{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:39:31Z","timestamp":1792172371656,"version":"4.4.0"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T00:00:00Z","timestamp":1684800000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wyss Medical Foundation"}],"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>There is a dearth of studies assessing the effects of SARS-CoV-2 on the healthcare system and access to care, especially in lower- and middle-income countries such as Malawi. We aimed to assess the impacts of COVID-19 on reported maternal and neonatal complications as well as potential changes in maternal care access to care among five primary care health facilities in Blantyre, Malawi.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This retrospective cohort study assessed maternal and neonatal register data from five participating health centers in Blantyre, Malawi using the Malawi District Health Information Software 2 (DHIS2) to compare outcomes from 15 months before COVID-19 emerged, defined as the pre-Covid period (January 2019 \u2013March 2020) with nine months after COVID-19 (April 2020 \u2013December 2020).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>There was a significant decrease in reported use of vacuum extraction, which went from &lt;0.01%in the pre-COVID period to 0% in the COVID period (p = 0.01). The proportion of births reporting fetal distress almost tripled from 0.46% to 1.36% (p = 0.001) during the COVID-19 period. Additionally, reported anticonvulsant use significantly increased from 0.01% to 1.2% (p&lt;0.01), and antibiotic use significantly increased from 0.45% to 1.6% (p = 0.01). Asphyxia was the only significant neonatal complication variable reported, increasing from 2.80% to 3.45% (p = 0.01).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Our findings suggest that significant outcomes were mainly due to the indirect effects of COVID-19 rather than the virus itself. Based on our findings and the contextual qualitative interviews with two Malawian expert midwives, we concluded that mothers may have been affected more due to understaffing and shortage of skilled personnel in the study health facilities. Therefore, the development of highly skilled health workers may contribute to better outcomes, along with adequate staffing and a streamlined referral process.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0285847","type":"journal-article","created":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T18:16:32Z","timestamp":1684865792000},"page":"e0285847","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Exploring the impact of COVID-19 on reported maternal and neonatal complications and access to maternal health care in five government health facilities in Blantyre, Malawi"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3901-3656","authenticated-orcid":true,"given":"Alden","family":"Blair","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winta","family":"Haile","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5218-9234","authenticated-orcid":true,"given":"Anna","family":"Muller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luseshelo","family":"Simwinga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Malirakwenda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Baltzell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,5,23]]},"reference":[{"key":"pone.0285847.ref001","volume-title":"OECD Economic Outlook, Volume 2020 Issue 1: Evaluating the impact of COVID-19 containment measures on activity and spending [Internet]","author":"OECD","year":"2020"},{"key":"pone.0285847.ref002","author":"Global Citizen","year":"2020","journal-title":"Pregnant Women in Rural Kenya Are Struggling to Access Health Care Amid COVID-19 [Internet]."},{"issue":"1","key":"pone.0285847.ref003","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1186\/s12913-021-07377-1","article-title":"Effects of the Covid-19 pandemic on maternity staff in 2020\u2014a scoping review.","volume":"21","author":"N Schmitt","year":"2021","journal-title":"BMC Health Serv Res."},{"key":"pone.0285847.ref004","volume-title":"Vol. 25, European Journal of Medical Research.","author":"K Diriba","year":"2020"},{"issue":"15","key":"pone.0285847.ref005","doi-asserted-by":"crossref","first-page":"9517","DOI":"10.3390\/ijerph19159517","article-title":"SARS-CoV-2 Infection in Pregnancy: Placental Histomorphological Patterns, Disease Severity and Perinatal Outcomes.","volume":"19","author":"YP Wong","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"9","key":"pone.0285847.ref006","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1097\/HJH.0000000000003213","article-title":"Preeclampsia and severe acute respiratory syndrome coronavirus 2 infection: a systematic review","volume":"40","author":"G Tossetta","year":"2022","journal-title":"J Hypertens"},{"issue":"10","key":"pone.0285847.ref007","doi-asserted-by":"crossref","first-page":"e1273","DOI":"10.1016\/S2214-109X(20)30345-4","article-title":"Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study","volume":"8","author":"A KC","year":"2020","journal-title":"Lancet Glob Health"},{"key":"pone.0285847.ref008","article-title":"Nepal sees huge rise in maternal deaths as Covid keeps women at home.","author":"R. 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