scholarly journals The impact of the COVID-19 pandemic on health service utilisation in Sierra Leone

2021 ◽  
Author(s):  
Stephen Sevalie ◽  
Daniel Youkee ◽  
Alex J van Duinen ◽  
Emma Bailey ◽  
Thaimu Bangura ◽  
...  
Keyword(s):  
Health Service ◽  
Sierra Leone ◽  
Health Systems ◽  
Hospital Admissions ◽  
Health Service Utilisation ◽  
Sub Saharan Africa ◽  
Service Utilisation ◽  
Hospital Data ◽  
Sub Saharan ◽  
The Impact

Introduction: The COVID-19 pandemic has adversely affected health systems in many countries, but little is known about effects on health systems in sub-Saharan Africa. This study examines the effects of COVID-19 on health service utilisation in a sub-Saharan country, Sierra Leone. Methods: Mixed-methods study using longitudinal nationwide hospital data (admissions, operations, deliveries and referrals), and qualitative interviews with healthcare workers and patients. Hospital data were compared across Quarters (Q) in 2020, with day 1 of Q2 representing the start of the pandemic in Sierra Leone. Admissions are reported in total and disaggregated by sex, service (surgical, medical, maternity, paediatric), and hospital type (government or private not for profit). Referrals in 2020 were compared with 2019, to assess whether any changes were the result of seasonality. Comparisons were performed using students t test. Qualitative data were analysed using thematic analysis. Results: From Q1-Q2, weekly mean hospital admissions decreased by 14.7% (p=0.005). Larger decreases were seen in male 18.8%, than female 12.5% admissions. The largest decreases were in surgical admissions, a 49.8 % decrease (p<0.001) and medical admissions, a 28.7% decrease (p=0.002). Paediatric and maternity admissions did not significantly change. Total operations decreased by 13.9% (p<0.001), whilst caesarean sections and facility-based deliveries showed significant increases, 12.7 % (p=0.014) and 7.5% (p=0.03) respectively. In Q3 total admissions remained 13.2% lower (p<0.001) than Q1. Mean weekly referrals were lower in Q2 and Q3 of 2020 compared to 2019, suggesting findings were unlikely to be seasonal. Qualitative analysis identified both supply-side factors, prioritisation of essential services, introduction of COVID-19 services and pausing elective care, and demand-side factors, fear of nosocomial infection and financial hardship. Conclusion: The study demonstrated a decrease in health service utilisation during Covid-19, the decrease is less than in other countries during COVID-19 and less than reported during the Ebola epidemic.

scholarly journals The impact of the COVID-19 pandemic on hospital utilisation in Sierra Leone

2021 ◽  
Vol 6 (10) ◽  
pp. e005988
Author(s):  
Stephen Sevalie ◽  
Daniel Youkee ◽  
A J van Duinen ◽  
Emma Bailey ◽  
Thaimu Bangura ◽  
...  
Keyword(s):  
Sierra Leone ◽  
Health Systems ◽  
Hospital Admissions ◽  
Qualitative Interviews ◽  
Sub Saharan Africa ◽  
Hospital Data ◽  
Sub Saharan ◽  
Hospital Utilisation ◽  
Student’S T ◽  
The Impact

IntroductionThe COVID-19 pandemic has adversely affected health systems in many countries, but little is known about effects on health systems in sub-Saharan Africa. This study examines the effects of COVID-19 on hospital utilisation in a sub-Saharan country, Sierra Leone.MethodsMixed-methods study using longitudinal nationwide hospital data (admissions, operations, deliveries and referrals) and qualitative interviews with healthcare workers and patients. Hospital data were compared across quarters (Q) in 2020, with day 1 of Q2 representing the start of the pandemic in Sierra Leone. Admissions are reported in total and disaggregated by sex, service (surgical, medical, maternity and paediatric) and hospital type (government or private non-profit). Referrals in 2020 were compared with 2019 to assess whether any changes were the result of seasonality. Comparisons were performed using Student’s t-test. Qualitative data were analysed using thematic analysis.ResultsFrom Q1 to Q2, weekly mean hospital admissions decreased by 14.7% (p=0.005). Larger decreases were seen in male 18.8% than female 12.5% admissions. The largest decreases were in surgical admissions, a 49.8% decrease (p<0.001) and medical admissions, a 28.7% decrease (p=0.002). Paediatric and maternity admissions did not significantly change. Total operations decreased by 13.9% (p<0.001), while caesarean sections and facility-based deliveries showed significant increases: 12.7% (p=0.014) and 7.5% (p=0.03), respectively. In Q3, total admissions remained 13.2% lower (p<0.001) than Q1. Mean weekly referrals were lower in Q2 and Q3 of 2020 compared with 2019, suggesting findings were unlikely to be seasonal. Qualitative analysis identified both supply-side factors, prioritisation of essential services, introduction of COVID-19 services and pausing elective care, and demand-side factors, fear of nosocomial infection and financial hardship.ConclusionThe study demonstrated a decrease in hospital utilisation during COVID-19, the decrease is less than reported in other countries during COVID-19 and less than reported during the Ebola epidemic.

