Table 1 Details of eligible studies

Abdisa D.K., Jaleta D.D., Feyisa J.W., et al., 2022. Ethiopia [21]

Assess the magnitude of delays in maternal health service utilization and its associated factors among pregnant women in the Ilubabor zone during the COVID-19 pandemic

Facility-based cross-sectional study

February–April 2021

402 pregnant women

Remarkable section of women experienced delays in seeking care with various factors, yet these delays were not related to pandemic fears.

Akaba G., Dirisu O., Okunade K., et al. 2022 Nigeria [22]

Explore the barriers and facilitators of access to MNCH services during the first wave of covid-19 pandemic in Nigeria

Qualitative

May–July 2020

54 study participants (service users, service providers and policymakers,)

Lack of PPE, shortage of manpower, long waiting times at the hospitals, prioritization of essential services, and lack of preparedness by health workers, were barriers to accessing MNCH services during the first wave of COVID-19. Enablers to access: COVID-19 preventive measures, community sensitization, and alternative strategies for administering immunization service at the clinics.

Asuming P.O., Gaisie D.A., Agula C., et al.,2022. Ghana [23]

Estimate the impact of Covid-19 on delivery of maternal health services using ANC attendance and delivery at health facilities as outcomes

Survey

September–November 2020

288 women (15–49 years)

Pandemic resulted in 23 and 25% reductions on facility and skilled delivery and uptake of antenatal care services respectively among women who were pregnant/ delivered before and during the pandemic period

Ateva E. 2020. Kenya [16]

Impact of COVID-19 on reproductive, maternal, and new-born health services.

Qualitative methods

April 17–May 14, 2020?

325 adolescent girls, single mothers, women, men, people living with disability, community health workers, and local administration officials.

Socioeconomic impact of the pandemic affected women/girls with reported incidences of sexual and gender-based violence, difficulties accessing health facilities and disrupted economic activities. Lack of transportation, verbal and physical harassment from law enforcing agencies when accessing health facilities.

Atim M.G., Kajogoo V.D., Amare D., et al., 2021. Uganda [24]

Identify impacts of COVID-19 on RMNCH indicators and outcomes of the HSDP in Uganda

Descriptive quantitative study

March 2020–May 2021

Government portals and review of relevant articles

3% declined in facility-based deliveries; 7.6% increase in maternal mortality. Antenatal, sexual, and reproductive health, emergency and obstetric, and postnatal care services all affected.

Balogun M., Banke-Thomas A., Sekoni A., et al., 2021. Nigeria [25]

Assess the challenges faced by women who used RMNCH services in Nigeria’s epicentre, their satisfaction with care received during the COVID-19 pandemic and the factors associated with their satisfaction.

Cross-sectional survey

September 16, 2020-October 12 2020

1241 women of reproductive age

Lockdowns and lack of transportation were barriers to accessing MHC services. Satisfaction scores for the interpersonal aspects of care were significantly lower in the PHCs and general hospitals compared to teaching hospitals.

Banke-Thomas A.,2022 Sub-Saharan Africa (Guinea, Nigeria, Tanzania, Uganda) [26]

Effect of COVID on MHC utilization in 4 sub-Saharan countries tertiary referral centres

Mixed methods

Quantitative: Mar 2019-Feb 2021. Qualitative: Semi-structured interviews July 2020-Feb 2021. Timeline data of COVID-19 epidemiology, national and hospital-level events

6 referral hospitals, 22 skill health personnel, WHO COVID-19 timeline cases

Identified 3 periods: first wave, slow wave, and second wave. MHC use lower than pre-pandemic in ¾ countries particularly 1st and 2nd wave but stable or higher than pre-pandemic during ‘slow wave’. Decreased use due to fear of infection, lack or high cost of transportation, and service closure.

Bekele C., Bekele D., Hunegnaw B.M., et al., 2022. Ethiopia [8]

Assess MNCH utilization during the first six months of the COVID-19 pandemic, as well as potential barriers and enablers of service utilization from health care providers and clients.

Mixed study design. Compared 1st 6 months pandemic to same period in prior year.

