- The COVID-19 pandemic is predicted to have profound results on healthcare methods. The federal government of Bangladesh has issues about diminished protection and high quality of maternal and baby well being providers, however little proof exists on service provision, utilisation, or variations.
- This examine provides empirical investigations of maternal and baby well being and vitamin service provision from the availability facet and repair utilisation from the demand facet earlier than and throughout the COVID-19 pandemic. We discovered that the COVID-19 pandemic adversely affected well being and vitamin service provision and utilisation for city populations in Dhaka, Bangladesh regardless of mitigation efforts and variations.
- Additional investments are wanted to supply well timed and correct info on COVID-19 to most of the people, enhance COVID-19 coaching for well being care suppliers, present incentives for well being care suppliers and guarantee availability of non-public protecting tools for each suppliers and beneficiaries.
The COVID-19 pandemic is predicted to have profound, and probably lasting, impacts on employment, public well being, meals safety and poverty (ILO, 2020; Laborde et al., 2020; World Financial institution, 2020). The disruptive results of the COVID-19 pandemic and authorities response measures, corresponding to lockdowns, might additional negatively affect healthcare methods, with ladies and kids among the many most susceptible to its penalties. Direct and oblique results of the pandemic on maternal and baby well being may very well be devastating, and jeopardise the vital features made during the last a number of many years. Modelling estimates made early within the pandemic recommend that reductions in important maternal and baby well being providers, coupled with decreased entry to meals, may lead to as much as 1,157,000 extra baby deaths and 56,700 maternal deaths (Roberton et al., 2020). These projected deaths may very well be better, as the present fashions haven’t but thought of potential detrimental results on maternal vitamin, micronutrient deficiencies or intrauterine development (Akseer et al., 2020).
Managing the competing calls for on well being service suppliers and sources to fight COVID-19 whereas making certain the continuity and supply of routine providers is one among many challenges nations are dealing with. The World Well being Group (WHO) Pulse Survey reported that almost all the 105 nations surveyed throughout 5 areas skilled demand- and supply-side disruptions to important well being providers between March and June 2020 (WHO, 2020b). Half of surveyed nations reported workers redeployment to COVID-19 reduction measures, and 56% and 61% skilled partial or extreme disruptions to antenatal care (ANC) providers and routine immunisations at well being services, respectively. Reductions in outpatient care attendance was reported by 76% of nations, primarily as a consequence of authorities lockdowns which hindered entry to well being providers. This pulse survey, nonetheless, solely represented the opinions of key informants with qualitative info on disruptions, highlighting the necessity for empirical proof from community-based well being suppliers and beneficiaries to quantify the detrimental impression of COVID-19 on maternal and baby well being and vitamin providers.
Insufficient integration of maternal, toddler and younger baby vitamin (MIYCN) providers into routine healthcare service supply was a priority in Bangladesh previous to the pandemic. A top quality evaluation of vitamin providers offered throughout ANC in Bangladesh confirmed that supply of providers was poor: <30% of ladies obtained 4 key ANC vitamin providers (weight measurement, provision of iron-folic acid dietary supplements, provision of calcium dietary supplements, food regimen counselling), 25% of sick youngsters had their weight checked towards a growth-chart, and <1% had their size/peak measured (Billah et al., 2017). Earlier nationwide vitamin methods sought to speed up progress in decreasing excessive charges of maternal and baby undernutrition, however lacked coordination, had restricted hyperlinks with the healthcare system, and poor supply of vitamin providers (Billah et al., 2017). Moreover, well being insurance policies have largely centered on supply of well being providers and enhancements in well being and vitamin outcomes in rural areas regardless of growing urbanisation (Govindaraj et al., 2018).
A number of initiatives have been undertaken by the private and non-private sectors to cope with the healthcare system disaster introduced on by COVID-19. The Authorities of Bangladesh created a particular insurance coverage and stimulus package deal for well being care suppliers and the Bangladesh Public Service Fee employed 2000 medical doctors and 5000 nurses to extend capability at authorities services. Non-public entities are constructing hospitals with intensive care items, donating private protecting tools (PPE), and offering money assist and meals (Reza et al., 2020). Improvement companions together with Alive & Thrive, UNICEF and the World Financial institution supported the Nationwide Vitamin Providers to develop the nationwide ‘Vitamin Important Providers Continuity Tips throughout COVID-19 Pandemic’ (Nationwide Vitamin Providers et al., 2020). The rules have been formally authorised and distributed in July 2020, specifying vitamin providers to be delivered at completely different ranges, service supply modalities, and key messages for pregnant ladies, breastfeeding moms, and caregivers of younger youngsters. The rules additionally included info on important provides and directions for coordination with related platforms and sectors, monitoring and reporting, and transitioning from COVID-19 to a “new regular” scenario.
