Resilience of hospital and allied infrastructure during pandemic and post pandemic periods for maternal health care of pregnant women and infants in Tamil Nadu, India - A counterfactual analysis.

COVID-19 has impacted the healthcare system across the globe. The study will span three pandemic waves in 2020, 2021, and 2022. The goal is to learn how the pandemic affects antenatal care (ANC) and emergency delivery care for pregnant women in Tamil Nadu, India, and how medical services respond. The study employs counterfactual analysis to evaluate the causal impact of the pandemic. A feedforward in combination with a simple auto-regressive neural network (AR-Net) is used to predict the daily number of calls for ambulance services (CAS). Three categories of the daily CAS count between January 2016 and December 2022 are utilised. The total CAS includes all types of medical emergencies; the second group pertains to planned ANC for high-risk pregnant women and the third group comprises CAS from pregnant women for medical emergencies. The second wave's infection and mortality rates were up to six times higher than the first. The phases in wave-II, post-wave-II, wave-III, and post-wave-III experienced a significant increase in both total IFT (inter-facility transfer) and total non-IFT calls covering all emergencies relative to the counterfactual, as evidenced by reported effect sizes of 1 and a range of 0.65 to 0.85, respectively. This highlights overwhelmed health services. In Tamil Nadu, neither emergency prenatal care nor planned prenatal care was affected by the pandemic. In contrast, the increase in actual emergency-related IFT calls during wave-II, post-wave-II, wave-III, and post-wave-III was 62%, 160%, 141%, and 165%, respectively, relative to the counterfactual. During the same time periods, the mean daily CAS related to prenatal care increased by 47%, 51%, 38%, and 38%, respectively, compared to pre-pandemic levels. The expansion of ambulance services and increased awareness of these services during wave II and the ensuing phases of Covid-19 pandemic have enhanced emergency care delivery for all, including obstetric and neonatal cohorts.

Prolonged school closure during the pandemic time in successive waves of COVID-19- vulnerability of children to sexual abuses - A case study in Tamil Nadu, India.

Objectives: The Tamil Nadu government mandated several stay-at-home orders, with restrictions of varying intensities, to contain the first two waves of the COVID-19 pandemic. This research investigates how such orders impacted child sexual abuse (CSA) by using counterfactual prediction to compare CSA statistics with those of other crimes. After adjusting for mobility, we investigate the relationship between situational factors and recorded levels of cases registered under the Protection of Children from Sexual Offences Act (POCSO). The situational factors include the victims' living environment, their access to relief agencies, and the competence and responsiveness of the police. Methods: We adopt an auto-regressive neural network method to make a counterfactual forecast of CSA cases that represents a scenario without stay-at-home orders, relying on the eight-year daily count data of POCSO cases in Tamil Nadu. Using the insights from Google's COVID-19 Community Mobility Reports, we measure changes in mobility across various community spaces during the various phases of stay-at-home orders in both waves in 2020 and 2021. Results: The steep falls in POCSO cases during strict stay-at-home periods, compared with the counterfactual estimates, were -72% (Cliff's delta -0.99) and -36% (Cliff's delta -0.65) during the first and second waves, respectively. However, in the post-lockdown phases, there were sharp increases of 68% (Cliff's delta 0.65) and 36% (Cliff's delta 0.56) in CSA cases during the first and second waves, with concomitantly quicker reporting of case registration. Conclusions: Considering that the median delay in filing CSA complaints was above 30 days in the mild and post-intervention periods, the upsurge of cases in the more relaxed phases indicates increased occurrences of CSA during strict lockdowns. Overall, higher victimization numbers were observed during the prolonged lockdown-induced school closures. Our findings highlight the time gap between the incidents and their registration during the strict lockdown phases.

Counterfactual analysis of the impact of the first two waves of the COVID-19 pandemic on the reporting and registration of missing people in India.

The primary duty of law enforcement agencies is to ensure that a victim has the necessary information and access to the relevant tools required to seek justice. In India, complex cases such as bodily offences and property crimes capture the work and efforts of many agencies involved; however, cases related to missing persons are not often accorded similar priority or seriousness. The COVID-19 pandemic and subsequent lockdowns have added further challenges to this scenario. The government-mandated lockdowns in Tamil Nadu generally exacerbated difficult socio-economic and living conditions, thereby directly or indirectly contributing to an increased load of missing person cases. This study aims to assess and identify the impact of mobility on reporting and registration of missing persons. By adopting an auto-regressive neural networks method, this study uses a counterfactual analysis of registered missing person cases during the government-mandated lockdowns in response to the global pandemic in 2020 and 2021. The registered cases are calculated based on the daily count of cases for eleven years in Tamil Nadu, India. The lockdowns identify eight different time windows to determine the impact of mobility on the registration of cases. While there has been no significant or drastic change over the pre-pandemic period, during the pandemic, especially during the restrictive phases of the pandemic, there was a sharp fall in cases compared to the counterfactual predicted (effect sizes: -0.981 and -0.74 in 2020 and 2021), signalling towards a choked mechanism of reporting. In contrast, when most mobility restrictions were removed, an increase in cases (effect sizes of +0.931 and 0.834 in 2020 and 2021) pointed to restored and enabled reporting channels. The research findings emphasise the significance of mobility as a factor in influencing the reporting and registration of missing persons and the need to ensure this continues to help families find redress.

