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Abstract

The COVID-19 pandemic has caused an abrupt reduction in the use of in-person health care. Children and women of reproductive age groups might be disproportionately affected by the disruption of routine health services, particularly in low and middle-income countries (LMICs). The aim of this study was to see the potential effects of the COVID-19 pandemic on maternal and child health (MCH) care service utilization and strategies for effective service implementation. A phenomenological qualitative inquiry was used. For the collection of the data, an in-depth interview was employed among women and informants from all levels of the health system including the health development army in July and September 2020. The data were analyzed thematically using framework analysis. The study identified a range of COVID-19 impacts on maternal and child health service utilization in Ethiopia. Namely, reduction in accessibility and quality of routine health services, low maternal and child health service utilization, challenges in the commitment of health workers, shortage in the supply of routine resources for maternal and child health services; and enduring strategies designed for effective maternal and child health service implementation. The impact of the COVID-19 pandemic on maternal and child health service utilization was identified in a clear thematic area. The findings of this study provide evidence on bases at the local level; will help the policymakers and local administrators to develop strategies for early preparedness in the context of pandemics.

Plain Language Summary

The Impact of COVID-19 on Maternal and Child Health Services and Strategies for Improvement

This study was aimed to see the potential effects of the COVID-19 pandemic on maternal and child health (MCH) care service utilization and strategies for effective service implementation. A phenomenological qualitative inquiry was used. The COVID-19 pandemic has caused disruption of health services on the global scale, including MCH care services. Various modalities used to combat the infection have aggravated the reduction of accessibility and quality of routine MCH care services and low MCH care service utilization. Low commitment of health care workers, lack of resources and movement restrictions has had a negative impact on the utilization of MCH care services. This COVID-19 pandemic has taught us is that health preparedness is necessary for dealing with any unprecedented situation in the future. Vulnerable people like pregnant women and newborns should be given a Special attention while planning for pandemic events. In order to control COVID-19 infection among pregnant women and lactating mothers effective preventive strategies via accessing the basic information to protect the health of themselves and their babies are mandatory. There is potential for bias as service user women were self-selected.

Keywords

Impact perceived COVID-19 pandemic MCH health service Ethiopia

Background

Globally, there are tremendous efforts to improve maternal and child health (MCH) care by inspiring countries to make efforts toward reduce the global burden of maternal and child mortality (Kisiangani et al., 2020; Yaya et al., 2019).

The global mortality of maternal from pregnancy-related complications were remains extremely high, majority of the mortality were in sub-Saharan Africa and Southern Asia. An estimated 5.3 million under-5 deaths and 2.5 million neonatal deaths were reported in 2020, while the maternal mortality rate is 211 per 100,000 live births (World Health Organization, 2016).

The 2019 pandemic situation of Corona Virus Disease (COVID-19) has been declared by the World Health Organization (WHO) on March 2020 (Hanaei et al., 2022). According to the current evidence the COVID-19 virus is primarily transmitted through respiratory droplets and contact routes. When a person is in close contact (within 1 m) with someone who has respiratory symptoms (e.g., coughing or sneezing), droplet transmission will occurred (Razzaq et al., 2020). Thus, the threat of having mucosae or conjunctiva will increase and in the specific circumstances and settings, airborne transmission may be possible (Razzaq et al., 2020; Shrestha et al., 2020).

The conventional preventative measures used by diurnal clinicians feel insufficient to stop the virus’s transmission. Severe Acute Respiratory Syndrome Coronavirus 2 can be carried by cases with asymptomatic COVID-19, according to recent compliances. It has been extremely difficult to find and block similar occurrences as a result. Therefore, all clinically concerned health professionals are needed to take strict personal protective precautions and avoid or limit physical contact that produces droplets or aerosols. Children and women of reproductive age groups might be disproportionately affected by the disruption of routine health services, particularly in low and middle-income countries (LMICs) but the mortality rates for COVID-19 appear to be low in this age group. With this in mind, we wanted to quantify the potential effects of the COVID-19 pandemic on maternal and child health care service utilization (Baud et al., 2020).