Regardless of these mitigation efforts, supply and receipt of well being and vitamin providers face many challenges. Well being suppliers are encountering competing calls for required to execute COVID-19 response duties whereas sustaining or re-establishing the supply of routine providers, and are at elevated danger for bodily, emotional and psychological misery (Cabarkapa et al., 2020; Giannis et al., 2021; Hassan et al., 2021). Journey restrictions and lowered mobilisation may trigger declines within the provision of maternal and baby well being providers and the demand for them amongst shoppers throughout the well being system. Statistics on routine month-to-month providers present that the variety of visits by pregnant and just lately delivered ladies for maternal well being providers sharply declined throughout Bangladesh on the onset of COVID-19 and the nationwide stay-at-home order (Ainul et al., 2020). These monitoring information offered a snapshot of well being providers corresponding to ANC, facility deliveries, and postnatal care, however didn’t have in-depth info on vitamin providers and couselling, or challenges and variations.
This paper aimed to (1) quantify the impact of the COVID-19 pandemic and COVID-19 restrictions on well being and vitamin service provision and utilisation by pregnant ladies and moms of youngsters underneath 2 years of age in Dhaka Metropolis, Bangladesh, and (2) establish adaptions and a spread of possible options which have the potential to strengthen supply and uptake of important well being and vitamin interventions within the context of COVID-19 and past.
2.1 Examine context
Earlier than the COVID-19 pandemic, the Alive & Thrive (A&T) initiative started implementing a programme of interventions designed to standardise the supply of MIYCN counselling providers in eight current city Maternal Neonatal and Youngster Well being (MNCH) services. These services, run by the non-governmental organisations Radda Maternal and Youngster Well being and Household Planning Centre (Radda) and Marie Stopes Bangladesh (MSB), present maternal and baby well being providers in city areas of Dhaka Metropolis. The baseline survey for the quasi-experimental impression analysis of the programme was performed in February 2020, earlier than the onset of the pandemic in Bangladesh (Nguyen et al., 2020). The survey used combined information assortment strategies together with in-person consumer interviews, facility assessments, supplier surveys and case observations of ANC visits and counselling periods. The sampling body for the baseline survey and the info collected offered a novel alternative for a pre- and post-assessment of the results of the pandemic and disruptions to well being and vitamin service supply and utilisation in Dhaka Metropolis.
On 26 March 2020, roughly 2 weeks after the primary case of COVID-19 within the nation was confirmed, the Authorities of Bangladesh issued a nationwide prolonged public vacation and strict stay-at-home order. Formal and casual financial actions have been restricted, instructional establishments have been closed, and public transportation by highway, rail and air was suspended to regulate neighborhood transmission of the virus. Well being services continued to supply important well being providers, however confronted intermittent disruptions and closures. The preliminary stay-at-home order remained in place till 30 Might 2020 after which localised restrictions have been enforced.
This present examine utilises the present contacts of well being suppliers, pregnant ladies, and moms from the February 2020 baseline survey to conduct cellphone surveys in September–October 2020, aiming to guage the results of the COVID-19 pandemic on service supply and receipt earlier than, throughout and after the stay-at-home orders went into impact. Telephone surveys have been thought of a safer means for information assortment at follow-up than in-person surveys, as a consequence of journey restrictions and the excessive danger of transmission of COVID-19. Each in-person and cellphone survey information assortment have been performed by the identical analysis agency, Information Evaluation and Technical Help (DATA).
