Impact of the COVID-19 pandemic on malaria in pregnancy indicators in Northern Uganda: a joinpoint regression analysis

ABSTRACT

Background

Pregnancy is both a risk factor for P. falciparum infection and development of severe malaria. In low- and middle-income countries, the COVID-19 pandemic severely impacted health systems, including utilization of maternal services. This study aimed to assess trends in delivering malaria in pregnancy-related health-care services before and during COVID-19 in Northern Uganda.

Methods

An interrupted time-series study comparing pre-COVID-19 (January 2018 to April 2020) and COVID-19 (May to December 2021) periods, based on the date the first COVID case was detected. The study involved 30 health facilities in Northern Uganda with 22,650 estimated pregnancies per year, 14% of which took place in hospital. Monthly data were sourced from District routinely collected indicators. Trends were analyzed by joinpoint regression models.

Results

From the onset of the COVID pandemic in Uganda (May 2020), we found a significant reduction in the number of women accessing a fourth antenatal care visit (from APC + 183.5 to + 4.98; p < 0.001) and taking at least three doses of intermittent preventive treatment in pregnancy (IPTp, from APC + 84.28 to -63.12; p < 0.001). However, we found no significant change in the trend of the total number of pregnant women managed as outpatients or hospitalized for malaria, as well as in the number of women attending their first antenatal visit and in the number of institutional deliveries.

Conclusions

In our study, the COVID-19 pandemic significantly reduced access to ANC visits and IPTp uptake. However, the healthcare system maintained its capacity for managing malaria cases, first antenatal visits, and institutional deliveries.

Trial registration: This study has been registered on the ClinicalTrials.gov public website on 26 April 2022. ClinicalTrials.gov Identifier: NCT05348746.

KEYWORDS:

• Malaria in pregnancy
• COVID-19
• malaria
• low- and middle-income countries
• maternal and child health

Acknowledgements

The authors thank the Cuamm team of Oyam (Polly, Gillian, Giulio, Esther, Peace, Babra, Nelson, Ronny, Isaac, Annet and Virgilia) and Kampala (Resty, Elvis, Esther and Tito).

Disclosure statement

The authors declare that they do not have any competing interests.

Author contributions

PL, FDG, JI and FVS conceived and designed the study; CB, EdV, GP, RN, RP, JO, NO, EO, JA, UF VT, LO and BN, collected the data; JI, MZ, CB and CA analyzed and interpreted the data; RN designed Figure 1; FVS drafted the work; DFB, CS, SO, CM, GDO, MLE supervised the work; PL, GP, JI, AS and FDG revised the manuscript. All the authors listed above approved the present manuscript, and have agreed both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. All authors have approved the submitted version of the manuscript and have agreed both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate and consent for publication

Study protocol has been approved by Lacor Hospital research Research and Ethics Committee (prot. no. LACOR-2022-95). In accordance with Ugandan Research Ethics Guidelines, since we used aggregated, retrospective data, informed consent to participate was not needed for this study and need for informed consent was waived by the same Research and Ethics Committee (prot. no LACOR-2022-95).

List of abbreviations

ANC	=	antenatal care
APC	=	average percentage changes
COVID-19	=	coronavirus disease 2019
CUAMM	=	University College for Aspiring Missionary Doctors
DHIMS2	=	District Health Information Management System II
HC	=	health center
IRS	=	indoor residual spraying
ITN	=	insecticide-treated net
SP-IPTp	=	intermittent preventive treatment in pregnancy with sulfadoxine–pyrimethamine

Additional information

Funding

The present study was funded by the Italian Agency for Development Cooperation (Agenzia Italiana per la Cooperazione e lo Sviluppo, AICS, Determina no 292, 21/10/2021). For this study, funders gave compensation for the contribution of part of the researchers listed as co-authors of the study. The funding body had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.