Impact of COVID-19 on utilization of maternal, newborn and child health services in Nigeria: protocol for a countrylevel mixed-methods study [version 2; peer review: 2 approved]

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Study Justification:
– The study aims to evaluate the impact of COVID-19 on the utilization of maternal, newborn, and child health (MNCH) services in Nigeria.
– It seeks to explore the barriers faced by women and their families in accessing MNCH services during the COVID-19 pandemic.
– The study will provide valuable insights into the contextual factors that have influenced the utilization of MNCH services during this time.
Highlights:
– The study will involve 18 healthcare facilities delivering MNCH services in six selected states across six geopolitical zones of Nigeria.
– Longitudinal data on MNCH services will be collected from these facilities, both before and after the first recorded case of COVID-19 in Nigeria.
– Qualitative data will be gathered through in-depth interviews conducted via mobile phones or Zoom meetings with stakeholders, including users of MNCH services, health workers, and policymakers.
– The study will use a mixed-methods approach, combining quantitative and qualitative data, to gain a comprehensive understanding of the impact of COVID-19 on MNCH service utilization in Nigeria.
Recommendations:
– Based on the findings of the study, policymakers should formulate policies and interventions to address the barriers identified and ensure sustained MNCH service delivery.
– Strategies should be developed to mitigate the impact of COVID-19 on the utilization of MNCH services, taking into account the contextual factors specific to Nigeria.
– Efforts should be made to strengthen healthcare systems and improve access to MNCH services, particularly during times of crisis such as the COVID-19 pandemic.
Key Role Players:
– Users of MNCH services (mothers, families)
– Health workers (doctors, nurses, midwives)
– Policymakers (government officials, health authorities)
– Researchers and data analysts
Cost Items for Planning Recommendations:
– Research personnel and their salaries
– Data collection tools and equipment (mobile phones, Zoom subscriptions)
– Ethical approvals and associated administrative costs
– Data analysis software and resources
– Communication and dissemination of findings (publication fees, conference attendance)
– Stakeholder engagement and collaboration expenses (meetings, workshops)

Background: Battling with COVID-19 and providing essential services along the continuum of care could be challenging. This study will evaluate the impact of COVID-19 on utilization of maternal, newborn and child health (MNCH) services in Nigeria and explore the barriers being experienced by women and their families in getting access to MNCH services, as well as other contextual factors that may have shaped the utilization of MNCH services during the COVID-19 pandemic. Methods and analysis: The study will adopt an observational mixedmethods study design involving 18 health care facilities delivering MNCH services in six selected states across six geopolitical zones of Nigeria. We will retrieve longitudinal data on MNCH services from all selected hospitals six months before and after the first recorded case of COVID-19 in Nigeria. Qualitative data will be collected using indepth interviews conducted via mobile phones or ZOOM meeting platforms among stakeholder participants (users of MNCH services, health workers and policymakers) to ascertain their perceptions on how COVID-19 has shaped the utilization of MNCH services. We will triangulate quantitative and qualitative data to better understand the impact of COVID-19 on the utilization of MNCH services in Nigeria. Ethics and dissemination: Ethics approvals have been obtained from the Health Research Ethics Committee of the tertiary hospitals involved in the study. Our findings will provide the first evidence from an African setting on the impact of COVID-19 on the utilization of MNCH services using a mixed-methods study design for policy formulation towards sustained MNCH service delivery.

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Based on the provided description, here are some potential innovations that could improve access to maternal health:

1. Telemedicine and virtual consultations: Utilizing mobile phones or platforms like ZOOM for conducting in-depth interviews with stakeholders can help overcome geographical barriers and improve access to maternal health services, especially in remote areas.

2. Mobile health (mHealth) applications: Developing mobile applications that provide information, reminders, and guidance on maternal health, including prenatal care, nutrition, and postpartum care, can empower women and their families to access and utilize MNCH services effectively.

3. Remote monitoring devices: Implementing remote monitoring devices, such as wearable sensors or mobile apps, that allow pregnant women to track their vital signs, fetal movements, and other relevant health indicators can enable early detection of complications and prompt intervention, thus improving maternal health outcomes.