scholarly journals Systematic Review on the Impact of Conditional Cash Transfers on Child Health Service Utilisation and Child Health in Sub-Saharan Africa

2021 ◽  
Vol 9 ◽  
Author(s):  
Chukwuemeka Onwuchekwa ◽  
Kristien Verdonck ◽  
Bruno Marchal
Keyword(s):  
Child Health ◽  
Health Service ◽  
Cash Transfers ◽  
Conditional Cash Transfers ◽  
Health Service Utilisation ◽  
Sub Saharan Africa ◽  
Service Utilisation ◽  
Sub Saharan ◽  
The Impact ◽  
And Child Health

Background: Conditional cash transfers (CCTs) are interventions which provide assistance in the form of cash to specific vulnerable groups on the condition that they meet pre-defined requirements. The impact of conditional cash transfers on children's access to health services and on their overall health has not been established in sub-Saharan Africa.Method: We conducted a systematic review aimed at summarising the available information on the impact of conditional cash transfers on health service utilisation and child health in sub-Saharan Africa. We searched databases for peer-reviewed articles, websites of organisations involved in implementing conditional cash transfer programmes, and Google scholar to identify grey literature. Records were selected based on predefined eligibility criteria which were drawn from a programme impact framework. Records were eligible if one of the following outcomes was evaluated: health services utilisation, immunisation coverage, growth monitoring, anthropometry, illness reported, and mortality. Other records which reported on important intermediate outcomes or described mechanisms significantly contributing to impact were also included in the review. Data items were extracted from eligible records into an extraction form based on predefined data items. Study quality indicators were also extracted into a quality assessment form.Results: Thematic narrative synthesis was conducted using data from nine included records. The review included five cluster randomised evaluations, one quasi-experimental clustered study, one randomised trial at the individual level, one mixed-method study and one purely qualitative study. There was insufficient evidence of an impact of conditional cash transfers on health service utilisation. There was also not enough evidence of an impact on nutritional status. No impact was observed on health status based on illness reports, nor on immunisation rates. None of the included records evaluated the impact on childhood mortality.Conclusions: The findings of this review suggest that a positive impact may be observed in health service utilisation and nutrition, however, this may not translate into improved child health. Further research is needed to understand the mechanisms and pathways by which these interventions work, explore the effect of contextual factors on their impact, and assess their cost implication especially within resource-constrained settings.

scholarly journals Association of frailty with health service utilisation and health care expenditure in sub-Saharan Africa: evidence from Côte d’Ivoire

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rachel C. Ambagtsheer ◽  
Richard K. Moussa
Keyword(s):  
Health Service ◽  
Cote D'ivoire ◽  
Côte D’Ivoire ◽  
Health Service Utilisation ◽  
Sub Saharan Africa ◽  
Service Utilisation ◽  
Self Medication ◽  
Cote D’Ivoire ◽  
Sub Saharan ◽  
Traditional Practitioners

