{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T22:04:54Z","timestamp":1767650694148,"version":"3.40.5"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T00:00:00Z","timestamp":1639612800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>During the early COVID-19 pandemic travel in Uganda was tightly restricted which affected demand for and access to care for pregnant women and small and sick newborns. In this study we describe changes to neonatal outcomes in one rural central Ugandan newborn unit before and during the early phase of the COVID-19 pandemic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We report outcomes from admissions captured in an electronic dataset of a well-established newborn unit before (September 2019 to March 2020) and during the early COVID-19 period (April\u2013September 2020) as well as two seasonally matched periods one year prior. We report excess mortality as the percent change in mortality over what was expected based on seasonal trends.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Findings<\/jats:title>\n<jats:p>The study included 2,494 patients, 567 of whom were admitted during the early COVID-19 period. During the pandemic admissions decreased by 14%. Patients born outside the facility were older on admission than previously (median 1 day of age vs. admission on the day of birth). There was an increase in admissions with birth asphyxia (22% vs. 15% of patients). Mortality was higher during COVID-19 than previously [16% vs. 11%, p = 0.017]. Patients born outside the facility had a relative increase of 55% above seasonal expected mortality (21% vs. 14%, p = 0.028). During this period patients had decreased antenatal care, restricted transport and difficulty with expenses and support. The hospital had difficulty with maternity staffing and supplies. There was significant community and staff fear of COVID-19.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Interpretation<\/jats:title>\n<jats:p>Increased newborn mortality during the early COVID-19 pandemic at this facility was likely attributed to disruptions affecting maternal and newborn demand for, access to and quality of perinatal healthcare. Lockdown conditions and restrictions to public transit were significant barriers to maternal and newborn wellbeing, and require further focus by national and regional health officials.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0260006","type":"journal-article","created":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T18:48:27Z","timestamp":1639680507000},"page":"e0260006","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":23,"title":["Impact of the early COVID-19 pandemic on outcomes in a rural Ugandan neonatal unit: A retrospective cohort study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3269-1892","authenticated-orcid":true,"given":"Anna","family":"Hedstrom","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Mubiri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Nyonyintono","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josephine","family":"Nakakande","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brooke","family":"Magnusson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madeline","family":"Vaughan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Waiswa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maneesh","family":"Batra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,12,16]]},"reference":[{"article-title":"Pulse survey on continuity of essential helath services during the COVID-19 pandemic.","year":"2020","author":"World Health Organization","key":"pone.0260006.ref001"},{"issue":"1","key":"pone.0260006.ref002","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1016\/S2214-109X(20)30456-3","article-title":"Counting stillbirths and COVID 19\u2014there has never been a more urgent time","volume":"9","author":"CSE Homer","year":"2021","journal-title":"The Lancet Global Health"},{"issue":"6","key":"pone.0260006.ref003","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-002754","article-title":"Protecting hard-won gains for mothers and newborns in low-income and middle-income countries in the face of COVID-19: call for a service safety net.","volume":"5","author":"WJ Graham","year":"2020","journal-title":"BMJ Glob Health"},{"key":"pone.0260006.ref004","unstructured":"United Nations. The Sustainable Development Goals Report 2020. New York, New York: 2020."},{"key":"pone.0260006.ref005","unstructured":"World Health Organization. Every Newborn: An Action Plan to End Preventable Death 2014 [cited 2021 27 May]. Available from: https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/Every_Newborn_Action_Plan-ENGLISH_updated_July2014.pdf."