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Background The COVID-19 pandemic has adversely affected access to essential healthcare services. This study aimed to explore healthcare providers’ perceptions and experiences of the response to the COVID-19 pandemic in three referral maternal and neonatal hospitals in Guinea. Methods We conducted a longitudinal qualitative study between June and December 2020 in two maternities and one neonatology referral ward in Conakry and Mamou. Participants were purposively recruited to capture diversity of professional cadres, seniority, and gender. Four rounds of in-depth interviews (46 in-depth interviews with 18 respondents) were conducted in each study site, using a semi-structured interview guide that was iteratively adapted. We used both deductive and inductive approaches and an iterative process for content analysis. Results We identified four themes and related sub-themes presented according to whether they were common or specific to the study sites, namely: 1) coping strategies & care reorganization, which include reducing staffing levels, maintaining essential healthcare services, suspension of staff daily meetings, insertion of a new information system for providers, and co-management with COVID-19 treatment center for caesarean section cases among women who tested positive for COVID-19; 2) healthcare providers’ behavior adaptations during the response, including infection prevention and control measures on the wards and how COVID-19-related information influenced providers’ daily work; 3) difficulties encountered by providers, in particular unavailability of personal protective equipment (PPE), lack of financial motivation, and difficulties reducing crowding in the wards; 4) providers perceptions of healthcare service use, for instance their fear during COVID-19 response and perceived increase in severity of complications received and COVID-19 cases among providers and parents of newborns. Conclusion This study provides insights needed to be considered to improve the preparedness and response of healthcare facilities and care providers to future health emergencies in similar contexts.

IntroductionIn sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic.MethodsMixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019–February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020–February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting.ResultsThree periods including a first wave, slow period and second wave were identified. Maternal health service utilisation was lower during the pandemic compared with the prepandemic year in all but one selected referral hospital. During the pandemic, service utilisation was particularly lower during the waves and higher or stable during the slow period. Fear of being infected in hospitals, lack of transportation, and even when available, high cost of transportation and service closures were key reasons affecting utilisation during the waves. However, community perception that the pandemic was over or insinuation by Government of the same appeared to stabilise use of referral hospitals for childbirth.ConclusionUtilisation of maternal health services across the continuum of care varied through the different periods and across countries. In crisis situations such as COVID-19, restrictions and service closures need to be implemented with consideration given to alternative options for women to access and use services. Information on measures put in place for safe hospital use should be communicated to women.

Introduction In sub-Saharan Africa, there is limited evidence on the COVID-19 health-related effect from front-line health provision settings. Therefore, this study aimed to analyse the effect of the COVID-19 pandemic on routine maternal and neonatal health services in three referral hospitals. Materials and methods We conducted an observational study using aggregate monthly maternal and neonatal health services routine data for two years (March 2019–February 2021) in three referral hospitals including two maternities: Hôpital National Ignace Deen (HNID) in Conakry and Hôpital Regional de Mamou (HRM) in Mamou and one neonatology ward: Institut de Nutrition et de Santé de l’Enfant (INSE) in Conakry. We compared indicators of health service utilisation, provision and health outcomes before and during the COVID-19 pandemic periods. An interrupted time-series analysis (ITSA) was performed to assess the relationship between changes in maternal and neonatal health indicators and COVID-19 through cross-correlation. Results During COVID-19, the mean monthly number (MMN) of deliveries decreased significantly in HNID ( p  = 0.039) and slightly increased in HRM. In the two maternities, the change in the MMN of deliveries were significantly associated with COVID-19. The ITSA confirmed the association between the increase in the MMN of deliveries and COVID-19 in HRM (bootstrapped F-value = 1.46, 95%CI [0.036–8.047], p  < 0.01). We observed an increasing trend in obstetric complications in HNID, while the trend declined in HRM. The MMN of maternal deaths increased significantly ( p  = 0.011) in HNID, while it slightly increased in HRM. In INSE, the MMN of neonatal admissions significantly declined ( p  < 0.001) and this decline was associated with COVID-19. The MMN of neonatal deaths significantly decreased ( p  = 0.009) in INSE and this decrease was related to COVID-19. Conclusion The pandemic negatively affected the maternal and neonatal care provision, health service utilisation and health outcomes in two referral hospitals located in Conakry, the COVID-19 most-affected region.

