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. 2024 Nov 18;13(11):5256–5264. doi: 10.4103/jfmpc.jfmpc_203_23

Maternal and child health services during COVID-19 in India: Highlighting the role of primary care physicians in maintaining continuum of care

Saurabh Sharma 1, Sumit Aggarwal 2, Kh Jiten Kumar Singh 1, Lucky Singh 1, Asheber Gaym 3, Damodar Sahu 1, Tulsi Adhikari 1, Saritha Nair 1, Anil Kumar 1, Atul Juneja 1, Mendu Vishnu Vardhana Rao 1,✉
PMCID: PMC11668487  PMID: 39722985

ABSTRACT

Background:

This study aims to address the lack of substantial evidence regarding the effect of COVID-19 on maternal and child health (MCH) services in India and also highlight the role of primary care physicians in maintaining essential services during a pandemic. While studies conducted worldwide and in India have examined the effects of COVID-19 on these services, a significant gap in robust evidence remains.

Methods:

Forty-two districts were selected randomly from seven regional states of India. Data on five selected MCH indicators were extracted from HMIS for the months from March to June 2019 and 2020. Relative changes in service utilization for each month from March to June over the two years were compared. Comparisons were also made between the selected districts based on the COVID-19 categorization into red and green zones.

Results:

COVID-19 and its associated restrictive measures created significant disruption to essential MCH service utilization in India across all states reviewed. Both institutional, and outreach services were impacted; however, hospital-based services were more impacted. Institutional deliveries and emergency obstetric services saw a decline in March and April 2020 which gradually improved between May and June in some states. Immunization sessions held in 2020 observed a decrease in April.

Conclusions:

The analysis indicates a disruption in service delivery during the initial phase of the lockdown. However, the services resumed gradually as national and state-specific operational guidelines were implemented to maintain a continuum of care.

Keywords: Antenatal, child health, covid-19, immunization, maternal health

Introduction

The unprecedented outbreak of COVID-19, which began in early 2020, has globally disrupted healthcare services, affecting low- and middle-income countries (LMICs) with weak and overburdened healthcare systems.[1] These countries, already facing challenges in providing equitable and accessible healthcare services, encountered significant difficulties in containing the spread of COVID-19.[2] Unfortunately, prioritizing COVID-19-related healthcare has the potential to compromise the delivery of crucial routine services such as maternal and child health (MCH) services, thereby endangering the lives of both mothers and children due to unaddressed preventable pregnancy complications.[3] World Health Organization (WHO) guidelines 2016, prioritize primary health services to mothers and newborns, adequate diet, and nutrition and early detection of pregnancy-related complications during antenatal care consultation for positive MCH outcomes.[4] In South Asia, specifically India, Pakistan, Bangladesh, and Afghanistan, there is a significant burden of newborn mortality, maternal mortality, and stillbirths, with India alone accounting for 12% of global maternal deaths.[5] The radical shift of the healthcare system to attend to the influx of COVID-19 cases has led to service disruptions, leading to an estimated 8.3% to 38.6% increase in maternal deaths and from 9.8% to 44.7% increase in child deaths per month in 118 LMIC countries.[6] The COVID-19 pandemic has strained immunization services coverage in at least 27 countries,[7] Furthermore, the indirect impacts of the COVID-19 outbreak have caused significant disruptions in MCH services, surpassing the direct effects of the pandemic on pregnant mothers and children.[8] Primary care providers (PCPs) and family physicians (FPs) play a vital role in providing MCH (MCH) services in India. However, the pandemic has disrupted the delivery of these services, leading to concerns about the health and well-being of mothers and children.