Qualitative; 2–20 November 2020. Quantitative; March 2019 to August 2020

8 health facilities (three hospitals and five health centres and interviews with 103 healthcare providers working in the MNCH units of the facilities. In addition to these, ten facility or MNCH department heads and nine women (pregnant and delivered in the time of COVID-19)

Service utilization of new family planning visits (43.2 to 28.5/month, p = 0.014) and sick under five child visits (225.0 to 139.8/month, P = 007) declined. Antenatal and postnatal care visits, facility delivery rates, and child routine immunization visits also decreased although this did not reach statistical significance. Interviews with health care providers and clients highlighted barriers to service utilization: fear of disease transmission, economic hardship, and transport service disruptions and restrictions

Bikwa Y., Murewanhema G., Kanyangarara M., et al., 2021. Zimbabwe [27]

Determine the impact of the lockdown on MCH outcomes at 2 tertiary hospitals in Harare, Zimbabwe. 2. Estimate changes in MCH interventions due to COVID on maternal, and neonatal mortality in Zimbabwe using the Lives Saved Tool (LiST)

Cross-sectional study. Retrospective study of secondary data

March–August 2020

19,835 hospital deliveries

There was diminution in the uptake of maternal health services and surged risk of dreadful maternal consequences during the lockdown

Burt J., Ouma J., Amone A., et al. 2021. Uganda [28].

Hypothesised that the early, strict lockdown which severely limited the movements of individuals in Uganda will have impacted access to services.

Observational study (quantitative)

July 2019–December 2020, July 2019–March 2020, April 2020–June 2020, July 2020–December 2020

Pregnant women

Sharp decrease in ANC attendance which remained at low level pre-covid with increased in pregnancy related problems such haemorrhage, and caesarean section

Carter ED, Zimmerman L, Qian J, et.al., 2022. Ethiopia [9]

To assess changes in RMNH intervention coverage before and during the COVID-19 pandemic using Performance Monitoring for Action Ethiopia longitudinal data

panel survey data

October and November 2019

Performance Monitoring for Action (PMA) survey

little disruption of RMNH services in Ethiopia in the initial months of the pandemic. There were no significant reductions in women seeking health services. Significant reductions in coverage of BCG vaccination observed in the COVID-19 affected cohort.

Enbiale W., Abdela S.G., Seyum M., et al., 2021 Ethiopia [29]

Assess effect of preventive COVID-19 measures on essential healthcare services in selected health facilities of Ethiopia

Comparative cross-sectional study

July 7, 2019, to July 6, 2020

Medical records of the visitors of health facilities. Data were retrieved from Health Management Information Systems

Institutional delivery, childhood immunization, antenatal care, did not vary significantly between pre-COVID-19 and during COVID-19.

Galle A., Kavira G., Semaan A., et al., 2022. DR. Congo [30].

MHC utilisation along the continuum during the COVID-19 pandemic in the Democratic Republic of the Congo, and factors associated with use of the full continuum

Cross-sectional survey

March 2020–May 2021

604 women (15–49 years) who were pregnant

Of the women who gave birth during the COVID-19 pandemic, 61% had ANC 4+ consultations, most had a skilled birth attendant (97%), and more than half (55%) had a PNC check for themselves and the newborn. One-third (36%) of women completed the continuum of maternal healthcare. Reasons for not seeking maternal care included lack of money and avoiding COVID-19 vaccination

Gebreegziabher, S.B., Marrye, S.S., Kumssa T.H., et al., 2022. Ethiopia [10]

To assess trends in selected maternal and child health services performance in the context of COVID-19 pandemic

cross-sectional data review

July 2019 to March 2021

95 government health centres, 56 public hospitals and 66 private health care facilities

Postnatal care visit, new contraceptives accepters, safe abortion care (M 87HC) and pentavalent-3 vaccination significantly decreased by 9.3%, 20.3%, 23.7 and 77.2% respectively during the first 8 months of the COVID-19 pandemic compared to the previous 8 months’ average performance.

