Background

Public health emergencies can disrupt the provision of and access to essential health-care services, exacerbating health crises. We aimed to assess the effect of the COVID-19 pandemic on essential health-care services in Kenya.

Methods

Using county-level data routinely collected from the health information system from health facilities across the country, we used a robust mixed-effect model to examine changes in 17 indicators of essential health services across four periods: the pre-pandemic period (from January, 2018 to February, 2020), two pandemic periods (from March to November 2020, and February to October, 2021), and the period during the COVID-19-associated health-care workers’ strike (from December, 2020 to January, 2021).

Findings

In the pre-pandemic period, we observed a positive trend for multiple indicators. The onset of the pandemic was associated with statistically significant decreases in multiple indicators, including outpatient visits (28·7%; 95% CI 16·0–43·5%), cervical cancer screening (49·8%; 20·6–57·9%), number of HIV tests conducted (45·3%; 23·9–63·0%), patients tested for malaria (31·9%; 16·7–46·7%), number of notified tuberculosis cases (26·6%; 14·7–45·1%), hypertension cases (10·4%; 6·0–39·4%), vitamin A supplements (8·7%; 7·9–10·5%), and three doses of the diphtheria, tetanus toxoid, and pertussis vaccine administered (0·9%; 0·5–1·3%). Pneumonia cases reduced by 50·6% (31·3–67·3%), diarrhoea by 39·7% (24·8–62·7%), and children attending welfare clinics by 39·6% (23·5–47·1%). Cases of sexual violence increased by 8·0% (4·3–25·0%). Skilled deliveries, antenatal care, people with HIV infection newly started on antiretroviral therapy, confirmed cases of malaria, and diabetes cases detected were not significantly affected negatively. Although most of the health indicators began to recover during the pandemic, the health-care workers’ strike resulted in nearly all indicators falling to numbers lower than those observed at the onset or during the pre-strike pandemic period.

Interpretation

The COVID-19 pandemic and the associated health-care workers’ strike in Kenya have been associated with a substantial disruption of essential health services, with the use of outpatient visits, screening and diagnostic services, and child immunisation adversely affected. Efforts to maintain the provision of these essential health services during a health-care crisis should target the susceptible services to prevent the exacerbation of associated disease burdens during such health crises.

Funding

Bill & Melinda Gates Foundation.

中文翻译：

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COVID-19 大流行和肯尼亚基本卫生服务中断：回顾性时间序列分析

背景

突发公共卫生事件可能会扰乱基本卫生保健服务的提供和获取，从而加剧健康危机。我们的目的是评估 COVID-19 大流行对肯尼亚基本医疗保健服务的影响。

方法

我们利用从全国各地卫生机构的卫生信息系统定期收集的县级数据，使用稳健的混合效应模型来检查四个时期内 17 项基本卫生服务指标的变化：大流行前时期（从 1 月到 1 月） 2018年至2020年2月）、两个大流行时期（2020年3月至11月和2021年2月至10月）以及与COVID-19相关的医护人员罢工期间（2020年12月至2021年1月） ）。

发现

疫情前期，我们观察到多项指标呈现积极趋势。大流行的爆发与多项指标的统计显着下降相关，包括门诊就诊次数（28·7%；95% CI 16·0–43·5%）、宫颈癌筛查（49·8%；20·6– 57·9%)、进行艾滋病毒检测的人数 (45·3%; 23·9–63·0%)、接受疟疾检测的患者人数 (31·9%; 16·7–46·7%)、通知人数肺结核病例 (26·6%; 14·7–45·1%)、高血压病例 (10·4%; 6·0–39·4%)、维生素 A 补充剂 (8·7%; 7·9–10 ·5%），并注射三剂白喉、破伤风类毒素和百日咳疫苗（0·9%；0·5–1·3%）。肺炎病例减少 50·6% (31·3–67·3%)，腹泻病例减少 39·7% (24·8–62·7%)，前往福利诊所就诊的儿童减少 39·6% (23·5 –47·1%）。性暴力案件增加了 8·0% (4·3–25·0%)。熟练的分娩、产前护理、新开始接受抗逆转录病毒治疗的艾滋病毒感染者、疟疾确诊病例和检测到的糖尿病病例没有受到显着的负面影响。尽管大多数健康指标在疫情期间开始恢复，但医护人员罢工导致几乎所有指标均低于疫情爆发时或罢工前期间观察到的数字。

解释

肯尼亚的 COVID-19 大流行和相关的医护人员罢工与基本卫生服务的严重中断有关，门诊就诊、筛查和诊断服务的使用以及儿童免疫接种受到了不利影响。在卫生保健危机期间维持提供这些基本卫生服务的努力应针对易受影响的服务，以防止此类卫生危机期间相关疾病负担的恶化。

资金

比尔及梅琳达·盖茨基金会。