Dataset Information

Indirect impacts of the COVID-19 pandemic at two tertiary neonatal units in Zimbabwe and Malawi: an interrupted time series analysis.

ABSTRACT:

Objectives

To examine indirect impacts of the COVID-19 pandemic on neonatal care in low-income and middle-income countries.

Design

Interrupted time series analysis.

Setting

Two tertiary neonatal units in Harare, Zimbabwe and Lilongwe, Malawi.

Participants

We included a total of 6800 neonates who were admitted to either neonatal unit from 1 June 2019 to 25 September 2020 (Zimbabwe: 3450; Malawi: 3350). We applied no specific exclusion criteria.

Interventions

The first cases of COVID-19 in each country (Zimbabwe: 20 March 2020; Malawi: 3 April 2020).

Primary outcome measures

Changes in the number of admissions, gestational age and birth weight, source of admission referrals, prevalence of neonatal encephalopathy, and overall mortality before and after the first cases of COVID-19.

Results

Admission numbers in Zimbabwe did not initially change after the first case of COVID-19 but fell by 48% during a nurses' strike (relative risk (RR) 0.52, 95% CI 0.41 to 0.66, p<0.001). In Malawi, admissions dropped by 42% soon after the first case of COVID-19 (RR 0.58, 95% CI 0.48 to 0.70, p<0.001). In Malawi, gestational age and birth weight decreased slightly by around 1 week (beta -1.4, 95% CI -1.62 to -0.65, p<0.001) and 300 g (beta -299.9, 95% CI -412.3 to -187.5, p<0.001) and outside referrals dropped by 28% (RR 0.72, 95% CI 0.61 to 0.85, p<0.001). No changes in these outcomes were found in Zimbabwe and no significant changes in the prevalence of neonatal encephalopathy or mortality were found at either site (p>0.05).

Conclusions

The indirect impacts of COVID-19 are context-specific. While our study provides vital evidence to inform health providers and policy-makers, national data are required to ascertain the true impacts of the pandemic on newborn health.

SUBMITTER: Chimhuya S

PROVIDER: S-EPMC9213761 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Indirect impacts of the COVID-19 pandemic at two tertiary neonatal units in Zimbabwe and Malawi: an interrupted time series analysis.

Chimhuya Simbarashe S Neal Samuel R SR Chimhini Gwen G Gannon Hannah H Cortina Borja Mario M Crehan Caroline C Nkhoma Deliwe D Chiyaka Tarisai T Wilson Emma E Hull-Bailey Tim T Fitzgerald Felicity F Chiume Msandeni M Heys Michelle M

BMJ open 20220621 6

<h4>Objectives</h4>To examine indirect impacts of the COVID-19 pandemic on neonatal care in low-income and middle-income countries.<h4>Design</h4>Interrupted time series analysis.<h4>Setting</h4>Two tertiary neonatal units in Harare, Zimbabwe and Lilongwe, Malawi.<h4>Participants</h4>We included a total of 6800 neonates who were admitted to either neonatal unit from 1 June 2019 to 25 September 2020 (Zimbabwe: 3450; Malawi: 3350). We applied no specific exclusion criteria.<h4>Interventions</h4>Th ...[more]