This study aimed to evaluate the impact of maternal obesity on obstetrical outcomes, including labor and delivery parameters, as well as maternal and neonatal prognosis. This observational multicenter cohort study was conducted over 6 months in Conakry, where Guinea's two busiest maternity hospitals are located. A total of 295 obese women (body mass index (BMI) > 30 kg/m2) and 590 normal-weight women (BMI 18.5-24.9 kg/m2) were included. Obstetrical characteristics and outcomes were compared between obese and normal-weight parturients. Compared to normal-weight women, obese parturients had significantly higher risks of labor induction (RR = 1.6, 95% CI [1.1-2.3]), occipital-posterior fetal position (RR = 1.8, 95% CI [1.3-2.8]), prolonged second stage of labor (RR = 1.7, 95% CI [1.2-2.3]), and oxytocin administration for uterine hypo-contractility (RR = 1.8, 95% CI [1.3-2.4]). Increased rates were also observed for episiotomy (RR = 2.5, 95% CI [1.6-3.9]), vacuum-assisted delivery (RR = 1.9, 95% CI [1.1-3.6]), cesarean section (RR = 1.7, 95% CI [1.3-4.4]), postpartum hemorrhage (RR = 1.8, 95% CI [1.3-5.2]), and postcesarean wound infection (RR = 3.3, 95% CI [2.2-19.6]). Neonates born to obese women were at an increased risk of perinatal asphyxia (RR = 2.9, 95% CI [1.3-6.4]), low APGAR score both at 1 min (RR = 1.7, 95% CI [1.3-2.2]) and 10 min (RR = 1.7, 95% CI [1.2-2.5]), and the need for neonatal resuscitation (RR = 1.6, 95% CI [1.2-2.1]). No significant differences were observed between groups regarding the risk of breech presentation, the type of cephalic presentation (occipital-anterior versus occipital-posterior), or neonatal mortality. In low-income settings, maternal obesity is associated with a significantly increased risk of adverse labor, delivery, and perinatal outcomes-mirroring patterns observed in higher-resource contexts. These findings underscore the need for enhanced healthcare provider training and the implementation of targeted maternal weight management strategies. Moreover, obstetrical protocols and clinical guidelines should be adapted based on maternal BMI to better address the specific risks associated with obesity in pregnancy.

IntroductionReferral hospitals in sub-Saharan Africa are located in crowded urban areas, which were often epicentres of the COVID-19 pandemic. This paper prospectively assesses how maternal healthcare was provided in six referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the COVID-19 pandemic.MethodsMixed-methods design using three data sources: (1) qualitative data from repeated rounds of semi-structured interviews conducted between July 2020 and February 2021 with 22 maternity skilled heath personnel (SHP) on perceptions of care provision; (2) quantitative monthly routine data on caesarean section and labour induction from March 2019 to February 2021; and (3) timeline data of COVID-19 epidemiology, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on timeline analysis, and triangulated during reporting.ResultsWe identified three periods: first wave, slow period and second wave. The first wave was challenging for SHP given little knowledge about COVID-19, lack of infection prevention and control training, and difficulties reaching workplace. Challenges that persisted beyond the first wave were shortage of personal protective equipment and no rapid testing for women suspected with COVID-19. We noted no change in the proportion of caesarean sections during the pandemic, and a small increase in the proportion of labour inductions. All hospitals arranged isolation areas for women suspected/confirmed with COVID-19 and three hospitals provided care to women with suspected/confirmed COVID-19. Breastfeeding was not discouraged and newborns were not separated from mothers confirmed with COVID-19. Care provision was maintained through dedication of SHP, support from hospital management and remote communication between SHP.ConclusionRoutine maternal care provision was maintained in referral hospitals, despite first wave challenges. Referral hospitals and SHP contributed to guideline development for pregnant women suspected/confirmed with COVID-19. Maternity SHP, women and pregnancy must always be included in priority setting when responding to health system shocks, including outbreaks.

