The effect of COVID-19 lockdowns on fertility in the Democratic Republic of the Congo

Most countries implemented public health measures, including lockdowns, during the COVID-19 pandemic. It has been speculated that the pandemic will affect fertility, but the direction, magnitude, and mechanisms of these effects are not well understood. Using data from the national health management information system and an augmented synthetic control methodology, we examined the impact of a lockdown of Kinshasa in April 2020 on the subsequent fertility of women, which we proxy by the number of births in health facilities months after the policy was implemented. Seven months after the lockdown, we see a large increase in births in Kinshasa, as compared to control areas, which at its peak represents an additional 5000 monthly births, or a 45% increase relative to baseline. We also observe increases in complimentary maternal health services but not in other health services. Increased births were observed among women both older and younger than 20. Lockdown policies have likely affected fertility and future pandemic preparedness plans should anticipate the effects find strategies to mitigate any negative unintended effects.

Impact of the COVID-19 pandemic and response on the utilisation of health services during the first wave in Kinshasa, the Democratic Republic of the Congo

IntroductionHealth service use among the general public can decline during infectious disease outbreaks and has been predicted among low and middle-income countries during the COVID-19 pandemic. In March 2020, the government of the Democratic Republic of the Congo (DRC) implemented public health measures across Kinshasa, including strict lockdown measures in the Gombe health zone, to mitigate impact of the pandemic. MethodsUsing data from the Health Management Information System (January 2018 - December 2020), we evaluated the impact of the pandemic on the use of essential health services (total visits, maternal health, vaccinations, visits for common infectious diseases, and diagnosis of non-communicable diseases) using interrupted time series with mixed effects segmented Poisson regression models during the first wave of the pandemic. Analyses were stratified by age, sex, health facility, and neighbourhood. ResultsHealth service use dropped rapidly following the start of the pandemic and ranged from 16% for hypertension diagnoses to 39% for diabetes diagnoses. However, reductions were highly concentrated in Gombe (81% decline in total visits) relative to health zones without lockdown. When the lockdown was lifted, total visits, visits for infectious diseases, and diagnoses for non-communicable diseases increased approximately two-fold. Hospitals were more affected than health centres. Overall, the use of maternal health services and vaccinations was not significantly affected. ConclusionThe COVID-19 pandemic resulted in important reductions in health service utilisation in Kinshasa, particularly Gombe. Lifting of lockdown led to a rebound in the level of health service use but it remained lower than pre-pandemic levels. Summary BoxO_ST_ABSWhat is already known about this subjectC_ST_ABSO_LISubstantial declines in the use of health services among the general public have been well-documented during previous outbreaks of infectious diseases. C_LIO_LIModelled studies predicted substantial increases in morbidity and mortality in many low- and middle-income countries (LMICs) mainly due to expected declines in the use of health services among the general public. C_LIO_LIOnly a small number of studies have so far evaluated the impact of the COVID-19 pandemic on the use of health services in LMICs and none have also evaluated both the implementation and lifting of lockdown measures. C_LI What are the new findingsO_LIThis study found that overall use of health services declined in Kinshasa but was most pronounced in the Gombe health zone which was subject to strict lockdown measures. C_LIO_LISome health services were more affected than others, most notably visits and tests for malaria and visits for new diagnoses of non-communicable diseases. Maternal and child health services were relatively unaffected. C_LIO_LIWhen the lockdown measures were lifted, health service utilization rebounded but remained at levels lower than those observed pre-pandemic. C_LI What do the new findings implyO_LIThe COVID-19 pandemic has likely had important effects on the use of health services among the general public throughout LMICs. However, evidence from Kinshasa suggests the effects may not be as widespread as previously assumed. C_LIO_LIThe impact of strict social distancing measures needs on COVID-19 outcomes needs to be weighed off against the potential population-level health effects of these policies in various international contexts. C_LI