PMID: 35728901

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Project description:BackgroundDespite an increase in hospital-based deliveries, neonatal mortality remains high in low-resource settings. Due to limited laboratory diagnostics, there is significant reliance on clinical findings to inform diagnoses. Accurate, evidence-based identification and management of neonatal conditions could improve outcomes by standardizing care. This could be achieved through digital clinical decision support (CDS) tools. Neotree is a digital, quality improvement platform that incorporates CDS, aiming to improve neonatal care in low-resource health care facilities. Before this study, first-phase CDS development included developing and implementing neonatal resuscitation algorithms, creating initial versions of CDS to address a range of neonatal conditions, and a Delphi study to review key algorithms.ObjectiveThis second-phase study aims to codevelop and implement neonatal digital CDS algorithms in Malawi and Zimbabwe.MethodsOverall, 11 diagnosis-specific web-based workshops with Zimbabwean, Malawian, and UK neonatal experts were conducted (August 2021 to April 2022) encompassing the following: (1) review of available evidence, (2) review of country-specific guidelines (Essential Medicines List and Standard Treatment Guidelinesfor Zimbabwe and Care of the Infant and Newborn, Malawi), and (3) identification of uncertainties within the literature for future studies. After agreement of clinical content, the algorithms were programmed into a test script, tested with the respective hospital's health care professionals (HCPs), and refined according to their feedback. Once finalized, the algorithms were programmed into the Neotree software and implemented at the tertiary-level implementation sites: Sally Mugabe Central Hospital in Zimbabwe and Kamuzu Central Hospital in Malawi, in December 2021 and May 2022, respectively. In Zimbabwe, usability was evaluated through 2 usability workshops and usability questionnaires: Post-Study System Usability Questionnaire (PSSUQ) and System Usability Scale (SUS).ResultsOverall, 11 evidence-based diagnostic and management algorithms were tailored to local resource availability. These refined algorithms were then integrated into Neotree. Where national management guidelines differed, country-specific guidelines were created. In total, 9 HCPs attended the usability workshops and completed the SUS, among whom 8 (89%) completed the PSSUQ. Both usability scores (SUS mean score 75.8 out of 100 [higher score is better]; PSSUQ overall score 2.28 out of 7 [lower score is better]) demonstrated high usability of the CDS function but highlighted issues around technical complexity, which continue to be addressed iteratively.ConclusionsThis study describes the successful development and implementation of the only known neonatal CDS system, incorporated within a bedside data capture system with the ability to deliver up-to-date management guidelines, tailored to local resource availability. This study highlighted the importance of collaborative participatory design. Further implementation evaluation is planned to guide and inform the development of health system and program strategies to support newborn HCPs, with the ultimate goal of reducing preventable neonatal morbidity and mortality in low-resource settings.

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Project description:An estimated 1.8 billion children live in countries where COVID-19 disrupted violence prevention and response. It is important to understand how government policies to contain COVID-19 impacted children's ability to seek help, especially in contexts where there was limited formal help-seeking prior to the pandemic. We aimed to quantify how the national lockdown in Zimbabwe affected helpline calls for violence against children, estimated the number of calls that would have been received had the lockdown not occurred and described characteristics of types of calls and callers before and after the national lockdown. We used an interrupted time series design to analyse the proportion of violence related calls (17,913 calls out of 57,050) to Childline Zimbabwe's national child helpline between 2017 to 2021. We applied autoregressive integrated moving average regression (ARIMA) models to test possible changes in call trends before and after the March 2020 lockdown and forecasted how many calls would have been received in the absence of lockdown. In addition, we examined call characteristics before and after lockdown descriptively. The proportion of violence related calls decreased in the 90 days after the lockdown and subsequently returned to pre-COVID-19 levels. We estimate that 10.3% (95% confidence interval [CI] 6.0-14.6%) more violence related calls would have occurred in this period had there not been a lockdown. Violence was increasingly reported as occurring in children's households, with fewer reports from children and formal child protection actors. Lockdowns dramatically change everyday life and strain populations, which is unlikely to reduce violence prevalence but may reduce help-seeking. The three months after COVID-19 lockdowns may be key time periods when help-seeking for violence decreases drastically. Policy makers should ensure that in-person and remote services support help-seeking. Interventions and campaigns may additionally want to target adult female family members in encouraging reporting of suspected violence cases when they occur within households and are perpetuated by other family members. We suggest a composite approach of scaling-up remote reporting mechanisms that are accessible and geographically well-distributed, establishing non-traditional sites for help seeking within communities and continuing limited in-person home visitation for known cases of violence.

Dataset Information

Indirect impacts of the COVID-19 pandemic at two tertiary neonatal units in Zimbabwe and Malawi: an interrupted time series analysis.

Objectives

Design

Setting

Participants

Interventions

Primary outcome measures

Results

Conclusions

Publications

Indirect impacts of the COVID-19 pandemic at two tertiary neonatal units in Zimbabwe and Malawi: an interrupted time series analysis.

Similar Datasets

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