Indirect effect of COVID-19 pandemic on maternal and neonatal health care in resource-poor setting

Background: COVID-19 pandemic has been affecting maternal and neonatal health worldwide. Our study was done to find the indirect effect of the pandemic due to associated lockdown, travel restrictions, etc. on maternal and neonatal health in a rural resource-limited area in northeast India.Methods: In this retrospective observational study, mothers of a rural, resource-limited area were enrolled if they delivered in the institution where the study was done. Hospital data regarding maternal mortality and stillbirth rate (SBR) from November 2019 till February 2020 (no-lockdown) was compared with the lockdown period (March 2020 till June 2020). Neonatal data of the no-lockdown and lockdown period were analysed and compared. All inborn and sick neonates delivered outside and admitted in the institution's neonatal unit after delivery (outborn) were included.Results: There was a 33% reduction of institutional delivery rate in Lockdown compared to the no-lockdown period. Outborn admission to the newborn unit was reduced by 41%. Stillbirth and death due to perinatal events increased significantly (relative risk (RR) 1.45, 95% CI: 0.85-2.48) amongst inborn in the lockdown period. During lockdown period maternal mortality increased from 551/100000 to 761/100000 live births (LB) (RR 1.38, 95% CI: 1.21-1.52) and NMR from 26/1000 to 32/1000 LB (RR: 1.23, 95% CI: 0.73-2.04).Conclusions: Significant adverse indirect effect of COVID-19 pandemic is observed on maternal and neonatal health. Ways for avoidance of reversion of gain achieved in NMR and MMR in the last few years in lower and middle-income countries (LMIC) needs to be urgently looked at.