Health systems in the past epidemics have struggled to maintain routine health services and utilization of services has decreased (Wilhelm & Helleringer, 2019). As noted by WHO, all people, efforts, and medical supplies shift to respond to the emergency. Due to the existence of emergency cases, the fundamental and regular required health treatments are sometimes overlooked (World Health Organization, 2018).

In 2014, a study conducted on the epidemic of Ebola virus disease estimated that, during the epidemic, there is a decline of coverage in antenatal care, family planning, facility delivery, and postnatal care. Similar disruptions had been observed with COVID-19. Both the availability and use of mother and child health care are being impacted by the pandemic and the response to it (Chang et al., 2004; Elston et al., 2016; Rust et al., 2009; Sochas et al., 2017). Findings from this study will be beneficial in providing key stakeholders at all levels of the health care system with the necessary information that will provide new direction, strategy and policy for the country towards mollifying the negative impact of COVID-19 on the formerly fragile health system, and thus help in sustaining previous efforts towards attaining the third sustainable development thing of “achieving good health and well- being for all” in Ethiopia.

Methods

Study Design

A transcendental/descriptive phenomenological study design was employed from July to September 2020.

Theoretical Framework

The descriptive phenomenology’s focus was to explore the correlation of the noema of experience (the “what”) and the noesis (the “how it is experienced”). Once “the things themselves have been identified, or otherwise analyzed, descriptive phenomenology considers its work done (Embree et al., 1997; Sloan & Bowe, 2014). The main purpose of phenomenological study design is to seek reality from individuals’ narratives of their perception, embody lived experience, feelings, and produce in-depth descriptions of a specific phenomenon, which starts and stops with lived experience. It should be a meaningful and significant experience of the phenomenon (Creswell et al., 2007; Moustakas, 1994; van Manen, 1990). The goal of phenomenological study design is to describe the meaning of this experience both in terms of what was experienced and how it was experienced (Teherani et al., 2015). A qualitative inquiry is descriptive in nature; the nature of a phenomenon can be shaped and fixed by the investigators in question, which assists in exploring and describing the views held by people.

Participant Selection

The study group comprised key informants at different level and women seeing maternal and child health services who were attending the maternal and child health clinic at selected health facilities and communities in Ethiopia.

Method of Approach

The study participants were approached by the principal investigator and research assistant using a face-to-face interview in their homes. The principal investigator and research assistant had reach experience in qualitative research data collection and analysis.

Sampling

A purposive sample of important informants, including community leaders in the chosen kebele, heads of various health systems at various levels, and MCH experts. Through the use of random purposive sampling approaches, participants in the in-depth interviews, or women who were using the facility at the time of the study were selected.

Sample Size

The number of participants interviewed was determined by the information saturation criterion, which means that the information generated from repeated interviews becomes saturated (Morgan, 1998; Sim, 1998). Thus, 24 participants for the in-depth and 50 participants for the key-informant interview were included in the study, and their informed consents were obtained.

Selection Criteria

Key informants were purposively selected based on their position who could be asked on the behalf of their expertise regarding the issue. The in-depth interview participant was selected randomly among women seeking maternal and child care at either of the selected facilities. At the conclusion of their regular activity and appointment, potential participants were approached (in alternate patterns) as they were leaving the facility and asked if they had an hour to spare to answer study questions that looked at the effect of COVID-19 on the use of maternal and child health services. The participants were made aware of the voluntary nature of their participation and the fact that choosing not to participate would have no negative effects on their ability to get future services. In order to conduct interviews, participants who were interested in taking part met the lead investigator in a private setting.

The researcher restated the study details prior to the interview to reaffirm that participant were free to end their involvement in the study at any time. When asked if they were okay with the interviews being videotaped, the participants were given the assurance that the data would be kept private and anonymous. Participants completed the consent form to indicate their desire to take part in the study when the researcher and they were both satisfied with the information they had received. Names of study participants were substituted by a special identification code to further maintain and protect their confidentiality.

The interviewer kept the discussion on topic by probing and seeking clarifications, which allowed the participants’ opinions to be conveyed without interruption. The conversation was interactive in its style. The study team from the health system and academic staff (who are fluent in Amharic) conducted the interviews in that language.