2.2 Well being supplier survey
We performed longitudinal quantitative surveys with well being suppliers at eight well being services operated by Radda and MSB. In February 2020, we undertook in-person surveys with 59 well being suppliers to evaluate their publicity to coaching on MIYCN, workload and time commitments, and providers offered, particularly well being and vitamin providers for moms and younger youngsters. In September–October 2020, we adopted up with the identical well being suppliers to gather info on trainings, receipt of non-public protecting tools (PPE), extra tasks, service provision for pregnant ladies and moms with youngsters <2 years, challenges and variations for service supply, and extra assist wanted throughout the COVID-19 pandemic. For all service-related questions, respondents have been requested to recall providers offered throughout March–Might 2020 and in September 2020, the month preceeding the survey. Well being suppliers have been additionally requested about communication channels, supervision, and their data of COVID-19 signs and prevention.
2.3 Pregnant ladies and mom surveys
In-person surveys with pregnant ladies (n = 498) and moms with youngsters <2 years (n = 528) who have been shoppers on the Radda and MSB well being services have been performed in February 2020 to evaluate their receipt of well being and vitamin providers. In September 2020, cellphone interviews have been administered with the identical respondents to know how service utilisation had modified throughout March–Might 2020 and in September 2020. Questionnaires for pregnant ladies and moms included modules on publicity to well being and vitamin providers, counselling messages, mode of service receipt, and challenges confronted in accessing providers.
2.4 Information evaluation
We performed descriptive evaluation to report traits of well being suppliers, pregnant ladies and moms. Modifications in service provision and utilisation have been calculated over three intervals: (1) February–Might 2020, between pre-pandemic time and the COVID-19 stay-at-home orders and restrictions, to evaluate service disruption; (2) Might–September 2020, when restrictions have been lifted in phases, to evaluate service resumption; and (3) February–September 2020, earlier than the onset of the pandemic via the easing of COVID-19 restrictions. Wilcoxon matched-pairs signed-rank check was used to find out whether or not the variations in means have been statistically important. All statistical analyses have been carried out with Stata (StataCorp, model 16).
2.5 Moral issues
Verbal consent was obtained from pregnant ladies, moms and well being care suppliers previous to their participation within the examine. The analysis protocol obtained moral clearance from the Institutional Overview Board on the Worldwide Meals Coverage Analysis Institute and the Bangladesh Medical Analysis Council. Further permissions for information assortment have been offered by Radda and MSB.
3.1 Traits of the examine pattern
Of the 59 well being suppliers interviewed in February 2020, 45 accomplished interviews by way of cellphone (a response charge of 76%). Amongst those that didn’t take part, seven well being suppliers modified jobs or moved to different locations, two refused to take part, and 5 have been unavailable (Desk S1). Half of the well being suppliers have been paramedics and almost 1 / 4 have been physicians or medical officers, employed for a mean of 5 years on the facility (Desk S2). Two thirds had a school diploma or larger schooling degree.
For the reason that majority of pregnant ladies had already delivered on the time of comply with up, solely 80 pregnant ladies of the 498 surveyed in February 2020 have been eligible to be interviewed and 40 accomplished the interview (a response charge of fifty%). Amongst moms with youngsters underneath 2 years of age, 73% (n = 387) of the pattern from February 2020 have been interviewed. Of those that didn’t take part, 84 had their telephones switched off, 34 didn’t reply the enumerators’ calls or the flawed cellphone quantity was offered, and 18 refused to take part or proceed with the interview (Desk S1). Pregnant ladies have been on common 23 years of age and of their 36.5 week of being pregnant (Desk S2). Moms have been 25 years of age on common and the imply age of their younger baby was 10 months. Ninety % of each teams of ladies have been housewives and roughly two thirds of them had obtained center faculty schooling or larger.
3.2 Sources and well being supplier data to reply to COVID-19
Practically all well being suppliers have been provided with PPE, together with masks, gloves, sanitiser/cleaning soap and medical robes (Determine 1). Face shields have been offered much less incessantly, however three out of 4 suppliers nonetheless obtained them. Trainings on COVID-19 have been much less universally obtained. Greater than half of well being suppliers obtained info, schooling, and communication supplies on COVID-19 or coaching on utilizing PPE, the best way to defend oneself from COVID-19 or on the best way to establish signs. However fewer than 1 / 4 obtained coaching on the best way to adapt ANC providers throughout COVID-19 or present breastfeeding or new child care.
