{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:10:21Z","timestamp":1787166621448,"version":"build-2736575974"},"reference-count":35,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2022,6,3]],"date-time":"2022-06-03T00:00:00Z","timestamp":1654214400000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"The Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["INV-006752 HaSET and INV-003612 ANC\/PNC Innovation"],"award-info":[{"award-number":["INV-006752 HaSET and INV-003612 ANC\/PNC Innovation"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,5,9]]},"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Health systems are often weakened by public health emergencies that make it harder to access health services. We aimed to assess maternal, newborn and child health (MNCH) service utilisation during the first 6\u2009months of the COVID-19 pandemic compared with prior to the pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a mixed study design in eight health facilities that are part of the Birhan field site in Amhara, Ethiopia and compared the trend of service utilisation in the first 6\u2009months of COVID-19 with the corresponding time and data points of the preceding year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>New family planning visits (43.2 to 28.5\/month, p=0.014) and sick under 5 child visits (225.0 to 139.8\/month, p=0.007) declined over the first 6\u2009months of the pandemic compared with the same period in the preceding year. Antenatal (208.9 to 181.7\/month, p=0.433) and postnatal care (26.6 to 19.8\/month, p=0.155) visits, facility delivery rates (90.7 to 84.2\/month, p=0.776), and family planning visits (313.3 to 273.4\/month, p=0.415) declined, although this did not reach statistical significance. Routine immunisation visits (37.0 to 36.8\/month, p=0.982) for children were maintained. Interviews with healthcare providers and clients highlighted several barriers to service utilisation during COVID-19, including fear of disease transmission, economic hardship, and transport service disruptions and restrictions. Enablers of service utilisation included communities\u2019 decreased fear of COVID-19 and awareness-raising activities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We observed a decline in essential MNCH services particularly in sick children and new family planning visits. To improve the resiliency of fragile health systems, resources are needed to continuously monitor service utilisation and clients\u2019 evolving concerns during public health emergencies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-059408","type":"journal-article","created":{"date-parts":[[2022,6,3]],"date-time":"2022-06-03T11:40:03Z","timestamp":1654256403000},"page":"e059408","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Impact of the COVID-19 pandemic on utilisation of facility-based essential maternal and child health services from March to August 2020 compared with pre-pandemic March\u2013August 2019: a mixed-methods study in North Shewa Zone, Ethiopia"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0348-7566","authenticated-orcid":false,"given":"Chalachew","family":"Bekele","sequence":"first","affiliation":[{"name":"HaSET MNCH Research Program, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delayehu","family":"Bekele","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bezawit Mesfin","family":"Hunegnaw","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimiko","family":"Van Wickle","sequence":"additional","affiliation":[{"name":"Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanos Ashenafi","family":"Gebremeskel","sequence":"additional","affiliation":[{"name":"Birhan HDSS, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Korte","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Tedijanto","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisanu","family":"Taddesse","sequence":"additional","affiliation":[{"name":"Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2716-1643","authenticated-orcid":false,"given":"Grace J","family":"Chan","sequence":"additional","affiliation":[{"name":"Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA"},{"name":"Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,6,3]]},"reference":[{"key":"2025101811160539000_12.6.e059408.1","unstructured":"World Organization H . 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