Non-Participation

No individuals refused to participate in this study.

Setting

The study was conducted in four regions; Amhara, Tigray, Oromia, Bienishangul Gumuz and two city administrations; Addis Ababa and Dire Dawa. The participating facilities included service users, MCH experts and organizational leaders at different level that is, federal ministry of health, regional health bureau, district health office, health center, health post and community.

Setting of the Data Collection

The data were collected at the interviewee’s work place in a quiet, secure, and comfortable place with minimum sound disturbance and voice to maintain the quality of the recording and facilitate open discussion. The time and place of the interview were determined by interviewees.

Presence of Non-Participants

Besides the participants and researchers, no one else participated in the study.

Description of Sample

The in-depth interview participants were women seeking maternal and child care at either of the selected facilities. Whereas, the key informants were community leaders, heads of the health system at different level and MCH experts.

Data Collection

Interview Guide

We used a pilot-tested semi-structured interview guide prepared in English and translated to Amharic (local language of the study area) to elicit details of the data through probes. The pilot-test was done among maternity and child health professionals, members of the health development army, and clients of maternal health services in non-participating facilities in the same locations. The interview guides for the IDIs and KIIs were developed separately based on literature related to the main research questions. Each guide was developed in the way that it captures the impact of COVID-19 pandemic on maternal and child health (MCH) care service utilization and strategies for effective service implementation.

A qualitative inquiry is descriptive in nature, allowing researchers to elicit and identify the characteristics of a phenomenon in question as well as examine and characterize the opinions held by people regarding a given subject and circumstance (Giorgi, 2009; Morse, 2015; Schwandt, 2001).

Repeated Interviews

Repeated interviews were not carried out.

Audio Recording

The researchers used audio recording to collect the data.

Field Notes

Field notes were made by the investigators during and after the interview. We performed the field notes to document contextual information and contribute rich descriptive details about the context of statements made, supplementing the recorded and transcribed participants’ statements. In addition, we used field notes to clarify who the speaker was when recorded voices sound similar, and to describe changes in body language, long pauses, facial expressions, making or losing eye contact, or other events that can help interpret the meaning from the context of what was said.

Duration of the Interview

The average duration of the interviews was 45 minutes time for each IDI and 55 minutes time for KIIs interviews.

Data Saturation

The term data saturation, in the current study, refers to the point in data collection when new interviews produced little or no new information to address the research question. Based on the existing literature, a minimum of 12 interviews is typically needed (Guest et al., 2020).

Data Management and Analysis

With the participants’ permission, the research team audio-recorded each interview, collected the transcripts, and then had them all translated into English. An impartial, native English and Amharic speaker double-checked the translation of the transcripts at random.

The qualitative data analysis program Open code 4.03 was used to import the transcripts. The data were analyzed using the framework analysis. The major steps in the framework analysis are as follows (Parkinson et al., 2016; Srivastava & Thomson, 2021):

✓ Familiarization with the data

✓ Development and refinement of a “thematic framework”

✓ Indexing or coding of data using the framework

✓ “Charting” the data through arrangement of appropriate thematic references in a summary “chart.”

The framework analysis uses a systematic approach to data management to give qualitative data coherence and structure (Srivastava & Thomson, 2021). To lessen the chance of losing important details, headings were assigned for the text passages that represented recurring themes based on the context and subsequently categorized to pertinent categories. The data were then combined using headings found from the thematic analysis and displayed in a chart (Srivastava & Thomson, 2021). By using a framework analysis technique, the analytical process could become more transparent, valid, and rigorous (Tuval-Mashiach, 2017). The analysis used both inductive and deductive categories as its methodology (Gale et al., 2013).

Number of Data Coders

Two individuals have performed the coding independently after repeated readings of the transcribed documents.