4. Community-based interventions: Establishing community health worker programs or mobile clinics that bring MNCH services closer to women in underserved areas can enhance access to prenatal care, skilled birth attendance, and postnatal care.

5. Public awareness campaigns: Conducting targeted public awareness campaigns through various media channels, including radio, television, and social media, to educate women and their families about the importance of accessing MNCH services and addressing any fears or misconceptions related to COVID-19.

6. Strengthening health systems: Investing in the overall strengthening of health systems, including infrastructure, human resources, and supply chains, to ensure the availability and accessibility of quality MNCH services, even during emergencies like the COVID-19 pandemic.

These innovations, if implemented effectively, can help overcome barriers and improve access to maternal health services in Nigeria, ultimately contributing to better maternal and child health outcomes.
AI Innovations Description
Based on the description provided, the recommendation to improve access to maternal health would be to develop innovative strategies that address the barriers identified in the study. These strategies could include:

1. Telemedicine and virtual consultations: Implementing mobile phone or Zoom-based consultations can help overcome geographical barriers and ensure that women have access to healthcare services, even during a pandemic.

2. Community-based outreach programs: Establishing community-based programs that provide education, support, and essential maternal health services can help reach women who may face challenges in accessing healthcare facilities.

3. Strengthening healthcare infrastructure: Investing in the improvement of healthcare facilities, particularly in rural areas, can enhance access to maternal health services. This could involve upgrading equipment, increasing staffing levels, and ensuring the availability of essential supplies.

4. Addressing socio-cultural factors: Identifying and addressing socio-cultural factors that may hinder women’s access to maternal health services is crucial. This could involve community engagement, awareness campaigns, and working with local leaders to promote the importance of maternal health.

5. Leveraging technology for data collection and monitoring: Using technology to collect and monitor data on maternal health services can help identify gaps and track progress. This can inform decision-making and resource allocation to ensure effective service delivery.

By implementing these recommendations, it is possible to develop innovative solutions that improve access to maternal health services, even in challenging circumstances such as the COVID-19 pandemic.
AI Innovations Methodology
Based on the provided description, it seems that the study aims to evaluate the impact of COVID-19 on the utilization of maternal, newborn, and child health (MNCH) services in Nigeria. The study will also explore the barriers faced by women and their families in accessing MNCH services during the pandemic. To simulate the impact of recommendations on improving access to maternal health, the following methodology could be considered:

1. Identify potential recommendations: Review existing literature, guidelines, and best practices to identify potential recommendations that could improve access to maternal health services. These recommendations could include strategies such as telemedicine, mobile health applications, community health worker programs, and improved transportation infrastructure.

2. Define indicators: Determine key indicators that can measure the impact of the recommendations on improving access to maternal health. These indicators could include the number of women accessing antenatal care, the percentage of women receiving skilled birth attendance, and the reduction in maternal mortality rates.

3. Data collection: Collect data on the current utilization of MNCH services in Nigeria, including the number of women accessing different services, the barriers they face, and the contextual factors influencing utilization during the COVID-19 pandemic. This data can be obtained from the selected 18 healthcare facilities delivering MNCH services in the six selected states.

4. Simulate impact: Use modeling techniques to simulate the potential impact of the identified recommendations on improving access to maternal health. This can involve creating scenarios that incorporate the implementation of the recommendations and estimating the resulting changes in the key indicators.

5. Analyze results: Analyze the simulated results to assess the potential impact of the recommendations on improving access to maternal health services. Compare the indicators before and after the simulation to determine the effectiveness of the recommendations in addressing the identified barriers and improving utilization.

6. Policy formulation: Based on the findings, formulate policy recommendations that can be implemented to improve access to maternal health services in Nigeria. These recommendations should consider the feasibility, cost-effectiveness, and sustainability of the proposed interventions.

7. Dissemination: Share the findings and policy recommendations with relevant stakeholders, including policymakers, healthcare providers, and community organizations. This can be done through reports, presentations, and targeted communication strategies to ensure the findings reach the intended audience and inform decision-making processes.

It is important to note that the methodology described above is a general framework and may need to be adapted based on the specific objectives and resources available for the study.

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