1 Bekele C, et al. BMJ Open 2022;12:e059408. doi:10.1136/bmjopen-2021-059408 Open access Impact of the COVID-19 pandemic on utilisation of facility-based essential maternal and child health services from March to August 2020 compared with pre-pandemic March–August 2019: a mixed-methods study in North Shewa Zone, Ethiopia Chalachew Bekele , 1 Delayehu Bekele, 2 Bezawit Mesfn Hunegnaw, 3 Kimiko Van Wickle, 4 Fanos Ashenaf Gebremeskel, 5 Michelle Korte, 6 Christine Tedijanto, 7 Lisanu Taddesse, 8 Grace J Chan 4,9 To cite: Bekele C, Bekele D, Hunegnaw BM, et al. Impact of the COVID-19 pandemic on utilisation of facility-based essential maternal and child health services from March to August 2020 compared with pre-pandemic March–August 2019: a mixed-methods study in North Shewa Zone, Ethiopia. BMJ Open 2022;12:e059408. doi:10.1136/ bmjopen-2021-059408 ► Prepublication history and additional supplemental material for this paper are available online. To view these fles, please visit the journal online (http://dx.doi.org/10.1136/ bmjopen-2021-059408). Received 22 November 2021 Accepted 09 May 2022 For numbered affliations see end of article. Correspondence to Dr Grace J Chan; grace.chan@hsph.harvard.edu Original research © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. ABSTRACT Introduction Health systems are often weakened by public health emergencies that make it harder to access health services. We aimed to assess maternal, newborn and child health (MNCH) service utilisation during the frst 6 months of the COVID-19 pandemic compared with prior to the pandemic. Methods We conducted a mixed study design in eight health facilities that are part of the Birhan feld site in Amhara, Ethiopia and compared the trend of service utilisation in the frst 6 months of COVID-19 with the corresponding time and data points of the preceding year. Result New family planning visits (43.2 to 28.5/month, p=0.014) and sick under 5 child visits (225.0 to 139.8/ month, p=0.007) declined over the frst 6 months of the pandemic compared with the same period in the preceding year. Antenatal (208.9 to 181.7/month, p=0.433) and postnatal care (26.6 to 19.8/month, p=0.155) visits, facility delivery rates (90.7 to 84.2/month, p=0.776), and family planning visits (313.3 to 273.4/month, p=0.415) declined, although this did not reach statistical signifcance. Routine immunisation visits (37.0 to 36.8/month, p=0.982) for children were maintained. Interviews with healthcare providers and clients highlighted several barriers to service utilisation during COVID-19, including fear of disease transmission, economic hardship, and transport service disruptions and restrictions. Enablers of service utilisation included communities’ decreased fear of COVID-19 and awareness-raising activities. Conclusion We observed a decline in essential MNCH services particularly in sick children and new family planning visits. To improve the resiliency of fragile health systems, resources are needed to continuously monitor service utilisation and clients’ evolving concerns during public health emergencies. INTRODUCTION The WHO declared COVID-19 a global pandemic on 11 March 2020 1 and Ethiopia registered its first case of COVID-19 on 13 March 2020. Ethiopia has reported relatively low numbers of COVID-19 cases and COVID- 19-related deaths, with 63 367 confirmed cases and 974 deaths in a population of 119 million, as of 10 September 2020. 2 The majority of reported cases were from the capital city, Addis Ababa, and only 365 confirmed cases and 8 deaths were registered by 30 August 2020 in the North Shewa Zone (the third administration unit of the country), where the study was conducted. STRENGTHS AND LIMITATIONS OF THIS STUDY ⇒ We presented data on service utilisation during the early months of the pandemic in a rural, agrarian region in Ethiopia. ⇒ The mixed-methods approach integrated both quan- titative service utilisation coverage and exploratory qualitative interviews to understand our fndings and the reasons for changes in service utilisation. ⇒ We focused on the coverage of service utilisation as the primary outcome rather than mortality or mor- bidity rates. ⇒ We do not have detailed data on service provision (eg, which services were restricted and for how long, in what manner). ⇒ Since we collected the qualitative data 3 months past the initial 6 months of the pandemic (March– August 2020), there may be recall bias. on September 29, 2023 by guest. Protected by copyright. http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2021-059408 on 3 June 2022. Downloaded from