# Shock, response, and resilience of COVID-19 on Kangaroo Mother Care service utilisation in public health facilities in Bangladesh: An interrupted time series analysis

## TL;DR

The study examines how the COVID-19 pandemic affected the use of Kangaroo Mother Care in Bangladesh, finding a drop during the first lockdown but recovery afterward.

## Contribution

This study quantifies the impact of the COVID-19 pandemic on Kangaroo Mother Care utilization in Bangladesh using an interrupted time series analysis.

## Key findings

- KMC utilization dropped by 20% during the first lockdown compared to pre-pandemic levels.
- KMC utilization increased by 8% in the post-pandemic period compared to pre-pandemic levels.
- District Hospitals showed a recovery trend, while Medical College Hospitals and Upazila Health Complexes had distinct patterns.

## Abstract

Premature births and low birth-weight (LBW) are significant contributors to neonatal mortality, particularly in Bangladesh. Kangaroo Mother Care (KMC) has emerged as a proven, safe, and cost-effective intervention to save lives. Nevertheless, the coronavirus disease 2019 (COVID-19) pandemic disrupted health care services, including KMC, and its specific impact on KMC utilisation in Bangladesh remains unknown. Thus, our objective was to evaluate the impact of COVID-19 on KMC utilisation in Bangladesh.

We conducted a secondary analysis of data, collected from 46 health care facilities in Bangladesh, utilising the District Health Information Systems 2 (DHIS2), spanning from January 2019 to August 2023. Our data set encompassed health care facilities with KMC data points available for at least two months between January 2018 and January 2019. We segmented our analysis to encompass distinct time periods, including pre-COVID-19, lockdown phases, and post-COVID-19. We employed descriptive statistics of KMC utilisation. We performed a segmented regression with a Poisson distribution which was adjusted for autocorrelation and seasonality.

Our study revealed a significant 20% reduction in KMC utilisation during the initial COVID-19 lockdown (incidence rate ratio (IRR) 0.80; 95% confidence interval (CI) = 0.76–0.84) in comparison to the pre-COVID-19 period. However, the 'between lockdown' phase saw a 5% increase in KMC provision (IRR 1.05; 95% CI = 1.01–1.08). Notably, KMC utilisation during the second lockdown resembled pre-pandemic levels, surpassing the initial lockdown period (IRR 0.99; 95% CI = 0.93–1.06). As we transitioned into post-COVID-19 period, KMC utilisation increased by 8% in comparison to the pre-COVID-19 era (IRR 1.08; 95% CI = 1.01–1.16). However, when we considered different facility types, District Hospitals (DH) mirrored the overall trend, whereas Medical College Hospitals (MCH) and Upazila Health Complexes (UHC) facilities exhibited distinctive patterns. Likewise, when assessing divisions, Dhaka, Khulna, and Rajshahi exhibited counter trends to the overall results.

Our study shed light on the profound impact of the COVID-19 pandemic on KMC utilisation, the adaptive responses of health care systems, and the subsequent resilience displayed. District Hospitals played a pivotal role in this rebound. It is essential to recognise that facilities in different divisions were disproportionately affected by the challenges brought forth by the COVID-19 pandemic.