Changes in the Utilization of Health Services in Kenya During the COVID-19 Pandemic: March to December 2020

Background: COVID-19 and its mitigation measures have been linked to reduced use of health services. Evidence on the effects of the pandemic on health services in sub-Saharan Africa is limited. We assessed the immediate impact of the COVID-19 pandemic on several health service indicators and outcomes in Kenya in 2020. Methods: We conducted time series analyses using monthly national health data from the Kenya Ministry of Health District Health Information System-2, covering January 2011 through December 2020 to model changes in selected health service indicators. We conducted several robustness checks and cross-checked our results using seasonal Holt-Winters, seasonal autoregressive integrated moving averages, and generalized additive linear models. Results: We found declines in outpatient visits (-22·9%), inpatient admissions (-10·0%), pneumonia (-22·2%), bed-nets (-39·4%), malaria (-5·3%), antenatal care (-9·3%), and facility births (-5·7%). We found an increase in family planning visits (+11·0%) and in Caesarean sections (+5·8%). We found model-dependent, bidirectional effects on infant immunizations, facility-reported deaths, and maternal deaths. Conclusions: While there was an overall drop in health service use, our results indicate mixed health system effects in response to the COVID-19 pandemic, with effect sizes and directionality that are dependent on the time series approach used. Measures to address large drops in service coverage like long lasting insecticide treated nets (LLIN) distribution may mitigate their long-term impacts on population health. Additional studies may be required to assess the longer-term effects of changes in use on health outcomes and provide better-informed mitigation options. Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: This activity was reviewed by the US Centers for Disease Control and Prevention (CDC), and was conducted consistent with applicable federal law and CDC policy.