Hailemariam S., Agegnehu W., and Derese M., 2021. Ethiopia [31]

COVID-19 related factors influencing antenatal care service uptake in rural Ethiopia

Community-based qualitative study

September 25–November 25 2020

44 pregnant women, and 9 healthcare providers

COVID-19 preventive measures, health facility related factors and individual factors were the primary cause for the decline in antenatal care service.

Kassie A., Wale A., Worke Y W., 2021. Ethiopia [11].

Evaluate indirect impact of COVID-19 on the utilization RMNCH services at government health facilities in Southwest Ethiopia, and its consequences.

comparative cross-sectional study

March–June 2019. March–June 2020

Reviewing hospital and health centres’ records

Significant reduction in mean ANC visits (943.25 vs 694.75), health facility birth (808.75 vs 619), family planning visits (4744.5 vs 3991.25), and newborn immunization (739.5 vs 528.5). In the same period rise in institutional stillbirth (14% vs 21.8%) and neonatal death (33.1% vs 46.2%).

Landrian A., Mboya J., Golub G., et al., 2022. Kenya [32].

Assess the effects of COVID-19 (ANC utilisation in Kenya and women’s reports of COVID-related barriers to ANC and correlates at the individual and household levels.

Interrupted time series design

September 2019–January 2020

1729 women, including 1189 women who delivered in healthcare facilities before the COVID-19 pandemic (from September 2019–January 2020) and 540 women who delivered during the pandemic (from July through November 2020)

Women delivering during COVID had significantly higher odds of delayed ANC initiation. Nearly half (n = 255/540; 47%) who delivered during COVID-19 reported that the pandemic affected their ability to access ANC

Laouan F. 2020. West Africa [33]

Effect of lockdowns on reduced income and access to basic needs esp. on women, and increased gender-based violence.

Qualitative

April 6 to 23, 2020

226 people across 12 countries

Women are struggling to access health services. Women confirm that governments and health clinics have diverted energy and attention away from Sexual Reproductive and Health and Rights (SRHR) services

Mongbo Y., Sombié I., Dao B., et al. 2021. Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, Togo [34]

Analyse the challenges and solutions for maintaining the Continuity of essential health services during the COVID-19 pandemic in Francophone West Africa.

Cross-sectional study

April 2020

18 managers of Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) and vaccination programmes

Challenges in maintaining the continuity of essential health services during the COVID were organisational, and staff related factors. Ineffective service organisation with limited equipment, and lack of standardised procedures and guidelines for diagnosing and managing coronavirus. Limited healthcare worker knowledge of COVID-19, led to postponement of vaccination programme.

Nwafor J.I., Aniukwu J.., Anozie B.O., et al., 2020. Nigeria [35]

Determine knowledge and practice of preventive measures to protect against the virus causing COVID-19 among pregnant women attending prenatal care.

Cross sectional

February–March 2020

284 Pregnant women

Although most of the study participants had adequate knowledge of the preventive measures, the level of practice of these measures remained poor.

Nwafor J.I., Okedo-Alex I.N., Ikeotuonye A.C., 2021. Nigeria [36]

Determine the prevalence and predictors of COVID-19-related depression, anxiety, and stress symptoms among pregnant women

Cross-sectional study

March 1–July 31, 2020

456 pregnant women

7.2 and 6.4% of women experienced severe and extremely severe depression respectively. 3.3 and 7.7% of participants had severe and extremely severe anxiety, respectively. Overall, 23% women had severe stress compared to 16.7% extremely severe stress.

Oladeji O., Oladeji B., Farah A.E., et al., 2020. Ethiopia [37]

Assess effect of the pandemic on the utilization of MNCH health services.

Quantitative retrospective chart review

January–March 2020, April–June 2020.

Population of 1,250,069, 127 health posts, 27 health centres and 1 regional and 1 referral hospital.

ANC visits pre-pandemic 4087.75 vs intra-pandemic 3497.75. Skilled birth attendant pre-COVID 1440.12 and intra-COVID 1131.75. Decline in both ANC and skilled birth attendant before and during the pandemic was 14.43 and 21.4% respectively.