During the pan-India COVID-19 which started in the last week of March and ended in the first week of June stringent travel and curfew restrictions except for essential services.[9,10] An increase in domestic workload; extreme physical and social isolation, insomnia, anxiety, and depression, increases the likelihood of preterm birth, delayed physical and cognitive growth, and adversely affects the physical and psychological health of both mother and child.[11] In addition, the preparedness, reassignment, and reinforcement of healthcare professionals and medical equipment to contain the pandemic led to the conversion of various healthcare facilities into dedicated COVID-19 treatment facilities and quarantine and isolation.[12] The reduced access to essential maternal and newborn health services has not only prevented vulnerable mothers from utilizing national conditional cash transfer schemes but has also contributed to the overall decline in life-saving services during the COVID-19 pandemic.[13,14,15]

Current evidence from LMIC countries, including India, has provided some insights on the impact of COVID-19 on maternal and child deaths and barriers faced by pregnant women and newborns to access obstetric care because of the pandemic nationwide. However, there is a shortage of robust evidence on the impact of COVID-19 on maternal and child services in India. Based on data obtained from the National Health Management Information System (HMIS), this study investigates the impact of COVID-19 on crucial healthcare services for mothers and children in India.

Methods

In this study, selected MCH indicators from the Health Management Information System (HMIS) were analyzed through secondary data analysis through a multi-year comparison and changes based on district categorizations as per COVID-19 burden, adopted by MoHFW in 2020. Data from March to June 2019 and 2020 were compared. Data on specific maternal and newborn indicators were extracted from the HMIS website (https://nrhm-mis.nic.in/hmisreports/frmstandard_reports.aspx) for seven states during the periods of 2019-20 and 2020-21 (Quarter 1). The extracted microdata for each state was saved in CSV Excel format and subsequently converted into SPSS and STATA formats for analysis. To ensure accuracy and reliability, the converted data was cross-validated by comparing it with the quarterly reports published by HMIS. The country was categorized into six regional zones (North, South, East, West, Central, and North-East) to cover major geographical regions. One State was selected from each respective zone. The districts in India were classified based on the COVID-19 caseload as red, orange, and green zone districts, where red signifies a higher caseload. Seven districts were further selected from each zone (three red zone districts, three green zone districts, and one aspirational district). In total, 42 districts were included in the study (list provided in the supplementary figure). The categorization of districts according to COVID-19 status is a dynamic process depending on the number of new cases of COVID-19. This study primarily focuses on the immediate impact assessment (March/April/May/June); hence the order dated 30/04/2020 number 28015/19/2020-EMR was used for district categorization. Therefore, the categorization list at a particular time point was considered (MOHFW. Government of India. 2020). Ethical committee approval File No: NCDIR/BEU/ICMR-CECHR/75/2020 Date: 4th June, 2020.

To comprehensively assess the impact of COVID-19 on both hospital-based and outreach services, this study selected five maternal health indicators. These indicators include two measures of antenatal care, two indicators related to intranatal processes, and one indicator focusing on childhood immunization services. The following indicators were utilized in the study: Pregnant women (PW) registered for ANC, PW provided with emergency obstetric care for pregnancy complications, Institutional deliveries conducted (C-section and Normal), home deliveries, and immunization sessions held. The relative change was calculated by dividing the absolute change (the difference in the value of the indicator in the years 2020 and 2019) by the indicator’s value in 2019. Relative change for each indicator refers to the absolute change as a percent of the indicator’s value in each month in the year 2020. Relative change from March 2019 data was compared with March 2020 data. A similar process was carried out for April, May, and June. Data were further categorized based on the COVID-19 categorization of districts into red and green districts. To show this, we have made bar graphs comparing the relative change in red and green zone districts in all six states. Delhi was not included in the red and green zone comparison graphs as all districts in Delhi were categorized as red zones.

Results

Antenatal care registration in 2020 witnessed a decline in March and April in all seven states compared to 2019. Delhi saw the steepest decline in ANC registration, with a relative change of 56.68 percent in March. In April, Uttar Pradesh witnessed a steep decline of 80.05% in ANC registration. The ANC registration increased in May in Assam, Madhya Pradesh, Telangana, and Odisha compared to 2019. Delhi, Maharashtra, and UP saw a decline in ANC registration in all four months from March to June 2020 compared to 2019 [Figure 1]. The number of Pregnant Women provided with emergency obstetric care in 2020 witnessed a decline in March in Assam, Delhi, Madhya Pradesh, and Odisha. The highest decline was observed in Assam and Odisha at 38.32% and 31.30%, respectively, in March. In April, the decline was observed in all states except UP and Telangana. Assam, Delhi, and Odisha saw a decline in emergency obstetric care in all four months from March to June. In contrast, Telangana saw an increase in emergency obstetric care in all four months from March to June [Figure 2].

