Indirect impacts of the COVID-19 pandemic at two tertiary neonatal units in Zimbabwe and Malawi: an interrupted time series analysis
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 a...
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e048955.full |
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| author | Michelle Heys Caroline Crehan Emma Wilson Felicity Fitzgerald Mario Cortina Borja Msandeni Chiume Samuel R Neal Hannah Gannon Gwen Chimhini Simbarashe Chimhuya Tim Hull-Bailey Tarisai Chiyaka Deliwe Nkhoma |
| author_facet | Michelle Heys Caroline Crehan Emma Wilson Felicity Fitzgerald Mario Cortina Borja Msandeni Chiume Samuel R Neal Hannah Gannon Gwen Chimhini Simbarashe Chimhuya Tim Hull-Bailey Tarisai Chiyaka Deliwe Nkhoma |
| author_sort | Michelle Heys |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-beee03003c544e1db5ef4ba20d504984 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
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| series | BMJ Open |
| spelling | doaj-art-beee03003c544e1db5ef4ba20d5049842025-01-27T14:40:10ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2021-048955Indirect impacts of the COVID-19 pandemic at two tertiary neonatal units in Zimbabwe and Malawi: an interrupted time series analysisMichelle Heys0Caroline Crehan1Emma Wilson2Felicity Fitzgerald3Mario Cortina Borja4Msandeni Chiume5Samuel R Neal6Hannah Gannon7Gwen Chimhini8Simbarashe Chimhuya9Tim Hull-Bailey10Tarisai Chiyaka11Deliwe Nkhoma12Department of Population, Policy & Practice, UCL Great Ormond Street Institute of Child Health, London, UKPopulation, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UKCentre for Public Health and Epidemiology, University of Nottingham, Nottingham, UKImperial College London, London, UKPopulation, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UKDepartment of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi1 Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UKPopulation, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UKDepartment of Paediatrics and Child Health, University of Zimbabwe College of Health Sciences, Harare, ZimbabweUnit of Child and Adolescent Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, ZimbabwePopulation, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UKCentre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, ZimbabweParent and Child Health Initiative Trust, Lilongwe, Central Region, MalawiObjectives 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.https://bmjopen.bmj.com/content/12/6/e048955.full |
| spellingShingle | Michelle Heys Caroline Crehan Emma Wilson Felicity Fitzgerald Mario Cortina Borja Msandeni Chiume Samuel R Neal Hannah Gannon Gwen Chimhini Simbarashe Chimhuya Tim Hull-Bailey Tarisai Chiyaka Deliwe Nkhoma Indirect impacts of the COVID-19 pandemic at two tertiary neonatal units in Zimbabwe and Malawi: an interrupted time series analysis BMJ Open |
| title | Indirect impacts of the COVID-19 pandemic at two tertiary neonatal units in Zimbabwe and Malawi: an interrupted time series analysis |
| title_full | Indirect impacts of the COVID-19 pandemic at two tertiary neonatal units in Zimbabwe and Malawi: an interrupted time series analysis |
| title_fullStr | Indirect impacts of the COVID-19 pandemic at two tertiary neonatal units in Zimbabwe and Malawi: an interrupted time series analysis |
| title_full_unstemmed | Indirect impacts of the COVID-19 pandemic at two tertiary neonatal units in Zimbabwe and Malawi: an interrupted time series analysis |
| title_short | Indirect impacts of the COVID-19 pandemic at two tertiary neonatal units in Zimbabwe and Malawi: an interrupted time series analysis |
| title_sort | indirect impacts of the covid 19 pandemic at two tertiary neonatal units in zimbabwe and malawi an interrupted time series analysis |
| url | https://bmjopen.bmj.com/content/12/6/e048955.full |
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