Greater than two thirds of suppliers knew to scrub fingers incessantly, put on a masks when exterior the house, and keep bodily distance from others. Roughly 40% linked PPE with transmission prevention and fewer than 1 / 4 talked about avoiding touching one’s face, nostril or mouth, or sanitising tools used for service supply.
3.3 Service provision earlier than the pandemic (February 2020), throughout stay-at house orders and journey restrictions (March–Might 2020) and within the month previous the survey (September 2020)
The impacts of the pandemic and COVID-19 restrictions on service supply are proven in Desk 1. In comparison with the pre-pandemic interval, fewer well being services offered ANC providers (falling by 6.6 pp) throughout the lockdown however well being suppliers reported that the majority providers for pregnant ladies throughout ANC continued to be supplied. One exception was anthropometric measurements, which dropped by 20 pp for weight measurements and 29 pp for peak measurements throughout the lockdown and continued to be at decrease ranges in September 2020 in comparison with the pre-pandemic (by 14 and 28 pp, respectively). Prescription of and counselling on iron and folic-acid (IFA) and calcium supplementation fell by lower than 4 pp. Supply of counselling on food regimen variety, meals consumption, weight acquire, and relaxation additionally decreased past the lockdown interval, dropping by 4.2–12.5 pp by September 2020.
Information from well being suppliers’ survey (n = 45). The odds of service supply signify suppliers’ studies of those providers being out there. ANC: antenatal care; IFA: iron and folic acid complement; MUAC: mid-upper arm circumference; NA: Not out there; ORS: oral rehydration answer; pp: share level.
p < 0.05.
Facility providers offered for moms with youngsters underneath 2 years of age, notably these which require proximity, have been extra severely affected (Desk 1). Throughout COVID-19 restrictions, measurements of weight, peak, and mid-upper arm circumference to evaluate the kid’s development dropped by 37, 57 and 41 pp, respectively, and baby immunisation providers fell by 38 pp. Counselling on unique breast feeding and complementary feeding fell by 12 and 19 pp. By September, some services resumed these providers, although provision was nonetheless markedly beneath pre-pandemic ranges.
3.4 Service utilisation earlier than the pandemic (February 2020), throughout stay-at-home orders and journey restrictions (March–Might 2020) and within the month previous the survey (September 2020)
Although the availability of most ANC providers continued all through the lockdown, service utilisation amongst pregnant ladies declined considerably, leading to decrease protection of the goal inhabitants. Facility visitations amongst pregnant ladies fell by 35 pp (Desk 2). Counselling on IFA supplementation, which 80% of pregnant ladies reported receiving in February, fell by 73 pp. Vital declines in utilisation or receipt of different ANC providers included measurement of weight (38 pp), receipt of IFA dietary supplements (28 pp), and receipt of counselling on calcium supplementation (28 pp), food regimen variety (25 pp), and amount of meals consumption (35 pp). Well being facility visitations continued to drop after the lockdown was lifted (8 pp) however different providers elevated modestly (between 5.0 and 15 pp) in September 2020.
Information from survey with pregnant ladies (n = 40) and moms of youngsters <2 years (n = 387). The odds of service utilisation signify beneficiaries’ studies of those providers being utilised. IFA: iron and folic acid complement. MUAC: mid-upper arm circumference.
p < 0.05.
p < 0.01.
p < 0.001.
Regardless of well being services persevering with to supply a number of providers throughout the lockdown for moms with youngsters underneath 2 years of age, visitations for these providers fell sharply (by 67 pp) (Desk 2). Youngster weight measurements and counselling on breastfeeding dropped by 50 and 53 pp, respectively. Alarmingly, fewer ladies sought immunisation providers for his or her youngsters; utilisation fell by 61 pp throughout the lockdown and by extra 5.1 pp by September 2020. Facility visitations and baby weight measurements elevated by ~11 pp after COVID-19 restrictions have been lifted, however different service utilisation charges remained comparatively the identical via September 2020.
3.5 Challenges in service provision and utilisation
Elevated workload throughout the pandemic was probably the most incessantly talked about issue confronted by well being suppliers (56%), adopted by scared to ship providers at house (38%) and lack of transportation to succeed in heath services (29%) (Determine 2). Lack of satisfactory modes of transportation additionally meant that well being suppliers needed to stroll lengthy distances to their office (16%). Well being suppliers’ household fears of the perceived dangers and prevented them persevering with to work throughout the pandemic have been additionally reported (11%).
