TY - JOUR
T1 - Reduced incidence of respiratory, gastrointestinal and malaria infections among children during the COVID-19 pandemic in Western Kenya
T2 - An analysis of facility-based and weekly diaries data
AU - Gómez-Pérez, Gloria P.
AU - de Groot, Richard
AU - Abajobir, Amanuel A.
AU - Wainaina, Caroline W.
AU - Rinke de Wit, Tobias F.
AU - Sidze, Estelle
AU - Pradhan, Menno
AU - Janssens, Wendy
N1 - Funding Information: Acknowledgments: We would like to thank all the participants from the villages included in this study from Kisumu and Kakamega counties in Kenya, and their representatives, for their trust and valuable contributions. Our deep thanks to the community healthcare workers and their hard and professional performing the weekly interviews described in this study. Funding: This project was funded by the Health Insurance Fund, Amref and PharmAccess Foundation through the i-PUSH programme (National Postcode Lottery), the Joep Lange Institute and the Netherlands Ministry of Foreign Affairs. Authorship contributions: AA, CW, ES were responsible for the data collection; ES, MP, WJ and TRdW conceived, designed and planned the study; RdG analysed and interpreted the data and wrote the first draft of the manuscript; GPGP interpreted the data and wrote the final draft of the manuscript. All authors have critically reviewed and approved the final version of the manuscript. Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and declare the following activities and relationships: AA, CW, and ES work at the African Population and Health Research Centre, Nairobi, Kenya; TRdW and GPGP work at PharmAccess Foundation, Amsterdam, The Netherlands, and WJ, RdG and MP work at the AIGHD and/or the Vrij University, Amsterdam, The Netherlands. Additional material Online Supplementary Document 1 Sochas L, Channon AA, Nam S. Counting indirect crisis-related deaths in the context of a low-resilience health system: the case of maternal and neonatal health during the Ebola epidemic in Sierra Leone. Health Policy Plan. 2017;32:iii32-9. Medline:29149310 doi:10.1093/heapol/czx108 2 Delamou A, Ayadi AME, Sidibe S, Delvaux T, Camara BS, Sandouno SD, et al. Effect of Ebola virus disease on maternal and child health services in Guinea: a retrospective observational cohort study. Lancet Glob Health. 2017;5:e448-57. Med-line:28237252 doi:10.1016/S2214-109X(17)30078-5 3 Walker PG, White MT, Griffin JT, Reynolds A, Ferguson NM, Ghani AC. Malaria morbidity and mortality in Ebola-affected countries caused by decreased health-care capacity, and the potential effect of mitigation strategies: a modelling analysis. Lancet Infect Dis. 2015;15:825-32. Medline:25921597 doi:10.1016/S1473-3099(15)70124-6 4 Wilhelm JA, Helleringer S. Utilization of non-Ebola health care services during Ebola outbreaks: a systematic review and meta-analysis. J Glob Health. 2019;9:010406. Medline:30701070 5 Jones SA, Gopalakrishnan S, Ameh CA, White S, van den Broek NR. ‘Women and babies are dying but not of Ebola’: the effect of the Ebola virus epidemic on the availability, uptake and outcomes of maternal and newborn health services in Si-erra Leone. BMJ Glob Health. 2016;1:e000065. Medline:28588954 doi:10.1136/bmjgh-2016-000065 6 Wang J, Xu C, Wong YK, He Y, Adegnika AA, Kremsner PG, et al. Preparedness is essential for malaria-endemic regions during the COVID-19 pandemic. Lancet. 2020;395:1094-6. Medline:32192582 doi:10.1016/S0140-6736(20)30561-4 7 Parpia AS, Ndeffo-Mbah ML, Wenzel NS, Galvani AP. Effects of Response to 2014-2015 Ebola Outbreak on Deaths from Malaria, HIV/AIDS, and Tuberculosis, West Africa. Emerg Infect Dis. 2016;22:433-41. Medline:26886846 doi:10.3201/ eid2203.150977 8 Hossain MM, Abdulla F, Karimuzzaman M, Rahman A. Routine Vaccination Disruption in Low-Income Countries: An Im-pact of COVID-19 Pandemic. Asia Pac J Public Health. 2020;32:509-10. Medline:32917115 doi:10.1177/1010539520957808 9 Kc A, Gurung R, Kinney MV, Sunny AK, Moinuddin M, Basnet O, et al. Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study. Lancet Glob Health. 2020;8:e1273-81. Medline:32791117 doi:10.1016/S2214-109X(20)30345-4 10 Ahmed SAKS, Ajisola M, Azeem K, Bakibinga P, Chen YF, Choudhury NN, et al. Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements. BMJ Glob Health. 2020;5:e003042. Medline:32819917 doi:10.1136/bmjgh-2020-003042 Publisher Copyright: © 2023 The Author(s)
PY - 2023/7/14
Y1 - 2023/7/14
