This study revealed an overall decline in the number of patients seeking healthcare services during the covid-19 pandemic. The overt difference in average number of patients seeking healthcare before and during COVID-19, could largely attributed to the widespread covid-19 interventions such as transport restrictions, curfew, diversion of health personnel and resources to respond to the COVID-19 pandemic. The reduction might also be owed to the barrier posed by patients’ fears of contracting Covid-19 . In addition, many healthcare seekers could have perceived negative reception at the facility during COVID-19 by the health professionals as reported in Ghana . They noted that healthcare professionals were applying unfriendly and high-level infection prevention protocols especially to patients presenting with cough and flu symptoms which affected care seeking among the population.
The monthly notification average data of number screened for TB, the number of presumptive TB cases identified from OPD, and the number of cases diagnosed with TB sharply declined during the covid-19 outbreak (April-May) compared to the monthly notification average data before covid-19 (January-February). The travel restrictions during the lock down might have made it difficult for presumptive TB patients to visit health facilities and seek medical care. The presumptive TB tracing and referral could have also been affected by the reallocation of health workers to fight the COVID-19 pandemic.
In terms of sputum examination and other laboratory diagnosis for TB, there was a clear slump in the number of patients seeking laboratory services during COVID-19. These could be because of increasing number of covid-19 cases that may have overwhelmed the Uganda healthcare system and necessitated transfer of TB laboratory to COVID-19 testing and temporarily closed their TB outpatient clinic during the intensive period of COVID-19, leaving TB patients with nowhere to go for sputum examination . This may impact TB treatment and diagnostic services for those seeking TB healthcare services .
Our study showed that the number of malaria diagnoses did not significantly change during the COVID-19 outbreak (April-May), although many studies have indicated that disruptions to malaria control activities have resulted in a resurgence in malaria morbidity and mortality. The minimal decrease in the number of malaria cases diagnosed could have been attributed to shortage of medication suppliers with VHTs that subsequently resulted into the continuous referrals of patients by Village health teams (VHTs) to health facilities for Artemisinin-based combination therapies (ACTs) and laboratory diagnosis of malaria at health facilities. VHTs implement Integrated Community Case Management (iCCM) of malaria, diarrhoea and pneumonia . The VHTs who previously got close to sick people in the community, could, have run short of ACT supply or feared contracting COVID-19 and preferred referral. However, while Malaria elimination campaigns must reach marginalized groups distant from the health facilities, the programmes are at risk of being scaled back for logistic reasons associated with COVID-19 interventions, putting communities at risk .
The data from our study also shows that ANC 1st contacts at the health facilities were severely affected by COVID – 19. Like our findings, health facilities in Rwanda saw a decline in antenatal attendances in the first months of the pandemic . Reduction of mortality and morbidities from vaccine-preventable diseases in developing countries involves successfully implementing strategies that ensure high coverage and minimize drop-outs and missed opportunities  . The decreases in childhood vaccinations could have detrimental vaccine-preventable disease outbreaks in the future due to COVID-19 disruptions of health seeking. The reasons for disrupted services could be attributed to fear of being exposed to people with COVID-19 at health facilities.
This study showed no difference in the numbers of mothers receiving PMTCT services at health facilities before and during the COVID-19 pandemic. The Joint United Nations Programmes on HIV/AIDS (UNAIDS) equally reported that the impact on services for the prevention of vertical transmission of HIV (from mother to child) is mixed—by April, some countries generally saw a decline in the number of women tested for HIV at their first antenatal clinic visit , but by June 2020 that decline had been reversed as corroborated with our findings . PMTCT services are received during Antenatal appointments. It is important for pregnant mothers to attend antenatal appointments, as these are the times when they can get an HIV test, receive treatment if tested HIV positive, and medical advice to help keep them and their babies healthy . On the other hand, this study revealed severe decline in the expected live births, obstetric and newborn care clients seeking healthcare at health facilities during the COVID-19 pandemic. This could be because most mothers resorted to the community traditional birth attendants (TBAs) as was the case in Kenya . In Kenya, most mothers resorted to giving birth in the homes of the traditional birth attendants, since most health facilities were temporarily shut down and health workers were reassigned to the COVID-19 crisis. These results underline the additional stressors of the COVID-19 pandemic overlaid on already stretched obstetric and newborn care services, like in Nepal , While the government of Uganda actively discourages TBA-supported births preferring that TBAs refer mothers to the nearest health facility, it would be better to the integrate traditional birth attendants during pandemics such as COVID-19 and other crises.
Focus on pandemic management and response with limited oversight of providing care to those suffering from other illness, healthcare personnel being required to quarantine, or becoming ill or dying, and therefore not being available for routine services. All these factors may have contributed to unwillingness to seek for healthcare and therefore cause delays in the diagnosis and commencement of treatment.