Abstract Background Frailty, a syndrome resulting in heightened risk of negative outcomes for older adults, is increasing across the globe. However, little is known about the health service impacts of frailty in low-income countries (LICs), and in particular, sub-Saharan Africa (SSA). This study explores the relationship between frailty and health service 1) utilisation and 2) expenditure within Côte d’Ivoire. Methods Participants aged 50 years and over participated in the Living Condition, Health and Resilience among the Elderly study. Frailty was assessed using a 30-item Frailty Index (FI). The association between frailty and self-reported health service utilisation was analysed for general practitioners (GPs), specialists, overnight hospitalisations, traditional practitioners and self-medication. Expenditure over the previous month included consulting, medications, hospitalisations and total expenditure. Results Among participants [n = 860, mean age (SD) = 61.8 (9.7) years, 42.9% female], 60.0% were frail, 22.8% pre-frail and 17.2% robust. The mean (SD) FI was 0.28 (0.17). Increased health service utilisation was associated with frailty for GP attendance, traditional practitioners and self-medication but not specialists or overnight hospitalisation. Pre-frailty and frailty were associated with increased total health service expenditure, with frailty also associated with aggregate consulting costs and medications. Conclusions Although frailty is associated with health service utilisation and expenditure in a variety of contexts, the study results suggest that such impacts may vary across the globe. The experience of frailty in LICs is likely to differ from that experienced elsewhere due to cultural traditions, attitudes to the health system, and accessibility, with more research needed.

scholarly journals Maternal health service utilisation of adolescent women in sub-Saharan Africa: a systematic scoping review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Tensae Mekonnen ◽  
Tinashe Dune ◽  
Janette Perz
Keyword(s):  
Maternal Health ◽  
Health Service ◽  
Adolescent Mothers ◽  
Maternity Care ◽  
Post Partum ◽  
Health Service Utilisation ◽  
Sub Saharan Africa ◽  
Maternal Health Service ◽  
Service Utilisation ◽  
Sub Saharan

Abstract Introduction Sub-Saharan Africa has the highest rate of adolescent pregnancy in the world. While pregnancy during adolescence poses higher risks for the mother and the baby, the utilisation of maternity care to mitigate the effects is low. This review aimed to synthesise evidence on adolescent mothers’ utilisation of maternity care in Sub-Saharan Africa and identify the key determinant factors that influence adolescent mothers’ engagement with maternity care. Method A systematic review of scholarly literature involving seven databases: ProQuest, PubMed, EMBASE/Elsevier, SCOPUS, PsycINFO, CINAHL and Infomit was conducted. Studies published in English between 1990 and 2017 that examined Sub-Saharan adolescent mothers’ experiences of utilising biomedical maternity care during pregnancy, delivery and the post-partum period were included. Results From 296 relevant articles 27 were identified that represent the experience of adolescent mothers’ maternal health service utilisation in Sub-Saharan Africa. The review indicates that maternal health service utilisation in the majority of Sub-Saharan African countries is still low. There is also a wide discrepancy in the use of maternity care services by adolescent mothers across countries in Sub-Saharan Africa. Conclusions The review reveals that a significant number of adolescents in Sub-Saharan Africa do not access and use maternity services during pregnancy. Several factors from individual to systemic levels contributed to low access and utilisation. This implies that interventions targeting the women, their partners, healthcare professionals, communities and the organisations (local to national) are necessary to improve adolescent mother’s engagement with maternity care in Sub-Saharan Africa.

scholarly journals An Observational Study of a National Referral System: An Analysis of 14,266 Referrals in Sierra Leone

2020 ◽  
Author(s):  
Daniel Youkee ◽  
Thaimu Bangura ◽  
Kwame O’Neill ◽  
Lucy Hartshorn ◽  
Sorie Samura
Keyword(s):  
Health Service ◽  
Observational Study ◽  
Sierra Leone ◽  
Health Service Utilisation ◽  
Service Availability ◽  
Service Utilisation ◽  
Bed Occupancy ◽  
District Hospitals ◽  
Tertiary Hospitals ◽  
Referral Systems

