Effect of the COVID-19 pandemic on maternal and neonatal health services in three referral hospitals in Guinea: an interrupted time-series analysis

(2023) 20:50 Millimouno et al. Reproductive Health https://doi.org/10.1186/s12978-023-01599-8 Reproductive Health Open Access RESEARCH Effect of the COVID‑19 pandemic on maternal and neonatal health services in three referral hospitals in Guinea: an interrupted time‑series analysis Tamba Mina Millimouno1,2*, Nafissatou Dioubaté1, Harissatou Niane3, Mamadou Cellou Diallo4, Cécé Maomou5, Telly Sy4, Ibrahima Sory Diallo3, Aline Semaan6, Thérèse Delvaux6, Lenka Beňová6 and Alexandre Delamou1,2 Abstract Introduction In sub-Saharan Africa, there is limited evidence on the COVID-19 health-related effect from front-line health provision settings. Therefore, this study aimed to analyse the effect of the COVID-19 pandemic on routine maternal and neonatal health services in three referral hospitals. Materials and methods We conducted an observational study using aggregate monthly maternal and neonatal health services routine data for two years (March 2019–February 2021) in three referral hospitals including two maternities: Hôpital National Ignace Deen (HNID) in Conakry and Hôpital Regional de Mamou (HRM) in Mamou and one neonatology ward: Institut de Nutrition et de Santé de l’Enfant (INSE) in Conakry. We compared indicators of health service utilisation, provision and health outcomes before and during the COVID-19 pandemic periods. An interrupted time-series analysis (ITSA) was performed to assess the relationship between changes in maternal and neonatal health indicators and COVID-19 through cross-correlation. Results During COVID-19, the mean monthly number (MMN) of deliveries decreased significantly in HNID (p = 0.039) and slightly increased in HRM. In the two maternities, the change in the MMN of deliveries were significantly associated with COVID-19. The ITSA confirmed the association between the increase in the MMN of deliveries and COVID-19 in HRM (bootstrapped F-value = 1.46, 95%CI [0.036–8.047], p < 0.01). We observed an increasing trend in obstetric complications in HNID, while the trend declined in HRM. The MMN of maternal deaths increased significantly (p = 0.011) in HNID, while it slightly increased in HRM. In INSE, the MMN of neonatal admissions significantly declined (p < 0.001) and this decline was associated with COVID-19. The MMN of neonatal deaths significantly decreased (p = 0.009) in INSE and this decrease was related to COVID-19. Conclusion The pandemic negatively affected the maternal and neonatal care provision, health service utilisation and health outcomes in two referral hospitals located in Conakry, the COVID-19 most-affected region. Keywords Effect, COVID-19, Pandemic, Maternal and neonatal health, Guinea *Correspondence: Tamba Mina Millimouno Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Millimouno et al. Reproductive Health (2023) 20:50 Introduction Globally, the COVID-19 pandemic has severely affected almost all sectors [1], compromising the achievement of the Sustainable Development Goal 3 (targets 3.1 and 3.2). In general, infectious disease outbreaks might be harmful to the utilisation and availability of essential reproductive health services [2–6], due to health authorities’ attention being shifted to respond to inevitable shocks, collapse of the health system, or intentional response decisions [7]. Studies report different findings on the effects of the COVID-19 pandemic on maternal and neonatal health services across the world. A study conducted in Nepal in 2020 showed a drastic 50% drop in facility-based deliveries and a significant increase of 27 neonatal deaths per 1000 live births during the first nine weeks of the pandemic [8]. In Zimbabwe, the Ministry of Health and Child Care reported a reduction in the use of maternity services, and the review of maternal care outcomes revealed an increasing trend in maternal deaths during the COVID-19 pandemic [9]. In South Africa, a study carried out in 2020 found a significant 50% drop in hospital admissions for under-five children and a 47% increase in neonatal hospital deaths during the three months following the start of the pandemic [10]. In the same country, another study showed mixed variations in hospital-based deliveries between March and May 2020 during the pandemic [11]. Mixed variation in hospitalbased deliveries was also reported in Nigeria during the pandemic [11]. In contrast, other studies have found no adverse effects of COVID-19 on maternal and neonatal health service provision and use [12, 13]. In Guinea, the COVID-19 outbreak spread upon its start on 12 March 2020 [14]. As of 28 February 2021, 15,894 confirmed cases of COVID-19, of which Page 2 of 13 89 deaths were reported countrywide [15]. Various response measures, including night-time curfew in the capital city and international travel ban at the national level were put in place (Fig. 1) [16], and new standard operating procedures for the provision of care were established in health facilities, namely in hospitals. These included reducing the number of health personnel by dismissing medical interns, replacing daily face-to-face hospital meetings with online communication groups (e.g. WhatsApp groups), and prioritising providing care to emergency cases over regular routine consultations [17]. Improving maternal and neonatal health is a priority for national health authorities in Guinea [18, 19], which calls the need for identifying how maternal and newborn healthcare provision and health service utilisation were maintained during the COVID-19 pandemic. There is limited knowledge about the effect of the COVID-19 pandemic on maternal and neonatal health services in Guinea [20]. Thus, this study aimed to fill this knowledge gap, in order to inform national health authorities of potential strategies to maintain and improve maternal and neonatal health within a pandemic context. The main objective of this study was to analyse (...truncated)