Assessing the impact of COVID-19 pandemic on maternal healthcare usage: evidence from routine health data in Kenya and Ethiopia.

Objectives: Lockdowns and fear of COVID-19 may have reduced access to antenatal care (ANC) and skilled birth attendance (SBA) in sub-Saharan Africa, which could undermine progress towards maternal and child survival and the sustainable development goals (SDGs). We analysed COVID-19's impact on maternal healthcare usage, focusing on subnational levels, to identify healthcare disruption hotspots that require targeted interventions and help policymakers prioritise resources to accelerate progress. Methods and analysis: Using monthly health management information system (HMIS) data, we tracked changes in healthcare access at subnational levels in Ethiopia and Kenya during the pandemic. We compared service usage before and during the pandemic, using interrupted time series and counterfactual analyses to evaluate the pandemic's impact on healthcare usage trends. We also performed geospatial mapping of the affected regions to identify hotspots. Results: Our results show significant changes at subnational levels. ANC declined in several Kenyan counties during the pandemic, with improvements observed in others. SBA disruptions were observed in two counties. In Ethiopia, ANC declined in the north but remained unchanged in the south, with some improvements observed in the two regions. Southern regions showed resilience in SBA, experiencing gains, while northern regions showed no change. Conclusion: Future disease outbreaks may continue to cause further disruptions to health service delivery, affecting maternal and child health outcomes. Our analysis highlights the low resilience of subnational health systems to shocks, underscoring the need to strengthen healthcare systems and HMIS data capture for better data quality. Evidence-based research is essential in identifying hotspots and supporting targeted interventions to achieve the SDGs and improve maternal and child health outcomes.