathmandu, Nepal.
  • Shrestha S; Seti Provincial Hospital, Dhangadi, Nepal.
  • Graham WJ; White Ribbon Alliance Nepal, Kathmandu.
  • Kinney M; White Ribbon Alliance Nepal, Kathmandu.
J Glob Health ; 11: 05010, 2021 May 11.
Article in English | MEDLINE | ID: covidwho-1248385
ABSTRACT

BACKGROUND:

The COVID-19 pandemic has led to system-wide disruption of health services globally. We assessed the effect of the pandemic on the disruption of institutional delivery care in Nepal.

METHODS:

We conducted a prospective cohort study among 52 356 women in nine hospitals to assess the disruption of institutional delivery care during the pandemic (comparing March to August in 2019 with the same months in 2020). We also conducted a nested follow up cohort study with 2022 women during the pandemic to assess their provision and experience of respectful care. We used linear regression models to assess the association between provision and experience of care with volume of hospital births and women's residence in a COVID-19 hotspot area.

RESULTS:

The mean institutional births during the pandemic across the nine hospitals was 24 563, an average decrease of 11.6% (P < 0.0001) in comparison to the same time-period in 2019. The institutional birth in high-medium volume hospitals declined on average by 20.8% (P < 0.0001) during the pandemic, whereas in low-volume hospital institutional birth increased on average by 7.9% (P = 0.001). Maternity services halted for a mean of 4.3 days during the pandemic and there was a redeployment staff to COVID-19 dedicated care. Respectful provision of care was better in hospitals with low-volume birth (ß = 0.446, P < 0.0001) in comparison to high-medium-volume hospitals. There was a positive association between women's residence in a COVID-19 hotspot area and respectful experience of care (ß = 0.076, P = 0.001).

CONCLUSIONS:

The COVID-19 pandemic has had differential effects on maternity services with changes varying by the volume of births per hospital with smaller volume facilities doing better. More research is needed to investigate the effects of the pandemic on where women give birth and their provision and experience of respectful maternity care to inform a "building-back-better" approach in post-pandemic period.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Delivery, Obstetric / Pandemics / COVID-19 / Maternal Health Services Type of study: Cohort study / Observational study / Prognostic study Limits: Adult / Female / Humans / Pregnancy Country/Region as subject: Asia Language: English Journal: J Glob Health Year: 2021 Document Type: Article Affiliation country: Jogh.11.05010

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Delivery, Obstetric / Pandemics / COVID-19 / Maternal Health Services Type of study: Cohort study / Observational study / Prognostic study Limits: Adult / Female / Humans / Pregnancy Country/Region as subject: Asia Language: English Journal: J Glob Health Year: 2021 Document Type: Article Affiliation country: Jogh.11.05010