Factors Influencing Utilization of Healthcare Services During Covid-19 Pandemic Among Pregnant Women and Caregivers With Children Under Two Years in Rongo Subcounty, Migori County, Kenya

Abstract

Health systems have failed in past epidemics to maintain routine essential services in health. People, resources, and essential supplies all diverted to address health emergency, sometimes resulting in lack of important basic and routine health services. Pregnant women are at an increased risk for severe illness, preterm birth and other adverse pregnancy outcomes from COVID-19 compared to non-pregnant women. During emergency cases, disintegration of health care services can have a profound effect as hospitals become strained or non-functional. Thus an outbreak of infectious disease can catalyze further health problems in a community as populations lose confidence in the available health facilities and significantly reduce usage of the healthcare system. The purpose of this study was to determine factors that influenced utilization of healthcare services among pregnant women and caregivers with children below two years during COVID-19 pandemic. This was a retrospective cross-sectional study with mixed data collection methods, where respondents were asked questions on how COVID-19 affected them with regard to utilization of MCH healthcare during the first peak of the COVID-19 in Kenya. Two high volume facilities were selected purposively based on volume and capacity of services offered. A random sample was drawn from the stratum using a list generated by Community Health Workers attached to the health facilities.Key informant interviews were used to collect data among health care providers and structured questionnaire was used for pregnant women and caregivers. Chi-square test was used to test for significance at p-value 0.05. Independent variables; social distancing, social stigma, communication and human mobility restriction were associated with health care service utilization and significant at 0.05 p-value. Correlation analysis indicated Social stigma (-.407, p<.512), social distancing (-.324, p<.001) and human mobility restrictions (-.606, p<.001) negatively influenced service utilization. Whereas COVID-19 related communication (.631, p<0.001) was protective and thus promoted service utilization. The hierarchical linear regression model explained 67.73% of the total variations in the health care service utilization, which is r = 0.6773. The study recommends that Migori County Department of Health should i) to develop risk communication plan to sensitize the community against stigma ii) use main media channels and develop measures against fake news, iii) Strengthening targeted community outreaches for pregnant women and caregivers with children under two years iv) develop referral networks and transportation mechanisms to improve facility-community connections during lockdown and past curfew hours.