},{"issue":"3","key":"pone.0260006.ref006","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.4269\/ajtmh.20-0546","article-title":"Predicting the Impact of COVID-19 and the Potential Impact of the Public Health Response on Disease Burden in Uganda","volume":"103","author":"D Bell","year":"2020","journal-title":"Am J Trop Med Hyg"},{"issue":"7","key":"pone.0260006.ref007","doi-asserted-by":"crossref","first-page":"e901","DOI":"10.1016\/S2214-109X(20)30229-1","article-title":"Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study","volume":"8","author":"T Roberton","year":"2020","journal-title":"The Lancet Global Health"},{"issue":"3","key":"pone.0260006.ref008","article-title":"Small and sick newborn care during the COVID-19 pandemic: global survey and thematic analysis of healthcare providers\u2019 voices and experiences","volume":"6","author":"SPN Rao","year":"2021","journal-title":"BMJ Glob Health"},{"volume-title":"Direct and Indirect impact of COVID-19 pandemic on children globally, and UNCEF mitigation strategies.","author":"L Pearson","key":"pone.0260006.ref009"},{"journal-title":"Vermont Oxford Network Section on Neonatal Perinatal Medicine","year":"2021","author":"COVID-19 Impact Audit","key":"pone.0260006.ref010"},{"key":"pone.0260006.ref011","article-title":"Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis.","author":"B Chmielewska","year":"2021","journal-title":"The Lancet Global Health"},{"key":"pone.0260006.ref012","article-title":"Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study.","author":"A Kc","year":"2020","journal-title":"The Lancet Global Health"},{"key":"pone.0260006.ref013","article-title":"Child health services during a COVID-19 outbreak in KwaZulu-Natal Province, South Africa","volume":"111","author":"C. Jensen","year":"2021","journal-title":"SAMJ Research"},{"key":"pone.0260006.ref014","doi-asserted-by":"crossref","first-page":"642508","DOI":"10.3389\/fped.2021.642508","article-title":"Decrease in Admissions and Change in the Diagnostic Landscape in a Newborn Care Unit in Northern Ghana During the COVID-19 Pandemic.","volume":"9","author":"A Abdul-Mumin","year":"2021","journal-title":"Front Pediatr"},{"volume-title":"Estimates developed by the United Nations Inter-Agency Group for Child Mortality","year":"2020","author":"UNICEF","key":"pone.0260006.ref015"},{"key":"pone.0260006.ref016","unstructured":"Uganda Demographic and Health Survey 2016. Kampala, Uganda: Uganda Bureau of Statistics, 2018."},{"key":"pone.0260006.ref017","unstructured":"Ugandan Ministry of Health. Timeline Kampala, Uganda: Republic of Uganda; 2020 [22.April.2021]. Available from: https:\/\/covid19.gou.go.ug\/timeline.html."},{"key":"pone.0260006.ref018","unstructured":"Ministry of Health Government of Uganda. Coronavirus (Pandemic) Covid-19 Kampala, Uganda 2021. Available from: https:\/\/www.health.go.ug\/covid\/."},{"key":"pone.0260006.ref019","unstructured":"Annual Health Sector Performance Report 2019\u20132020 FY. Kampala: 2020."},{"issue":"3","key":"pone.0260006.ref020","doi-asserted-by":"crossref","first-page":"e043773","DOI":"10.1136\/bmjopen-2020-043773","article-title":"Mixed-method study to assess the feasibility, acceptability and early effectiveness of the Hospital to Home programme for follow-up of high-risk newborns in a rural district of Central Uganda: a study protocol.","volume":"11","author":"D Kabugo","year":"2021","journal-title":"BMJ open"},{"volume-title":"The Republic of Uganda Ministry of Health Annual Health Sector Performance Report Financial Year 2019\u20132020","year":"2020","author":"The Republic of Uganda Ministry of Health","key":"pone.0260006.ref021"},{"volume-title":"Kiwoko hospital excursion inspires visiting midwives from Eastern Uganda","year":"2018","author":"KA Kirunda","key":"pone.0260006.ref022"},{"issue":"3","key":"pone.0260006.ref023","doi-asserted-by":"crossref","first-page":"437","DOI":"10.4187\/respcare.03438","article-title":"Implementation of Bubble CPAP in a Rural Ugandan Neonatal ICU.","volume":"60","author":"RM McAdams","year":"2015","journal-title":"Respir Care"},{"key":"pone.0260006.ref024","article-title":"Socioeconomic impact of Covid-19 in Uganda.","author":"Development Initiatives","year":"2020","journal-title":"How has the government allocated public expenditure for FY 2020\/21?"},{"key":"pone.0260006.ref025","article-title":"Civil society response to President Museveni\u2019s directive that pregnant women will no longer be banned from using transport to seek health services during COVID-19 lockdown.","author":"N Musisi","year":"2020","journal-title":"Health Gap Global Access Project"},{"key":"pone.0260006.ref026","article-title":"Gender and COVID-19 Control Measures in Uganda","author":"B. Atim Alupo","year":"2020","journal-title":"Australian Institute of International Affairs"},{"key":"pone.0260006.ref027","unstructured":"Epi Info version 7.1.4 [Internet]. Center for Disease Control,. 2014. Available from: https:\/\/www.cdc.gov\/epiinfo\/index.html."},{"key":"pone.0260006.ref028","unstructured":"STATA. version 15 ed2017."},{"issue":"1","key":"pone.0260006.ref029","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1186\/s12889-021-10532-2","article-title":"Violence and discrimination among Ugandan residents during the COVID-19 lockdown.","volume":"21","author":"E Katana","year":"2021","journal-title":"BMC public health"},{"key":"pone.0260006.ref030","unstructured":"Felix K. Makerere University Centre of Excellence for Maternal Newborn and Child Health, editor2020. Available from: https:\/\/www.mnh.musph.ac.ug\/blog\/coping-with-provision-of-maternal-newborn-health-care-during-covid-19-lockdown-in-rural-uganda\/."