Description of the Coding Tree

All tape-recorded data interviews and field notes were independently transcribed verbatim to Amharic (the local language) and then translated into the English language. The translated transcriptions were imported into Open code 4.03 software for the purpose of coding. Then the codebook, with its definitions, was prepared in a separate word sheet document. The analysis was performed by using the four theme development phases: 1. Familiarization with the data, 2. Re-visit research objectives, 3. Develop a framework, and 4. Identify patterns and Connections. Central themes were constructed based on the natural meaning of the categories. The investigators cross-cheeked the themes that emerged after analysis with the respective quotes. The findings were reported by a detailed description and interpretation of the meanings of the themes. Direct quotes of the participants were also included in the write-up of the findings to provide clear images for readers. The overall process of data analysis used an inductive approach, that is, a data-driven coding process through the discussion of the researchers to identify themes. Finally, the study findings were reported based on the consolidated criteria for reporting qualitative research (COREQ) guidelines.

Participant Checking

The summary of the research findings was checked by the participants who provided relevant feedback.

Trustworthiness

A study’s credibility is ensured if the results are reliable (Connelly, 2016). The research team has spent a lot of time in the field gathering data, which has been helpful in capturing the reality of individuals being investigated. Daily base debriefing is also carried out. All co-authors were given access to the collected data and provided with constructive criticism and ideas. To enhance the validity and plausibility of the conclusions, the data collected were triangulated with data from field notes, documentary reviews, and observations.

Results

A total of 74 interviews were conducted at each level of the health system, of which 50 key informants and 24 in-depth interviews from the selected facilities and kebele were interviewed. Many of the key informant participants was male, with in the age of 25 to 34 years and employed whereas the entire in-depth interview participant was female, many of them were with the age of 25 to 34 years of age and primary level education. The entire key informant participant was actively involved in the health care delivery system at different level. Socioeconomic characteristics of the participant are provided in Table 1.

Table 1.

Socio Demographic Characteristics of Participating Key Informants and Individual Service Users, 2020.

Characteristics	Key informants n (%)	In-depth interview n (%)
Total number of participants	50	24
Sex
M	30 (60%)	0
F	20 (40%)	24 (100%)
Age in years
15–24	5 (10%)	2 (8.3%)
25–34	35 (7%)	18 (75%)
≥35	10 (20%)	4 (16.67%)
Educational level
Primary school and below	0	22 (91.67%)
Secondary school	0	2 (8.33%)
10+	14 (28%)	0
Diploma and above	26 (52%)	0

The analysis of the literature included studies that described the difficulties that key informants and service users (women) faced after the pandemic for maternity and child health care. However, analysis of the data from the present study yielded five themes, which are as follows: reduction in accessibility and quality of routine health services, Low maternal and child health service utilization, Challenges on the commitment of health workers, Shortage in the supply of routine resources for maternal and child health services; and Enduring strategies designed for effective service implementation and Suggested recommendation for the future as described below.

Reduction in Accessibility and Quality of Routine Health Services

In a situation without the prevention strategy for the reduction of accessibility and quality of routine health services, the participant perceived the pandemic COVID-19 to seeking routine health services to be inaccessible and low quality. The participant stated that the pandemic COVID-19 was a negative step toward dis-enabling the accessibility and quality of routine health services to seek any health care services at a health facility with bearing a burden of stress and fear.

A 38 years old MCH expert reported that,

The routine health service was highly influenced by the pandemic COVID-19 especially during the month of March and April most of the health facility were closed by giving emergency service only…

Similarly, the quality of routine health services was also affected by the pandemic. Quality of care is ultimately aimed at health improvements rather than simply increasing service inputs or refining system processes, and should reflect the desires of key stakeholders, including service users and communities. As stated by many of the participants, both curative and preventive care, and facility and community-based care for individuals and populations were damaged by the pandemic COVID-19.

Participant from Regional health bureau MCH focal reported that,

The accessibility and quality of the MCH service were highly cracked by the COVID-19 pandemic that is, poor quality with low accessibility of the usual health services…

Low Maternal and Child Health Service Utilization

Distraction of health workers and resources to direct COVID-19 response activities compromised the facilities’ capacity to deliver essential Maternal and child health services appropriately. A reduction in client flow was attributed to fear of acquiring COVID-19 at health facilities, limited access due to movement restrictions, and dedication of health facilities as COVID-19 treatment centers. All MCH users significantly decreased as compare to the previous similar years and a month before COVID-19.

