Impact of Covid-19 Restrictions on the Provision of Maternal Health Services at Mbuya Nehanda Maternity Hospital, Parirenyatwa Group of Hospitals. Harare

Abstract

The recent coronavirus disease 2019 (COVID-19) pandemic has had a disastrous effect on the healthcare delivery system on a global scale, but pregnant women face unique challenges. In Zimbabwe, the public health measures for infection control of COVID-19 focused on lockdown of people in their homes and physically restricting movement. The purpose of this study is to assess the impact of these measures on the delays to the provision of essential maternal health services. The Thaddeus & Maine Three Delays Model was utilized focusing on the second delay, the ability of pregnant women to access antenatal services, trend in admissions for delivery and maternal deaths. The research hypothesis is that maternal morbidity and mortality increased because of COVID-19 lockdown restrictive measures. The number of anteclinic (ANC) visits decreased significantly (p<0.001) from a pre-lockdown mean of 208.1 ±52.50 to 88.4 ± 9.40 during lockdown. The volumes of admissions and maternal deaths did not differ significantly (p=0.220) between the pre-lockdown era (Mean=905.8 ±431.71) and during lockdown (Mean=742.5 ±95.17). Compared to the pre-COVID-19 period, the odds of presenting with pregnancy complications doubled during the COVID-19 lockdown (OR=2.0; 95% CI: 1.5 - 2.8, p=0.050). The ANC visits decreased during lockdown (p<0.001) pre-lockdown (M=208.1±52.50) and during lockdown (M=88.4±9.40). The total admissions are not significantly different (p=0.22) during lockdown, pre-lockdown mean (M=905.8±431.71) and during lockdown (M=742.5±95.17). The referral admissions are not significantly different (p=0.195), pre-lockdown mean (M=828.3±476.77) and during lockdown (M=636.3±88.34), compared to direct admissions that are also not significantly different during lockdown (p=0.49), pre-lockdown mean (M=77.58±105.56) and during lockdown (M=106.25±=94.64). The maternal deaths are not significantly different (p=0.64), pre-lockdown mean (M=2.50±1.38) and during lockdown (M=2.17±1.99). The complications found in high-risk pregnancies are anemia in pregnancy, Bartholin’s abscesses, big abdomen, big baby, bleeding, breach baby, born before arrival, COVID-19, diarrhea, fetal distress, gestational diabetes, multiple pregnancies, painful varicose veins, preeclampsia, preterm labour, previous caesarian procedure, thick mucus, thick muscle, threatening miscarriage and vaginal wall tear. Healthcare workers highlight that lockdown roadblocks, transport availability and delays to reach MNMH impacted maternal healthcare delivery. There was no evidence that mobile telephone services were utilized for tracking and communicating with pregnant women in the pre- and during lockdown period.