Effects of covid-19 pandemic and sars cov-2 infection on maternal healthcare services and pregnancy outcomes at Jaramogi Oginga Odinga teaching and referral Hospital in western Kenya (retrospective cross sectional and cohort study)

Abstract

The coronavirus disease 2019 (COVID-19) pandemic occasioned significant disruptions in the delivery of healthcare services globally. There is limited knowledge on the effect of the pandemic on the utilization of maternal healthcare services, associated feto-maternal outcomes and its effects on pregnancy outcomes in the Western Kenya region. Furthermore, little knowledge is available regarding the direct effects of Covid-19 infection on pregnancy outcomes. The objective of this study was two-fold: 1) To assess the changes on maternal healthcare utilization, pregnancy outcomes, feto-maternal outcomes during the pre-COVID-19 compared to the Covid-19 era, and 2) to determine the effect of the SARS CoV-2 infection on maternal and fetal outcomes at Jaramogi Oginga Teaching and Referral Hospital (JOOTRH), Kisumu. A hospital-based retrospective cross-sectional and retrospective cohort study designs were used. The subjects were pregnant women who sought maternal healthcare services at JOOTRH between 2018 and 2022. Data was abstracted from MCH clinic and maternity ward records. For objective 1 and 2, the whole population was used (2018 to 2022) and for objective 3, a sample size of 140 participants, calculated using Fleiss formula was used. Statistical Package for Social Sciences version 27 was used for data analysis. Descriptive, inferential statistics were applied. For objective 1 and 2, unpaired t-test was used to establish the difference between pre-Covid -19 and during Covid -19. For objective 3, relative risk and odds ratios were used to estimate the risk of SARS Cov-2 infection. There was a 37.9% (17782) decline in ANC visits during COVID-19. The ¬¬total deliveries decreased by 16.7%, (1940) postnatal services reduced by 35% (5779) during the Covid-19 pandemic, indicating that the Covid-19 pandemic had a major impact on access to maternal services. Maternal and neonatal outcomes were also negatively impacted with 39.7% (23) increase maternal sepsis and a 26.4% (45) increase in fresh stillbirths and a 34.3% (333) increase in low birth weight babies during Covid-19. SARS-CoV-2 positive mothers had a higher risk of adverse maternal and fetal outcomes compared to those not infected. The pandemic interrupted maternal healthcare services access and led to adverse pregnancy outcomes. The Covid-19 infection predisposed expectant mothers to adverse maternal and fetal outcomes. Developing hospital protocols on home-based care services and safe vaccination to pregnant mothers during pandemics and prioritization of expectant women on timely diagnosis and management of Covid-19 infection. Lastly, to encourage high powered studies to evaluate the intricate effect of Covid-19 on the utero-placental unit and associated complications