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Indirect Effects on Maternal and Child Mortality from the COVID-19 Pandemic: Evidence from Disruptions in Healthcare Utilization in 18 Low- and Middle-Income Countries

41 Pages Posted: 9 Sep 2021

See all articles by Tashrik Ahmed

Tashrik Ahmed

World Bank

Timothy Roberton

Johns Hopkins University - Bloomberg School of Public Health

Monitoring of Essential Health Services Team

World Bank - The Global Financing Facility for Women, Children, and Adolescents

Jean Patrick Alfred

Minister of Public Health and Population of the Republic of Haiti

Martina L. Baye

Cameroun Ministére de la Sante Publiqué

Mamatou Diabate

Ministère de la Santé et de l'Hygiène Publique du Mali

Helen Kiarie

Government of Kenya - Department of Health Informatics Monitoring and Evaluation

Paul Mbaka

Republic of Uganda Ministry of Health

Nur Ali Mohamud

Nigeria Federal Ministry of Health

Charles Mwansambo

Ministry of Health. Malawi

Youssoupha Ndiaye

Ministère de la santé et de l'action sociale, Senegal

Charles Nzelu

Nigeria Federal Ministry of Health

Anthony Ofosu

Ghana Health Services- Centre for Health Information Management

Tsihory Raharison

Ministère de la santé publique de Madagascar

Husnia Sadat

World Bank - Development Research Group

Francis Smart

Government of Sierra Leone - Ministry of Health and Sanitation

Helal Uddin

Bangladesh Ministry of Health and Family Welfare

Naod Wendrad

Ethiopia Federal Ministry of Health

Chea Sanford Wesseh

Liberia Ministry of Health

Mohamad Lamine Yansane

Ministère de la santé de la Republique de Guinee

Sylvain Yuma

Democratic Republic of Congo - Ministry of Health

Petronella Vergeer

The Global Financing Facility for Women, Children, and Adolescents

Peter Meredith Hansen

World Bank - The Global Financing Facility for Women, Children, and Adolescents

Jed Friedman

World Bank - Development Research Group (DECRG); World Bank Group

Gil Shapira

The World Bank

More...

Abstract

Background: The COVID-19 pandemic has had wide-reaching direct and indirect impacts on population health. We describe one of the most critical of these secondary consequences, the decrease in the utilization of health services and the resulting consequences for mortality. In low- and middle-income countries, these disruptions can halt progress towards reducing maternal and child mortality.

Methods: Data on service utilization from January 2018 to June 2021 is extracted from health management information systems of 18 low- and lower-middle-income countries. Interrupted time series design is used to estimate percent change in the volumes of essential health services delivered during the pandemic compared to projected volumes based on pre-pandemic trends. The Lives Saved Tool mathematical model is used to estimate the impact of the service utilization disruptions on child and maternal mortality. In addition, the estimated monthly disruptions are also correlated to the COVID-19 burden, time since the start of the pandemic, and relative severity of mobility restrictions.

Findings: We estimate that decreases in essential health service utilization between March 2020 and June 2021 led to 113,873 additional deaths in the 18 countries, representing 3.8% and 1.4% increases in child and maternal mortality, respectively. This corresponds to an average of 2.6 indirect deaths per COVID-19 death officially reported in the same period. This excess mortality results from the decline in utilization of the RMNCH services included in the analysis, but the utilization shortfalls vary substantially between countries, health services, and over time. The largest disruptions, resulting in 27.5% of the excess death, occurred during the second quarter of 2020, regardless of whether countries experienced the highest rate of COVID-19-related deaths during the same months. There is a significant relationship between the magnitude of service disruptions and the stringency of mobility restrictions.   

Interpretation: Large declines in health care utilization during the COVID-19 pandemic amplify the pandemic's harmful impacts on health outcomes. As efforts and resource allocation towards prevention and treatment of COVID-19 continue, essential health services must be maintained, particularly in low and middle-income countries.

Funding: The Global Financing Facility for Women, Children, and Adolescents.

Declaration of Interests: We declare no competing interests.

