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dc.contributor.authorSevalie, Stephen
dc.contributor.authorYoukee, Daniel
dc.contributor.authorvan Duinen, Aalke Johan
dc.contributor.authorBailey, Emma
dc.contributor.authorBangura, Thaimu
dc.contributor.authorMangipudi, Sowmya
dc.contributor.authorMansaray, Esther
dc.contributor.authorOdland, Maria Lisa
dc.contributor.authorParmar, Divya
dc.contributor.authorSamura, Sorie
dc.contributor.authorVan Delft, Diede
dc.contributor.authorWurie, Haja
dc.contributor.authorDavies, Justine I
dc.contributor.authorBolkan, Håkon Angell
dc.contributor.authorLeather, Andy J.M.
dc.date.accessioned2021-11-09T09:22:01Z
dc.date.available2021-11-09T09:22:01Z
dc.date.created2021-11-02T23:08:30Z
dc.date.issued2021
dc.identifier.citationBMJ Global Health. 2021, 6 (10), 1-11.en_US
dc.identifier.issn2059-7908
dc.identifier.urihttps://hdl.handle.net/11250/2828597
dc.description.abstractIntroduction The COVID-19 pandemic has adversely affected health systems in many countries, but little is known about effects on health systems in sub-Saharan Africa. This study examines the effects of COVID-19 on hospital utilisation in a sub-Saharan country, Sierra Leone. Methods Mixed-methods study using longitudinal nationwide hospital data (admissions, operations, deliveries and referrals) and qualitative interviews with healthcare workers and patients. Hospital data were compared across quarters (Q) in 2020, with day 1 of Q2 representing the start of the pandemic in Sierra Leone. Admissions are reported in total and disaggregated by sex, service (surgical, medical, maternity and paediatric) and hospital type (government or private non-profit). Referrals in 2020 were compared with 2019 to assess whether any changes were the result of seasonality. Comparisons were performed using Student’s t-test. Qualitative data were analysed using thematic analysis. Results From Q1 to Q2, weekly mean hospital admissions decreased by 14.7% (p=0.005). Larger decreases were seen in male 18.8% than female 12.5% admissions. The largest decreases were in surgical admissions, a 49.8% decrease (p<0.001) and medical admissions, a 28.7% decrease (p=0.002). Paediatric and maternity admissions did not significantly change. Total operations decreased by 13.9% (p<0.001), while caesarean sections and facility-based deliveries showed significant increases: 12.7% (p=0.014) and 7.5% (p=0.03), respectively. In Q3, total admissions remained 13.2% lower (p<0.001) than Q1. Mean weekly referrals were lower in Q2 and Q3 of 2020 compared with 2019, suggesting findings were unlikely to be seasonal. Qualitative analysis identified both supply-side factors, prioritisation of essential services, introduction of COVID-19 services and pausing elective care, and demand-side factors, fear of nosocomial infection and financial hardship. Conclusion The study demonstrated a decrease in hospital utilisation during COVID-19, the decrease is less than reported in other countries during COVID-19 and less than reported during the Ebola epidemic. Data availability statement Data are available on reasonable request. Data are available on reasonable request submitted to the corresponding author, subject to academic review and acceptance of a data-sharing agreement.en_US
dc.language.isoengen_US
dc.publisherBMJ Publishing Groupen_US
dc.rightsNavngivelse-Ikkekommersiell 4.0 Internasjonal*
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/deed.no*
dc.titleThe impact of the COVID-19 pandemic on hospital utilisation in Sierra Leoneen_US
dc.typePeer revieweden_US
dc.typeJournal articleen_US
dc.description.versionpublishedVersionen_US
dc.source.pagenumber1-11en_US
dc.source.volume6en_US
dc.source.journalBMJ Global Healthen_US
dc.source.issue10en_US
dc.identifier.doi10.1136/bmjgh-2021-005988
dc.identifier.cristin1950805
cristin.ispublishedtrue
cristin.fulltextoriginal
cristin.qualitycode1


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Navngivelse-Ikkekommersiell 4.0 Internasjonal
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