Figure 1.

Figure 1

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Percent relative change in the number of pregnant women registered for ANC for the year 2020 vs 2019

Figure 2.

Figure 2

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Percent relative change in the number of pregnant women provided with emergency obstetric care for pregnancy complications for the year 2020 vs 2019

Institutional deliveries conducted in 2020 witnessed a decline in March in all states except Maharashtra and UP as compared to 2019. Telangana and Odisha observed the highest decline in Institutional deliveries in March of 32.30% and 31.30%, respectively. In May, the decline was observed in all states. Telangana witnessed the highest decline of 41.69% in institutional deliveries in May. Telangana, Delhi, MP, and Odisha saw a decline in institutional deliveries in all four months from March to June [Figure 3].

Figure 3.

Figure 3

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Percent relative change in the number of institutional deliveries for the year 2020 vs 2019

The number of home deliveries in 2020 witnessed a decline in March in all states except Maharashtra. Delhi reported an increase in the number of home deliveries for April, May, and June with a relative change of 20%, 18%, and 8%, respectively. In April, the increase in home deliveries was observed in Assam, Delhi, and Maharashtra. Home deliveries increased by 20.40% and 14.48% in Delhi and Maharashtra, respectively [Figure 4]. Immunization sessions held in 2020 saw an increase in March in Madhya Pradesh, Maharashtra, Odisha, and Telangana. In April, all states observed a decline in the number of immunization sessions held, and the trend continued in May except in Odisha and Telangana, in which an upward trend was seen. UP and Delhi witnessed the highest decline of 94.04% and 79.36% and 61.61% and 47.90% in April and May [Figure 5].

Figure 4.

Figure 4

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Percent relative change in the number of home deliveries for the year 2020 vs 2019

Figure 5.

Figure 5

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Percent relative change in the number of immunization sessions held in the selected states for the year 2020 vs 2019

A comparison between the selected red and green zone districts showed that ANC registration in UP, Telangana, and Maharashtra’s red zone districts was more affected than green zone districts [Figure 6]. The red zone districts of Assam, MP, Maharashtra, and Odisha witnessed a steeper decline in emergency obstetric care services than green zone districts. On the contrary, Telangana and Uttar Pradesh witnessed the opposite trend, with the emergency obstetric care services affected more in the green zone districts to the tune of 67% and 40%, respectively [Figure 7]. Telangana, Maharashtra, MP, and Assam witnessed a higher decline in red zone districts than green zone districts. In Red zone districts of Telangana, there was a steep decline of 39.37% in institutional deliveries conducted, while in green zone districts decline of 24.13% was observed [Figure 8].

Figure 6.

Figure 6

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Relative Change in Pregnant Women registered for ANC during 2019 and 2020 in six states for the selected Red and Green Zone districts

Figure 7.

Figure 7

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Relative Change in Pregnant Women provided with emergency obstetric care for pregnancy complications during 2019 and 2020 in six states for the selected Red and Green Zone districts

Figure 8.

Figure 8

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Relative Change in Institutional deliveries conducted (C section and Normal) during. 2019 and 2020 in six states for the selected Red and Green Zone districts

Similarly, in Maharashtra, red zone districts witnessed a decline of 27.94% in institutional deliveries conducted, while in green zone districts, a decline of 14.32% was observed. In Maharashtra, red zone districts witnessed an increase of 30.21% in-home deliveries, while in green zone districts, a tremendous increase of 80% was observed [Figure 9]. Red zone districts of MP witnessed a steep decline of 34.23% in immunization sessions held, while in green zone districts decline of 2.26% was observed. While in red zone districts of UP, there was a steep decline of 40.15% in immunization sessions held, while in green zone districts decline of 42.12% was observed. In Telangana, red zone districts witnessed a decline of 12.87% in immunization sessions held, while in green zone districts, an increase of 18.99% was observed [Figure 10].

Figure 9.