We also deserve help during the pandemic: The effect of the COVID-19 pandemic on foreign domestic workers in Hong Kong

The coronavirus disease 2019 (COVID-19) pandemic poses particular challenges for migrant workers around the world. This study explores the unique experiences of foreign domestic workers (FDWs) in Hong Kong, and how COVID-19 impacted their health and economic wellbeing. Interviews with FDWs (n = 15) and key informants (n = 3) were conducted between May and August 2020. FDWs reported a dual-country experience of the pandemic, where they expressed concerns about local transmission risks as well as worries about their family members in their home country. Changes to their current work situation included how their employers treated them, as well as their employment status. FDWs also cited blind spots in the Hong Kong policy response that also affected their experience of the pandemic, including a lack of support from the Hong Kong government. Additional support is needed to mitigate the particularly negative effects of the pandemic on FDWs.

Evidence of the effectiveness of travel-related measures during the early phase of the COVID-19 pandemic: a rapid systematic review

ObjectiveTo review evidence of the effectiveness of travel measures implemented during the early stages of the COVID-19 pandemic in order to recommend change on how evidence is incorporated in the International Health Regulations (2005) (IHR). DesignWe used an abbreviated preferred reporting items for systematic reviews and meta-analysis protocol (PRISMA-P) and a search strategy aimed to identify studies that investigated the effectiveness of travel-related measures (advice, entry and exit screening, medical examination or vaccination requirements, isolation or quarantine, the refusal of entry, and entry restrictions), pre-printed or published by June 1, 2020. ResultsWe identified 29 studies, of which 26 were modelled (vs. observational). Thirteen studies investigated international measures while 17 investigated domestic measures (one investigated both), including suspended transportation (24 studies), border restrictions (21), and screening (5). There was a high level of agreement that the adoption of travel measures led to important changes in the dynamics of the early phases of the COVID-19 pandemic. However, most of the identified studies investigated the initial export of cases out of Wuhan, which was found to be highly effective, but few studies investigated the effectiveness of measures implemented in other contexts. Early implementation was identified as a determinant of effectiveness. Most studies of international travel measures failed to account for domestic travel measures, and thus likely led to biased estimates. Poor data and other factors contributed to the low quality of the studies identified. ConclusionTravel measures, especially those implemented in Wuhan, played a key role in shaping the early transmission dynamics of the COVID-19 pandemic, however, the effectiveness of these measures was short-lived. There is an urgent need to address important evidence gaps, but also a need to review the way in which evidence is incorporated in the IHR in the early phases of a novel infectious disease outbreak. What is already known on this subject?O_LIPrevious reviews of the evidence from outbreaks of influenza and other infectious disease have generally found that there is limited evidence that travel-measures are effective at containing outbreaks. C_LIO_LIHowever, it is unclear if the lessons from other infectious disease outbreaks would be relevant in the context of COVID-19. C_LIO_LIBased on evidence at the time, WHO did not recommend any travel restrictions when it declared COVID-19 a Public Health Emergency of International Concern. C_LI What does this study add?O_LIThis study rapidly reviews the evidence on the effectiveness of travel measures implemented in the early phase of the pandemic on epidemiological countries. C_LIO_LIThe study investigated both international and domestic travel measures and a wide range of travel measures. C_LIO_LIThe study finds that the domestic travel measures implemented in Wuhan were effective at reducing the importation of cases internationally and within China. The study also finds that travel measures are more effective when implemented earlier in the outbreak. C_LIO_LIThe findings generate recommendations on how to incorporate evidence into the International Health Regulations and highlights important research gaps that remain. C_LI How might this affect future outbreaks?O_LIThe findings of this study suggest the need to decouple recommendations of travel measures from the declaration of a public health emergency of international concern. C_LIO_LIHighlights the need to evaluate the potential effectiveness of travel measures for each outbreak, and not just assume effectiveness based on past outbreak scnearios. C_LI