A Participant from health center reported that:

“it is clearly observed that by taking similar months of the last year 2011 E.C with 2012 E.C there is high discrepancy b/n the MCH services that is, the performance of all components ANC1 2011 E.C March was 106% versus 88% 2012 E.C, ANC4 66% versus 61%; April ANC1 87% versus 63%, ANC459% versus 50%… All components (ANC, DS, PNC, FP) were very low during this year as compare to the last year with the same month. Home delivery was high during the pandemic as compare to before the pandemic (Before COVID February institutional delivery was 60% but during COVID March it was 56%). There is a facility that completely closes services like FP, ANC, and PNC; except emergencey.The services were totally/completely closed in the city area. Generally, there is low service utilization, accessibility and coverage; and high number of home delivery due to the pandemic effect…

During the introduction period of the pandemic COVID-19 all health services were compromised due to fear of the pandemic. The direction given from the higher officials of the health system were also confusing the community and the health workers in the health service utilization. Due to this MCH service utilization were very low.

A participant from Health center reported that,

There was an impact on maternal health services. “As direction on regional health bureau, mothers were not recommended to come to health institution that is, antenatal care visitors should not come frequently to health institutions, maximum they came once or twice only, therefore, we worked on this direction due to this service would achieve low especially Antenatal care visit 1 and 4. In our woreda still challenging and unimproved activity is home delivery; many mothers give birth at home, for different reasons. For example infrastructure and poor confidence in health institutions. We never achieve skilled delivery more than 30% before, COVID-19 made a double burden on skilled delivery service, it declined from 25% to 22%…

Challenges on the Commitment of Health Workers

The pandemic COVID-19 challenges the health workers commitment and capacity to deliver routine and essential health care due to departure of resources, fear, stigma, and movement restrictions that resulted in decreased caring and respect the client in the compassionate manner, which in turn results in decreased client demand for maternal and child health services.

A program manager from a regional level reported that,

The health workers were not actively involved in the routine activity, the community also not utilizing the health facility for maternal services…

Health workers experienced a shortage of PPE; increased workload; fear of acquiring COVID-19 and passing it to their families; and stigma from clients, Facilities implemented strong, on-site preventive measures which respondents believed could “boost confidence of clients” and protect health worker.

One participant reported that,

The commitment of health workers was highly challenged and they are obligated to stop their routine activity due to frustration and lack of personal protective equipment’s (PPE).As any other community they have fear and frustration; lack of personal protective equipment’s… makes them to fear… Generally speaking, the health workers feels fear of the pandemic, lacks of PPE and low commitment to serve before COVID were the major things which makes their commitment under questions…

Shortage in the Supply of Resources for Maternal and Child Health Services

For the successful accomplishment of every health care service, supplying of the essential resource is mandatory. The maternal and child health services were challenged with the shortage of resource during the pandemic COVID-19. Some facility faces a challenges of lack of vaccine like BCG and measles vaccine due to the pandemic COVID-19.

EPI focal person from health center reported that,

In recent times there are shortage and interruption of BCG vaccine. We provide BCG vaccine for two weeks by sharing vaccine from other health facilities in the town but we have no BCG vaccine todays onward…

Lack of personal protective equipment (PPE) is one of the challenges raised by many of the study participants. The lack of PPE makes the health workers to feel fear in giving the health care services in the compassionate, respectful and caring manner.

MCH officer from regional health bureau reported that,

The health workers were obligated to stop their routine activity due to frustration and lacks of personal protective equipment’s (PPE)… As any other community they have fear and frustration; lack of personal protective equipment’s…makes them to fear…

Enduring Strategies Designed for Effective Service Implementation

With all the challenges of COVID-19 pandemic, the health sector system in collaboration with all other concerned stakeholders has designed different existing strategy for the effective service implementation. The participants were stated that house to house vaccination activity by keeping the physical distancing and contact with a campaign is one of the best strategies implemented to be effective in the immunization program. Where as to be successful by maternal health services the health system in all level has established a task force supported by a working guide line that is responsible to trace mothers for the services.

