Effects of COVID-19 on Maternity Services in Selected Public Health Facilities from the Priority MNCH Counties in Kenya

Background: Covid-19 is a rapidly evolving pandemic, affecting both developed and developing countries. Maternity services in low resource countries are adapting to provide antenatal and postnatal care midst a rapidly shifting health system environment due to the pandemic. Objectives: The objective of the study was to determine the effect of COVID-19 on maternity services in selected levels III and IV public health facilities within five MNCH priority counties in Kenya. Method: A two-stage sampling approach was used to select health facilities. The study employed cross-sectional and observational retrospective approaches. Data was collected from Maternity facilities managers and registers in a total of 28 levels III and IV facilities. Open Data Kit (ODK) formatted tools were used to collect data. Data was analysed using STATA Version 15. Descriptive statistics, Chi-square and fishers exact tests were used to analyse data. For all tests, a p-value <0.05 was taken as statistically significant. Results: A total of 31 midwifery managers were interviewed and a total of 801 maternity records (400 before COVID and 401 during COVID-19 pandemic) were reviewed from levels III (66%) and IV (34%) facilities. The managers indicated that Antenatal Care (ANC) visits had reduced (67.9%), referrals of mothers with complications got delayed (29%), mothers feared delivering in hospitals (64.5%). The managers reported that New-born care services were most affected by the pandemic (54.8%) followed by ANC services (45.2%). Facility records revealed a 19% higher ANC attendance before COVID than during the pandemic. Neonatal deaths increased significantly during Covid-19 period ((P=0.010) by 38%. Live births significantly increased during the pandemic (p <0.0001). Significant increases also observed in mothers who developed labour complications (p=0.0003) and number of mothers that underwent caesarean sections (p <0.001) during the pandemic period. Conclusion: The fear of the Covid-19 pandemic had a cross-cutting effect on utilisation of maternity services.