Disruptions of neurological services, its causes and mitigation strategies during COVID-19: a global review

Table 2 Causes of service disruption described in the studies

Reason of the disruption	Number of studies (n = 240) (%)	Studies focused on adults (n = 184) (%)	Studies focused on children (n = 28) (%)	Studies from HICs (n = 180) (%)	Studies from LMICs (n = 30) (%)
Travel restrictions hindering patient access to health facilities	196 (81.7%)	149 (81.0%)	26 (92.9%)	146 (81.1%)	25 (83.3%)
Closure of inpatient and outpatient services or consultations as per health authority directive	157 (65.4%)	120 (65.2%)	23 (82.1%)	114 (63.3%)	20 (66.7%)
Decrease in outpatient volume due to patients not presenting	135 (56.2%)	113(61.4%)	13 (46.4%)	112 (62.2%)	15 (50%)
Decreased volume of patients due to cancellation of elective care	109 (45.4%)	79 (42.9%)	17 (60.7%)	77 (42.8%)	11 (36.7%)
Inpatient services and or hospital beds not available	52 (21.7%)	37 (20.1%)	7 (25.0%)	30 (16.7%)	7 (23.3%)
Clinical staff deployed and tasks shifted to provide COVID-19 clinical management or emergency support	40 (16.7%)	31 (16.8%)	3 (10.7%)	25 (19.2%)	5 (16.7%)
Unavailability or stock out of essential medicines, medical diagnostics or other health products at health facilities	40 (16.7%)	29 (15.8%)	3 (1.07%)	22 (12.2%)	7 (23.3%)
Insufficient PPE available for health care providers to provide services	22 (9.2%)	18 (9.8%)	1 (3.6%)	11 (6.1%)	3 (10%)
Insufficient staff to provide services due to staff illness/quarantine	11 (4.6%)	8 (4.3%)	1 (3.6%)	5 (2.8%)	2 (6.7%)

Percentages are calculated over the 240 total studies that analyzed disruption of neurological services, and over the total number of studies that assessed only adults (n = 184) or only children (n = 28); and over the total number of studies from high-income countries (HICs) (n = 180) or low–middle-income countries (LMICs) (n = 30)