One MCH focal person from RHB reported that,

After being familiar about the pandemic and once the community were aware those immunization site missed the service were conduct campaign; which was successful in most of the area, therefore the immunization were not that much affected by the pandemic…

There is media prevention program via awareness creation in order to solve the fear of the large community on COVID-19, establishment of quarantine home, resource mobilization at the health facility level, making expectant ladies must stay in a medical facility for delivery service whose home is too far from the health facility, active surveillance of pregnant women, registration, availability ambulance, and strong follow-up via monitoring at the local level was few of the strategy implemented for the effectiveness of the services.

A participant who is EPI focal person from health center reported that,

Solving the fear of COVID via the media prevention mechanism of the COVID, establishing quarantine home, solving the resource problem at the health facility, making the women whose house is very remote from the health center to stay at health facility which was completely left during the beginning of pandemic, using the ambulance for transporting women from home to health center and back to home; there is active surveillance of pregnant women and registrations Strategy: Strong monitoring and follow-up by themselves at the local level, fulfilling the resource…

The health extension workers and other health professionals were actively involved in the awareness creation program about the COVID-19 and other health services via different health learning materials including locally available audio-visual teaching learning materials.

A 33 years old service user women reported that,

Gradually the community start adapts with the pandemic and their fear for the disease reduces time to time. Moreover the community gets health information about corona virus through health extension workers and through different media channels…

In addition to that the participants also have suggested important recommendations that should be considered with the current COVID-19 pandemic and for the future in facing such pandemic situation.

RHB MCH focal person reported that,

Therefore all organizations (not only the health sector) should be actively involved in the MCH health services and COVID-19 prevention activity, there should be strong integrations b/n government, non-government organizations, the media and the community at large; and take over strong actions to be suscceful…

Discussion

The pandemic COVID-19 could reduce the maternal and child health care service utilization. This study has attempted to see the potential effects of COVID-19 pandemic on maternal and child health (MCH) care service utilization and strategies for effective service implementation in Ethiopia. Findings from this research categorize reduction in accessibility and quality of routine health services, low maternal and child health services utilization, challenges on the commitment of health workers and shortage in the supply of routine resources for MCH care services as an impact of COVID-19 pandemic. Enduring strategies designed for effective MCH care service implementation were a category of the finding from this study.

The current study showed that the quality and the accessibility of the routine health services were not given properly during the COVID-19 period especially when the pandemic was first introduced in Ethiopia most of the health facilities were not open for the routine health services. This finding is in line with a finding from Qatar, Bangladesh, Kenya, Nigeria and Pakistan (Abebe et al., 2020; Al-Kuwari et al., 2021; Africanews, 2020; Anwar et al., 2020; Nyagah et al., 2020; Waris et al., 2020). Accessibility of effective health care communication using the primary health care is needed about COVID-19 and about health service provision that is, about the services are available, precautions are being taken to prevent virus transmission and who should continue to seek healthcare (Srivastava & Thomson, 2021).This implies that the accessibility and quality of routine health services could be ensured through the primary healthcare, which is the first line of defence against Covid-19 pandemic.

The current study also showed that maternal and child health care service utilization including immunization, ANC, delivery service, family planning, and PNC in Ethiopia reported having problem in getting to health facility due to anxiety, fear of the pandemic and lack of transportation. This finding is in line with a study in Panama and Zimbabwe (Chitando, 2020; Pant et al., 2020). During lockdown Pregnant and postpartum women are at high risk of nutritional deficiency and they are unable to have regular antenatal and postnatal services, they will be deprived of the micronutrient supplements that they get from the health facilities. In addition, without regular checkup there are chances of certain danger signs going unidentified, which makes them vulnerable to complications related to pregnancy and childbirth (Pant et al., 2020). This implies that efforts have to be made to boost maternal health during pandemic situations. Various IEC (Information, Education and Communication) materials have to be produced to raise awareness regarding prevention of mother and child during COVID-19.

