Health service utilisation during the COVID-19 pandemic in sub-Saharan Africa in 2020: a multicountry empirical assessment with a focus on maternal, newborn and child health services.

INTRODUCTION: There are concerns about the impact of the COVID-19 pandemic on the continuation of essential health services in sub-Saharan Africa. Through the Countdown to 2030 for Women's, Children's and Adolescents' Health country collaborations, analysts from country and global public health institutions and ministries of health assessed the trends in selected services for maternal, newborn and child health, general service utilisation. METHODS: Monthly routine health facility data by district for the period 2017-2020 were compiled by 12 country teams and adjusted after extensive quality assessments. Mixed effects linear regressions were used to estimate the size of any change in service utilisation for each month from March to December 2020 and for the whole COVID-19 period in 2020. RESULTS: The completeness of reporting of health facilities was high in 2020 (median of 12 countries, 96% national and 91% of districts ≥90%), higher than in the preceding years and extreme outliers were few. The country median reduction in utilisation of nine health services for the whole period March-December 2020 was 3.9% (range: -8.2 to 2.4). The greatest reductions were observed for inpatient admissions (median=-17.0%) and outpatient admissions (median=-7.1%), while antenatal, delivery care and immunisation services generally had smaller reductions (median from -2% to -6%). Eastern African countries had greater reductions than those in West Africa, and rural districts were slightly more affected than urban districts. The greatest drop in services was observed for March-June 2020 for general services, when the response was strongest as measured by a stringency index. CONCLUSION: The district health facility reports provide a solid basis for trend assessment after extensive data quality assessment and adjustment. Even the modest negative impact on service utilisation observed in most countries will require major efforts, supported by the international partners, to maintain progress towards the SDG health targets by 2030.

[Determinants of home delivery in two neighborhoods in Commune V of Bamako]. / Comparaison des determinants de l'accouchement a domicile dans deux quartiers en Commune V de Bamako.

OBJECTIVE: The objective was to study the determinants of home delivery in the Commune V Health District of Bamako. MATERIALS AND METHODS: We conducted an analytical cross-sectional study among women who delivered at home, in two neighborhoodsofSabalibougou and Badalabougou, from March 2015 to February 2016, and who were admitted at the Maternity of the Commune V Referral Health Center during the same period. Two groups of women from two neighborhoods were compared. The data were entered and analyzed using EpiInfo 3.5.3. We presented the Odds Ratios and confident intervals. RESULTS: The frequency of home delivery was 16.18%. The age group 35 years and over were the most represented in both Sabalibougou with 80.75% and Badalabougou with 19.42%.In Sabalibougou, compared to Badalabougou, we found 0.49 times fewer women in school (p = 0.01); 8.92 times more women with gainful occupation (p = 10-8); 3.5 times more partners with non-gainful occupation (p = 10-6); 4.59 times more risk to give birth at home (p = 10-8); 3 times more risk not to perform antenatal care (p = 0.0002); 3.26 times more appreciation of the high cost of delivery care (p = 10-4) and 3.03 times more lack of financial support (p=3*10-4). CONCLUSION: The frequency of home delivery was higher in Sabalibougou. The determinants of this phenomenon were: the low level of schooling, the low socioeconomic level, the non-use of antenatal care, theperceived high cost of delivery care.

OBJECTIF: L'objectif était d'étudierles déterminants de l'accouchement à domicile en Commune V de Bamako. MATÉRIELS ET MÉTHODES: Nous avons mené une étude transversale analytique chez les femmes qui ont accouchées à domicile, dans les quartiers de Sabalibougou et Badalabougou, de Mars 2015 en Février 2016 et reçues à la maternité du Centre de Santé de Référence de la Commune V pendant la même période. Les deux quartiers ont été comparés. Les données ont été saisies et analysées sur EpiInfo 3.5.3, avec présentation des Odds Ratios et intervalles de confiance. RÉSULTATS: La fréquence de l'accouchement à domicile était de 16,18%.La tranche d'âge 35 ans et plus était la plus représentée à Sabalibougou (80,75%) et à Badalabougou (19,42%). Nous avons trouvéà Sabalibougou, comparé à Badalabougou, 0,49 fois moins de femmes scolarisées (p=0,01) ;8,92 fois plus de femmes avec activité rémunératrice (p=10-8) ;3,5 fois plus de partenaires avec activité non rémunératrice (p=10-6) ; 4,59 fois plus de risque d'accoucher à domicile (p=10-8) ; 3 fois plus de risque de ne pas réaliser de consultation prénatale (p=0,0002) ;3,26 fois plus d'appréciation du coût de l'accouchement élevé (p=10-4) et3,03 fois plus de manque de moyens (p=3*10-4). CONCLUSION: La fréquence de l'accouchement à domicile était plus élevée à Sabalibougou.Les déterminants étaient : l'absence de scolarisation, lemanque de moyens financiers, l'absence de réalisation de consultation prénatale, le coût jugé élevé de l'accouchement.