},{"key":"pone.0260006.ref031","unstructured":"Hivos People Unlimited, Akina Mama wa Afrika. The state of social protection in Uganda in reseponse to Covid-19. 2020."},{"article-title":"Indirect Effects of COVID-19 on Maternal, Neonatal, Child, Sexual and Reproductive Health Services in Kampala, Uganda.","year":"2021","author":"JF Burt","key":"pone.0260006.ref032"},{"key":"pone.0260006.ref033","unstructured":"Antenatal visits, deliveries drop in health facilities in Teso. The Independent. 2020 14 May 2020."},{"issue":"3","key":"pone.0260006.ref034","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1002\/ijgo.13487","article-title":"COVID-19 is increasing Ghanaian pregnant women\u2019s anxiety and reducing healthcare seeking","volume":"152","author":"CA Moyer","year":"2021","journal-title":"International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics"},{"key":"pone.0260006.ref035","article-title":"The perfect storm: Disruptions to institutional delivery care arising from the COVID-19 pandemic in Nepal.","author":"K Ashish","year":"2021","journal-title":"Journal of Global Health"},{"issue":"3","key":"pone.0260006.ref036","doi-asserted-by":"crossref","first-page":"e000065","DOI":"10.1136\/bmjgh-2016-000065","article-title":"\u2019Women and babies are dying but not of Ebola\u2019: the effect of the Ebola virus epidemic on the availability, uptake and outcomes of maternal and newborn health services in Sierra Leone.","volume":"1","author":"SA Jones","year":"2016","journal-title":"BMJ Glob Health"},{"issue":"7","key":"pone.0260006.ref037","doi-asserted-by":"crossref","first-page":"e901","DOI":"10.1016\/S2214-109X(20)30229-1","article-title":"Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study.","volume":"8","author":"T Roberton","year":"2020","journal-title":"Lancet Glob Health"},{"volume-title":"Rampant Absenteeism and Unsatisfactory Attendance to Duty by Health Workers","year":"2020","author":"D. Atwine","key":"pone.0260006.ref038"},{"key":"pone.0260006.ref039","article-title":"Early indirect impact of COVID-19 pandemic on utilization and outcomes of reproductive, maternal, newborn, child and adolescent health services in Kenya.","author":"D Shikuku","year":"2020","journal-title":"pre-print"},{"issue":"5","key":"pone.0260006.ref040","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1038\/s41372-021-01019-4","article-title":"COVID-19 preparedness-a survey among neonatal care providers in low- and middle-income countries.","volume":"41","author":"C Klingenberg","year":"2021","journal-title":"Journal of perinatology: official journal of the California Perinatal Association"},{"key":"pone.0260006.ref041","article-title":"Indirect impacts of the COVID-19 pandemic at two tertiary neonatal units in Zimbabwe and Malawi: an interrupted time series analysis.","author":"S Chimhuya","year":"2021","journal-title":"pre-print"},{"issue":"2","key":"pone.0260006.ref042","doi-asserted-by":"crossref","first-page":"114","DOI":"10.7196\/SAMJ.2021.v111i2.15243","article-title":"Child health services during a COVID-19 outbreak in KwaZulu-Natal Province, South Africa","volume":"111","author":"C Jensen","year":"2020","journal-title":"S Afr Med J"},{"key":"pone.0260006.ref043","first-page":"5","article-title":"Childhood immunisations in India during the COVID-19 pandemic","author":"A Shet","year":"2021","journal-title":"BMJ Paediatrics Open"},{"key":"pone.0260006.ref044","first-page":"100733","article-title":"Preterm care during the COVID-19 pandemic: A comparative risk analysis of neonatal deaths averted by kangaroo mother care versus mortality due to SARS-CoV-2 infection.","author":"N Minckas","year":"2021","journal-title":"EClinicalMedicinePubMed Central PMCID"},{"journal-title":"Too far to walk: maternal mortality in context","year":"1994","author":"Thaddeus","key":"pone.0260006.ref045"},{"issue":"10281","key":"pone.0260006.ref046","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1016\/S0140-6736(21)00632-2","article-title":"The first and second waves of the COVID-19 pandemic in Africa: a cross-sectional study","volume":"397","author":"SJ Salyer","year":"2021","journal-title":"The Lancet"},{"issue":"6","key":"pone.0260006.ref047","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-002967","article-title":"Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic","volume":"5","author":"A Semaan","year":"2020","journal-title":"BMJ Glob Health"},{"volume-title":"A module from the suite of health service capacity assessments in the context of the COVID-19 pandemic.","year":"2020","author":"Continuity of essential health services: Facility assessment tool","key":"pone.0260006.ref048"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0260006","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T18:49:10Z","timestamp":1639680550000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0260006"}},"subtitle":[],"editor":[{"given":"Robert Jeenchen","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,12,16]]},"references-count":48,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0260006","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2021,12,16]]}}}