WikiJournal Preprints/What Impact Have SARS-CoV-2/Covid-19 Pandemic on the Reproductive and Child Health Programme of Andhra Pradesh State in India over the 3 months after nationwide Lock down announcement in March 2020?

Introduction
The delivery of reproductive and child health services is of utmost importance and prime concern in India particularly states like Andhra Pradesh with limited resources, poor infrastructure and huge demand on healthcare system. Andhra Pradesh is spread over area of 160205 square kilometres, 13 districts with a total population of 49.67 million as per 2011 census.

The SARS-CoV-2 pandemic had presented a challenge even for developed healthcare systems around the world. A sense of fear gripped the whole world due to pandemic and the state of Andhra Pradesh in India is not an exception. The scarce healthcare resources including manpower, infrastructure, transportation (ambulance services) etc. have been largely deployed to tackle the situation of pandemic. This shift has tremendous effect on ongoing various health programmes running previously before the pandemic era. Pregnant mother & children’s are especially more vulnerable groups. The OPD/IPD services also suffered a lot due to pandemic impact as well as field health services are also compromised. The Pandemic situation challenged not only the health system but also community. The people have a sense of fear in meeting others particularly with peoples of healthcare system until unless there is some sort of acute emergency. Moreover most of the beds were reserved for covid-19 patients and as per protocols the community and system both have constrains erupting from the sudden situations of pandemic.

The advocacy for maternal and child health have been done and emphasised by many national and international organisation for several decades considering them especially vulnerable groups   in times of disaster such as pandemic. The Covid-19 pandemic has clearly disclosed the weakness of health system to protect above mentioned vulnerable groups. The situation also produced a demand of separate cadre to protect mother and child health in situations of disaster like pandemic. It seems many protective beneficial health services were not delivered in covid-19 era which may produce undesirable and detrimental effects at mass level. To understand the real impact of covid-19 on maternal and child health the data analysis for the month of April to June 2020 is compared with previous year data of same months and the facts are presented as table and charts.

Objective
The main aim of this research is to find out impact of SARS-CoV-2 pandemic on the Reproductive and Child Health Programme of Andhra Pradesh in India over the 3 months after Lockdown imposition countrywide in March 2020. For this purpose important indicator related to child & mother health protection i.e. immunisation, maternal health and family planning were taken into consideration.

Materials and Methodology
Secondary data from HMIS of Ministry of Health & Family Welfare Government of India for Andhra Pradesh 2019 & 2020 were taken for analysis and understanding the impact of pandemic on RCH programme over 3 months after lockdown viz. April/May/June 2020. It’s a novel qualitative and quantitative (mixed) cross-sectional comparative analytic research study on lockdown intervention impacts on RCH programme.

The data obtained is analysed by using Microsoft Office software. Following items are considered to know the impact of Covid-19 Pandemic on delivery of health services to mother and child under RCH programme- see- Table 1-Immunisation & Table 2 – Maternal Health & Family Planning

Table 1-Immunisation - Andhra Pradesh Table 2 – Maternal Health & Family Planning -Andhra Pradesh

Settings & Design:
Different indicators group of RCH programme (immunisation, maternal & child health, family planning) for state of Andhra Pradesh were collected and compared from previous year. The percentage increase & decrease is calculated from the available data to know the status of delivery of important & essential health services. The data is also shown in tabulated as well as graphical form for ease of understanding. All the data obtained were analysed using Microsoft office software. The analysis report is presented as graphs and also in letters.

Results
Results of data analysis regarding performance of Andhra Pradesh during the month of April to June 2020 as compared to previous year same month was compared for RCH services.

The immunisation services had been adversely affected during the months analysed as compared to previous year. It seems that not only newborn children but even the older ones have not been provided proper immunisation services as evident from the data analysis. See Table 3 - Comparison on immunisation coverage for 2019 & 2020 for the month of April to June – Andhra Pradesh & Figure 1 - Comparison on immunisation coverage for 2019 & 2020 for the month of April to June - Andhra Pradesh (see supplements)

For BCG immunisation there is a decrease of 19.8 % as compared to previous year data. Since BCG is given at birth it seems that either less no. of children’s is born during this period or many have not received it.

For Penta3+DPT3 the decrease was 32.0 %. For DT or DPT5 the decrease was 4.1 %.

For Measles+MR the decrease was 22.5 %. For OPV3 the decrease was 28.1 %.

For TT10 the increase was 8.6%. For TT16 the increase was 0.4%.

VITAMIN A (1ST DOSE) DECREASE 13.4 % VITAMIN A (5TH DOSE) DECREASE 17.3%

Vitamin A 2nd to 9th dose starts from 16 months of age (one dose every 6 month). VITAMIN A (9TH DOSE) INCREASE 3.5 %

Here it is important to mention that vitamins A as well as OPV both are administered orally. The only difference is that OPV3 is given at the age of 14 weeks whereas vitamin A is started from 9 month onwards. The full scenario for immunisation is as follow: see Table 3 & Figure 1

Table 3 - Comparison on immunisation coverage for 2019 & 2020 for the month of April to June - Andhra Pradesh The ANC services and institutional deliveries are important to assess the status of maternal care. Although home deliveries are reduced but at the same time the institutional deliveries also reduced which is a matter of great concern.