Figure 9

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Relative Change in Home deliveries during 2019 and 2020 in six states for the selected Red and Green Zone districts

Figure 10.

Figure 10

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Relative Change in Immunization session held during 2019 and 2020 in six states for the selected Red and Green Zone districts

Discussion

The indirect impact of COVID-19 on MCH services has been predicted using various mathematical modeling exercises and studies conducted in lower and middle-income countries.[6,7,10] COVID-19 has had an impact on both institutional as well as outreach services which has been documented in studies conducted in lower- and middle-income countries.[16,17,18] The effect seems more on the institutional level services. A decline in health-care-seeking behavior and disrupted MCH services have been suggested as possible causes.[19] The present analysis clearly shows that the antenatal care registration in 2020 witnessed a decline in March and April in all seven states compared to 2019, which might be because of the lockdown restrictions which led to both interruption in health care delivery services as well as decreased demand due to fear of COVID-19 among the beneficiaries. As most metro cities were the maximum impact during the initial period of the pandemic, Delhi too witnessed the steepest decline of more than 50% in ANC registrations in April as all districts were categorized as red zone districts.[20,21] Delhi and Maharashtra saw a decline in ANC registration in all four months from March to June 2020 compared to 2019, which were also the most affected states in India. A comparison between the selected red and green zone districts showed that antenatal registration in UP, Telangana, and Maharashtra was more affected than in green zone districts. However, various other factors also govern these indicators, and these may vary from State to State, including population dynamics and preparedness of the public health system.

In response to the COVID-19 pandemic, India has made significant efforts to adapt and enhance its healthcare infrastructure to effectively address the dual challenge of combating COVID-19 while ensuring the provision of essential services, including MCH. Globally, Primary Care has emerged as a critical cornerstone in the response to COVID-19. Primary Care plays a vital role in identifying and triaging potential COVID-19 cases, ensuring early diagnosis, and alleviating the burden on hospital services. During the initial phase of the pandemic, the World Health Organization recognized the significance of Primary Care and issued interim guidance outlining its role in the COVID-19 response. This guiding document established six principles that guided the involvement of Primary Care in effectively addressing the challenges posed by the pandemic which included continuation of essential health services. To ensure the seamless provision of healthcare services, the government of India has formulated advisories and guidelines, empowering state governments to develop their action plans. These guidelines have played a pivotal role in facilitating the maintenance of a continuum of care and have provided valuable support to state governments in strategizing their healthcare initiatives.[21] However, health facility-level care which included institutional deliveries and emergency obstetrics services, witnessed a decline in March in all states except Maharashtra and UP as compared to 2019. Telangana, Delhi, MP, and Odisha saw a decline in institutional deliveries in all four months from March to June. These findings are similar to a single-center study by Goyal et al.[8] in which they observed around 50% decline in institutional deliveries; the major reasons being interrupted services, lack of transport, and fear of contracting COVID-19.[8]

India followed the global strategy for taming the pandemic by implement a country-wide lockdown announced in the last week of March 2020. Beneficiaries faced many challenges, including lack of transport and interrupted services, further compounded by the fear of contracting COVID-19. The number of home deliveries in 2020 witnessed a decline in March in all states except Maharashtra; however, Assam, Delhi, and Maharashtra reported an increase in the number of home deliveries during April.

In late March 2020, WHO released an advisory to prioritize childhood immunization temporarily suspend mass vaccination campaigns and weigh local risks and benefits in decisions on whether to continue immunization outreach activities. In a survey of over 129 countries, fifty percent reported complete suspensions or substantial disruptions to immunization services in March and April, putting an estimated 80 million children under one year old at increased risk of contracting vaccine-preventable diseases (WHO, 2020).[22] As per our analysis, similar trends were seen in April, where all states observed a decline in the number of immunization sessions held, and the trend continued in May except in Odisha and Telangana, in which an upward trend was seen. UP and Delhi registered a decline of around 94.04% and 79.36%; 61.61% and 47.90% in April and May, respectively. Our findings provide an overview of the initial impact of COVID-19 on immunization services, followed by an upward trajectory in June in most states as the services resumed and guidelines regarding immunization services were released from time to time. However, the study has its limitations. The analysis was limited to the lockdown period from March end to June 2020. The restrictions during that period were gradually relaxed impact which can be observed in the analysis. The effect of the pandemic on data collection and quality of HMIS data is also one of the limitations, and the findings should be interpreted considering these limitations.

