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. 2024 Nov 22:14:05040.
doi: 10.7189/jogh.14.05040.

Impact of COVID-19 on the utilisation of maternal health services in Bangladesh: A division-level analysis

Affiliations

Impact of COVID-19 on the utilisation of maternal health services in Bangladesh: A division-level analysis

Aniqa Tasnim Hossain et al. J Glob Health. .

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic had substantially disrupted maternal health care provision and utilisation in Bangladesh. However, the extent of geographical disparities in service utilisation and how the health system withstood these challenges have not been studied. This study explores the divisional disparities in trends and disruptions in maternal health service utilisation caused by the COVID-19 pandemic.

Methods: Data was extracted from the District Health Information Software of Bangladesh from January 2017 to December 2021. We assessed the trend of first antenatal care visit, institutional delivery and number of caesarean sections over these years. We explored both the yearly and monthly trends to see the variations in the number of utilisations. Segmented regression with Poisson distribution was used to assess changes in service utilisation during the COVID-19 period. We reported incidence rate ratio (IRR) of service utilisation with a 95% confidence interval (CI) in different divisions during COVID-19 (2020-2021) compared to the reference period (2017-2019).

Results: Initially, a notable decline in maternal health care utilisation was observed in 2020 compared to the pre-pandemic period of 2017-2019. Divisional disparities were observed in this trend. Overall, compared to the pre-pandemic period, we observed around 30% decline in all three selected indicators of maternal health care. The lowest value was observed in Chattogram in 2020 (IRR = 0.66; 95% CI = 0.55-0.79) and Rajshahi in 2021 (IRR = 0.71; 95% CI = 0.60-0.82). For institutional delivery, Barishal division had the lowest IRR (0.64; 95% CI = 0.60-0.68) in 2020 and, in 2021 Rajshahi had the lowest IRR (0.71; 95% CI = 0.60-0.82). For caesarean section, the lowest value was observed in Barishal division (IRR = 0.48; 95% CI = 0.44-0.53) in 2020 and in Mymensingh (IRR = 0.37; 95% CI = 0.32-0.43) in 2021. By 2021, the three maternal health care utilisation indicators demonstrated recovery.

Conclusions: The effect of the pandemic, including lockdown, on the selected maternal service utilisation was observed in Bangladesh though there were substantial geographic disparities. These disruptions slightly recovered after the initial shock. These results will support the government in preparing the national and regional health systems for future epidemics in Bangladesh.

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Conflict of interest statement

Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests.

Figures

Figure 1
Figure 1
Population density and number of health facilities by division.
Figure 2
Figure 2
Yearly trend of maternal health indicators, number of first Antenatal Care contact, number of institutional delivery and number of caesarean sections from DHIS2 by divisions in Bangladesh. DHIS2 – District Health Information Software, version 2.
Figure 3
Figure 3
Monthly trend of first antenatal care visit using DHIS2 data set from 2017 to 2021. DHIS2 – District Health Information Software, version 2.
Figure 4
Figure 4
Monthly trend of institutional delivery using DHIS2 data set from 2017 to 2021. DHIS2 – District Health Information Software, version 2.
Figure 5
Figure 5
Monthly trend of caesarean section using DHIS2 data set from 2017 to 2021. DHIS2 – District Health Information Software, version 2.

References

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