The indirect impact of COVID-19 pandemic on inpatient admissions in 204 Kenyan hospitals: An interrupted time series analysis
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 servic...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Public Library of Science
2021
|
| _version_ | 1826289808150888448 |
|---|---|
| author | Wambua, S Malla, L Mbevi, G Nwosu, A-P Tuti, T Paton, C Cheburet, S Manya, A English, M Okiro, EA |
| author_facet | Wambua, S Malla, L Mbevi, G Nwosu, A-P Tuti, T Paton, C Cheburet, S Manya, A English, M Okiro, EA |
| author_sort | Wambua, S |
| collection | OXFORD |
| description | 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. |
| first_indexed | 2024-03-07T02:34:33Z |
| format | Journal article |
| id | oxford-uuid:a859b1a4-7422-493f-9819-bb4adaed2988 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T02:34:33Z |
| publishDate | 2021 |
| publisher | Public Library of Science |
| record_format | dspace |
| spelling | oxford-uuid:a859b1a4-7422-493f-9819-bb4adaed29882022-03-27T03:00:57ZThe indirect impact of COVID-19 pandemic on inpatient admissions in 204 Kenyan hospitals: An interrupted time series analysisJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:a859b1a4-7422-493f-9819-bb4adaed2988EnglishSymplectic ElementsPublic Library of Science2021Wambua, SMalla, LMbevi, GNwosu, A-PTuti, TPaton, CCheburet, SManya, AEnglish, MOkiro, EAThe 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. |
| spellingShingle | Wambua, S Malla, L Mbevi, G Nwosu, A-P Tuti, T Paton, C Cheburet, S Manya, A English, M Okiro, EA The indirect impact of COVID-19 pandemic on inpatient admissions in 204 Kenyan hospitals: An interrupted time series analysis |
| title | The indirect impact of COVID-19 pandemic on inpatient admissions in 204 Kenyan hospitals: An interrupted time series analysis |
| title_full | The indirect impact of COVID-19 pandemic on inpatient admissions in 204 Kenyan hospitals: An interrupted time series analysis |
| title_fullStr | The indirect impact of COVID-19 pandemic on inpatient admissions in 204 Kenyan hospitals: An interrupted time series analysis |
| title_full_unstemmed | The indirect impact of COVID-19 pandemic on inpatient admissions in 204 Kenyan hospitals: An interrupted time series analysis |
| title_short | The indirect impact of COVID-19 pandemic on inpatient admissions in 204 Kenyan hospitals: An interrupted time series analysis |
| title_sort | indirect impact of covid 19 pandemic on inpatient admissions in 204 kenyan hospitals an interrupted time series analysis |
| work_keys_str_mv | AT wambuas theindirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT mallal theindirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT mbevig theindirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT nwosuap theindirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT tutit theindirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT patonc theindirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT cheburets theindirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT manyaa theindirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT englishm theindirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT okiroea theindirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT wambuas indirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT mallal indirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT mbevig indirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT nwosuap indirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT tutit indirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT patonc indirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT cheburets indirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT manyaa indirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT englishm indirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis AT okiroea indirectimpactofcovid19pandemiconinpatientadmissionsin204kenyanhospitalsaninterruptedtimeseriesanalysis |