ArticleBMJ open2025
District variation in the impact of COVID-19 on maternal, neonatal and child health service utilisation, delivery and outcomes in Gauteng province, South Africa: a cross-sectional study.
Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis study investigated district-level variations in the impact of COVID-19 on maternal, neonatal and child healthcare (MNCH) service utilisation, delivery and health outcomes in Gauteng, one of the hardest-hit provinces in South Africa. STUDY
designA cross-sectional quantitative study.
main outcome measuresWe collected District Health Information System data for MNCH services from all 493 public healthcare facilities across all five districts in Gauteng province. We applied simple linear regression to assess key performance indicators before (March 2019 to February 2020) and during (March 2020 to February 2021) the COVID-19 pandemic. A pooled multiple linear regression model compared the impact of the pandemic in each district with that of the Johannesburg reference district. The regression models followed the bootstrap approach. Analyses were performed in Stata V.17.0.
resultsRegarding service utilisation, primary headcount under 5 years (n) significantly decreased in all five districts during COVID-19. The effect was greater in Johannesburg (-20 954.5, 95% CI -28 913.3 to -12 995.7; p<0.001), and similar to that in Tshwane and Ekurhuleni compared with Sedibeng and West Rand. Postnatal care visits within 6 days (rate) declined in all five districts, with a more pronounced effect in Johannesburg (-24.9, 95% CI -31.8 to -18.0; p<0.001). Antenatal care first visits before 20 weeks (rate) decreased in four districts, with severe effects in Ekurhuleni (-3.6, 95% CI -6.9 to -0.3; p=0.033), Sedibeng (-4.4, 95% CI -7.3 to -1.4; p=0.004) and West Rand (-7.5, 95% CI -11.3 to -3.7; p<0.001) compared with Johannesburg. Service delivery metrics, such as measles second dose coverage (%) and fully immunised under 1 year (%), declined across all five districts, although fully immunised declined remarkably in Johannesburg and Sedibeng only. Health outcomes, like pneumonia case fatality rates for under 5 years (%), declined while facility deaths 0-6 (rate) increased exclusively in Tshwane. Tshwane and Sedibeng suffered the most, with four of the eight selected indicators adversely affected by COVID-19 in each of the districts.
conclusionIn Gauteng province, the COVID-19 pandemic caused a heterogeneous adverse impact on MNCH service utilisation, delivery and health outcomes across the districts. Recognising the geographical differences in the effects of outbreaks and pandemics is critically important for informed decision-making to support healthcare services recovery in affected areas and for planning against future crises.
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