The indirect impact of Covid-19 pandemic on inpatient admissions in 204 Kenyan hospitals

An interrupted time series analysis

Datos Bibliográficos

ID19590971
AutoresSteven Wambua (0000-0003-2300-7670, Kenya Medical Research Institute, autor de correspondencia), Lucas Malla (Kenya Medical Research Institute), George Mbevi (0000-0003-1533-9800, Kenya Medical Research Institute), Amen-Patrick Nwosu (0000-0001-6991-7798, University of Oxford), Timothy Tuti (0000-0002-7915-3004, Kenya Medical Research Institute), Chris Paton (0000-0001-6952-9621, University of Oxford), Samuel Cheburet (Ministry of Health), Ayub Manya (0000-0001-5026-2074, Ministry of Health), Mike English (0000-0002-7427-0826, Kenya Medical Research Institute), Emelda A Okiro (0000-0001-9543-8360, Kenya Medical Research Institute)
EditoresJake Michael Pry
Año2021
Volumen1
Número11
Páginase0000029
Fecha de publicación2021-11-17
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaPLOS Global Public Health (JOURNAL)
Identificadores de la revistaISSN: 2767-3375 • E-ISSN: 2767-3375
EditorialPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0000029
PMID36962093
OpenAlexW3212180673
IdiomaEN
Citas recibidas5
Referencias citadas36

The first case of severe acute respiratory coronavirus 2 (SARS-CoV-2) was identified in March 2020 in Kenya resulting in the implementation of public health measures (PHM) to prevent large-scale epidemics. We aimed to quantify the impact of COVID-19 confinement measures on access to inpatient services using data from 204 Kenyan hospitals. Data on monthly admissions and deliveries from the District Health Information Software version 2 (DHIS 2) were extracted for the period January 2018 to March 2021 stratified by hospital ownership (public or private) and adjusting for missing data using multiple imputation (MI). We used the COVID-19 event as a natural experiment to examine the impact of COVID-19 and associated PHM on use of health services by hospital ownership. We estimated the impact of COVID-19 using two approaches; Statistical process control (SPC) charts to visualize and detect changes and Interrupted time series (ITS) analysis using negative-binomial segmented regression models to quantify the changes after March 2020. Sensitivity analysis was undertaken to test robustness of estimates using Generalised Estimating Equations (GEE) and impact of national health workers strike on observed trends. SPC charts showed reductions in most inpatient services starting April 2020. ITS modelling showed significant drops in April 2020 in monthly volumes of live-births (11%), over-fives admissions for medical (29%) and surgical care (25%) with the greatest declines in the under-five’s admissions (59%) in public hospitals. Similar declines were apparent in private hospitals. Health worker strikes had a significant impact on post-COVID-19 trends for total deliveries, live-births and caesarean section rate in private hospitals. COVID-19 has disrupted utilization of inpatient services in Kenyan hospitals. This might have increased avoidable morbidity and mortality due to non-COVID-19-related illnesses. The declines have been sustained. Recent data suggests a reversal in trends with services appearing to be going back to pre- COVID levels

Interrupted time series · Interrupted Time Series Analysis · Kenya · Medical emergency · Pandemic · Psychological intervention · Public health · Statistics · COVID-19 and healthcare impacts · COVID-19 epidemiological studies · Demography · Emergency and Acute Care Studies · Medicine · Nursing · Emergency Medicine