JO Adeyemo, MA Fagbola, AA Akande, FM OlaOlorun, OO Sekoni, and AM Adebayo
Reproductive and Family Health Unit, Department of Community Medicine, University College Hospital, Ibadan, Nigeria.
Abstract
The impact of the novel corona virus disease (COVID-19) pandemic cuts across all sectors and has brought to the fore the true realities and status of health systems globally, revealing the gaps and cracks even in seemingly perfect health systems. The fragile and weak health system in the country is also riddled with a lot of sub-optimal health indicators including reproductive health. It is important to anticipate and look out for these effects in order to plan for and ensure early detection and necessaryn intervention to mitigate such. This paper discusses the potential effect of COVID-19 on reproductive health indicators in Nigeria. The reproductive health indices of a population have far and wide reaching impact on the health status of the population. However, reproductive health indicators are usually among the worst hit during health emergencies or disasters as seen in the Ebola pandemic in sub-Saharan Africa. Interventions must be put in place so that the pandemic does not set Nigeria back from the marginal gains made in reproductive health over the years.
Keywords: COVID-19 pandemic, Potential impact, Reproductive health indicators, Nigeria
Correspondence:
Dr. A.M. Adebayo
Department of Community Medicine,
University College Hospital,
Ibadan.
Email: davidsonone@yahoo.com
The Corona virus disease (COVID-19) is the greatest threat to humanity and life as we know it since the turn of the century. The novel corona virus disease was detected in 2019 in Wuhan city, Hubei province of China following an outbreak investigation into an upper/lower respiratory airway disease1. COVID-19 is suggested to have emanated from an animal source, particularly the large thriving wet animal market in Wuhan. However, human to human spread via droplet transmission, and contact with infected surfaces and fomites has since been established. COVID-19 was declared a global pandemic by the World Health Organization on 11th March 2020.3Since first reported in December 2019 till date, there have been over 104,370,550 confirmed cases worldwide with over 2,271,180 deaths and there seems to be no end yet in sight as new infections continue to increase in numbers each day.2
The COVID-19 outbreak continues to evolve in the WHO African Region since the first case was reported on the 25th February 2020 in Algeria. Since then, all Member States have reported COVID-19. The highest case load has been observed in the West African region, 43% of total confirmed cases.4 Nigeria recorded its first case of COVID-19 on 27th February 2020, an Italian expatriate worker who has since recovered from the illness. However, even though testing facilities are inadequate and contact tracing sub-optimal due to several logistic challenges, 136,030 confirmed cases with 1,632 deaths have been recorded in the country as at the 5th February 2021 with increasing number of new cases each day5 . Infection of health workers rose from 401 as at 12th May 2020 to 812 by 3rd June 2020, with Nigeria being the most affected in Africa, thereby worsening the strain on the weak health care system.4,6 Despite the graded ease of lockdown measures, the experience of a second wave of infection in Europe and America has also been observed in Africa.
Although said to be a largely mild disease with better rates of recovery among the young and healthy with no premorbid disease condition, the ease of spread and the uncertainty around the disease and its history, treatment modalities and full spectrum continues to fuel fears globally
Health and Socioeconomic Impact of COVID19
Apart from its direct effect on health, numerous other effects spiral from the pandemic. Notable is its immense effect on global economy which is largely from the consequences of measures to reduce spread and mitigate the effect of the disease such as travel bans/restrictions, restriction of movement, lockdown and closure of businesses including manufacturing plants. The world has been said to be having a global economic recession. Also, the broad effect of the global pandemic on health is becoming increasingly evident with the collapse of health systems, shortage of healthcare workers and other essential manpower, scarcity of essential health commodities including personal protective equipment (PPE), diversion of resources from non-COVID cases, interruption and cessation of other health services like family planning and immunization services leading to increased morbidity and mortality from non-COVID causes and leaving a negative impact on health indicators. Health indicators are useful in describing and monitoring a population’s health status, they are summary measures that capture relevant information on different attributes and dimensions of health status and performance of a health system. The fragile and weak health system in the country is also riddled with a lot of sub-optimal health indicators including reproductive health. Notably, mounting up adequate response to the pandemic has led to diversion of resources and focus from other health necessities, particularly for children and women of reproductive age who are especially vulnerable. The effects of this may not be noticeable immediately but it has the potential to negatively impact the health of populations and bring a loss in the gains made in global health over the past few decades, especially in developing countries.
COVID-19 and Reproductive Health Indicators in Nigeria
The reproductive health indices of a population have far and wide reaching impact on the health status of the population. However, reproductive health indicators are usually among the most affected during health emergencies or disasters as seen in the Ebola pandemic in sub-Saharan Africa. This paper discusses the potential effect of COVID-19 on reproductive health indicators in Nigeria. It is important to anticipate and look out for these effects in order to plan for and ensure early detection and necessary intervention to mitigate such.
Reproductive health indicators are largely populationbased indicators that provide an overview of the reproductive health situation at the global and national level. There are numerous reproductive health indicators, however WHO’s set of 17 indicators as seen later in this paper covers the main reproductive health areas and represents the consensus among international agencies of the key indicators for international and cross-country comparison.
Nigeria, a resource constrained country, is generally classified as a low-medium income country, with a population of about 200 million and almost half (40%)of her population currently living below the poverty line. Nigeria’s fragile health system suffers largely from health inequalities, both between and within her regions.7 This stems largely from deep seated corruption at all levels and poor political will in matters pertaining to the health system, evidenced by persistent poor budgetary allocation to health. Some core drivers of Nigeria’s poor health indicators include the following: the increasing rate of poverty, limited National Health Insurance Scheme (NHIS) coverage and high rate of out-of-pocket health care financing, declining proportion of functional primary health care, and increasing rate of vertical health intervention.8
Reproductive health indicators in the country are below par and progress has been slow despite numerous interventions, hence the fear of the possible effect of COVID-19 on reproductive health indicators in the country which may worsen the health status and set the country back in the few areas with seeming progress. If adequate measures are not painstakingly taken, it would affect the nation’s capacity to meet up with the sustainable development goals, especially goals 3 and 5.
According to the Nigeria DHS 2018 report, contraceptive prevalence rate was as low as 13% in 2003, rose to 15% in 2008, and remained at 15% in 2013. However in 2018 the contraceptive prevalence rate was 17%, showing a minimal increase over the years. With a target of moving contraceptive prevalence rate to 27% by 2020 the pandemic will worsen this index and probably set the country back from the minimal achievements recorded so far.9,10 Response measures against COVID-19 have brought major disruptions to contraceptive supply chains. Principal manufacturers of contraceptives in Asia have had to operate at reduced capacity or stop production. For example, the world’s largest condom producer – Malaysia’s Karex Bhd – which make a fifth of the world’s condoms was shut for one week in March and only reopened at 50% capacity. This will create a looming scarcity of contraceptive products with anticipated effects on the unmet need for family planning, total fertility rate, contraceptive prevalence rate and the number of clients seeking abortion services.