Probably the most incessantly cited challenges for pregnant ladies and moms to go to well being services have been fears of leaving the home (33% and 19%) and getting contaminated with COVID-19 on the well being centre (28% and 14%) (Determine 2). Unavailability of providers or service suppliers was reported by roughly one in 10 ladies. Journey limitations as a consequence of lack of transportation or households wanting ladies to stay at house have been confronted much less incessantly (3%–8%).
3.6 Variations to service provisions
Well being supplier variations to routine strategies of service supply are offered in Desk 3. Most well being suppliers reported making variations to ANC providers, and almost all reported making variations to counselling providers for pregnant ladies and moms. The first technique of adaptation was provision of providers over cellphone (37% for ANC providers, 49% for counselling of pregnant ladies, and 44% for counselling of moms with younger youngsters). Greater than half of well being suppliers tailored providers for baby immunisations, together with coordinating with their colleagues (48%) or supervisors (16%) to rearrange immunisation drives, calling moms to schedule immunisation appointments (36%), and sending reminders to moms by way of WhatsApp messages or cellphone calls to encourage them to stick to immunisation schedules (16%). Further variations have been additionally made on counselling content material by adopting the ‘Vitamin Important Providers Continuity Tips throughout COVID-19 Pandemic’ (Nationwide Vitamin Providers et al., 2020) for use throughout common and cellular provision of providers and supportive supervision, together with messages on maternal vitamin and emphasising the safety, promotion, and assist of applicable and secure feeding for youngsters throughout the COVID-19 pandemic.
|Providers for pregnant ladies||Providers for moms with youngsters <2 years|
|Adaptation for ANC|
|Delivered to beneficiary houses||5.3||NA|
|Reminded via WhatsApp message/cellphone name||2.6||NA|
|Adaptation for baby immunisation|
|Coordinated with different colleagues to rearrange appointments at immunisation drives||NA||48.0|
|Made an appointment for immunisation||NA||36.0|
|Reminded via WhatsApp message/cellphone name||NA||16.0|
|Coordinated with supervisor to rearrange appointments at immunisation drives||NA||16.0|
|Organized for transportation to immunisation drives||NA||4.0|
|Adaptation for counselling|
|Utilizing a cellphone name||48.8||43.9|
|At a neighborhood occasion||7.0||7.3|
|Utilizing a video name||2.3||2.4|
|Counsel moms on practices to proceed breastfeeding throughout COVID-19||NA||75.6|
- Abbreviations: ANC, antenatal care; NA, not out there.
3.7 Further assist required for service provision
Further sources and assist wanted by well being care suppliers are offered in Determine 3. Coaching on greatest practices to comply with throughout COVID-19 (e.g., what providers to supply and the best way to present them) was probably the most cited want talked about for these offering ANC providers (51%) and providers for moms with younger youngsters (53%), with ANC suppliers additional mentioning consciousness trainings on security protocols that staff ought to comply with (36%). Suppliers of ANC and built-in administration of childhood sickness (IMCI) providers listed ensured availability of masks, gloves, face shields and sanitisers/soaps for well being suppliers (22% and 24%, respectively), provision of masks to all beneficiaries (11% and 18%), and availability of water, cleaning soap and sanitiser on the well being facility (11% and 16%) as extra assist wanted. Incentives to work throughout the pandemic and offset the heightened dangers was additionally talked about by suppliers (9%–11%).
Our examine is likely one of the first empirical investigations of city MNCH service provision and utilisation earlier than and throughout the COVID-19 pandemic in Bangladesh. Utilizing longitudinal surveys of well being suppliers, pregnant ladies and moms of youngsters <2 years of age, we doc the reported challenges and variations by suppliers and beneficiaries throughout the nationwide stay-at-home order and 4 months after restrictions have been eased. Regardless of variations to service provisions, continued availability of routine maternal and baby well being providers didn’t translate into service utilisation.
