AFJOG

African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | 31 ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | The impact of the Covid -19 pandemic on Obstetric care in a resource limited setting: A 12- month retrospective chart review „  €    ‚…†‡ … ˆ †‡ Variableswith Significant Differences in Proportions There was an increase in proportion of unemployed women (p=0.03), neonatal birthweight of 2501-3999g (p<0.001), and neonates who were not admitted to NICU (p<0.001) during the pandemic. However, there was a decrease in the proportion of women who had 5 or more routine antenatal visits (p=0.05), caesarean sections (p=0.03), stillbirths (p=0.05), neonates with NICU admission (p=0.004), cardiac comorbidities (p=0.05) and diabetic comorbidities (p=0.04) during the pandemic. (Figure 2). Figure 2: Variables with significant differences in proportions when comparing maternal and neonatal outcomes of those attending Grey's Hospital before (1 March 2019 – 29 February 2020) and during (1 March 2020 – 28 February 2021) the COVID-19 pandemic DISCUSSION: Our study highlighted a reduction in booked patients, as well as women attending 5 or more routine antenatal visits during the pandemic. Other studies carried out in similar settings had similar findings 4-6 . In a Jordanian study, the proportion of women not receiving antenatal care before the pandemic as compared to during the pandemic increased from 4.0% to 59.2% 7 . Similarly a study conducted in the United Kingdom (UK) found a substantial decline in antenatal appointments of 70.4%8, while an Indian study found that 206 (32.5%) of pregnant women had attended fewer antenatal visits than advised 9 . This decline in ANC booking and attendance may have been as a result of fear of patients contracting COVID-19 at the hospital and thus opting to rather wait at home until labour or to deliver at home. 9 Fear of contravening social policies such as lockdowns 10 , the lack of financial resources and transportation to attend antenatal care resulting from the economic impacts of the pandemic 10 , facility barriers 5 , as well as simply being ignorant about antenatal care could also have contributed 9 . There was an increase in the proportion of unemployed women in our study population during the pandemic, which is in keeping with findings from other literature. The Jordanian study found that the proportion of employed women before versus during Covid-19 dropped by 22.6% (from 38.6% to 16% respectively) 7 . Similarly a study in the United States (USA) conducted on women of child-bearing age found that the rate of unemployment in women not looking for work tripled from 3% to 9%, while those women who were unemployed and looking for work quadrupled from 4% to 17%; during the pandemic 11 . These findings are expected as COVID-19 caused a significant drop in overall economic activity ultimately resulting in economic recession. This was mainly due to the reduction in demand of non-essential services delivered to in-person customers, a decline in personal consumption as individuals feared contracting COVID-19, and the implementation of social policies such as shutting down of non-essential businesses as well as stay-at-home orders.10 Implementation of social policies was most likely the greatest contributor of unemployment, as findings from South Africa show that women tend to be employed as unskilled labour which was the greatest affected during the pandemic 12 . Our study found that the proportion of women who delivered through caesarean delivery was lower during the pandemic than before. This could be attributed to the fact that the neonatal birthweights were mostly within normal ranges, since the evidence suggests that the rate of caesarean deliveries increases with small and large newborns13. Additionally, the observed decrease in cardiac and diabetic comorbidities in our study population meant that the proportion of high-risk pregnancies subsequently decreased, hence a decrease in the need for caesarean deliveries 14 . There was a 6.5% increase in stillbirths during the pandemic , and significantly fewer NICU admissions. However, a greater proportion of neonates weighed between 2501-3999g at birth. Similarly, a retrospective study conducted in Isreal found that there were more stillbirths during Covid-19 (n=6, 0.4%) than before (n=5, 0.1%), p=0.037015. Furthermore, analysis of data from the South African District Health Information System (DHIS) showed that there was a significant increase in national stillbirths (p<0.00001)16. Unlike our findings, a study conducted in Malawi found a decrease in the number of stillbirths from 13% in the second and third waves of the pandemic, to 0% in the fourth wave of the pandemic 17 , and further studies conducted in Israel found that there were no differences in stillbirths, NICU admissions and birthweights when comparing the two time periods 18, 19 . Although not statistically significant, a 6.5% increase in stillbirths is alarming, and may be explained by the decline in attendance of five or more routine ANC visits. A Kenyan study found that pregnant women who attended five or more ANC visits, although not significant, were associated with a 40% lower likelihood of experiencing stillbirths 20 . This is because adherence to routine ANC appointments increases the chances and quality of detecting and subsequently managing pregnancy risks and concurrent illnesses 21, 22 thus resulting in improved odds of delivering healthy neonates 22 . The fewer NICU admissions may be attributed to the increase in stillbirths as well as the increase in birthweights ranging between 2501-3999g. Figure 2 : Variables with significant differences in proportions when comparing maternal an neonatal outcomes of those attending Grey's Hospital before (1 March 2019 – 29 February 2020) and during (1 March 2020 – 28 February 2021) the COVID- 19 pandemic Discussion Our study highlighted a reduction in booked patients, as well as women attending 5 or more routine a tenatal visits during the pandemic. Other studies c rrie out sim lar settings had similar findings 4-6 . In a Jordanian study, the proportion of women not receiving antenatal care before the pandemic as compared to during the pandemic increased from 4.0% to 59.2% 7 . Similarly a study conducted in the United Kingdom (UK) found a substantial declin in antenat l appointments of 70.4% 8 , while an Indian study found that 206 (32.5%) of pregnant women had attended fewer antenatal visits than advised 9 . 78,8 74,6 81,4 93,9 40,9 37,5 62,5 25,9 27,6 83,1 70,1 76,9 91,6 52,4 27 73 7,1 9,4 0 10 20 30 40 50 60 70 80 90 100 Occupation (Unemployed) Routine Visits (≥5) Caesarean section (Yes) Stillbirth (No) Birthweight (2501-3999g) NICU Admission (Yes) NICU Admission (No) Cardiac (Yes) Diabetes (Yes) Percentage (%) Outcomes of Interest Pre-Covid Peri-Covid