Program for Education in Global and Population Health

Indirect Consequences: A Literature Review of the Collateral Effects of the COVID-19 Pandemic Across Sub-Saharan Africa. Acute Care and Emergency Referral Systems (ACERS)

Natakie Boychuk

Name: Natalie Boychuk
School: Mailman School of Public Health, Class of 2021
Mentor: Rachel Moresky, MD, MPH and Koku Awoonor-Williams, MD

 

 

Laura Carson

Name: Laura Carson 
School: Mailman School of Public Health, Class of 2021
Mentor: Rachel Moresky, MD, MPH and Koku Awoonor-Williams, MD

 

 

Alex Northrup

Name: Alexander Northrop
School: Vagelos College of Physicians and Surgeons, Class of 2023. Varmus Global Scholar 2020
Mentor: Rachel Moresky, MD, MPH and Koku Awoonor-Williams, MD

 

 

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Abstract

The COVID-19 pandemic has disrupted healthcare systems worldwide, including those in sub-Saharan Africa (SSA). These disruptions include direct consequences of community transmission of SARS-CoV-2 and indirect consequences of the pandemic. It is crucial to understand the indirect ways in which COVID-19 may uniquely challenge health systems across SSA so that health systems strengthening efforts may be prioritized. We conducted a literature review with literature published in the initial phases of the COVID-19 pandemic to determine the indirect effects of COVID-19 on 1) the provision of accessible, equitable, high-quality, and efficient healthcare services, 2) healthcare-seeking behavior, and 3) health outcomes in sub-Saharan Africa. We used key terms related to the indirect effects of COVID-19 on PubMed, Google Scholar, and Scopus. Titles and abstracts were screened by two reviewers for inclusion, followed by a full revision of the text by two reviewers if the article was determined to meet the inclusion criteria. In total, the search terms yielded 744 results in PubMed, 147 on Google Scholar, and 35 on Scopus. 33 met the inclusion criteria for this literature review: 16 articles covered health service provision, 4 focused on healthcare-seeking behavior, and 13 focused on non-COVID-19 health outcomes. There is limited primary data on the indirect effects of COVID-19 in SSA, testifying to the need for additional local- and national-level analyses. Available data suggest diverse short-term indirect effects in SSA; however, future research is needed to capture the pandemic’s effects on intermediate- and long-term health outcomes and health system resiliency.