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Effect of lifting COVID-19 restrictions on utilisation of primary care services in Nepal: a difference-in-differences analysis

INTRODUCTION: An increasing number of studies have reported disruptions in health service utilisation due to the COVID-19 pandemic and its associated restrictions. However, little is known about the effect of lifting COVID-19 restrictions on health service utilisation. The objective of this study wa...

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Autores principales: Kapoor, Neena R, Aryal, Amit, Mehata, Suresh, Dulal, Mahesh, Kruk, Margaret E, Bauhoff, Sebastian, Arsenault, Catherine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9709811/
https://www.ncbi.nlm.nih.gov/pubmed/36446449
http://dx.doi.org/10.1136/bmjopen-2022-061849
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author Kapoor, Neena R
Aryal, Amit
Mehata, Suresh
Dulal, Mahesh
Kruk, Margaret E
Bauhoff, Sebastian
Arsenault, Catherine
author_facet Kapoor, Neena R
Aryal, Amit
Mehata, Suresh
Dulal, Mahesh
Kruk, Margaret E
Bauhoff, Sebastian
Arsenault, Catherine
author_sort Kapoor, Neena R
collection PubMed
description INTRODUCTION: An increasing number of studies have reported disruptions in health service utilisation due to the COVID-19 pandemic and its associated restrictions. However, little is known about the effect of lifting COVID-19 restrictions on health service utilisation. The objective of this study was to estimate the effect of lifting COVID-19 restrictions on primary care service utilisation in Nepal. METHODS: Data on utilisation of 10 primary care services were extracted from the Health Management Information System across all health facilities in Nepal. We used a difference-in-differences design and linear fixed effects regressions to estimate the effect of lifting COVID-19 restrictions. The treatment group included palikas that had lifted restrictions in place from 17 August 2020 to 16 September 2020 (Bhadra 2077) and the control group included palikas that had maintained restrictions during that period. The pre-period included the 4 months of national lockdown from 24 March 2020 to 22 July 2020 (Chaitra 2076 to Ashar 2077). Models included month and palika fixed effects and controlled for COVID-19 incidence. RESULTS: We found that lifting COVID-19 restrictions was associated with an average increase per palika of 57.5 contraceptive users (95% CI 14.6 to 100.5), 15.6 antenatal care visits (95% CI 5.3 to 25.9) and 1.6 child pneumonia visits (95% CI 0.2 to 2.9). This corresponded to a 9.4% increase in contraceptive users, 34.2% increase in antenatal care visits and 15.6% increase in child pneumonia visits. Utilisation of most other primary care services also increased after lifting restrictions, but coefficients were not statistically significant. CONCLUSIONS: Despite the ongoing pandemic, lifting restrictions can lead to an increase in some primary care services. Our results point to a causal link between restrictions and health service utilisation and call for policy makers in low- and middle-income countries to carefully consider the trade-offs of strict lockdowns during future COVID-19 waves or future pandemics.
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spelling pubmed-97098112022-11-30 Effect of lifting COVID-19 restrictions on utilisation of primary care services in Nepal: a difference-in-differences analysis Kapoor, Neena R Aryal, Amit Mehata, Suresh Dulal, Mahesh Kruk, Margaret E Bauhoff, Sebastian Arsenault, Catherine BMJ Open Health Services Research INTRODUCTION: An increasing number of studies have reported disruptions in health service utilisation due to the COVID-19 pandemic and its associated restrictions. However, little is known about the effect of lifting COVID-19 restrictions on health service utilisation. The objective of this study was to estimate the effect of lifting COVID-19 restrictions on primary care service utilisation in Nepal. METHODS: Data on utilisation of 10 primary care services were extracted from the Health Management Information System across all health facilities in Nepal. We used a difference-in-differences design and linear fixed effects regressions to estimate the effect of lifting COVID-19 restrictions. The treatment group included palikas that had lifted restrictions in place from 17 August 2020 to 16 September 2020 (Bhadra 2077) and the control group included palikas that had maintained restrictions during that period. The pre-period included the 4 months of national lockdown from 24 March 2020 to 22 July 2020 (Chaitra 2076 to Ashar 2077). Models included month and palika fixed effects and controlled for COVID-19 incidence. RESULTS: We found that lifting COVID-19 restrictions was associated with an average increase per palika of 57.5 contraceptive users (95% CI 14.6 to 100.5), 15.6 antenatal care visits (95% CI 5.3 to 25.9) and 1.6 child pneumonia visits (95% CI 0.2 to 2.9). This corresponded to a 9.4% increase in contraceptive users, 34.2% increase in antenatal care visits and 15.6% increase in child pneumonia visits. Utilisation of most other primary care services also increased after lifting restrictions, but coefficients were not statistically significant. CONCLUSIONS: Despite the ongoing pandemic, lifting restrictions can lead to an increase in some primary care services. Our results point to a causal link between restrictions and health service utilisation and call for policy makers in low- and middle-income countries to carefully consider the trade-offs of strict lockdowns during future COVID-19 waves or future pandemics. BMJ Publishing Group 2022-11-29 /pmc/articles/PMC9709811/ /pubmed/36446449 http://dx.doi.org/10.1136/bmjopen-2022-061849 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Health Services Research
Kapoor, Neena R
Aryal, Amit
Mehata, Suresh
Dulal, Mahesh
Kruk, Margaret E
Bauhoff, Sebastian
Arsenault, Catherine
Effect of lifting COVID-19 restrictions on utilisation of primary care services in Nepal: a difference-in-differences analysis
title Effect of lifting COVID-19 restrictions on utilisation of primary care services in Nepal: a difference-in-differences analysis
title_full Effect of lifting COVID-19 restrictions on utilisation of primary care services in Nepal: a difference-in-differences analysis
title_fullStr Effect of lifting COVID-19 restrictions on utilisation of primary care services in Nepal: a difference-in-differences analysis
title_full_unstemmed Effect of lifting COVID-19 restrictions on utilisation of primary care services in Nepal: a difference-in-differences analysis
title_short Effect of lifting COVID-19 restrictions on utilisation of primary care services in Nepal: a difference-in-differences analysis
title_sort effect of lifting covid-19 restrictions on utilisation of primary care services in nepal: a difference-in-differences analysis
topic Health Services Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9709811/
https://www.ncbi.nlm.nih.gov/pubmed/36446449
http://dx.doi.org/10.1136/bmjopen-2022-061849
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