Empirical evidence of the impact of mobility on property crimes during the first two waves of the COVID-19 pandemic.

This paper seeks to evaluate the impact of the removal of restrictions (partial and complete) imposed during COVID-19-induced lockdowns on property offences such as robbery, burglary, and theft during the milder wave one and the more severe wave two of the pandemic in 2020 and 2021, respectively. Using 10-year data of the daily counts of crimes, the authors adopt an auto-regressive neural networks method to make counterfactual predictions of crimes, representing a scenario without the pandemic-induced lockdowns. The difference between the actual and forecast is the causal impact of the lockdown in all phases. Further, the research uses Google Mobility Community Reports to measure mobility. The analysis has been done at two levels: first, for the state of Tamil Nadu, which has a sizeable rural landscape, and second for Chennai, the largest metropolitan city with an urban populace. During the pandemic-induced lockdown in wave one, there was a steep decline in the incidence of property offences. On removing restrictions, the cases soared above the counterfactual predicted counts. In wave two, despite the higher severity and fatality in the COVID-19 pandemic, a similar trend of fall and rise in property cases was observed. However, the drop in mobility was less substantial, and the increase in the magnitude of property offences was more significant in wave two than in wave one. The overall trend of fluctuations is related to mobility during various phases of restrictions in the pandemic. When most curbs were removed, there was a surge in robberies in Tamil Nadu and Chennai after adjusting for mobility. This trend highlights the effective increase in crime due to pandemic-related economic and social consequences. Further, the research enables law enforcement to strengthen preventive crime work in similar situations, when most curbs are removed after a pandemic or other unanticipated scenarios.

Relationship between mobility and road traffic injuries during COVID-19 pandemic-The role of attendant factors.

This study investigates the important role of attendant factors, such as road traffic victims' access to trauma centres, the robustness of health infrastructure, and the responsiveness of police and emergency services in the incidence of Road Traffic Injuries (RTI) during the pandemic-induced COVID-19 lockdowns. The differential effects of the first and second waves of the pandemic concerning perceived health risk and legal restrictions provide us with a natural experiment that helps us differentiate between the impact of attendant factors and the standard relationship between mobility and Road Traffic Injuries. The authors use the auto-regressive recurrent neural network method on two population levels-Tamil Nadu (TN), a predominantly rural state, and Chennai, the most significant metropolitan city of the state, to draw causal inference through counterfactual predictions on daily counts of road traffic deaths and Road Traffic Injuries. During the first wave of the pandemic, which was less severe than the second wave, the traffic flow was correlated to Road Traffic Death/Road Traffic Injury. In the second wave's partial and post lockdown phases, an unprecedented fall of over 70% in Road Traffic Injury-Grievous as against Road Traffic Injury-Minor was recorded. Attendant factors, such as the ability of the victim to approach relief centres, the capability of health and other allied infrastructures, transportation and medical treatment of road traffic crash victims, and minimal access to other emergency services, including police, assumed greater significance than overall traffic flow in the incidence of Road Traffic Injury in the more severe second wave. These findings highlight the significant role these attendant factors play in producing the discrepancy between the actual road traffic incident rate and the officially registered rate. Thus, our study enables practitioners to observe the mobility-adjusted actual incidence rate devoid of factors related to reporting and registration of accidents.

Impact of COVID-19 pandemic on road safety in Tamil Nadu, India.

This study uses structured literature mapping to review worldwide trends in traffic safety following the phenomenon of the COVID-19 pandemic. Motivated by dissimilar findings globally and a lack of evidence from emerging nations which have been significantly more affected by road traffic crashes, the study examines the impact of the pandemic-induced lockdown on road traffic deaths and injuries in Tamil Nadu, India. Using a holistic approach, methods such as ARIMA, Holt-Winters, Bayesian Structural Time Series, and Generalized Additive Model are employed for counterfactual prediction, to draw a causal inference of lockdown on traffic safety. In line with global studies, a substantial reduction in traffic crashes, injuries, and fatalities during lockdowns has been found. However, the comparison of relative differences shows that the number of grievous injuries reduced more than minor injuries, crashes, or fatalities. Furthermore, these relative differences were sustained even when metrics returned to normalcy in the post-lockdown phases. Further spatial stratification at two levels (cities and districts) shows that the macroscopic state-level trends are also broadly seen in the sub-units. This validates the consistency of trends across rural-urban differences and shows that, despite variations in the degree of enforcement of the lockdown within Chennai city, contrary to expectation, increased police presence did not have a differential impact on road crashes.