Additionally, this analysis sheds light on the monthly trends observed throughout the pandemic and highlights the crucial role of primary care physicians in delivering essential health services. These findings underscore the critical significance of MCH services, both during and beyond the COVID-19 pandemic. Primary care physicians (PCPs) and family practitioners (FPs) have a pivotal role in delivering these vital services. Their involvement includes offering comprehensive education and guidance to pregnant women and their families on the risks associated with COVID-19 and effective preventive measures. Additionally, PCPs and FPs are instrumental in conducting screenings for COVID-19 and other potential complications among pregnant women, promptly referring them to specialized care when necessary. Furthermore, they contribute to providing essential postnatal care to new mothers and their infants. By undertaking these measures, the healthcare workforce, in collaboration with PCPs and FPs, can effectively ensure that mothers and children in India have unrestricted access to the essential care they require to maintain good health during and beyond the challenges posed by the COVID-19 pandemic.[23]

Financial support and sponsorship

This study has been funded by Indian Council of Medical Research, New Delhi.

Conflicts of interest

There are no conflicts of interest.

References

  • 1.Metzl JM, Maybank A, De Maio F. Responding to the COVID-19 pandemic: The need for a structurally competent health care system. JAMA. 2020;324:231–2. doi: 10.1001/jama.2020.9289. [DOI] [PubMed] [Google Scholar]
  • 2.Hodkinson B, Singh P, Gcelu A, Molano WB, Pons-Estel G, Alpízar-Rodríguez D. Navigating COVID-19 in the developing world. Clin Rheumatol. 2020;39:2039–42. doi: 10.1007/s10067-020-05159-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Kumar C, Sodhi C, Jaleel CP A. Reproductive, maternal and child health services in the wake of COVID-19: Insights from India. J Glob Heal Sci. 2020;2:1–16. [Google Scholar]
  • 4.WHO recommendations on antenatal care for a positive pregnancy experience. [[Last accessed on 2023 Jan 23]]. Available from: https://www.who.int/publications/i/item/9789241549912 .
  • 5.Guo S, Carvajal-Aguirre L, Victora CG, Barros AJD, Wehrmeister FC, Vidaletti LP, et al. Equitable coverage?The roles of the private and public sectors in providing maternal, newborn and child health interventions in South Asia. BMJ Glob Heal. 2019;4:1–10. doi: 10.1136/bmjgh-2019-001495. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Roberton T, Carter ED, Chou VB, Stegmuller AR, Jackson BD, Tam Y, et al. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: A modelling study. Lancet Glob Heal. 2020;8:e901–8. doi: 10.1016/S2214-109X(20)30229-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.International Child Health Group;Royal College of Paediatrics &Child Health;Royal College of Paediatrics &Child Hea. Impact of the COVID-19 pandemic on global child health: Joint statement of the International Child Health Group and the Royal College of Paediatrics and Child Health. Arch Dis Child. 2021;106:115–6. doi: 10.1136/archdischild-2020-320652. [DOI] [PubMed] [Google Scholar]
  • 8.Goyal M, Singh P, Singh K, Shekhar S, Agrawal N, Misra S. The effect of the COVID-19 pandemic on maternal health due to delay in seeking health care: Experience from a tertiary center. Int J Gynecol Obstet. 2021;152:231–5. doi: 10.1002/ijgo.13457. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Ray D, Salvatore M, Bhattacharyya R, Wang L, Du J, Mohammed S, et al. Predictions, role of interventions and effects of a historic national lockdown in India's response to the COVID-19 pandemic: Data science call to arms. Harvard data Sci Rev. 2020;2020((Suppl 1)) doi: 10.1162/99608f92.60e08ed5. doi:10.1162/99608F92.60E08ED5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Shrivastava S, Rai S, Sivakami M. Challenges for pregnant women seeking institutional care during the COVID-19 lockdown in India: A content analysis of online news reports. Indian J Med Ethics. 2021;VI:1–24. doi: 10.20529/IJME.2021.004. [DOI] [PubMed] [Google Scholar]