N2 - Background Epidemics can cause significant disruptions of essential health care services. This was evident in West-Africa during the 2014-2016 Ebola outbreak, raising concerns that COVID-19 would have similar devastating consequences for the continent. Indeed, official facility-based records show a reduction in health care visits after the onset of COVID-19 in Kenya. Our question is whether this observed reduction was caused by lower access to health care or by reduced incidence of communicable diseases resulting from reduced mobility and social contacts. Methods We analysed monthly facility-based data from 2018 to 2020, and weekly health diaries data digitally collected by trained filedworkers between February and November 2020 from 342 households, including 1974 individuals, in Kisumu and Kakamega Counties, Kenya. Diaries data was collected as part of an ongoing longitudinal study of a digital health insurance scheme (Kakamega), and universal health coverage implementation (Kisumu). We assessed the weekly incidence of self-reported medical symptoms, formal and informal health-seeking behaviour, and foregone care in the diaries and compared it with facility-based records. Linear probability regressions with household fixed-effects were performed to compare the weekly incidence of health outcomes before and after COVID-19. Results Facility-based data showed a decrease in health care utilization for respiratory infections, enteric illnesses, and malaria, after start of COVID-19 measures in Kenya in March 2020. The weekly diaries confirmed this decrease in respiratory and enteric symptoms, and malaria / fever, mainly in the paediatric population. In terms of health care seeking behaviour, our diaries data find a temporary shift in consultations from health care centres to pharmacists / chemists / medicine vendors for a few weeks during the pandemic, but no increase in foregone care. According to the diaries, for adults the incidence of communicable diseases/symptoms rebounded after COVID-19 mobility restrictions were lifted, while for children the effects persisted. Conclusions COVID-19-related containment measures in Western Kenya were accompanied by a decline in respiratory infections, enteric illnesses, and malaria / fever mainly in children. Data from a population-based survey and facility-based records aligned regarding this finding despite the temporary shift to non-facility- based consultations and confirmed that the drop in utilization of health care services was not due to decreased accessibility, but rather to a lower incidence of these infections.
AB - Background Epidemics can cause significant disruptions of essential health care services. This was evident in West-Africa during the 2014-2016 Ebola outbreak, raising concerns that COVID-19 would have similar devastating consequences for the continent. Indeed, official facility-based records show a reduction in health care visits after the onset of COVID-19 in Kenya. Our question is whether this observed reduction was caused by lower access to health care or by reduced incidence of communicable diseases resulting from reduced mobility and social contacts. Methods We analysed monthly facility-based data from 2018 to 2020, and weekly health diaries data digitally collected by trained filedworkers between February and November 2020 from 342 households, including 1974 individuals, in Kisumu and Kakamega Counties, Kenya. Diaries data was collected as part of an ongoing longitudinal study of a digital health insurance scheme (Kakamega), and universal health coverage implementation (Kisumu). We assessed the weekly incidence of self-reported medical symptoms, formal and informal health-seeking behaviour, and foregone care in the diaries and compared it with facility-based records. Linear probability regressions with household fixed-effects were performed to compare the weekly incidence of health outcomes before and after COVID-19. Results Facility-based data showed a decrease in health care utilization for respiratory infections, enteric illnesses, and malaria, after start of COVID-19 measures in Kenya in March 2020. The weekly diaries confirmed this decrease in respiratory and enteric symptoms, and malaria / fever, mainly in the paediatric population. In terms of health care seeking behaviour, our diaries data find a temporary shift in consultations from health care centres to pharmacists / chemists / medicine vendors for a few weeks during the pandemic, but no increase in foregone care. According to the diaries, for adults the incidence of communicable diseases/symptoms rebounded after COVID-19 mobility restrictions were lifted, while for children the effects persisted. Conclusions COVID-19-related containment measures in Western Kenya were accompanied by a decline in respiratory infections, enteric illnesses, and malaria / fever mainly in children. Data from a population-based survey and facility-based records aligned regarding this finding despite the temporary shift to non-facility- based consultations and confirmed that the drop in utilization of health care services was not due to decreased accessibility, but rather to a lower incidence of these infections.
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U2 - https://doi.org/10.7189/jogh.13.06024
DO - https://doi.org/10.7189/jogh.13.06024
M3 - Article
C2 - 37448326
SN - 2047-2978
VL - 13
SP - 6024
JO - Journal of Global Health
JF - Journal of Global Health
M1 - 06024
ER -