Oluoch-Aridi J., Chelagat T., Nyikuri M.M., et al., 2020. Kenya [38]

Effects of the COVID-19 pandemic and mitigation strategies on access to health care services in informal settlements.

Qualitative methods

May–June 2020

71 women

Increase awareness of the symptoms and preventative measures for COVID-19 among women in informal settlements. Economic constraints, fear of contracting COVID among others, compounded by imposed lockdown and curfew resulted to reduced access to care. Advances in quality of care due to short-waiting times, hygiene measures, and responsive health personnel at the out-patient department were reported by most respondents.

Ombere S.O. (2021) Kenya [39]

How poor expectant mothers with low bargaining power cope during COVID-19 in Kilifi County, Kenya,

Qualitative study

June 13–July 24 2020

12 purposively selected mothers who were either expectant or had new-born babies. 5 matrons-in-charge of maternal health services and 4 traditional birth attendants.

Expectant mothers feared attending hospitals for perinatal care due to the possibility of contracting COVID-19. An increase in home deliveries with the assistance of traditional birth attendants (TBAs) who were also overwhelmed with women who sought their services.

Pires P.D., Macaringue C, Abdirazak A., et al., 2021. Mozambique [40]

Assess the impact of Covid-19 on access to maternal and children health services in Nampula and estimate Alert Community for a Prepared Hospital project sustainability

Mixed methods

March–May 2019 & 2020

Health professionals, traditional birth attendants and patients from 2 health centres and 2 hospitals

Comparing 2019 maternal health services indicators with those from 2020, the intervention group had decreases of rate of MHC and increase rate in home deliveries. The non-intervention group showed a decrease in women in first antenatal visits in first trimester. Interviews revealed that most health professionals, traditional birth attendants and patients, have adequate knowledge about Covid-19.

Semaan A., Banke-Thomas A., Amongin D., et al., 2022. Sub-Saharan Africa (Guinea, Nigeria, Tanzania, and Uganda) [41]

Assesses how maternal healthcare was provided in six referral hospitals in Guinea, Nigeria, Tanzania, and Uganda during the first year of the COVID-19 pandemic.

Mixed-methods design

qualitative data between July 2020 and February 2021 quantitative from March 2019 to February 2021 timeline data of COVID-19 epidemiology, national and hospital-level events

6 referral hospitals, 22 maternity skilled heath personnel, WHO COVID-19 timeline cases

Identified 3 periods: first wave, slow period and second wave. Skilled health personnel had challenges during the first wave due to little knowledge about COVID-19, lack of infection prevention and control training, and difficulties reaching workplace. Shortage of personal protective equipment and no rapid testing for women suspected with COVID-19 were Challenges that persisted beyond the first wave.

Shakespeare C., Dube H., Moyo S., Eet al.,2021. Zimbabwe [42]

Impact of Covid-19 and lockdown control measures on non-Covid outcomes in tertiary level maternity unit in Zimbabwe

Interrupted time series before and during COVID waves

January–March 2020, April–June 2020

All women delivered within the study period

The rate of women delivering at the hospital declined from a mean of 41.6% (SD ± 1.1) to 35.8% (SD ± 4.3) which was statistically significant, p = 0.03. Between January–March and April–June 2020, the mean monthly deliveries declined from 747.3 (SD ± 61.3) in the first quarter of 2020 to 681.0 (SD ± 17.6) during lockdown (p = 0.20). Caesarean rate declined from a mean of 29.8% (SD ± 1.7) to 28.0% (SD ± 1.7), (p = 0.18)

Shapira G. Ahmed T., Henriette S., et al., 2021. Sub-Saharan Africa (Cameroon, Democratic Republic of Congo, Liberia, Malawi, Mali, Nigeria, Sierra Leone and Somalia) [12]

To predict what service utilization levels would have been in March–July 2020 in the absence of the pandemic

interrupted time series design

January 2018 to February 2020

administrative systems for 63,954 facilities

All countries experienced service disruptions for at least 1 month, but the magnitude and duration of the disruptions vary. Child vaccinations were most commonly affected service and fell by the largest margin. Estimated cumulative shortfall of 328,961 third-dose pentavalent vaccinations during the 5 months in these eight countries. Decreases in MHC are less generalized, although significant declines in institutional deliveries, antenatal care and postnatal care were detected in some countries

Shikuku D., Nyaok I. K, Nyaga, L.N., et al., 2021. Kenya [43]

Determine the initial impact of COVID-19 pandemic on RMNCAH services in Kenya.

