Regional differences in the utilisation of antenatal care and skilled birth attendant services during the COVID-19 pandemic in Nigeria: an interrupted time series analysis

Rotimi Felix Afolabi; Mobolaji M Salawu; Eniola A Bamgboye; Segun Bello; Ayo Stephen Adebowale; Magbagbeola David Dairo; Steven N Kabwama; Irene Wanyana; Susan Kizito; Rawlance Ndejjo; Rhoda K Wanyenze; Olufunmilayo Ibitola Fawole

doi:10.1136/bmjgh-2023-012464

Regional differences in the utilisation of antenatal care and skilled birth attendant services during the COVID-19 pandemic in Nigeria: an interrupted time series analysis

BMJ Glob Health. 2023 Oct;8(10):e012464. doi: 10.1136/bmjgh-2023-012464.

Affiliations

¹ Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria rotimifelix@yahoo.com.
² Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
³ Population and Health Research Entity, Faculty of Humanity, North-West University, Mafikeng, South Africa.
⁴ Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
⁵ Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
⁶ Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

Abstract

Introduction: The COVID-19 pandemic has had a substantial negative impact on the utilisation of essential health services (EHS) globally, especially in resource-limited settings such as Nigeria. High maternal deaths associated with low access to and utilisation of EHS such as antenatal care (ANC) and skilled birth attendants (SBAs) remain a concern during the COVID-19 era. The study assessed the COVID-19 pandemic effects on ANC and SBA utilisation across regions in Nigeria.

Methods: Monthly data on ANC and SBA between January 2017 and July 2021 were obtained from the Federal Ministry of Health database. An interrupted time-series analysis, implemented using the Prophet model, was conducted to compare the regional variation of outcomes during the COVID-19 pandemic. Average percentage changes (PC) between the observed and predicted outcomes including their 95% CI were reported.

Results: From March 2020 to July 2021, the number of ANC visits was significantly lower than expected by a 16%-43% change in five of the six regions in Nigeria. The highest significant reduction was in North-West (PC=-43.4; 95% CI: -52.6 to -34.1) and the least in South-West (PC=-15.5; 95% CI: -24.8 to -6.1), with no significant change in the South-East. The number of deliveries by SBA was significantly lower than expected by a 18%-43% change in all the regions (p<0.01). North-East (PC=-43.3; 95% CI: -51.7 to -34.9) and South-West (PC=-18.3; 95% CI: -25.2 to -11.5), respectively, had the highest and the least decline in SBA utilisation. Overall, ANC and SBA patterns of change were relatively similar across the north-south divide though the change effect was considerably pronounced in the north.

Conclusion: There was a substantial reduction in ANC and SBA utilisation due to the COVID-19 pandemic in Nigeria, especially in the northern regions. Targeted and contextually relevant interventions should be implemented to alleviate the impact of emergency response on access to EHS and promote access to care during the pandemic.

Keywords: COVID-19; Public Health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Female
Humans
Interrupted Time Series Analysis
Nigeria / epidemiology
Pandemics
Pregnancy
Prenatal Care*
Socioeconomic Factors

Grants and funding

INV-019313/GATES/Bill & Melinda Gates Foundation/United States