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The knock-on effects of Covid-19 pandemic on supply and availability of maternal and child health products and vaccines

 Authors: Tsegaye Melaku, Desta Assefa, Fanta Gashe, Mestawet Getachew, Temesgen Kabeta, Zeleke Mekonnen Institute of Health, Jimma University, Ethiopia

 Abstract

In many low- and middle-income countries, the 2019 novel coronavirus (COVID-19) has challenged efforts to ensure access to and availability of quality maternal, newborn, and child health (MCH) services and essential MCH commodities. The study aimed to evaluated the knock-on effects of the COVID-19 pandemic on the availability and stock status of maternal-child health products and childhood vaccines at health facilities  in Ethiopia. We have prospectively assessed the availability of maternal-child health products (MCH) and childhood vaccines and accessories, which are listed in the Ethiopian national essential medicines list.

Introduction

  1. The COVID-19 pandemic has exposed supply chain and logistics vulnerabilities.
  2. It has put a tremendous strain on supply and availability of essential medicines, especially in low and middle countries.
  3. COVID-19 has challenged efforts to ensure access to and availability of MCH services and essential MCH commodities
  4. Direct and indirect effects of the pandemic on MCH services could be devastating, and jeopardize the important
  5. made over the last several decades

Methods and materials 

  1. A mixed methods study conducted in health facilities (5 hospitals) located in seven Jimma zone, Oromia regional state
  2. Tools used:
  3. Logistics System Assessment Tool (LSAT)
  4. Logistic Indicators Assessment Tool (LIAT)
  5. Inventory Management Assessment Tool (IMAT)
  6. Pharmaceutical products: Twenty eight (28) maternal and child health products   and Fourteen (14) childhood vaccines and accessories
  7. Product availability was assessed based on the World Health Organization’s availability index.

Table 1:  Mean availability of maternal and child health products at hospitals

S.No Maternal and child health products Before COVID-19 (%) WHO availability index During COVID-19 (%) WHO availability index
1 Albendazole – 400mg – Tablet 64 Fairly high 54 Fairly high
2 Amoxicillin 125/250 mg dispersible tablet 66 Fairly high 52 Fairly high
3 Ampicillin 250 or 500 mg powder for injection 76 Fairly high 64 Fairly high
4 Azithromycin 500 mg tablet/Capsule 70 Fairly high 58 Fairly high
5 Benzathine benzylpenicillin 2.4 mU Injection 52 Fairly high 50 Fairly high
6 Calcium-gluconate 10%/10 ml Injection 30 Low 25 Very low
7 Chlorhexidine 21 g gel 38 Low 30 Low
8 Cefixime 400mg tablet 0 Very low 0 Very low
9 Dexamethasone 4 mg/1 ml Injection 76 Fairly high 48 Low
10 Ferrous + Folic Acid – (60mg + 400mcg) – Tablet 70 Fairly high 64 Fairly high
11 Gentamicin 40 mg/ml in 2 ml Injection 76 Fairly high 66 Fairly high
12 Hydralazine 20 mg Injection 72 Fairly high 64 Fairly high
13 Magnesium sulfate 50%/10 ml Injection 66 Fairly high 56 Fairly high
14 Methyldopa 250/500mg mg Tablet 56 Fairly high 32 Low
15 Methylergometrine Maleate – 0.2mg/ml – Injection 52 Fairly high 38 Low
16 Metronidazole 500 mg/100 ml Infusion 52 Fairly high 40 Low
17 Mifepristone-Misoprostol(200 mg+200mcg) Tablet 52 Fairly high 44 Low
18 Misoprostol 200 mcg Tablet 36 Low 16 Very low
19 Nifedipine (Immediate) 20 mg Capsule 56 Fairly high 42 Low
20 Oral rehydration salt 20.5g – Powder 68 Fairly high 60 Fairly high
21 Oxytocin 10 IU Injection 76 Fairly high 68 Fairly high
22 Resomal 42g sachet 66 Fairly high 48 Low
23 Tetanus-Diphtheria-Toxoid)/Tetanus Toxoid 72 Fairly high 66 Fairly high
24 Tetracycline – 1% – Eye Ointment 68 Fairly high 64 Fairly high
25 Vitamin K1 – 1mg/0.5ml – Injection 62 Fairly high 46 Low
26 Water For Injection – 10ml – Injection 72 Fairly High 66 Fairly high
27 Zinc Sulphate – 20mg Tablet ( scored & Dispersible ) 72 Fairly high 64 Fairly high
28 Zink Sulphate 10 tab + Oral rehydration salt 2 sachet 62 Fairly high 44 Low

 

Table 2: Mean availability of childhood vaccines and accessories at hospitals 

S.No Vaccines and accessories Before COVID-19 (%) WHO availability index During COVID-19 (%) WHO availability index
1 BCG with  Diluent 70 Fairly high 66 Fairly high
2 BOPV with Droppers 64 Fairly high 54 Fairly high
3 DPT-Hib-Hep(Pentavalent) 70 Fairly high 66 Fairly high
4 Inactivated poliovirus vaccine 64 Fairly high 56 Fairly high
5 Measles with diluent 60 Fairly high 52 Fairly high
6 Mixing syringe (BCG) 3cc 75 Fairly high 64 Fairly high
7 Mixing syringe (measles) 5cc 74 Fairly high 66 Fairly high
8 Pneumococcal vaccine (PCV10) 67 Fairly high 64 Fairly high
9 Rotavirus vaccine 60 Fairly high 54 Fairly high
10 Safety box 100 High 100 High
11 Syringe, A-D, 0.05ml 60 Fairly high 54 Fairly high
12 Syringe, A-D, 0.5ml 64 Fairly high 52 Fairly high
13 Tetanus-Diphtheria(TD) 72 Fairly high 66 Fairly high
14 Vitamin A 100000IU 66 Fairly high 54 Fairly high

Discussion

  1. The overall mean availability of selected maternal and child health products was 43.2%. It was 52.9% (range 21.0% to 63.6%) prior COVID-19 and 42.6% (range 19% to 56.4%) during COVID-19 time.
  2. The average monthly orders fill rates of hospitals for the selected products ranged from 39 % to 82%.
  3. Before COVID-19 the average order fill rate was near 70% of total orders placed by the hospitals.
  4. However, immediately after the COVID-19 case notification in Ethiopia, the percentage of order filled correctly in items and quantities began decreasing.
  5. Major challenges & experiences related to medicines supply
  6. Lack of financial capacity to procure commodities
  7. Weak logistic management information system (LMIS)
  8. Lack of crisis specific guideline
  9. Shift of focus to COVID-19 service provision

Conclusion

  1. The overall stockout situation in the study area has worsened during COVID-19 compared to pre-COVID-19 time. Medicine order fill rate experienced a negative trend throughout 2020.
  2. None of the surveyed MCH products met the ideal availability benchmark of 80% in the public hospitals.
  3. However, availability of paracetamol 500mg tablets, which is produced in Ethiopia, surprisingly improved during the pandemic. Whereas the child formulation (oral syrup) of paracetamol experienced high stockout levels.
  4. A range of policy frameworks and options targeting inevitable outbreaks should exist to enable governments to ensure that these essential medicines are consistently available and affordable.

References

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