ObjectivesThe COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic and elucidates pathways to these changes.DesignProspective observational mixed-methods study, combining monthly routine data (March 2019–February 2021) and qualitative data from prospective semi-structured interviews. Data were analysed separately, triangulated during synthesis and presented along three country-specific pandemic periods: first wave, slow period and second wave.SettingSix referral maternities in four sub-Saharan African countries: Guinea, Nigeria, Tanzania and Uganda.Participants22 skilled health personnel (SHP) working in the maternity wards of various cadres and seniority levels.ResultsPercentages of obstetric complications were constant in four of the six hospitals. The percentage of obstetric referrals received was stable in Guinea and increased at various times in other hospitals. SHP reported unpredictability in the number of referrals due to changing referral networks. All six hospitals registered a slight increase in stillbirths during the study period, the highest increase (by 30%–40%) was observed in Uganda. Four hospitals registered increases in facility maternal mortality ratio; the highest increase was in Guinea (by 158%), which had a relatively mild COVID-19 epidemic. These increases were not due to mortality among women with COVID-19. The main pathways leading to these trends were delayed care utilisation and disruptions in accessing care, including sub-optimal referral linkages and health service closures.ConclusionsMaternal and perinatal survival was negatively affected in referral hospitals in sub-Saharan Africa during COVID-19. Routine data systems in referral hospitals must be fully used as they hold potential in informing adaptations of maternal care services. If combined with information on women’s and care providers’ needs, this can contribute to ensuring continuation of essential care provision during emergency.

IntroductionL'objectif de ce travail était d'étudier les facteurs associés à la pratique des rapports sexuels chez les élèves adolescents de la commune de Matoto à Conakry.MéthodesIl s'agissait d'une étude transversale, descriptive et analytique étendue sur 3 mois (1er mars - 31 mai 2018) ayant concerné les élèves âgés de 10 à 19 ans fréquentant les collèges et lycées de la commune de Matoto à Conakry.RésultatsParmi les 500 élèves interrogés, 226 (162 filles et 64 garçons) déclarent avoir eu des rapports sexuels soit une fréquence de 45,2%. Le préservatif n'était utilisé que par 16,4% des élèves et les contraceptifs par 35,4%. La fréquence des infections sexuellement transmissibles était de 23,5%. Parmi les filles ayant eu des rapports sexuels, 32,1% ont eu au moins une grossesse et celle-ci s'est soldée par un avortement clandestin dans 30,8% des cas. Le facteur associé à la réalisation des rapports sexuels chez les adolescents était les sorties nocturnes (p = 0,000).ConclusionLes rapports sexuels sont fréquents chez les élèves adolescents de la commune de Matoto. Le préservatif et les contraceptifs sont peu utilisés. Il ressort aussi de notre étude que les sorties nocturnes étaient le facteur le plus associé à la pratique.

The purpose of this study is to analyze the factors associated with sexual practices among adolescent students in Matoto, Conakry. We conducted a cross-sectional, descriptive and analytical study of students aged 10-19 years attending colleges and high schools in Matoto, Conakry over a period of 3 months (1 March -31 May 2018). Out of 500 students surveyed, 226 (162 girls and 64 boys; 45.2%) reported having sexual intercourse. Condom was used by 16.4% of students and contraceptives by 35.4%. The rate of sexually transmitted infections was 23.5%. Among girls who had sexual intercourse, 32.1% had had at least one unintended pregnancy ending in clandestine abortion in 30.8% of cases. The factor associated with sexual practices among adolescents was night life (p = 0.000). Sexual intercourse is frequent among adolescent students in Matoto. Condom and contraceptives are little used. In our study, night life was the principal factor associated with sexual practice.