Evidence map›Paper›PMID 40751199›Full record

ArticleBMC health services research2025

Establishing the effect of COVID-19 lockdown policy on the utilization of facility-based delivery in Kenya: a multi-method study.

MaryBennah N Kuloba, Christoph Strupat, Thit Thit Aye, Phidelis N Wamalwa, Judy Gichuki, Benjamin Tsofa, Manuela De Allegri

Erratum issuedAbstract read
In one paragraph

Article in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

MaryBennah N KulobaHeidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Im Neuenheimer Feld 130.3, 69120, Germany. mary.kuloba@uni-heidelberg.de.ORCID http://orcid.org/0000-0002-0394-4619
Christoph StrupatGerman Institute of Development and Sustainability (IDOS), Tulpenfeld 6, Bonn, 53113, Germany.
Thit Thit AyeHeidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Im Neuenheimer Feld 130.3, 69120, Germany.ORCID http://orcid.org/0000-0002-8498-200X
Phidelis N WamalwaHeidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Im Neuenheimer Feld 130.3, 69120, Germany.ORCID http://orcid.org/0000-0001-7789-1292
Judy GichukiDepartment of Health Services, Nairobi County Government, P.O. Box, Nairobi, 45844-00100, Kenya.
Benjamin TsofaHealth Policy and Systems Research, Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Hospital Road, P.O. Box 230, Kilifi, Kenya.
Manuela De AllegriHeidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Im Neuenheimer Feld 130.3, 69120, Germany.ORCID http://orcid.org/0000-0002-8677-1337

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAmidst the COVID-19 pandemic, lockdown policies emerged as pivotal policies to contain viral transmission. Questions arise about whether their implementation challenged access to care, particularly in regions with fragile health systems, such as sub-Saharan Africa. Robust evidence on the effect of lockdown policies on access to healthcare services is sparse, also due to a lack of suitable data. We addressed this knowledge gap and assessed the effect of the COVID-19 lockdown policy on facility-based delivery during the first wave of the pandemic in Kenya.

methodsWe triangulated results from two parallel yet independent quantitative analyses, exploiting the fact that COVID-19 lockdown policies in Kenya were implemented only in some counties. First, we relied on nationally representative repeated cross-sectional population-based surveys conducted in 2018 and 2020, with data being analyzed using a pre-post study with control. Second, we used monthly data from the Kenya Health Information System (from January 2019 to November 2020) to construct an interrupted time series (ITS) with independent controls, setting April 2020 as the interruption month (i.e., the onset of the lockdowns).

resultsThe controlled pre-post-analysis detected no significant effect of the lockdown policy on facility-based delivery in lockdown counties compared with non-lockdown counties. The ITSA model showed that the lockdown counties experienced an immediate increase of 4.97% (CI: 0.51%, 9.43%) in facility-based delivery compared with the non-lockdown counties during the first wave of the pandemic. This was followed by a significant monthly decrease of 0.97% (CI: -1.60%, -0.34%) compared with non-lockdown counties.

conclusionWe found no overall effect of the lockdown policy on facility-based deliveries. Our findings suggest that when managed effectively, lockdowns do not disrupt access to maternal health services. Our findings highlight the importance of implementing context-specific strategies to safeguard maternal healthcare during public health crises. Future research should explore localized and socioeconomic differences in how populations respond to public health interventions during pandemics.

Indexed as

Communicable Disease ControlCOVID-19Delivery, ObstetricHealth PolicyHealth Services AccessibilityQuarantineAdultCross-Sectional StudiesFemaleHumansInterrupted Time Series AnalysisKenyaPandemicsPregnancySARS-CoV-2Difference-in-DifferenceFacility-based deliveryHealth systemsInterrupted time series analysisLockdown policyPandemic preparednessPre-post-study

Identifiers

PMID40751199
PMCPMC12315436

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.