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Original research
Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision
  1. Stefan Reinders1,
  2. Angela Alva1,
  3. Luis Huicho2,
  4. Magaly M Blas1
  1. 1Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
  2. 2Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
  1. Correspondence to Stefan Reinders; reinders.stefan{at}gmail.com

Abstract

Aim To explore indigenous communities’ responses to the COVID-19 pandemic and its consequences for maternal and neonatal health (MNH) care in the Peruvian Amazon.

Methods Mamás del Río is a community-based, MNH programme with comprehensive supervision covering monthly meetings with community health workers (CHW), community leaders and health facilities. With the onset of the lockdown, supervisors made telephone calls to discuss measures against COVID-19, governmental support, CHW activities in communities and provision of MNH care and COVID-19 preparedness at facilities. As part of the programme’s ongoing mixed methods evaluation, we analysed written summaries of supervisor calls collected during the first 2 months of Peru’s lockdown.

Results Between March and May 2020, supervisors held two rounds of calls with CHWs and leaders of 68 communities and staff from 17 facilities. Most communities banned entry of foreigners, but about half tolerated residents travelling to regional towns for trade and social support. While social events were forbidden, strict home isolation was only practised in a third of communities as conflicting with daily routine. By the end of April, first clusters of suspected cases were reported in communities. COVID-19 test kits, training and medical face masks were not available in most rural facilities. Six out of seven facilities suspended routine antenatal and postnatal consultations while two-thirds of CHWs resumed home visits to pregnant women and newborns.

Conclusions Home isolation was hardly feasible in the rural Amazon context and community isolation was undermined by lack of external supplies and social support. With sustained community transmission, promotion of basic hygiene and mask use becomes essential. To avoid devastating effects on MNH, routine services at facilities need to be urgently re-established alongside COVID-19 preparedness plans. Community-based MNH programmes could offset detrimental indirect effects of the pandemic and provide an opportunity for local COVID-19 prevention and containment.

  • public health
  • infectious diseases
  • health policy
  • maternal medicine
  • COVID-19

Data availability statement

De-identified supervisor reports are available from the corresponding author upon reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Data availability statement

De-identified supervisor reports are available from the corresponding author upon reasonable request.

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Footnotes

  • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

  • Contributors MMB and SR conceived the study. SR, AA and MMB contributed to the study design. SR and AA implemented and supervised the study execution and analysed the data. SR developed the first draft of the manuscript. SR, LH and MMB interpreted the data. All authors critically reviewed and gave final approval to the manuscript.

  • Funding The MDR programme’s implementation and evaluation is funded by the National Council of Science and Technology (grant number 135-2016) and Grand Challenges Canada (grant number 0816-05).

  • Disclaimer The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.