Cross – sectional design

March–June 2019 & 2020

Pregnant women, adolescent girls from 47 counties

No differences in monthly mean attendance between March–June 2019 vs 2020 for MHC services attendance pre-pandemic period and intra-pandemic period, but there were some increases in some aspect of MHC services among adolescents.

Tadesse E. 2020. Ethiopia [44]

Assess the impact of the COVID-19 on ANC utilization among pregnant women attending public facilities in Northeast Ethiopia

facility-based cross-sectional study

February 2–August 30 2020

389 pregnant women

Pandemic influenced the uptake of ANC services. Consequently, the age, residency, educational status, history of still birth, interruption, and diversion of maternity health-care service, fear of COVID-19 pandemic, and transport inaccessibility were notable factors which contributed to the low antenatal care service use by pregnant women.

Tefera B., Tariku Z., Kebede M. et al., 2022. Ethiopia [13]

Describe MNCH utilization before and during Covid-19 announcement in Ethiopia and forecast 12 months client flow, at Dire Dawa Public Health Facilities

Interrupted time series analysis

Feb 01 to March 13, 2021

Five public health centres and one public referral hospital

Total services utilization showed steady fall during the interruption point. Family planning, Institutional delivery, and child immunization sharply fell during Covid-19. PNC and child immunization dropped 30 and 16% percentage point drop respectively

Temesgen K., Wakgari N., Tefera B., et al., 2021a. Ethiopia [14]

Assess maternal health care services utilization amid the COVID-19 pandemic in West Shoa Zone, Central Ethiopia

Community-based cross-sectional study (quantitative)

July 1 – July 30 2020

844 pregnant women or those gave birth in the last 6 months before the study

Low prevalence of maternal health service utilization. Maternal educational status, distance from the health facility, monthly estimated income, fear of COVID-19 infection, permission request from husband to visit a health facility, and practicing COVID-19 prevention measures related MHC utilization.

Temesgen K., Workie A., Dilnessa T., et al., 2021b. Ethiopia [45]

Assess the impact of COVID-19 infection on RMHC services among mothers getting service in governmental health institutions of Dessie town, 2020 G.C.

Cross-sectional study design using mixed (quantitative supplemented with qualitative) method

July 1–152,020

422 women

Less decrease in ANC and delivery attendance compared to PNC attendance which decreased nearly by half. Elements that influence these services were inappropriate service delivery due to fear of health care providers, shortage of medical supplies and staff workload.

Wanyana D., Wong R.,and Hakizimana D. 2021. Rwanda [15]

Assess the change in the utilization of MNCH services during the COVID-19 outbreak.

Cross-sectional quantitative study

March–April 2019 & 2020

MCH indicators from each of the 30 districts

During the COVID-19 outbreak in Rwanda, the utilization of 15 MCH services in all four categories— ANC, deliveries, PNC, and vaccinations significantly declined.

WHO 2022. Geneva [46]

A rapid assessment of the impact of the COVID-19 pandemic on health systems and essential health services across the life course

Web-based survey

November–December 2021

233 countries

Facility-based births were reduced in 45% of the countries between November to December 2021 compared to pre-pandemic era.

Zimmerman L.A., Desta S., Karp C., et al., 2021. Ethiopia [47].

To examine the effect of COVID-19 on health facility delivery in Ethiopia.

Survey

October–November 2019, June 2020

2855 pregnant women or less than six weeks postpartum

In urban areas, a 77% reduced relative risk of delivering in a hospital during COVID. No significant differences between the pre- and COVID-19 periods within rural strata where the majority of women deliver at home (55.6%). Nationally, no change in facility births. 20.0% of urban women said COVID-19 affected where they delivered relative to 8.7% of rural women (p-value = 0.01).