  • 11.Davenport MH, Meyer S, Meah VL, Strynadka MC, Khurana R. Moms are not OK: COVID-19 and maternal mental health. Front Glob Womens Heal. 2020;1:1–6. doi: 10.3389/fgwh.2020.00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Mukherjee A, Bandopadhyay G, Chatterjee SS. COVID-19 pandemic: Mental health and beyond-the Indian perspective. Ir J Psychol Med. 2021;38:140–4. doi: 10.1017/ipm.2020.63. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Sengupta N, Sinha A. Is India's safe motherhood scheme leading to better child health care practices? Glob Soc Welf. 2018;5:49–58. [Google Scholar]
  • 14.Sen S, Chatterjee S, Khan PK, Mohanty SK. Unintended effects of Janani Suraksha Yojana on maternal care in India. SSM Popul Heal. 2020;11:100619. doi: 10.1016/j.ssmph.2020.100619. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Kumar G, Choudhary TS, Srivastava A, Upadhyay RP, Taneja S, Bahl R, et al. Utilisation, equity and determinants of full antenatal care in India: Analysis from the National Family Health Survey 4. BMC Pregnancy Childbirth. 2019;19:327. doi: 10.1186/s12884-019-2473-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Ahmed T, Rahman AE, Amole TG, Galadanci H, Matjila M, Soma-Pillay P, et al. The effect of COVID-19 on maternal newborn and child health (MNCH) services in Bangladesh, Nigeria and South Africa: Call for a contextualised pandemic response in LMICs. Int J Equity Health. 2021;20:1–6. doi: 10.1186/s12939-021-01414-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Alegbeleye BJ, Mohammed RK. Challenges of healthcare delivery in the context of COVID-19 pandemic in Sub-Saharan Africa. Iberoam J Med. 2020;2:100–9. [Google Scholar]
  • 18.Walker PGT, Whittaker C, Watson OJ, Baguelin M, Winskill P, Hamlet A, et al. The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries. Science. 2020;369:413–22. doi: 10.1126/science.abc0035. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Khalil A, von Dadelszen P, Kalafat E, Sebghati M, Ladhani S, Ugwumadu A, et al. Change in obstetric attendance and activities during the COVID-19 pandemic. Lancet Infect Dis. 2021;21:e115. doi: 10.1016/S1473-3099(20)30779-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Mandal S, Bhatnagar T, Arinaminpathy N, Agarwal A, Chowdhury A, Murhekar M, et al. Prudent public health intervention strategies to control the coronavirus disease 2019 transmission in India: A mathematical model-based approach. Indian J Med Res. 2020;151:190–9. doi: 10.4103/ijmr.IJMR_504_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Guidance Note on Provision of Reproductive, Maternal, Newborn, Child, Adolescent Health Plus Nutrition (RMNCAH+N) services during & post COVID-19 Pandemic. [[Last accessed 2023 Jan 20]]. Available from: https://www.mohfw.gov.in/pdf/UpdatedAdditionalguidelinesonrationaluseofPersonalProtectiveEquipmentsettingapproachforHealthf .
  • 22.World Health Organization. Maintaining essential health services: New operational guidance for the COVID-19 context. 2020. Available from: https://www.who.int/news/item/01-06-2020-maintaining-essential -healthservices-new-operational-guidance-for-the-covid-19-context .
  • 23.At least 80 million children under one at risk of diseases such as diphtheria, measles and polio as COVID-19 disrupts routine vaccination efforts, warn Gavi, WHO and UNICEF. [[Last accessed on 2023 Jan 23]]. Available from: https://www.who.int/news/item/22-05-2020-at-least-80-millionchildren-under-one-at-risk-of-diseases-such-as-diphtheriameasles-and-polio-as-covid-19-disrupts-routine-vaccination-efforts-warn-gavi-who-and-unicef .

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