The impact of the COVID-19 pandemic on the surgical care continuum in Ethiopia: a national survey.

Abstract

Background: The COVID-19 pandemic severely affected social welfare, the economy, and global health, making delivering even the essential health service impossible. Surgical and anesthetic care was one of the essential parts of the health system that the COVID-19 pandemic greatly affected. This study aimed to assess the impact of COVID-19 on surgical care provision and the effectiveness of recovery measures in Ethiopia.

Methods: An analysis of trends in a subcategory of surgical procedures performed in the years before COVID-19 and after the COVID-19 pandemic, which was designated as phases 0, 1, and 3, was conducted for public hospitals in Ethiopia that provided surgical services for three consecutive years, from January 2019 to March 2021. There were 24 general hospitals, 24 referral hospitals, and 91 primary hospitals. The indicators for assessing the impact of COVID-19 on the surgical care continuum were surgical volume, delay for surgical admission, cesarean section rate, and surgical site infection rate. The national District Health Information System (DHIS-2) of the Ministry of Health of Ethiopia was used to retrieve selected surgical services performance indicators.

Results: Comparing the first COVID-19 pandemic year to the year prior to the pandemic, the mean surgical volume in primary hospitals grew while the surgical volume at referral hospitals decreased. The average reported rate of cesarean sections during the epidemic years was 23.7%. When compared to the pre-pandemic (phase 0), the pandemic year 2020 (phase 1), the mean caesarian section rate increased for referral, general, and primary hospitals. During the post-pandemic year, there is a clinically significant delay in surgical admission for referral, general and primary hospitals.

Conclusion and recommendation: Compared to the pre-pandemic period, COVID-19 significantly impacted the Ethiopian surgical care continuum, indicated by decreased surgical volume and increased surgical admission delays. To build a more resilient health system and meet community surgical service demand during public health emergencies, strengthening surgical service at primary health care units, such as primary hospitals and health centers with operation theatre blocks, should be prioritized.