Barriers to accessing mother, new-born and child health services in urban Gambia during COVID-19: An interview-based qualitative study.

AO_SCPLOWBSTRACTC_SCPLOWO_ST_ABSIntroductionC_ST_ABSEvidence is being consolidated that shows that the utilisation of mother, newborn, and child health (MNCH) services has declined in low-income countries (LICs) during the COVID-19 pandemic. Very little is known about the effects of the pandemic on MNCH service utilisation in the Gambia. We set out to explore the COVID-19-related factors affecting the utilisation of antenatal and immunisation services in the Gambia. MethodsA qualitative methodology was used to explore patients and providers experiences of MNCH services during the pandemic in two Local Government Areas (LGAs) in the Gambia. Thirty-one study participants were recruited from four health facilities, applying a theory-driven sampling framework, including health workers as well as female patients. Qualitative evidence was collected through theory-driven semi-structured interviews, and was recorded, translated into English, transcribed, and analysed thematically, applying a social-ecological framework. ResultsIn our interviews, we identified five main themes, ranging from individual factors to interpersonal, community, institutional and policy factors. Individual factors revolved around patients fear of being infected in the facilities, and of being quarantined, and their anxiety about passing on infections to family members. Interpersonal factors involved the reluctance of partners and family members, as well as perceived negligence and disrespect by health workers. Community factors included misinformation within the community and mistrust of vaccines. Institutional factors included the shortage of health workers, closures of health facilities, and the lack of personal protective equipment (PPEs) and essential medicines. Finally, policy factors revolved around the consequences of COVID-19 prevention measures, particularly the shortage of transport options and mandatory wearing of face masks. ConclusionsOur findings suggest that patients fears of contagion, perceptions of poor treatment in the health system, and a general anxiety around the imposing of prevention measures, undermined the uptake of MNCH services. In future emergencies, the government in the Gambia, and governments in other LICs, will need to consider the unintended consequences of epidemic control measures on the uptake of MNCH services.