Maternal and Child Health Care Outcomes in Kenya Before and During COVID-19a
| Nairobi | Kisumu | Kakamega | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Average | SD | P Value | Average | SD | P Value | Average | SD | P Value | ||
| Panel A. Percentage of women with a skilled/complicated/normal/cesarean/referred delivery out of all women who enrolled in MomCare during the control or study period with an expected delivery date before the end of the study period. | ||||||||||
| Percentage of skilled deliveries | Before | 12.2 | 3.19 | 0.000b | 9.0 | 3.16 | 0.000b | 8.2 | 1.72 | 0.000b |
| During | 17.2 | 4.79 | 18.3 | 8.09 | 16.0 | 4.77 | ||||
| Percentage of complicated deliveries | Before | 3.1 | 1.97 | 0.012b,c | 2.0 | 2.10 | 0.067c | 1.0 | 1.55 | 0.175c |
| During | 0.0 | 0.00 | 0.0 | 0.00 | 0.0 | 0.00 | ||||
| Percentage of normal deliveries | Before | 77.6 | 3.41 | 0.678 | 85.3 | 7.81 | 0.519 | 78.3 | 11.08 | 0.010 |
| During | 80.0 | 3.58 | 87.3 | 1.03 | 82.0 | 3.90 | ||||
| Percentage of cesarean deliveries | Before | 19.3 | 3.49 | 0.172 | 12.3 | 5.99 | 0.00b | 20.5 | 10.58 | 0.000b |
| During | 19.8 | 3.82 | 12.7 | 1.03 | 18.0 | 3.90 | ||||
| Percentage of deliveries through referral | Before | 17.8 | 3.13 | 0.329 | 0.8 | 1.17 | 0.001b | 0.0 | 0.00 | 0.102c |
| During | 17.0 | 2.00 | 4.8 | 1.72 | 0.7 | 0.82 | ||||
| Panel B. Percentage of women who were classified at some point during their pregnancy as having a medium- or high-risk pregnancy out of all women who enrolled in MomCare during the control or study period. | ||||||||||
| Percentage of medium-risk mothers | Before | 32.5 | 3.21 | 0.616 | 16.5 | 1.38 | 0.157 | 37.2 | 4.07 | 0.000b |
| During | 29.3 | 0.82 | 20.2 | 1.94 | 24.0 | 3.69 | ||||
| Percentage of high-risk mothers | Before | 35.2 | 2.64 | 0.324 | 43.2 | 3.60 | 0.848 | 36.0 | 4.34 | 0.000b |
| During | 38.5 | 2.59 | 45.2 | 0.41 | 45.5 | 5.09 | ||||
| Panel C. Percentage of women (newborns) who received the listed diagnostic tests and supplements out of all women who enrolled in MomCare (newborns in a MomCare clinic) during the control or study period. | ||||||||||
| Percentage of mothers with ANC profile test | Before | 73.3 | 8.38 | 0.000b | 69.0 | 6.90 | 0.368 | 70.3 | 3.78 | 0.000b |
| During | 60.0 | 16.94 | 70.7 | 2.50 | 52.5 | 11.17 | ||||
| Percentage of mothers with blood pressure at each visit | Before | 19.0 | 7.24 | 0.000b | 92.7 | 1.75 | 0.991 | 85.7 | 15.63 | 0.000b |
| During | 42.3 | 7.87 | 91.5 | 1.87 | 83.7 | 10.25 | ||||
| Percentage of mothers with at least one ultrasound | Before | 18.2 | 5.49 | 0.000b | 28.8 | 5.49 | 0.041b | 25.5 | 7.64 | 0.000b |
| During | 20.7 | 5.32 | 24.3 | 4.89 | 16.7 | 2.88 | ||||
| Percentage of mothers with folic/ferrous supplement | Before | 71.3 | 4.84 | 0.133 | 85.8 | 4.92 | 0.671 | 87.3 | 8.55 | 0.279 |
| During | 69.0 | 6.45 | 86.2 | 3.31 | 82.0 | 1.55 | ||||
| Percentage of mothers with urine analysis at each visits | Before | 60.3 | 9.93 | 0.000b | 89.2 | 3.37 | 0.948 | 84.5 | 3.27 | 0.881 |
| During | 66.0 | 4.77 | 87.0 | 2.53 | 86.7 | 2.34 | ||||
| Percentage of mothers with oxytocin at delivery | Before | 11.8 | 3.43 | 0.546 | 9.3 | 2.16 | 0.345 | 8.2 | 1.72 | 0.170 |
| During | 12.3 | 1.75 | 11.2 | 1.83 | 10.0 | 1.26 | ||||
| Percentage of mothers with hemoglobin test at delivery | Before | 35.0 | 7.48 | 0.001b | 51.3 | 3.98 | 0.750 | 44.5 | 3.99 | 0.354 |
| During | 32.0 | 5.76 | 49.8 | 2.86 | 43.8 | 7.22 | ||||
| Percentage of newborns with vitamin K | Before | 93.7 | 3.44 | 0.610 | 87.0 | 7.01 | 0.692 | 95.2 | 3.60 | 0.033b |
| During | 86.3 | 3.93 | 87.5 | 1.05 | 82.3 | 3.56 | ||||
Abbreviation: ANC, antenatal care; COVID-19, coronavirus disease; SD, standard deviation; VDRL, venereal disease research laboratory.
↵a Results of Chi-squared test comparisons across the 6 months before the first case of COVID-19 in Kenya (September 2019–February 2020) and the following 6 months (March 2020–August 2020) (data derived as per February 15, 2021).
↵b Significant differences.
↵c P values based on a heteroscedastic unpaired t-test instead of a Chi-squared test since the latter is inconclusive when one of the comparison groups has mean zero throughout.
d Definitions: skilled deliveries=births that occur in a health facility connected to MomCare; complicated deliveries=births that include prepartum complications (e.g., obstructed labor) or intrapartum or postpartum hemorrhage; normal delivery=spontaneous or induced vaginal births; medium-risk mothers=mothers whose pregnancies include non-severe complications, including but not limited to asthma, urinary tract infection, candidiasis, or female genital mutilation; high-risk mothers=mothers whose pregnancies include severe complications or high-risk factors including but not limited to: pregnancies in women aged 19 years and younger, pregnancies in women aged 35 years and older; history of cesarean delivery, anemia, hypertension, diabetes, HIV, or pre-eclampsia; mothers with ANC profile test=mothers who received tests to determine blood grouping, hemoglobin (Hb), hepatitis B antigen, HIV test, VDRL test, and a urine analysis.