Impact of the COVID-19 pandemic on access to and delivery of maternal and child healthcare services in low-and middle-income countries: a systematic review of the literature.

Background: The COVID-19 pandemic has had a multifaceted impact on maternal and child services and adversely influenced pregnancy outcomes. This systematic review aims to determine the impact of the COVID-19 pandemic on access to and delivery of maternal and child healthcare services in low- and middle-income countries. Methods: The review was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A primary search of electronic databases was performed using a combination of search terms related to the following areas of interest: "impact' AND 'COVID-19' AND 'maternal and child health services' AND 'low- and middle-income countries. A narrative synthesis approach was used to analyse and integrate the results. Results: Overall, 45 unique studies conducted across 28 low- and middle-income countries met the inclusion criteria for the review. The findings suggest the number of family planning visits, antenatal and postnatal care visits, consultations for sick children, paediatric emergency visits and child immunisation levels decreased compared to the pre-pandemic levels in the majority of included studies. An analytical framework including four main categories was developed based on the concepts that emerged from included studies: the anxiety of not knowing (1), overwhelmed healthcare systems (2), challenges perceived by healthcare professionals (3) and difficulties perceived by service users (4). Conclusion: The COVID-19 pandemic disrupted family planning services, antenatal and postnatal care coverage, and emergency and routine child services. Generalised conclusions are tentative due to the heterogeneity and inconsistent quality of the included studies. Future research is recommended to define the pandemic's impact on women and children worldwide and prepare healthcare systems for future resurgences of COVID-19 and potential challenges beyond. Systematic review registration: PROSPERO (CRD42021285178).

Explaining the rise of economic and rural-urban inequality in clean cooking fuel use in Tanzania.

Despite the high rate of economic growth and electrification in the last two decades in Tanzania, only 6.9 % of the nation's households have access to clean cooking fuel technology which is concentrated among the rich urban households. Analysing data from two waves of the Tanzania National Panel Survey (2014/15 and 2020/21), we estimate the economic and rural-urban inequalities in the use of clean cooking fuel. Using the concentration curve, Erreygers concentration index and non-linear Fairlie decomposition, we find an increase in economic inequality and rural-urban inequality in the use of clean cooking fuel. Based on our analysis, factors such as the household head's education, household economic status and household connection to electricity contribute to the rural-urban inequality in the use of clean cooking fuel. Policy changes are vital for ensuring both rural and urban households have equitable access to education, electricity connection and household economic status to address inequality in the use of clean cooking fuel.