Keywords: COVID-19, Maternal mortality, Child mortality, Essential health services, Health system resilience, service disruptions

Suggested Citation

Ahmed, Tashrik and Roberton, Timothy and Team, Monitoring of Essential Health Services and Alfred, Jean Patrick and Baye, Martina L. and Diabate, Mamatou and Kiarie, Helen and Mbaka, Paul and Mohamud, Nur Ali and Mwansambo, Charles and Ndiaye, Youssoupha and Nzelu, Charles and Ofosu, Anthony and Raharison, Tsihory and Sadat, Husnia and Smart, Francis and Uddin, Helal and Wendrad, Naod and Wesseh, Chea Sanford and Yansane, Mohamad Lamine and Yuma, Sylvain and Vergeer, Petronella and Hansen, Peter Meredith and Friedman, Jed Arnold and Shapira, Gil, Indirect Effects on Maternal and Child Mortality from the COVID-19 Pandemic: Evidence from Disruptions in Healthcare Utilization in 18 Low- and Middle-Income Countries. Available at SSRN: https://ssrn.com/abstract=3916767 or http://dx.doi.org/10.2139/ssrn.3916767

Tashrik Ahmed (Contact Author)

World Bank

1818 H Street, NW
Washington, DC 20433
United States

Timothy Roberton

Johns Hopkins University - Bloomberg School of Public Health ( email )

615 North Wolfe Street
Baltimore, MD 21205
United States
443-844-9749 (Phone)

Monitoring of Essential Health Services Team

World Bank - The Global Financing Facility for Women, Children, and Adolescents

United States

Jean Patrick Alfred

Minister of Public Health and Population of the Republic of Haiti ( email )

Haiti

Martina L. Baye

Cameroun Ministére de la Sante Publiqué ( email )

Mamatou Diabate

Ministère de la Santé et de l'Hygiène Publique du Mali ( email )

Helen Kiarie

Government of Kenya - Department of Health Informatics Monitoring and Evaluation ( email )

Nairobi
Kenya

Paul Mbaka

Republic of Uganda Ministry of Health

Kampala
Uganda

Nur Ali Mohamud

Nigeria Federal Ministry of Health ( email )

Charles Mwansambo

Ministry of Health. Malawi ( email )

Lilongwe
Malawi

Youssoupha Ndiaye

Ministère de la santé et de l'action sociale, Senegal ( email )

Senegal

Charles Nzelu

Nigeria Federal Ministry of Health ( email )

Anthony Ofosu

Ghana Health Services- Centre for Health Information Management ( email )

Private Mail Bag, Ministries, Accra.
Ghana, Greater Accra
Ghana

Tsihory Raharison

Ministère de la santé publique de Madagascar ( email )

Madagascar

Husnia Sadat

World Bank - Development Research Group ( email )

Washington, DC 20433
United States

Francis Smart

Government of Sierra Leone - Ministry of Health and Sanitation ( email )

Freetown
Sierra Leone

Helal Uddin

Bangladesh Ministry of Health and Family Welfare

Bangladesh

Naod Wendrad

Ethiopia Federal Ministry of Health ( email )

Ethiopia

Chea Sanford Wesseh

Liberia Ministry of Health ( email )

Congo Town, Monrovia
Liberia

Mohamad Lamine Yansane

Ministère de la santé de la Republique de Guinee ( email )

Guinea

Sylvain Yuma

Democratic Republic of Congo - Ministry of Health ( email )

Congo, Democratic Republic of the (Zaire)

Petronella Vergeer

The Global Financing Facility for Women, Children, and Adolescents ( email )

Peter Meredith Hansen

World Bank - The Global Financing Facility for Women, Children, and Adolescents ( email )

United States

Jed Arnold Friedman

World Bank - Development Research Group (DECRG)

1818 H. Street, N.W.
MSN3-311
Washington, DC 20433
United States

World Bank Group ( email )

1818 H Street, N.W.
Washington, DC 20433
United States

Gil Shapira

The World Bank ( email )

1818 H. Street, N.W.
MSN3-311
Washington, DC 20433
United States

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