PDF(Pubmed)
Abstract：
BACKGROUND: The emergence of COVID-19 precipitated containment policies (e.g., lockdowns, school closures, etc.). These policies disrupted healthcare, potentially eroding gains for Sustainable Development Goals including for neonatal mortality. Our analysis aimed to evaluate indirect effects of COVID-19 containment policies on neonatal admissions and mortality in 67 neonatal units across Kenya, Malawi, Nigeria, and Tanzania between January 2019 and December 2021.
METHODS: The Oxford Stringency Index was applied to quantify COVID-19 policy stringency over time for Kenya, Malawi, Nigeria, and Tanzania. Stringency increased markedly between March and April 2020 for these four countries (although less so in Tanzania), therefore defining the point of interruption. We used March as the primary interruption month, with April for sensitivity analysis. Additional sensitivity analysis excluded data for March and April 2020, modelled the index as a continuous exposure, and examined models for each country. To evaluate changes in neonatal admissions and mortality based on this interruption period, a mixed effects segmented regression was applied. The unit of analysis was the neonatal unit (n = 67), with a total of 266,741 neonatal admissions (January 2019 to December 2021).
RESULTS: Admission to neonatal units decreased by 15% overall from February to March 2020, with half of the 67 neonatal units showing a decline in admissions. Of the 34 neonatal units with a decline in admissions, 19 (28%) had a significant decrease of ≥ 20%. The month-to-month decrease in admissions was approximately 2% on average from March 2020 to December 2021. Despite the decline in admissions, we found no significant changes in overall inpatient neonatal mortality. The three sensitivity analyses provided consistent findings.
CONCLUSIONS: COVID-19 containment measures had an impact on neonatal admissions, but no significant change in overall inpatient neonatal mortality was detected. Additional qualitative research in these facilities has explored possible reasons. Strengthening healthcare systems to endure unexpected events, such as pandemics, is critical in continuing progress towards achieving Sustainable Development Goals, including reducing neonatal deaths to less than 12 per 1000 live births by 2030.
METHODS: The Oxford Stringency Index was applied to quantify COVID-19 policy stringency over time for Kenya, Malawi, Nigeria, and Tanzania. Stringency increased markedly between March and April 2020 for these four countries (although less so in Tanzania), therefore defining the point of interruption. We used March as the primary interruption month, with April for sensitivity analysis. Additional sensitivity analysis excluded data for March and April 2020, modelled the index as a continuous exposure, and examined models for each country. To evaluate changes in neonatal admissions and mortality based on this interruption period, a mixed effects segmented regression was applied. The unit of analysis was the neonatal unit (n = 67), with a total of 266,741 neonatal admissions (January 2019 to December 2021).
RESULTS: Admission to neonatal units decreased by 15% overall from February to March 2020, with half of the 67 neonatal units showing a decline in admissions. Of the 34 neonatal units with a decline in admissions, 19 (28%) had a significant decrease of ≥ 20%. The month-to-month decrease in admissions was approximately 2% on average from March 2020 to December 2021. Despite the decline in admissions, we found no significant changes in overall inpatient neonatal mortality. The three sensitivity analyses provided consistent findings.
CONCLUSIONS: COVID-19 containment measures had an impact on neonatal admissions, but no significant change in overall inpatient neonatal mortality was detected. Additional qualitative research in these facilities has explored possible reasons. Strengthening healthcare systems to endure unexpected events, such as pandemics, is critical in continuing progress towards achieving Sustainable Development Goals, including reducing neonatal deaths to less than 12 per 1000 live births by 2030.
摘要：
背景：COVID-19沉淀遏制政策的出现(例如，封锁,学校关闭,等。).这些政策扰乱了医疗保健，可能侵蚀可持续发展目标的收益，包括新生儿死亡率。我们的分析旨在评估COVID-19遏制政策对肯尼亚67个新生儿病房新生儿入院率和死亡率的间接影响，马拉维,尼日利亚,和坦桑尼亚在2019年1月至2021年12月之间。
方法：牛津严格度指数用于量化肯尼亚一段时间内的COVID-19政策严格度，马拉维,尼日利亚,坦桑尼亚。在2020年3月至4月期间，这四个国家的严格程度显着增加（尽管坦桑尼亚的情况较少），因此定义了中断点。我们使用三月作为主要中断月份，与四月进行敏感性分析。额外的敏感性分析不包括2020年3月和4月的数据，将该指数建模为连续暴露，并检查了每个国家的模型。根据此中断期评估新生儿入院率和死亡率的变化，采用混合效应分段回归。分析单位是新生儿单元（n=67），共有266,741例新生儿入院（2019年1月至2021年12月）。
结果：从2020年2月到3月，新生儿病房的入院率总体下降了15%，67个新生儿病房中有一半显示入院率下降。在接诊人数下降的34个新生儿病房中,19（28%）有显著下降≥20%。从2020年3月到2021年12月，招生人数平均逐月下降约2%。尽管录取率有所下降,我们发现住院新生儿总死亡率无显著变化.三个敏感性分析提供了一致的结果。
结论：COVID-19控制措施对新生儿入院有影响，但未发现住院新生儿总死亡率有显著变化.这些设施的其他定性研究探索了可能的原因。加强医疗系统以应对突发事件，如流行病，对于实现可持续发展目标至关重要，包括到2030年将新生儿死亡人数减少到每1000活产婴儿中不到12人。
方法：牛津严格度指数用于量化肯尼亚一段时间内的COVID-19政策严格度，马拉维,尼日利亚,坦桑尼亚。在2020年3月至4月期间，这四个国家的严格程度显着增加（尽管坦桑尼亚的情况较少），因此定义了中断点。我们使用三月作为主要中断月份，与四月进行敏感性分析。额外的敏感性分析不包括2020年3月和4月的数据，将该指数建模为连续暴露，并检查了每个国家的模型。根据此中断期评估新生儿入院率和死亡率的变化，采用混合效应分段回归。分析单位是新生儿单元（n=67），共有266,741例新生儿入院（2019年1月至2021年12月）。
结果：从2020年2月到3月，新生儿病房的入院率总体下降了15%，67个新生儿病房中有一半显示入院率下降。在接诊人数下降的34个新生儿病房中,19（28%）有显著下降≥20%。从2020年3月到2021年12月，招生人数平均逐月下降约2%。尽管录取率有所下降,我们发现住院新生儿总死亡率无显著变化.三个敏感性分析提供了一致的结果。
结论：COVID-19控制措施对新生儿入院有影响，但未发现住院新生儿总死亡率有显著变化.这些设施的其他定性研究探索了可能的原因。加强医疗系统以应对突发事件，如流行病，对于实现可持续发展目标至关重要，包括到2030年将新生儿死亡人数减少到每1000活产婴儿中不到12人。