On the availability facet, disruptions to providers offered for pregnant ladies and moms of younger youngsters have been most pronounced amongst these requiring in-person proximity, particularly anthropometric measurements of pregnant ladies and kids, and baby immunisations. The supply of those providers improved by September 2020 however remained markedly low in comparison with pre-pandemic ranges. Our outcomes align and complement nationwide monitoring information from the Bangladesh Ministry of Well being and Household Welfare which confirmed extreme declines within the provision of ANC and postnatal well being providers at authorities well being services throughout COVID-19 restrictions, with restricted resumption of providers in most districts after restrictions eased (Ainul et al., 2020), although the degrees of decline have been a lot smaller in our pattern in comparison with nationwide statistics. The Nationwide Vitamin Council of Bangladesh additionally used routine well being system monitoring information to evaluate and anticipate the impacts of COVID-19 on malnutrition instances by way of lowered entry to providers for pregnant and just lately delivered ladies. Each the protection and high quality of providers have been discovered to have declined. Throughout stay-at-home orders and journey restrictions, the variety of ANC visits by moms fell by 31%, and vitamin counselling and IFA distribution throughout ANC visits fell by 33% and 34%, respectively. Whereas vitamin providers for pregnant and lactating ladies grew to become extra out there in June, they’d nonetheless not returned to pre-COVID-19 ranges by August (Bangladesh Nationwide Vitamin Council, 2020).
Authorities well being services in Bangladesh are reported to have handled overcrowding, poor hygiene practices, lack of sanitation services, and acute shortages of PPE (Hassan et al., 2021; Reza et al., 2020), probably exacerbating the lack of well being suppliers to soundly proceed the availability of routine MCHN providers. Commonplace coaching on COVID-19 administration and prevention have additionally largely been missing for all sorts and ranges of well being staff in Bangladesh (Bangladesh Nationwide Vitamin Council, 2020). Greater ranges of coaching and PPE in our examine well being services may very well be defined by our restricted pattern of urban-NGO services, which can be higher outfitted and ready to ship providers throughout the pandemic than authorities services. Practically all suppliers reported receiving some PPE and roughly half obtained info, schooling, and communication supplies on COVID-19. Although suboptimal, our survey outcomes point out larger ranges of supplier preparedness for providers throughout the pandemic in comparison with healthcare suppliers in different nations. A cross-sectional survey of well being professionals throughout 81 nations discovered solely 30% obtained coaching and half obtained tips on care provision throughout COVID-19 (Semaan et al., 2020). Amongst healthcare staff in Libya, solely half of these surveyed obtained satisfactory coaching; additionally they had low consciousness of and preparedness for COVID-19 (Elhadi et al., 2020). Elevated workloads, anxiousness over danger of an infection and, typically, harassment over stigma and opposition to the federal government’s pandemic response measures have elevated stress on well being care suppliers. Concern of contracting COVID-19 at well being services was not distinctive to beneficiaries. Relations of well being suppliers additionally expressed objections to their working throughout the pandemic (11%). The proportion of well being suppliers dealing with this problem could also be underreported in our pattern, as A&T data indicated excessive well being facility workers turnover for that reason. These workers who had already resigned by the point of survey are subsequently not represented within the information.
On the demand facet, service utilisation by pregnant ladies and moms fell drastically throughout the pandemic. Fears of contracting the virus and hesitancy to go away their houses was reported by greater than half of the ladies in our pattern, probably impacting their time spent within the clinic and skill to totally utilise the out there in-person providers. Total, well being facility visits by pregnant ladies and moms fell by 35 and 67 pp throughout the stay-at-home order, respectively, with visits falling an extra 7.5 pp amongst pregnant ladies 4 months after COVID-19 restrictions have been lifted. Precautionary measures and restrictions meant to sluggish the transmission of COVID-19 compelled well being suppliers to adapt routine strategies of service supply. But, regardless of well being suppliers adapting counselling providers by switching to cell phone for pregnant (49%) ladies and moms of younger youngsters (44%), utilisation of counselling providers amongst each teams of ladies fell. Massive, important drops have been noticed for IFA (63 pp) and meals consumption (20 pp) counselling for pregnant ladies and breastfeeding counselling (66 pp) for just lately delivered ladies by September 2020. Continued low ranges of utilisation amongst pregnant ladies and moms of younger youngsters point out an pressing want for motivating and supporting beneficiaries to proceed in search of routine well being providers. Declines in household revenue and will increase in meals insecurity reported amongst rural Bangladeshi ladies and their households (Hamadani et al., 2020) might create extra monetary limitations and constraints in accessing providers, indicating additional assist wanted for beneficiaries. Coverage methods to enhance utilisation may embody consciousness campaigns, mass media, and social safety to assist households affected by the socio-economic impacts of the pandemic.