Regarding the commitment of health workers in response to COVID-19 pandemic they were highly challenged to serve the community. In some facilities there was a shortage of health care workers, because they were engaged in treating emergency cases only while in other centers maternal and child health services were condensed despite being classified as essential service. Additionally, a lack of preparedness of health institutions appears to be another factor that hinders MCH care service delivery. With rising number of COVID-19 cases in the Ethiopia context and shortages of personal protective equipment, health workers are frightened, stressed and demoralized in many of the health facilities. Other studies conducted in India, Australia, and Canada (Bisht et al., 2020; Canadian Medical Association, 2020; Wiley et al., 2020; Woodley, 2020) also showed similar finding with the current study. The health workers were distressed by the lack of personal protective equipment’s (PPEs) in the health facility and developed anxiety due to the fatality ;and way of the transmission of the COVID. They were scared that they would get infected and were also concerned about the possibility to infect their family members.

There is a shortage in the supply of routine logistics for the maternal and child health care service utilization. The COVID-19 epidemic has had a direct impact on logistics storage and movement. Thus, the pandemic’s effects on the health sector’s logistical supply chain may have an impact on the availability and standard of MCH health care services (Twinn et al., 2020).

With all the above impacts, strategies designed and efforts have been made for effective MCH care service implementation (American College of Obstetricians and Gynecologists, 2020; Hollier, 2021; Jardine et al., 2021; Scientific Brief, 2020). House to house community mobilization, and Various IEC (Information, Education and Communication) materials have been produced to raise awareness regarding the prevention of mother and child during COVID-19.These prevention activity include information disseminated by the COVID task force, health extension workers and health development army. Due to high number of dropout rate for immunization and the increasing number of home births, the ministry of health decided to have immunization campaign for the dropout which is successful and establishing a task force supported by working guide line, up to the lower level; the way how can we combat the challenges and COVID adaptive solutions to be successful in the maternal health service utilization; there is strong follow-up by reporting and other means of communication up to the health facility level.

Strengths and Limitations

A qualitative methodology was used in the study, which produced detailed, highly contextualized material and provided insights into important topics, particularly those that could have an impact on policies and programs. It also included various facilities throughout Ethiopia and a variety of locations. Due to the self-selection of service user women, there is also a chance for bias.

Conclusions

The COVID-19 pandemic has caused disruption of health services on the global scale, including MCH care services. Various modalities used to combat the infection have aggravated the reduction of accessibility and quality of routine MCH care services and low MCH care service utilization. Low commitment of health care workers, lack of resources and movement restrictions has had a negative impact on the utilization of MCH care services. This COVID-19 pandemic has taught us is that health preparedness is necessary for dealing with any unprecedented situation in the future. Vulnerable people like pregnant women and newborns should be given a Special attention while planning for pandemic events. In order to control COVID-19 infection among pregnant women and lactating mothers effective preventive strategies via accessing the basic information to protect the health of themselves and their babies are mandatory.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Consent for Publication

Not applicable.

ORCID iD

Adane Nigusie

Data Availability Statement

The data used for this study is available up on reasonable request from the corresponding author.

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Perceived Impact of COVID-19 and Strategies for effective Implementation of Maternal and Child Health Care Services in Ethiopia: A Qualitative Study

Abstract

Plain Language Summary

Keywords

Background

Methods

Study Design

Theoretical Framework

Participant Selection

Method of Approach

Sampling

Sample Size

Selection Criteria

Non-Participation

Setting

Setting of the Data Collection

Presence of Non-Participants

Description of Sample

Data Collection

Interview Guide

Repeated Interviews

Audio Recording

Field Notes

Duration of the Interview

Data Saturation

Data Management and Analysis

Number of Data Coders

Description of the Coding Tree

Participant Checking

Trustworthiness

Results

Reduction in Accessibility and Quality of Routine Health Services

Low Maternal and Child Health Service Utilization

Challenges on the Commitment of Health Workers

Shortage in the Supply of Resources for Maternal and Child Health Services

Enduring Strategies Designed for Effective Service Implementation

Discussion

Strengths and Limitations

Conclusions

Footnotes

Declaration of Conflicting Interests

Funding

Consent for Publication

ORCID iD

Data Availability Statement

References