Abstract Background Referral systems are critical to a well-functioning health system. In 2017, a special cadre of referral coordinators were trained and deployed at every district and tertiary hospital in Sierra Leone. We analyse the referrals coordinated by the network to understand health service utilisation, referral pathways and outcomes.Methods A retrospective observational study of incoming referrals to all district and tertiary hospitals in Sierra Leone from 1st November 2017 until 31st October 2018. Multivariate analysis was performed on all referrals and a subgroup analysis of urgent referrals (n=10,865). Hospital preparedness and readiness scores were sourced from the Service Availability and Readiness Assessment 2017.Results 14,266 referrals were captured over the 12 months. Referral indices ranged from 0·51-5·97, with the highest indices found in Freetown and Pujehun. Bed occupancy ranged from 36·8-83·3%. 606 deaths were recorded, mortality rate per referral was 4.25%, with the majority of deaths, 446 (73.60%) occurring in the U5 population. Higher OR for mortality are seen from referrals originating from higher levels of the health system. The OR for mortality for a referral from the lowest level, MCHP, was 0.77, whilst from tertiary level was 2.40 (MCHP 0·77, CHP 0·90, CHC 1·40, district 2·06 and tertiary 2·40). For urgent referrals, factors associated with mortality were U5s, adult non-maternity cases and being seen by a clinician within one hour. Referrals from district hospitals to tertiary hospitals only accounted for 0·5% of all referrals. No correlation was found between referral index, bed occupancy and hospital service availability and readiness scores. The study did not detect any difference in total number of national referrals during the rainy season.Conclusions Wide variations in bed occupancy and referrals by district highlight disparities in health service utilisation. Low rates of referral from district hospitals to tertiary care should be further investigated. Referral indices and referral mortality rates are useful to monitor over time and to make inter district comparisons. Referral systems and pathways are useful indicators of health service utilisation and further research should be undertaken to standardise definitions and identify performance indicators for referral systems in low resource settings.

scholarly journals Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ryan A. Simmons ◽  
Rebecca Anthopolos ◽  
Wendy Prudhomme O’Meara
Keyword(s):  
Health Service ◽  
Cohort Analysis ◽  
Child Survival ◽  
Sub Saharan Africa ◽  
Survival Models ◽  
Poor Child ◽  
Risk Of Death ◽  
Increased Risk ◽  
Sub Saharan ◽  
The Impact

AbstractEach year, > 3 million children die in sub-Saharan Africa before their fifth birthday. Most deaths are preventable or avoidable through interventions delivered in the primary healthcare system. However, evidence regarding the impact of health system characteristics on child survival is sparse. We assembled a retrospective cohort of > 250,000 children in seven countries in sub-Saharan Africa. We described their health service context at the subnational level using standardized surveys and employed parametric survival models to estimate the effect of three major domains of health services—quality, access, and cost—on infant and child survival, after adjusting for child, maternal, and household characteristics. Between 1995 and 2015 we observed 13,629 deaths in infants and 5149 in children. In fully-adjusted models, the largest effect sizes were related to fees for services. Immunization fees were correlated with poor child survival (HR = 1.20, 95% CI 1.12–1.28) while delivery fees were correlated with poor infant survival (HR = 1.11, 95% CI 1.01–1.21). Accessibility of facilities and greater concentrations of private facilities were associated with improved infant and child survival. The proportion of facilities with a doctor was correlated with increased risk of death in children and infants. We quantify the impact of health service environment on survival up to five years of age. Reducing health care costs and improving the accessibility of health facilities should remain a priority for improving infant and child survival. In the absence of these fundamental investments, more specialized interventions may not achieve their desired impact.

scholarly journals Healthcare utilisation after discharge in patients admitted with gout in Western Australia

2021 ◽  
Author(s):  
Erin Kelty ◽  
Philip Robinson ◽  
Catherine Hill ◽  
Johannes Nossent ◽  
Warren Raymond ◽  
...  
Keyword(s):  
Health Care ◽  
Health Service ◽  
Health Care Costs ◽  
Linear Models ◽  
Hospital Admissions ◽  
Healthcare Utilisation ◽  
Health Service Utilisation ◽  
Service Utilisation ◽  
Median Cost ◽  
Care Costs

Abstract Objectives Evidence suggests that gout is associated with high health care costs and that many inpatient admissions are preventable. Understanding the drivers of health care costs in patients with gout will allow more targeted intervention. The objective was to examine factors associated with high health service utilisation and costs in patients admitted to hospital with gout. Methods Hospital and emergency department data was obtained for patients who had been admitted to hospital with a diagnosis of gout for the first time between 2002 and 2009. The total number, cost and potentially preventable events for the follow-up period was calculated for up to five years post the initial gout hospitalisation. The association between patient characteristics with health service utilisation and health care costs was examined using generalised linear models. Results The cohort included 4,379 individuals, that had 22,222 ED attendances (median cost: $1,826 per patient, IQR: $433 - $4,414), and 58,920 hospital admissions (median cost: $25,009 per patient, IQR: $6,844 - $60,535). Gout was not a primary driver of ED attendances or hospitalisations. A history of smoking and comorbidities including cardiovascular disease, diabetes and mental health disorders were associated with an increase health service utilisation and costs. Conclusion The presence of comorbidities play an important role the risk of health service utilization in people with gout and represents an opportunity to both improve the health-related outcomes for these patients and reduce re-presentations and associated health care costs for the health care system.