To the very best of our data, literature on service provision and utilisation throughout COVID-19 is proscribed, particularly in low- and middle-income nations. Widespread perceptions of lowered maternal care and important well being providers have been qualitatively reported by well being suppliers and well being officers however haven’t been supported by empirical findings (Semaan et al., 2020; WHO, 2020a). We discover comparable reductions in MNCH service utilisation to these reported in a current examine performed in Uttar Pradesh, India, the place utilisation for many providers did not resume after frontline staff resumed service provision (Nguyen et al., 2021). Our outcomes are additionally in line with studies from the Authorities of Bangladesh that well being facility closures, journey restrictions, concern of transmission, insecurity within the well being system, and psychological stress contributed to reductions in well being service utilisation regardless of enhancements in protection and high quality as soon as restrictions lifted (Bangladesh Nationwide Vitamin Council, 2020).
This examine provides a novel perspective on service provision from provide facet and repair utilisation from demand facet for city inhabitants, which may be very restricted until date. Utilizing longitudinal samples of each well being suppliers and beneficiaries, we offered perception info at three key time factors: Earlier than the onset of the pandemic, throughout authorities enforcement of COVID-19 restrictions, and after restriction was lifted. Our outcomes align and complement related information from the Authorities of Bangladesh (Bangladesh Nationwide Vitamin Council, 2020) and advance our understanding of the results of COVID-19 lockdown on the availability, entry and uptake of well being and vitamin providers and of options to strengthen important interventions within the context of COVID-19 and past.
Bearing comparable challenges as different cellphone surveys (Kempf & Remington, 2007), the response charge was decrease amongst moms in our cellphone survey (76%). The pattern measurement of pregnant ladies at follow-up was small, given that the majority ladies had already delivered by the point of the survey. Though we cowl a major type of personal well being service provision in city areas, our pattern is just not consultant of the universe of city well being suppliers and shoppers of those services. Lastly, to scale back the cellphone survey size and complexity, questions capturing variations to maternal and baby providers primarily centered on supply somewhat than counselling content material.
The COVID-19 pandemic adversely affected well being and vitamin service provision and utilisation for city populations in Dhaka, Bangladesh, regardless of mitigation efforts and variations. Additional investments are wanted to supply well timed and correct info on COVID-19 to most of the people, enhance COVID-19 coaching for well being care suppliers, present incentives for well being care suppliers, and guarantee availability of PPE for each suppliers and beneficiaries.
The Invoice and Melinda Gates Basis, via Alive & Thrive, managed by FHI Options. Further funding assist is from CGIAR Analysis Program on Agriculture for Vitamin and Well being (A4NH), led by the Worldwide Meals Coverage Analysis Institute.
CONFLICTS OF INTEREST
The authors declare that they haven’t any conflicts of curiosity.
PHN: Conseptualization, evaluation, draft manuscript, consolidation of co-athor feedback, revisions, and paper finalization. CS: Literature overview, information interpretation, draft manuscript of choose sections, revisions and paper finalization. AP and SK: Area work coordination, information analyses, draft manuscript of choose sections, and manuscript overview. LMT: Information analyses, information visualisation, and manuscript overview. DA, MA, SI, KK and JE-A: Information interpretation, and manuscript overview and edits. PM: Overview of statistical analyses, information interpretation, and manuscript overview and edits. All authors learn and authorised the ultimate submitted manuscript.
The info that assist the findings of this examine can be found within the tables/figures and supplementary materials of this text. Further information can be found upon request.
|mcn13218-sup-0001-Table S1-S2.docxPhrase 2007 doc
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Desk S1: Participant circulate for well being suppliers, pregnant ladies and moms of youngsters <2y
Desk S2: Background traits1 of the examine pattern participated each surveys earlier than and throughout the COVID pandemic (February 2020 and September 2020)
Please observe: The writer is just not answerable for the content material or performance of any supporting info provided by the authors. Any queries (aside from lacking content material) needs to be directed to the corresponding writer for the article.
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