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Effects of COVID-19 on paediatric cardiac centres in low-income and middle-income countries: a mixed-methods study
Campbell Dopke1,2, Jean Connor3, Bistra Zheleva4
1Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, District of Columbia, USA.
Insights
The COVID-19 pandemic reduced paediatric cardiac surgery case volumes by 20% in low-income countries. This impacted access to care, financial stability, and healthcare providers, threatening long-term services for congenital heart disease (CHD).
Area of Science:
- Global Health
- Paediatric Cardiology
- Health Services Research
Background:
- The COVID-19 pandemic significantly disrupted healthcare systems worldwide.
- Critical access centers in low- and middle-income countries (LMICs) face unique challenges in maintaining specialized services.
- Congenital heart disease (CHD) requires continuous, specialized care, making these services particularly vulnerable to global health crises.
Purpose of the Study:
- To evaluate the impact of the COVID-19 pandemic on paediatric cardiac services in critical access centers within LMICs.
- To quantify changes in case volume and casemix during the pandemic.
- To understand the qualitative experiences of healthcare providers and programs.
Main Methods:
- A mixed-methods approach was employed.
- Data were collected from eight International Quality Improvement Collaborative (IQIC) sites participating in CHD care in LMICs.
- Quantitative analysis of case volume and casemix changes (2019 vs. 2020) and qualitative analysis of semi-structured interviews with program representatives.
Main Results:
- A 20% aggregate reduction in case volume was observed across seven reporting sites between 2019 and 2020.
- Qualitative findings revealed universal impacts on access to care, financial stability, and professional/personal well-being of healthcare providers.
- The pandemic posed a significant threat to the delivery of CHD surgery in resource-constrained settings.
Conclusions:
- The COVID-19 pandemic has severely impacted paediatric cardiac services in LMICs, affecting patient access, workforce, and institutional stability.
- These disruptions pose a long-term threat to vulnerable CHD programs beyond the immediate global health emergency.
- Sustained efforts are crucial to protect and preserve essential CHD services in LMICs during and after pandemics.
Objectives:
The aim of this study was to understand the effects of the COVID-19 pandemic on paediatric cardiac services in critical access centres in low-income and middle-income countries.
Design:
A mixed-methods approach was used.
Setting:
Critical access sites that participate in the International Quality Improvement Collaborative (IQIC) for congenital heart disease (CHD) were identified.
Participants:
Eight IQIC sites in low-income and middle-income countries agreed to participate.
Outcome Measures:
Differences in volume and casemix before and during the pandemic were identified, and semistructured interviews were conducted with programme representatives and analysed by two individuals using NVivo software. The qualitative component of this study contributed to a better understanding of the centres' experiences and to identify themes that were common across centres.
Results:
In aggregate, among the seven critical access sites that reported data in both 2019 and 2020, there was a 20% reduction in case volume, though the reduction varied among programmes. Qualitative analysis identified a universal impact for all programmes related to Access to Care/Clinical Services, Financial Stability and Professional/Personal Issues for healthcare providers.
Conclusions:
Our study identified and quantified a significant impact of the COVID-19 pandemic on critical access to CHD surgery in low-income and middle-income countries, as well as a significant adverse impact on both the skilled workforce needed to treat CHD and on the institutions in which care is delivered. These findings suggest that the COVID-19 pandemic has been a major threat to access to care for children with CHD in resource-constrained environments and that this effect may be long-lasting beyond the global emergency. Efforts are needed to preserve vulnerable CHD programmes even during unprecedented pandemic situations.
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