scholarly journals Using Linked Data to Estimate the True Number of Individuals Impacted by Residential Fire

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Nargess Ghassempour ◽  
Lara A Harvey ◽  
W. Kathy Tannous
Keyword(s):  
Emergency Department ◽  
Health Service ◽  
Health Services ◽  
Hospital Admissions ◽  
Population Based ◽  
Health Service Utilisation ◽  
Service Utilisation ◽  
Residential Fire ◽  
True Number ◽  
Residential Fires

IntroductionResidential fires remain a significant global public health problem. It is recognised that the reported number of residential fires, fire-related injuries and deaths significantly underestimate the true number. Australian population-based surveys show that around two-thirds of respondents who experience a residential fire are unwilling to call fire services, and studies from the US and New Zealand highlight that many individuals who access medical treatment for fire-related injuries do not have an associated fire incident report. Objectives and ApproachThis population-based study aimed to quantify the total number of residential fires, fire-related injuries and associated health service utilisation. The cohort included all persons residing at a residential address in New South Wales, Australia, which experienced a fire between 1 January 2005 - 31 December 2014. The cohort comprised linked person-level data from eight administrative datasets and includes information about nature of fire, first responder use (Fire and Rescue (FRNSW) and ambulance services), health service utilisation (emergency department, hospital and burns outpatient clinic) and health outcomes. ResultsOver the study period, FRNSW responded to 42,491 residential-fire incidents, involving 42,160 individuals with some individuals reporting multiple times. In total, 3,382 individuals used one or more health service and 154 individuals died. Of individuals who contacted FRNSW, 1,661 (3.9%) used health services;ambulance (n=1,101), emergency department (n=1,114), hospital admissions (n=168). There were 95 deaths. There were 1,721 (51%) additional individuals who used one or more health service as a result of a residential-fire that did not contact FRNSW and 59 additional deaths were identified. Conclusion / ImplicationsThis study found that more than half of individuals who used health services for residential fire-related injuries did not have an associated fire report, highlighting the importance of data linkage for accurate communication to policy makers and the public on the prevalence and impact of residential-fires.

scholarly journals The impact of a health facility construction campaign on health service utilisation and outcomes: analysis of spatially linked survey and facility location data in Ethiopia

2020 ◽  
Vol 5 (8) ◽  
pp. e002430
Author(s):  
Kevin Croke ◽  
Andualem Telaye Mengistu ◽  
Stephen D. O'Connell ◽  
Kibrom Tafere
Keyword(s):  
Caesarean Section ◽  
Health Service ◽  
Neonatal Mortality ◽  
Facility Delivery ◽  
Health Facilities ◽  
Health Service Utilisation ◽  
Service Utilisation ◽  
Percentage Points ◽  
Facility Construction ◽  
The Impact

BackgroundAccess to health facilities in many low-income and middle-income countries remains low, with a strong association between individuals’ distance to facilities and health outcomes. Yet plausibly causal estimates of the effects of facility construction programmes are rare. Starting in 2004, more than 2800 government health facilities were built in Ethiopia. This study estimates the impact of this programme on maternal health service utilisation and birth outcomes.MethodsWe analyse the impact of Ethiopia’s health centre construction programme on health service utilisation and outcomes, using a difference-in-difference design. We match facility opening years to child birth years in four rounds of Demographic and Health Surveys (DHS) using georeferenced data. We also use event study models to test for pre-trends in the outcomes of interest.ResultsOpening of new health facilities within 5 km increases facility delivery by 7.2 percentage points (95% CI 5.2 to 9.1) and antenatal care by 0.38 visits (95% CI 0.24 to 0.52). It is not significantly associated with changes in caesarean section births or neonatal mortality. Opening of district hospitals increases facility delivery by 18.2 percentage points (95% CI 12.7 to 23.7), and caesarean section births by 6.8 percentage points (95% CI 2.5 to 11.2), but is not associated with reduction of neonatal mortality.ConclusionsEthiopia’s facility construction program improved access to antenatal and delivery care. However, there was no detectable association between facility construction and neonatal mortality. Increased access to care must be combined with health system quality improvements and broader social development initiatives to sustainably improve health outcomes.

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