The scenario is as below: See Table 4 - Comparison on maternal health coverage for 2019 & 2020 for the month of April to June – Andhra Pradesh & Figure 2- Comparison on maternal health coverage for 2019 & 2020 for the month of April to June – Andhra Pradesh (see supplements)

Table 4 - Comparison on maternal health coverage for 2019 & 2020 for the month of April to June - Andhra Pradesh Although there is a general trend of increase in all above indicators every year as the population of India is growing rapidly. The decrease of such important indicators clearly signifies that covid-19 pandemic have a negative impact on delivery of important health services such as maternal and child health. The role of family planning is very important in context of India. All important family planning programmes show a decrease from previous year timeline for the same months indicating that the population control strategy of India also suffered during this period. See Table 5 - Comparison on family planning coverage for 2019 & 2020 for the month of April to June – Andhra Pradesh & Figure 3 - Comparison on family planning coverage for 2019 & 2020 for the month of April to June - Andhra Pradesh (see supplements)

Table 5 - Comparison on family planning coverage for 2019 & 2020 for the month of April to June - Andhra Pradesh

Discussion
The analysis of secondary data obtained from HMIS of Ministry of Health & Family Welfare website for RCH programme of the state of Andhra Pradesh shows that the lockdown period & initial early phase of SARS-CoV-2 pandemic have a negative impact over the delivery of RC health services as well as the indicators are also affected negatively.

Besides the pandemic the state is also having lack of resources, manpower poor infrastructure as well as positive deviance at community level. These are the barriers in fact beside the epidemic. It seems that there is lack of proper plan to deal with such pandemic situation.  Providing RCH (reproductive and child health) service is always a big concern for populous state of Andhra Pradesh with high levels of fertility. During the pandemic era it’s more challenging to deliver such essential services due to fear factors at community as well as personal level of healthcare staff. Decreasing rate of immunisation can lead to emergence of diseases which is being controlled by such programmes. At the same time poor ANC services can put maternal as well as foetus life in danger. The decrease in family planning services might add more to ongoing population explosion putting more stress on available resources.

Although the state have imposed epidemic disease act but it seems to be ineffective to get positive results on RCH programme. The need is to develop a separate cadre for RCH services in order to reap the benefits of demographic dividend in coming years. The Government of Andhra Pradesh should develop a strong strategy to protect maternal and child health in conditions of distress such as covid-19 pandemic. For this the barriers and promoters of RCH programme needs to be dealt in proper way to achieve the maximum output.

Conclusion
The State of Andhra Pradesh has taken various steps and strategy like other state but it seems to be insufficient to give the desired results. The barriers of healthcare system and delivery of services should be rectified added with a proper dynamic plan to carry on usual health delivery services even in pandemics & other situations of distress. The state of Andhra Pradesh needs to develop an exclusive plan to tackle such situations to ensure delivery of very essential services such as RCH during pandemics or any other natural calamities.

Ø  Establishment of exclusive Reproductive and child health department is required at central level as well as at all the states and union territories of India.

Ø  Covid-19 pandemic has given us a lesson that we must have equity in healthcare & the child and women’s who are considered most vulnerable in situations of distress must have adequate supportive healthcare all the times especially during pandemics and other natural calamities. Women of reproductive age group and children’s constitutes a large portion of population and the country and state must have a separate department to ensure the delivery of health services to this vulnerable section of the population.

Ø  India being the second most populous country in the world should have a robust population control strategy to operate in any situations.

Declarations
-This paper has not been previously published and is not currently under consideration by another journal. The document is Microsoft word with English (India) language & 2632 words Total.

- Ethics approval and consent to participate: Not applicable. This study has not involved any human or animals in real or for experiments.

-Consent for publication: Not applicable

-Availability of data and materials: The data & materials for study are mentioned in article and available as reference.

-Conflicts of Interest/ Competing Interest: There are no conflicts / competing of interest

- Funding-Self sponsored. No aid taken from individual or agency etc.

- Authors' contributions: The whole work is solely done and verified by the Author - Dr Piyush Kumar,

M.B.B.S. - Sri Krishna Medical College, EMOC- General Medical Officer- Bihar Health Services, Government of Bihar, India, under supervision of Dr Habib Hasan Farooqui from IIPH-Delhi.

- Acknowledgements- I am thankful to advocate Anupama my wife and my daughters Aathmika-Atheeva for cooperation.

- Author information: The author is currently working as senior medical officer for the government of Bihar.

-Financial Support & sponsorship: Nil

-Author contact information

1 Department of Health, Government of Bihar, MOBILE - +919955301119/+917677833752,

Email drpiyush003@gmail.com

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Acknowledgements
I am thankful to advocate Anupama my wife and my daughters Aathmika-Atheeva for cooperation.

Competing interests
There are no conflicts / competing of interest

Ethics statement
Not applicable. This study has not involved any human or animals in real or for experiments.