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      Effect of COVID-19 pandemic on inpatient service utilization and patient outcomes in Uganda

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          Abstract

          COVID-19 has had devastating effects on health systems but reports from sub-Saharan Africa are few. We compared inpatient admissions, diagnostic tests performed, clinical characteristics and inpatient mortality before and during the COVID-19 pandemic at an urban tertiary facility in Uganda. We conducted a retrospective chart review of patients admitted at Kiruddu National Referral Hospital in Uganda between January–July 2019 (before the pandemic) and January–July 2020 (during the pandemic). Of 3749 inpatients, 2014 (53.7%) were female, and 1582 (42.2%) had HIV. There was a 6.1% decline in admissions from 1932 in 2019 to 1817 in 2020. There were significantly fewer diagnostic tests performed in 2020 for malaria, tuberculosis, and diabetes. Overall, 649 (17.3%) patients died. Patients admitted during the COVID-19 pandemic (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 1.04–1.5, p = 0.018), patients aged ≥ 60 years (aOR 1.6, 95% CI 1.2–2.1, p = 0.001), HIV co-infected (aOR 1.5, 95% CI 1.2–1.9, p < 0.001), and those admitted as referrals (aOR 1.5, 95% CI 1.2–1.9, p < 0.001) had higher odds of dying. The COVID-19 pandemic disrupted inpatient service utilization and was associated with inpatient mortality. Policy makers need to build resilience in health systems in Africa to cope with future pandemics.

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          Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study

          Timothy Roberton, Emily Carter, Victoria Chou … (2020)
          Summary Background While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food. Methods We modelled three scenarios in which the coverage of essential maternal and child health interventions is reduced by 9·8–51·9% and the prevalence of wasting is increased by 10–50%. Although our scenarios are hypothetical, we sought to reflect real-world possibilities, given emerging reports of the supply-side and demand-side effects of the pandemic. We used the Lives Saved Tool to estimate the additional maternal and under-5 child deaths under each scenario, in 118 low-income and middle-income countries. We estimated additional deaths for a single month and extrapolated for 3 months, 6 months, and 12 months. Findings Our least severe scenario (coverage reductions of 9·8–18·5% and wasting increase of 10%) over 6 months would result in 253 500 additional child deaths and 12 200 additional maternal deaths. Our most severe scenario (coverage reductions of 39·3–51·9% and wasting increase of 50%) over 6 months would result in 1 157 000 additional child deaths and 56 700 additional maternal deaths. These additional deaths would represent an increase of 9·8–44·7% in under-5 child deaths per month, and an 8·3–38·6% increase in maternal deaths per month, across the 118 countries. Across our three scenarios, the reduced coverage of four childbirth interventions (parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments) would account for approximately 60% of additional maternal deaths. The increase in wasting prevalence would account for 18–23% of additional child deaths and reduced coverage of antibiotics for pneumonia and neonatal sepsis and of oral rehydration solution for diarrhoea would together account for around 41% of additional child deaths. Interpretation Our estimates are based on tentative assumptions and represent a wide range of outcomes. Nonetheless, they show that, if routine health care is disrupted and access to food is decreased (as a result of unavoidable shocks, health system collapse, or intentional choices made in responding to the pandemic), the increase in child and maternal deaths will be devastating. We hope these numbers add context as policy makers establish guidelines and allocate resources in the days and months to come. Funding Bill & Melinda Gates Foundation, Global Affairs Canada.
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            Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review

            Ray Moynihan, Sharon Sanders, Zoe A Michaleff … (2021)
            Objectives To determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic. Design Systematic review. Eligibility Eligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19. Data sources PubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact. Data analysis Risk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis. Outcome measures Primary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores). Results 3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR −51% to −20%), comprising median reductions for visits of 42% (−53% to −32%), admissions 28% (−40% to −17%), diagnostics 31% (−53% to −24%) and for therapeutics 30% (−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference. Conclusions Healthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery. PROSPERO registration number CRD42020203729.
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              Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration — United States, 2020

              Jeanne Santoli, Megan C Lindley, Malini B. DeSilva … (2020)
              On March 13, 2020, the president of the United States declared a national emergency in response to the coronavirus disease 2019 (COVID-19) pandemic (1). With reports of laboratory-confirmed cases in all 50 states by that time (2), disruptions were anticipated in the U.S. health care system's ability to continue providing routine preventive and other nonemergency care. In addition, many states and localities issued shelter-in-place or stay-at-home orders to reduce the spread of COVID-19, limiting movement outside the home to essential activities (3). On March 24, CDC posted guidance emphasizing the importance of routine well child care and immunization, particularly for children aged ≤24 months, when many childhood vaccines are recommended.
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                Author and article information

                Contributors
                Joseph Baruch Baluku: bbjoe18@gmail.com
                Journal
                Journal ID (nlm-ta): Sci Rep
                Journal ID (iso-abbrev): Sci Rep
                Title: Scientific Reports
                Publisher: Nature Publishing Group UK (London )
                ISSN (Electronic): 2045-2322
                Publication date (Electronic): 15 June 2023
                Publication date PMC-release: 15 June 2023
                Publication date Collection: 2023
                Volume: 13
                Electronic Location Identifier: 9693
                Affiliations
                [1 ]GRID grid.11194.3c, ISNI 0000 0004 0620 0548, Makerere University College of Health Sciences, ; Kampala, Uganda
                [2 ]GRID grid.415861.f, ISNI 0000 0004 1790 6116, MRC/UVRI & LSHTM Uganda Research Unit, ; Entebbe, Uganda
                [3 ]GRID grid.513250.0, Kiruddu National Referral Hospital, ; Kampala, Uganda
                [4 ]GRID grid.11194.3c, ISNI 0000 0004 0620 0548, Makerere University Lung Institute, ; PO Box 26343, Kampala, Uganda
                [5 ]GRID grid.461255.1, ISNI 0000 0004 1780 2544, Department of Medicine, , St Francis Hospital Nsambya, ; Kampala, Uganda
                [6 ]GRID grid.442626.0, ISNI 0000 0001 0750 0866, Department of Medical Microbiology & Immunology, Faculty of Medicine, , Gulu University, ; Gulu, Uganda
                [7 ]Uganda Martyrs Hospital, Lubaga, Uganda
                [8 ]Clockworks Research Company Limited, Kampala, Uganda
                Article
                Publisher ID: 36877
                DOI: 10.1038/s41598-023-36877-9
                PMC ID: 10272226
                PubMed ID: 37322097
                SO-VID: c0828eb6-797a-4482-9630-382b20f2efa5
                Copyright © © The Author(s) 2023
                License:

                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/.

                History
                Date received : 20 August 2022
                Date accepted : 12 June 2023
                Categories
                Subject: Article
                Custom metadata
                issue-copyright-statement © Springer Nature Limited 2023

                ScienceOpen disciplines: Uncategorized
                Keywords: health care,risk factors,signs and symptoms
                Data availability:
                ScienceOpen disciplines: Uncategorized
                Keywords: health care, risk factors, signs and symptoms

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