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Abstract
Objectives To measure the effects of the COVID-19 pandemic on maternal and perinatal health services and outcomes in Mozambique.
Design This is an observational study analysing routine service delivery data using interrupted time series analysis. We used 43 months of district-level panel data with April 2020 as the point of interruption, adjusting for seasonality and population growth to analyse service utilisation outcomes.
Setting The 222 public health facilities in Nampula Province, Mozambique, from January 2018 to July 2021.
Outcome measures The change in the number of antenatal care (ANC) visits and facility deliveries, and the change in the rate of adverse birth outcomes at pandemic onset and over time compared with expected levels and trends, respectively.
Results There were no significant disruptions to ANC at pandemic onset. Following this, there was a significant monthly increase of 29.8 (18.2–41.4) first ANC visits and 11.3 (5.5–17.2) ANC visits within the first trimester per district above prepandemic trends. There was no significant change in the number of fourth ANC visits completed. At the onset of COVID-19, districts experienced a significant decrease of 71.1 (−110.5 to −31.7) facility deliveries, but the rate then increased significantly above prepandemic trends. There was no significant increase in any adverse birth outcomes during the pandemic. Conversely, districts observed a significant monthly decrease of 5.3 uterine rupture cases (−9.9 to −0.6) and 19.2 stillbirths (−33.83 to −4.58) per 100 000 facility deliveries below prepandemic trends. There was a significant drop of 23.5 cases of neonatal sepsis/100 000 facility deliveries per district at pandemic onset.
Conclusion Despite pandemic interference, Nampula Province saw no disruptions to ANC, only temporary disruptions to facility deliveries and no increases in adverse birth outcomes. ANC visits surprisingly increased, and the rates of uterine rupture, stillbirth and neonatal sepsis decreased, suggesting that Nampula Province may offer insights about health system resilience.
- COVID-19
- OBSTETRICS
- International health services
- PUBLIC HEALTH
Data availability statement
Data may be obtained from a third party and are not publicly available. The datasets analysed in the current study are available from Mozambique’s national health management information system and may be accessed with permission from the Ministry of Health in Mozambique.
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
Data may be obtained from a third party and are not publicly available. The datasets analysed in the current study are available from Mozambique’s national health management information system and may be accessed with permission from the Ministry of Health in Mozambique.
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Footnotes
MML and JV are joint first authors.
Contributors MML and JV conceptualised and designed the study with support from EK and AB. JV prepared the data set and MML conducted the analysis with support from AM. All authors contributed to interpretation of findings. MML wrote the first draft of the manuscript with contributions and reviews from all authors. MML is guarantor for this work.
Funding Funding for this research was provided by the FHI Foundation through a Ward Cates Emerging Scientific Leader Award.
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.
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