Date of Award

2023

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Muzdalifat Abeid

Second Supervisor/Advisor

Dr. Nancy Matillya

Department

Family Medicine (East Africa)

Abstract

Background

While substantial progress had been made in reducing maternal deaths, there was a risk that the COVID-19 pandemic might have reversed the progress made in maternal and newborn health in the last two decades. As such, maternal and newborn outcomes had been a topic of interest during the pandemic.

Objectives

This study aimed to compare the number of childbirths as an indicator of maternal health service utilization and to assess maternal and newborn outcomes before COVID-19 (2011-2019) and during the COVID-19 pandemic (2020/2021) in 22 health facilities in Dar es Salaam.

Methodology

A retrospective cohort study was conducted at 22 health facilities in Dar es Salaam from March to June 2022, involving pregnant women who attended these health facilities from 2011 to 2021. Data were manually extracted from the District Health Information Software in Dar es Salaam regional office. Simple descriptive analysis was conducted using whole numbers. The number of childbirths was presented in absolute numbers, while maternal mortality was presented as a ratio. Neonatal mortality, stillbirth, and cesarean section rates were also presented. The year was considered the exposure of interest; 2019 was assumed to represent the period before the pandemic, whereas 2020 to 2021 represented the pandemic period. Simple linear graphs were used to show the outcomes of interest in specific years. The comparison of means between the pre COVID-19 and during COVID-19 era was done using a paired sample t-test. Statistical analysis was performed using SPSS version 25.0, and all calculations considered 5% as the test of significance.

Results

Between 2011 and 2021, a total of 888,375 childbirths occurred in 22 Comprehensive Community Based Rehabilitation in Tanzania supported health facilities. The first year of the COVID-19 outbreak in Tanzania (2020) saw an 11% decline in childbirth volume compared to the preceding v year (2019), but this decrease was not statistically significant (p-value = 0.47, paired sample t-test). During the COVID-19 era, worrisome trends emerged in maternal and newborn health. The cesarean section rate, stillbirth rate, neonatal mortality rate, and maternal mortality ratio all increased when compared to the two years before the COVID-19 pandemic. However, it is essential to underscore that despite these observed increases, none of these alterations yielded statistical significance within the given dataset.

Conclusion

COVID-19 outbreak had both direct and indirect effects on maternal and neonatal morbidity and mortality. It was observed that during COVID-19, there was a decrease in childbirth volume, an increase in the caesarean section rate, an increased neonatal mortality rate, an increased number of stillbirths, together with an increased maternal mortality ratio. As Tanzania continues to implement public health measures to curb different pandemics, including COVID-19 and Ebola, different strategies and guidelines need to be implemented to combat the direct and indirect effects of these pandemics on maternal and perinatal outcomes.

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